Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2008
A mission-based productivity compensation model for an academic anesthesiology department.
We replaced a nearly fixed-salary academic physician compensation model with a mission-based productivity model with the goal of improving attending anesthesiologist productivity. ⋯ Implementing a productivity-based faculty compensation model in an academic department was associated with increased mean supplemental pay with relatively fewer faculty. ASA units per month and ASA units per operating room full-time equivalent increased, and these metrics are the most likely drivers of the increased compensation. This occurred despite a slight decrease in clinical productivity as measured by ASA units per anesthetizing location. Academic and educational output was stable.
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Anesthesia and analgesia · Dec 2008
Oxygen consumption of a pneumatically controlled ventilator in a field anesthesia machine.
Field anesthesia machines (FAM) have been developed for remote locations where reliable supplies of compressed medical gases or electricity may be absent. In place of electricity, pneumatically controlled ventilators use compressed gas to power timing circuitry and actuate valves. We sought to determine the total O(2) consumption and ventilator gas consumption (drive gas [DG] plus pneumatic control [PC] gas) of a FAM's pneumatically controlled ventilator in mechanical models of high (HC) and low (LC) total thoracic compliance. ⋯ To prepare for loss of central DG supply, patient safety will be improved by estimating cylinder duration for low total thoracic compliance. Using data from the smaller compliance and greatest V(T) model (LC-1000), a full O(2) E cylinder would be depleted in <42 min, whereas a full H cylinder would last approximately 433 min.
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Anesthesia and analgesia · Dec 2008
The effects of spinal anesthesia with lidocaine and sufentanil on lower urinary tract functions.
Spinal local anesthetics interrupt the micturition reflex; bladder function remains impaired until sensory block had regressed to the S3 segment. Intrathecal opioids cause dose-dependent suppression of detrusor contractility. We studied the effects of spinal anesthesia with a combination of lidocaine and sufentanil on lower urinary tract function. ⋯ Bladder contractility returns much later than recovery of sensory function in sacral dermatomes (S3) when hyperbaric lidocaine combined with sufentanil is used for spinal anesthesia.
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Anesthesia and analgesia · Dec 2008
Elastomeric pump reliability in postoperative regional anesthesia: a survey of 430 consecutive devices.
Postoperative analgesia via continuous perineural infusion of local anesthetics compares favorably with systemic analgesia. Elastomeric pumps increase patient satisfaction compared with electronic models. In in vitro investigations, infusions remained within 15% of their designated set rates. We assessed in vivo the infusion rate of elastomeric pumps in regional analgesia after orthopedic surgery. ⋯ In vivo reliability of elastomeric pumps is different than in vitro. In the event of early insufficient postoperative perineural analgesia, an absence of deflation of the elastomeric pump must be considered. We recommend weighing these devices every 3 h during the first 24 h of infusion.