Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2013
ReviewBrief report: a cost analysis of neuraxial anesthesia to facilitate external cephalic version for breech fetal presentation.
In this study, we sought to determine whether neuraxial anesthesia to facilitate external cephalic version (ECV) increased delivery costs for breech fetal presentation. ⋯ The total cost of delivery in women with breech presentation may be decreased (up to $720) or increased (up to $112) if ECV is attempted/performed with neuraxial anesthesia compared with ECV without neuraxial anesthesia. Increased ECV success with neuraxial anesthesia and the subsequent reduction in breech cesarean delivery rate offset the costs of providing anesthesia to facilitate ECV.
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Anesthesia and analgesia · Jul 2013
Comparative Study Controlled Clinical TrialA comparison of ultrasound-guided and landmark-based approaches to saphenous nerve blockade: a prospective, controlled, blinded, crossover trial.
Blockade of the saphenous nerve is often used for surgeries below the knee. Depending on the approach, success rates vary widely ranging from 33% to 88%. In this prospective volunteer study, we compared 2 ultrasound-guided techniques, the modified vastus medialis and perifemoral saphenous nerve block with a below the knee field block. ⋯ In our prospective study, we have demonstrated that ultrasound-guided above the knee saphenous nerve blocks have higher success rates than a below the knee field block and are easily performed in a short amount of time.
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Anesthesia and analgesia · Jul 2013
Multicenter StudyValue of a scheduled duration quantified in terms of equivalent numbers of historical cases.
Probabilistic estimates of case duration are important for several decisions on and soon before the day of surgery, including filling or preventing a hole in the operating room schedule, and comparing the durations of cases between operating rooms with and without use of specialized equipment to prevent resource conflicts. Bayesian methods use a weighted combination of the surgeon's estimated operating room time and historical data as a prediction for the median duration of the next case of the same combination. Process variability around that prediction (i.e., the coefficient of variation) is estimated using data from similar procedures. A Bayesian method relies on a parameter, τ, that specifies the equivalence between the scheduled estimate and the information contained in the median of a certain number of historical data. ⋯ Understanding performance of Bayesian methods for case duration is important because variability in durations has a large influence on appropriate management decisions the working day before and on the day of surgery. Both scheduled durations and historical data need to be used for these decisions. What matters is not the choice of τ but quantifying the variability using the Bayesian method and using it in managerial decisions.
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Anesthesia and analgesia · Jul 2013
The accuracy, precision and reliability of measuring ventilatory rate and detecting ventilatory pause by rainbow acoustic monitoring and capnometry.
Current methods for monitoring ventilatory rate have limitations including poor accuracy and precision and low patient tolerance. In this study, we evaluated a new acoustic ventilatory rate monitoring technology for accuracy, precision, reliability, and the ability to detect pauses in ventilation, relative to capnometry and a reference method in postsurgical patients. ⋯ In this study of a population of postsurgical patients, the acoustic monitor and capnometer both reliably monitored ventilatory rate. The acoustic monitor was statistically more accurate and more precise than the capnometer, but differences in performance were modest. It is not known whether the observed differences are clinically significant. The acoustic monitor was more sensitive to detecting pauses in ventilation. Acoustic monitoring may provide an effective and convenient means of monitoring ventilatory rate in postsurgical patients.
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Anesthesia and analgesia · Jul 2013
The impact of video laryngoscopy use during urgent endotracheal intubation in the critically ill.
The video laryngoscope (VL) has been shown to improve laryngoscopic views and first-attempt success rates in elective operating room and simulated tracheal intubations compared with the direct laryngoscope (DL). However, there are limited data on the effectiveness of the VL compared with the DL in urgent endotracheal intubations (UEIs) in the critically ill. We assessed the effectiveness of using a VL as the primary intubating device during UEI in critically ill patients when performed by less experienced operators. ⋯ UEI using a VL as the primary device improved intubation success and decreased complications compared with a DL when PCCM fellows were the primary operators. These data suggest that the VL should be used as the primary device when urgent intubations are performed by less experienced operators.