Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2005
Randomized Controlled Trial Comparative Study Clinical TrialSpinal 2-chloroprocaine for surgery: an initial 10-month experience.
Spinal 2-chloroprocaine (2-CP) is currently being investigated as a short-acting alternative to lidocaine, which frequently causes transient neurologic symptoms (TNS) in surgical patients. TNS has not been reported with 2-CP in volunteers in doses ranging from 30 to 60 mg and appears to provide an excellent level of surgical anesthesia. In this retrospective study, we describe the experience with spinal 2-CP in surgical patients during its first 10 mo of clinical use at our institution. ⋯ Time from placement of the block to the end of the surgical procedure was 53.1 +/- 20.7 min. Times to ambulation and discharge were 155.1 +/- 34.7 min and 207.9 +/- 69.4 min, respectively. 2-CP spinal anesthesia has proven to be a safe and effective alternative to lidocaine and procaine for ambulatory surgical procedures of < or =1 h, with a predictable regression of block height. No patients reported TNS after surgery.
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Anesthesia and analgesia · Feb 2005
The prevalence and characteristics of incentive plans for clinical productivity among academic anesthesiology programs.
Performance-based compensation is encouraged in medical schools to improve faculty productivity. Medical specialties other than anesthesiology have used financial incentives for clinical work. The goal of this study was to determine the prevalence and the types of clinical incentive plans among academic anesthesiology departments. ⋯ Sixty-nine percent of academic anesthesiology departments did not vary compensation according to clinical activity during regular hours. Most did vary payments on the basis of call and/or late rooms worked. Larger departments were more likely to use clinical incentive plans.
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Anesthesia and analgesia · Feb 2005
Randomized Controlled Trial Clinical TrialContinuous gastric decompression for postoperative nausea and vomiting after coronary revascularization surgery.
Postoperative nausea and vomiting is common after cardiac surgery and may contribute to significant morbidity. Gastric decompression during anesthesia has been used for postoperative nausea and vomiting prophylaxis in shorter duration noncardiac surgery with conflicting results. We tested the hypothesis that gastric decompression during elective coronary revascularization surgery with cardiopulmonary bypass and continued afterwards until tracheal extubation would reduce the incidence of vomiting or retching and nausea. ⋯ The incidence of vomiting or retching was 13.4% in patients with gastric decompression, compared with 11.5% in the control group (P = 0.7). Similarly, there was no statistically significant difference between the two groups in the incidence of nausea (32.7% versus 25.0%, P = 0.6), median severity of nausea on a visual analog scale at 12 h (25; range, 0-55 mm versus 30; range, 0-60 mm, P = 0.4), or antiemetics administration (38.5% versus 28.8%, P = 0.3). Continuous gastric decompression during coronary revascularization surgery and afterwards until tracheal extubation did not reduce the incidence of vomiting or retching or the incidence and severity of nausea in these patients.
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Anesthesia and analgesia · Feb 2005
Does methemoglobin from oxidized hemoglobin-based oxygen carrier (hemoglobin Glutamer-200) interfere with lactate measurement (YSI 2700 SELECT Biochemistry Analyzer)?
In this study, we validated the accuracy of lactate measurements (YSI 2700 SELECT glucose/lactate analyzer) in the presence of methemoglobin from an oxidized bag of hemoglobin-based oxygen carrier (Met-HBOC), hemoglobin glutamer-200 (Oxyglobin; Biopure Corp). Different combinations of concentrated L-lactate solution, pooled canine plasma, and Plasmalyte A were added to 4 sample groups (1%, 10%, 20%, and 40% Met-HBOC [1.3 g/dL]) to yield linear increases in lactate concentration in consecutive samples. The mean difference between measured and calculated lactate was -5.1 mg/dL (1% Met-HBOC), -5.8 mg/dL (10% Met-HBOC), -4.6 mg (20% Met-HBOC), and -8.5 mg/dL (40% Met-HBOC). ⋯ The Bland-Altman correlation (r) was r = -0.94 (P = 0.01), r = -0.91 (P < 0.001), r = -0.90 (P < 0.001), and r = -0.94 (P < 0.001), respectively, where r = 0 for perfect agreement between measured and calculated values. Results indicate that true lactate levels in the presence of Met-HBOC are underestimated when measured by an YSI 2700 analyzer independent of the amount of Met-HBOC present. When interpreting lactate concentrations from a patient with a HBOC present in plasma, underestimation of true lactate levels may occur unrelated to methemoglobin concentrations.