Anesthesiology
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Randomized Controlled Trial Comparative Study
Paravertebral versus Pectoralis-II (Interpectoral and Pectoserratus) Nerve Blocks for Postoperative Analgesia after Non-Mastectomy Breast Surgery: A Randomized, Controlled, Observer-Masked Noninferiority Trial.
Pectoralis-II and paravertebral nerve blocks are both used to treat pain after breast surgery. Most previous studies involving mastectomy identified little difference of significance between the two approaches. Whether this is also accurate for nonmastectomy procedures remains unknown. ⋯ After nonmastectomy breast surgery, two-level paravertebral blocks provided superior analgesia and opioid sparing compared with pectoralis-II blocks. This is a contrary finding to the majority of studies in patients having mastectomy, in which little significant difference was identified between the two types of blocks.
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Comparative Study
Mechanical power in decelerating flow versus square flow ventilation in pediatric ARDS.
Mechanical power is a summary variable quantifying the risk of ventilator-induced lung injury. The original mechanical power equation was developed using square flow ventilation. However, most children are ventilated using decelerating flow. It is unclear whether mechanical power differs according to mode of flow delivery. This study compared mechanical power in children with acute respiratory distress syndrome who received both square and decelerating flow ventilation. ⋯ Mechanical power was marginally lower in square flow than in decelerating flow, although the clinical significance of this is unclear. Upward of 30% of mechanical power may go toward overcoming resistance, regardless of age. This is nearly three-fold greater resistance compared to what has been reported in adults.
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The Gompertz-Makeham law describes a characteristic pattern of mortality in human populations where the death rate is near constant between ages 18 and 30 yr (Makeham law) and rises exponentially thereafter (Gompertz law). This pattern has not been described in surgical populations, but if true, it would have important implications for understanding surgical risk and design and interpretation of surgical risk models. The aim of this study was to determine whether the Gompertz-Makeham law applies to perioperative mortality risk and the conditions under which it may apply. ⋯ The Gompertz-Makeham law seems to apply in a national cohort of surgical patients. The inflection point for increased 1-month risk is apparent at age 30 yr. A strict exponential rise in mortality risk occurs thereafter. This finding improves the understanding of surgical risk and suggests a concept-driven approach to improve modeling of age and important interactions in future surgical risk models.