Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2007
Randomized Controlled TrialThe analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial.
The transversus abdominis plane (TAP) block is a novel approach for blocking the abdominal wall neural afferents via the bilateral lumbar triangles of Petit. We evaluated its analgesic efficacy in patients during the first 24 postoperative hours after abdominal surgery, in a randomized, controlled, double-blind clinical trial. ⋯ The TAP block provided highly effective postoperative analgesia in the first 24 postoperative hours after major abdominal surgery.
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Anesthesia and analgesia · Jan 2007
Meta AnalysisPerioperative beta-blockers for preventing surgery-related mortality and morbidity: a systematic review and meta-analysis.
Perioperative beta-blockers are suggested to reduce cardiovascular mortality, myocardial-ischemia/infarction, and supraventricular arrhythmias after surgery. We reviewed the evidence regarding the effectiveness of perioperative beta-blockers for improving patient outcomes after cardiac and noncardiac surgery. ⋯ Beta-blockers reduced perioperative arrhythmias and myocardial ischemia, but they had no effect on myocardial infarction, mortality, or length of hospitalization.
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Anesthesia and analgesia · Jan 2007
An update on pediatric anesthesia liability: a closed claims analysis.
Respiratory complications were associated with half of pediatric malpractice claims from the 1970s to 1980s in the ASA Closed Claims Database. Advances in pediatric anesthesia practice have occurred in the 1980s and 1990s and may be reflected in liability trends. ⋯ Death/BD remained the dominant injuries in pediatric anesthesia malpractice claims in the 1990s. Cardiovascular events joined respiratory events as the major sources of liability.
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Anesthesia and analgesia · Jan 2007
Intrathoracic pressure regulation improves 24-hour survival in a porcine model of hypovolemic shock.
The intrathoracic pressure regulator (ITPR) plus positive pressure ventilation (PPV) has been shown to improve coronary and cerebral perfusion pressures during hypovolemia by improving mean arterial blood pressure and by decreasing right atrial and intracranial pressures. We hypothesized that application of intermittent negative intrathoracic pressure in a pig model of severe hypovolemic hypotension would increase 24-h neurological intact survival rates. ⋯ Use of the ITPR plus PPV for 90 min significantly increased arterial blood pressure and 24 h neurologically intact survival rates compared with controls treated with PPV alone.
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Anesthesia and analgesia · Jan 2007
Six sigma methodology can be used to improve adherence for antibiotic prophylaxis in patients undergoing noncardiac surgery.
Six Sigma methodology is a data management process that can be used to achieve a goal of near perfection in process performance. An audit of 615 surgeries over 2 mo revealed only 38% of noncardiac patients admitted on the day of surgery at our institution received perioperative antimicrobial prophylaxis within the target interval of < or =60 min before incision. ⋯ We conclude that Six Sigma methods were used to successfully improve our process for timing of perioperative antibiotic prophylaxis before surgical incision. An electronic anesthesia record keeping system is a useful tool to monitor this process improvement.