Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2011
Multicenter Study Comparative StudyThe effect of hospital size and surgical service on case cancellation in elective surgery: results from a prospective multicenter study.
Short-term case cancellation causes frustration for anesthesiologists, surgeons, and patients and leads to suboptimal use of operating room (OR) resources. In many facilities, >10% of all cases are cancelled on the day of surgery, thereby causing major problems for OR management and anesthesia departments. The effect of hospital type and service type on case cancellation rate is unclear. ⋯ When benchmarking cancellation rates among hospitals, comparisons should control for academic institutions having higher incidences of case cancellation than nonacademic hospitals and general surgery services having higher incidences than other services.
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Anesthesia and analgesia · Sep 2011
ReviewIs ultrasound guidance advantageous for interventional pain management? A review of acute pain outcomes.
Ultrasound (US) guidance for peripheral nerve blockade has gained popularity worldwide. The reported benefits of real-time sonographic visualization compared with traditional nerve localization techniques generally apply to procedural and technical block-related outcomes whereas acute pain-related outcomes are featured less prominently. In this review, we evaluated the effect of US guidance compared with traditional nerve localization techniques for interventional management of acute pain and acute pain-related outcomes. ⋯ At present, there is insufficient evidence in the contemporary literature to define the effect of US guidance on acute pain and related outcomes compared with traditional nerve localization techniques for interventional acute pain management.
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Assessment of diastolic function should be a component of a comprehensive perioperative transesophageal echocardiographic examination. Abnormal diastolic function exists in >50% of patients presenting for cardiac and high-risk noncardiac surgery, and has been shown to be an independent predictor of adverse postoperative outcome. Normalcy of systolic function in 50% of patients with congestive heart failure implicates diastolic dysfunction as the probable etiology. ⋯ The availability of more sophisticated Doppler techniques, e.g., Doppler tissue imaging and flow propagation velocity, makes it possible to interrogate left ventricular diastolic function with greater precision, analyze specific stages of diastole, and to differentiate abnormalities of relaxation from compliance. Additionally, various Doppler-derived ratios can be used to estimate left ventricular filling pressures. The varying hemodynamic environment of the operating room mandates modification of the diagnostic algorithms used for ambulatory cardiac patients when left ventricular diastolic function is evaluated with transesophageal echocardiography in anesthetized surgical patients.