Anesthesiology
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Randomized Controlled Trial Clinical Trial
Oxygen uptake after major abdominal surgery: effect of clonidine.
To examine the effect of an alpha-2 agonist, clonidine, on oxygen uptake and on the incidence of postoperative shivering, 28 patients presenting for major abdominal surgery were randomly assigned in a double-blind manner to one of two groups. Intraoperatively, 14 patients received 5 micrograms.kg-1 clonidine infused over 3 h (clonidine group), and 14 patients received placebo (placebo group). Oxygen uptake was measured continuously over the first 3 postoperative hours with a mass spectrometer system. ⋯ There were no differences among groups in the incidence of shivering and in the rate of increase of esophageal temperature. By contrast, oxygen uptake was lower in the clonidine group (P = 4 x 10(-4)). This contrasting pattern may be secondary to a reduction in the intensity of mean muscular tremor in the clonidine group.
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Malpractice claims filed against anesthesiologists for care involving obstetric (OB) anesthesia (n = 190) were taken from the American Society of Anesthesiologists' Closed Claims Database and compared to claims not involving OB cases (n = 1351). The most common complications in the OB claims were (percentage of all OB claims): maternal death (22%), newborn brain damage (20%), and headache (12%). In contrast, the most common complications in the nonobstetric (non-OB) group were (percentage of all non-OB claims): death (39%), nerve damage (16%), and brain damage (13%). ⋯ Claims involving general anesthesia were more frequently associated with severe injuries and resulted in higher payments than did claims involving regional anesthesia. Payments were made in a similar proportion of OB and non-OB claims (53 and 59%, respectively). For cases in which payments were made, the median payment for OB claims was significantly greater ($203,000) than for non-OB claims ($85,000; P less than or equal to 0.05).