Anesthesiology
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Operating room (OR) managers seeking to maximize labor productivity in their OR suite may attempt to reduce day-today variability in hours of OR time for which there are staff but for which there are no cases ("underutilized time"). The authors developed a method to analyze data from surgical services information systems to evaluate which management interventions can most effectively decrease variability in underutilized time. ⋯ This method can be used for decision support to determine how to decrease variability in underutilized OR time.
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Although respiratory depression is the most well-known and dangerous side effect of opioids, no pharmacokinetic-pharmacodynamic model exists for its quantitative analysis. The development of such a model was the aim of this study. ⋯ The model described the data for the entire opioid-PaCo2 response surface examined. Indirect response models appear to be a promising tool for the quantitative evaluation of drug-induced respiratory depression.
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The association between epidural analgesia for labor and the risk of cesarean section for dystocia remains controversial The authors hypothesized that if epidural analgesia were an important factor in determining cesarean section rates, then obstetricians with higher rates of utilization of epidural analgesia for labor would have higher rates of cesarean section for dystocia. ⋯ The frequency of use of epidural analgesia does not predict obstetricians' rates of cesarean section for dystocia. After accounting for a number of known patient risk factors, obstetrical practice style appears to be a major determinant of rates of cesarean section.
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Insertion of a gastric tube (GT) in anesthetized, paralyzed, and intubated patients can be difficult The purpose of this study was to determine fiberoptically why GTs succeed or fail to enter the esophagus and, based on these findings, to determine a mechanism for converting failures into successes. ⋯ GTs enter the hypopharynx just lateral to the arytenoid cartilages. Consequently, the most common sites of resistance at the laryngeal level are the arytenoid cartilages and piriform sinuses. Lateral neck pressure compresses the piriform sinuses and moves the arytenoid cartilages medially, relieving 85% of these GT impactions.