Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2008
The risk of severe postoperative pain: modification and validation of a clinical prediction rule.
Recently, a prediction rule was developed to preoperatively predict the risk of severe pain in the first postoperative hour in surgical inpatients. We aimed to modify the rule to enhance its use in both surgical inpatients and outpatients (ambulatory patients). Subsequently, we prospectively tested the modified rule in patients who underwent surgery later in time and in another hospital (external validation). ⋯ A previously developed prediction rule to predict severe postoperative pain was modified to allow use in both inpatients and outpatients. By validating the rule in patients who underwent surgery several years later in another hospital, it was shown that the rule could be generalized in time and place. We demonstrated that, instead of deriving new prediction rules for new populations, a simple adjustment may be enough to recalibrate prediction rules for new populations. This is in line with the perception that external validation and updating of prediction rules is a continuing and multistage process.
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IV lidocaine (1.5 mg/kg) administered to facilitate endotracheal intubation was associated with transient bronchospasm in a 17-month-old-female with mild intermittent asthma. Immediately after lidocaine administration, the patient developed diffuse bilateral expiratory wheezes and dramatic increases in peak inspiratory pressure. ⋯ This is consistent with recent clinical studies suggesting that IV lidocaine may cause airway narrowing in asthmatics. Practitioners should be aware of this potential complication.
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Anesthesia and analgesia · Oct 2008
The effect of injectate conductivity on the electric field with the nerve stimulator needle: a computer simulation.
Electrical neural stimulation is commonly used to localize neural structures and place local anesthetic for regional anesthesia. The sharp tip of the stimulating needle gives rise to an electric field which is highly localized. The electrostatic effect of the injected solution on the field distribution and strength has not previously been modeled. ⋯ The electric field magnitude in the vicinity of the needle tip decayed more slowly with distance than predicted by Coulomb's law. This was independent of the presence of injectate. The near instantaneous abolition of muscle twitch with injection of small volumes of local anesthetic is consistent with an electrostatic effect, rather than a pharmacological or mechanical one. The change in field strength depended upon the volume of the injectate and its conductivity relative to that of the surrounding tissue. In this simulation, even tiny volumes of injectate lead to significant changes in field and therefore threshold current, which may have clinical implications.
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Anesthesia and analgesia · Oct 2008
Adoption of anesthesia information management systems by academic departments in the United States.
Information technology has been promoted as a way to improve patient care and outcomes. Whereas information technology systems for ancillary hospital services (e.g., radiology, pharmacy) are deployed commonly, it has been estimated that anesthesia information management systems (AIMS) are only installed in a small fraction of United States (US) operating rooms. In this study, we assessed the adoption of AIMS at academic anesthesia departments and explored the motivations for and resistance to AIMS adoption. ⋯ At least 61 or 44% of the 140 US academic departments surveyed in this study have already implemented, are planning to acquire, or are currently searching for an AIMS. Adoption of AIMS technology appears to have reached sufficient momentum within academic anesthesiology departments to result in a fundamental change.
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Anesthesia and analgesia · Oct 2008
Percutaneous pulsed radiofrequency reduces mechanical allodynia in a neuropathic pain model.
Neuropathic pain is a result of a primary lesion or dysfunction of the peripheral or central nervous system, and its treatment is challenging. Animal models have been helpful in understanding mechanisms of neuropathic pain and in developing new treatment strategies. In this study, we examined the effect of percutaneous pulsed radiofrequency (PRF), which is a minimally invasive pain treatment method, on mechanical allodynia in a neuropathic pain rat model. ⋯ Percutaneous PRF is an effective treatment option in the NP pain model, and further studies are needed to clarify its underlying mechanisms of action.