Anesthesia and analgesia
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Anesthesia and analgesia · May 2013
Review Comparative StudyEstimating surgical case durations and making comparisons among facilities: identifying facilities with lower anesthesia professional fees.
Consumer-driven health care relies on transparency in cost estimates for surgery, including anesthesia professional fees. Using systematic narrative review, we show that providing anesthesia costs requires that each facility (anesthesia group) estimate statistics, reasonably the mean and the 90% upper prediction limit of case durations by procedure. The prediction limits need to be calculated, for many procedures, using Bayesian methods based on the log-normal distribution. ⋯ Such comparisons of durations among facilities should be performed with correction for the effects of the multiple comparisons. Our review also has direct implications to the potentially more important issue of how to study the association between anesthetic durations and patient morbidity and mortality. When pooling duration data among facilities, both the large heterogeneity in the means and coefficients of variation of durations among facilities need to be considered (e.g., using "multilevel" or "hierarchical" models).
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Anesthesia and analgesia · May 2013
Altered arterial compliance in hypertensive pregnant women is associated with preeclampsia.
Vascular alterations are present in pregnant women affected by preeclampsia. In this study, we assessed arterial compliance in women affected by hypertensive disorders of pregnancy. We hypothesized that arterial compliance is reduced in women affected by preeclampsia. ⋯ The noninvasive assessment of arterial elasticity may contribute toward characterization of the nature of the pathophysiology in pregnancy-induced hypertensive disorders. The vascular alterations of the small arteries, as assessed by C2, may reflect the extent of vascular alterations present with preeclampsia.
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Anesthesia and analgesia · May 2013
Ryanodine receptor type 1 gene variants in the malignant hyperthermia-susceptible population of the United States.
Mutations in the ryanodine receptor type 1 gene (RYR1) that encodes the skeletal muscle-specific intracellular calcium (Ca(2+)) release channel are a cause of malignant hyperthermia (MH). In this study, we examined RYR1 mutations in a large number of North American MH-susceptible (MHS) subjects without prior genetic diagnosis. ⋯ The identification of novel RYR1 variants and previously observed RYR1 variants of uncertain significance in independent MHS families is necessary for demonstrating the significance of these variants for MH susceptibility and supports the need for functional studies of these variants. Continued reporting of the clinical phenotypes of MH is necessary for interpretation of genetic findings, especially because the pathogenicity of most of these genetic variants associated with MHS remains to be elucidated.
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Anesthesia and analgesia · May 2013
Decreased erythrocyte deformability after transfusion and the effects of erythrocyte storage duration.
Erythrocyte cell membranes undergo morphologic changes during storage, but it is unclear whether these changes are reversible. We assessed erythrocyte cell membrane deformability in patients before and after transfusion to determine the effects of storage duration and whether changes in deformability are reversible after transfusion. ⋯ The findings demonstrate that increased duration of erythrocyte storage is associated with decreased cell membrane deformability and that these changes are not readily reversible after transfusion.
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Anesthesia and analgesia · May 2013
The impact of postoperative nausea and vomiting prophylaxis with dexamethasone on postoperative wound complications in patients undergoing laparotomy for endometrial cancer.
Dexamethasone is widely used for postoperative nausea and vomiting (PONV) prophylaxis. However, there are limited data on the risk of wound complications associated with single-dose dexamethasone use for this purpose. We performed this retrospective study to determine whether intraoperative dexamethasone for PONV prevention increases the risk or severity of postoperative wound complications. ⋯ Intraoperative dexamethasone for PONV prophylaxis does not seem to increase the rate or severity of postoperative wound complications in women undergoing laparotomy for endometrial cancer. BMI and smoking were significant predictors of wound complications in this patient population.