Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2013
Rescheduling of Previously Cancelled Surgical Cases Does Not Increase Variability in Operating Room Workload When Cases Are Scheduled Based on Maximizing Efficiency of Use of Operating Room Time.
Conceptually, cancelling a case close to the scheduled day of surgery increases variability in operating room (OR) workload (i.e., total hours of scheduled cases plus turnovers), creating managerial problems. However, in our recent study of an OR scheduling office, cancellations (slightly) reduced variability in workload among days. If a relatively low incidence of cancellations does not cause increased variability in workload, this would be a useful finding when focusing strategic OR management initiatives. However, the previous study considered only the effect on the schedule for the day the cancelled case originally was scheduled to be performed, not the future date on which the case was performed. ⋯ Rescheduled cancelled cases did not increase variability in OR workload. This finding is useful combined with our recent finding that cancellation slightly reduces variability in OR workload on the date of cancellation. Cancellations should not be interpreted as a system failure that increases variability in surgical workload. We recommend that anesthesiologists aim to reduce cancellation rates if above benchmarked averages, but otherwise focus on more strategically beneficial initiatives. We recommend also that these results be considered if cancellation rates are used in assessing anesthesiology group performance.
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Anesthesia and analgesia · Oct 2013
The Association Between Preoperative Anemia and 30-Day Mortality and Morbidity in Noncardiac Surgical Patients.
Anemia has been associated with increased postoperative morbidity and mortality. We used the American College of Surgeons National Surgical Quality Improvement Program database to retrospectively assess the relationship between preoperative anemia and 30-day postoperative mortality and morbidity in noncardiac surgical patients, careful to distinguish confounding variables from mediator variables. ⋯ Preoperative anemia appears to be associated with baseline diseases that markedly increase mortality. Anemia per se is a rather weak independent predictor of postoperative mortality. Our analysis also illustrates how analyzing large variable-rich registries challenges investigators to discriminate between confounding variables and mediator variables, i.e., factors that might be considered as "causal pathways" for the effect of the exposure or intervention on outcome.
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Anesthesia and analgesia · Oct 2013
Propofol Shares the Binding Site with Isoflurane and Sevoflurane on Leukocyte Function-Associated Antigen-1.
We previously demonstrated that propofol interacted with the leukocyte adhesion molecule leukocyte function-associated antigen-1 (LFA-1) and inhibited the production of interleukin-2 via LFA-1 in a dependent manner. However, the binding site(s) of propofol on LFA-1 remains unknown. ⋯ We demonstrated that propofol bound to the lovastatin site in LFA-1. Previously we showed that the volatile anesthetics isoflurane and sevoflurane bound to this site. Taken together, the lovastatin site is an example of the common binding sites for anesthetics currently used clinically.
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Anesthesia and analgesia · Oct 2013
Direct Pulse Oximetry Within the Esophagus, on the Surface of Abdominal Viscera, and on Free Flaps.
Pulse oximetry is a noninvasive photometric technique that provides information about arterial blood oxygen saturation (SpO2) and heart rate and has widespread clinical applications. This is accomplished via peripheral pulse oximetry probes mainly attached to the finger, toe, or earlobe. The direct application of pulse oximetry to an organ, such as the esophagus, liver, bowel, stomach or free flap, might provide an indication of how well perfused an organ or a free flap is. Also, the placement of a pulse oximetry probe at a more central site, such as the esophagus, might be more reliable at a time when conventional peripheral pulse oximetry fails. ⋯ The technological developments and the measurements presented in this work pave the way to a new era of pulse oximetry where direct and continuous monitoring of blood oxygen saturation of internal organs and tissues (esophagus, bowel, liver, stomach, free flaps) could be possible.
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Anesthesia and analgesia · Oct 2013
The Association of Preoperative Statin Use and Acute Kidney Injury After Noncardiac Surgery.
Our objective was to examine the association between preoperative statin therapy and the incidence of postoperative acute kidney injury (AKI) in patients undergoing elective noncardiac surgery. ⋯ Our data did not support the hypothesis that preoperative statin therapy in doses routinely used to treat hypercholesterolemia is associated with a change in the incidence of AKI, postoperative dialysis, or hospital mortality in patients undergoing noncardiac surgery.