Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2010
Randomized Controlled TrialPropofol reduces the distribution and clearance of midazolam.
Midazolam, at sedative levels, increases blood propofol concentrations by 25%. We evaluated the reverse interaction and determined the influence of propofol on the pharmacokinetics of midazolam. ⋯ Propofol reduces the distribution and clearance of midazolam in a concentration-dependent manner. In addition, inclusion of heart rate as a covariate improved the pharmacokinetic model of midazolam predominantly through a reduction in the intraindividual variability.
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Anesthesia and analgesia · Jun 2010
ReviewReview article: review of behavioral operations experimental studies of newsvendor problems for operating room management.
Operating room (OR) managers must plan staffing in the face of uncertain demand for OR time. Planning too much staffing results in underutilized OR time. Planning too little staffing causes overutilized time, which is approximately twice as expensive as underutilized time. ⋯ Experimental studies of the newsvendor problem provide mechanistic insights into the reasons that OR managers make poor decisions when planning OR staffing. The students face no organizational factors or personality issues that potentially influence OR managers, strongly suggesting that observed psychological biases are innate and play an important role in influencing the decisions of OR managers. Results suggest that only the use of computerized decision-support systems can effectively circumvent these biases.
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Anesthesia and analgesia · Jun 2010
Randomized Controlled TrialPerioperative glucose and insulin administration while maintaining normoglycemia (GIN therapy) in patients undergoing major liver resection.
Although hyperglycemia is a well-recognized risk factor in the context of cardiac surgery, the relevance of perioperative glycemic control for patients undergoing major noncardiac operations has received little attention. We designed this study to assess the hyperglycemic response to liver resection, and to test the hypothesis that perioperative glucose and insulin administration while maintaining normoglycemia (GIN therapy) provides glycemic control superior to that achieved by the conventional use of insulin. ⋯ GIN therapy effectively provides normoglycemia in patients undergoing liver resection (clinicaltrials.gov, NCT00774098).
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Anesthesia and analgesia · Jun 2010
Clinical TrialPrepuncture ultrasound imaging to predict transverse process and lumbar plexus depth for psoas compartment block and perineural catheter insertion: a prospective, observational study.
All widely used psoas compartment block/catheter techniques have a common limitation: external landmarks do not accurately predict lumbar plexus depth, leaving practitioners to "guess" at what depth to stop advancing the placement needle when neither transverse process nor lumbar plexus is intercepted. We assessed the accuracy of ultrasound in estimating transverse process depth before needle insertion and prediction of actual needle-to-plexus intercept depth for psoas compartment nerve blocks and perineural catheter insertion. ⋯ For psoas compartment blocks/catheters, prepuncture ultrasound imaging accurately predicts transverse process depth to within 1 cm, and if the lumbar plexus is estimated to be within 3 cm of the transverse process, ultrasound allows prediction of maximal lumbar plexus depth to within 1 cm.