Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2014
Observational StudyEpidurals in Patients Receiving Thromboprophylaxis with Unfractionated Heparin Three Times a Day: The Value of Activated Partial Thromboplastin Time Testing.
Dosing subcutaneous (SC) unfractionated heparin (UFH) 3 times a day (TID) for deep venous thrombosis prophylaxis is used for patients in the United States undergoing nonorthopedic surgery. There is a lack of data on the risks of neuraxial techniques in patients receiving TID SC UFH; however, concerns have been raised about higher bleeding risks. In this prospective study, we evaluated the value of activated partial thromboplastin time (aPTT) testing at the time of removal of epidural catheters as a risk-reduction strategy for this population. ⋯ The routine use of aPTT testing on patients receiving TID SC UFH at the time of removal of epidural catheters as a risk-reduction strategy is not supported by our results, where only 2.8% (95% CI: 1.7%-4.3%) of these patients had abnormal aPTT values. Our study adds to the limited data currently available on the safety of epidural analgesia in patients receiving TID SC UFH. Given the rare incidence of neuraxial hematoma (95% CI: 0%-0.001%), definitive conclusions on the risks of TID SC UFH administration in patients receiving epidural analgesia cannot be drawn based on our sample size.
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Anesthesia and analgesia · Nov 2014
Catechol-O-Methyltransferase Polymorphisms Predict Opioid Consumption in Postoperative Pain.
Previous studies have associated the catechol-O-methyltransferase (COMT) enzyme rs4680 polymorphism with opioid consumption in the treatment of chronic cancer pain. In this study, we evaluated the association between COMT rs4680 and rs4818 polymorphisms and opioid consumption in the acute postoperative period after a nephrectomy. ⋯ The genetic variant of the COMT rs4680 single nucleotide polymorphism is associated with variability in opioid consumption in postoperative nephrectomy patients. The COMT rs4818 polymorphism may prove useful in predicting emesis medication use postoperatively.
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Anesthesia and analgesia · Nov 2014
Biography Historical ArticleFreeman Allen: Boston's Pioneering Physician Anesthetist.
On October 16, 1846 dentist William T. G. Morton successfully demonstrated at the Massachusetts General Hospital that ether could prevent the pain of surgery. ⋯ It was not until the end of the 19th century that a few pioneering physicians began devoting their careers to administering anesthesia to patients, studying ways to make it safer and more effective, and teaching others about its use. One of these individuals was Freeman Allen, who was appointed the first physician anesthetist to the medical staff at the Massachusetts General Hospital and several other major hospitals in Boston. We describe this remarkable man, his contributions to the early development of anesthesiology as a medical specialty, and the true cause of his untimely death.
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Anesthesia and analgesia · Nov 2014
Fall-Prevention Strategies and Patient Characteristics That Impact Fall Rates After Total Knee Arthroplasty.
Fall prevention has emerged as a national quality metric, a focus for The Joint Commission, because falls after orthopedic surgery can result in serious injury. In this study, we examined patient characteristics and effects of fall-prevention strategies on the incidence of postoperative falls in patients undergoing total knee arthroplasty. ⋯ Our data demonstrate a reduction in fall incidence coinciding with the implementation of a multi-intervention fall-prevention strategy. Despite prevention efforts, patients of advanced age, elimination-related activities, and patients in the intermediate phase (late postoperative day 1 through day 3) of recovery continue to have a high risk for falling. Therefore, fall-prevention strategies should continue to provide education to all patients (especially elderly patients) and reinforce practices that will monitor patients within their hospital rooms.
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Anesthesia and analgesia · Nov 2014
Hypersensitivity Reactions to Intravenous Lipid Emulsion in Swine: Relevance for Lipid Resuscitation Studies.
Reports in the recent experimental literature have provided contradicting results in different animal species regarding the efficacy of IV lipid emulsion (ILE) in the reversal of cardiovascular and central nervous system symptoms of local anesthetic and other lipophilic drug overdoses. In particular, ILE seemed to be effective in rats, rabbits, dogs, and humans, but not in swine, for which it not only failed to reverse the adverse effects of anesthetics, but the animals also developed a generalized cutaneous mottling or a dusky appearance immediately after ILE, suggestive of another type of toxicity. The latter symptoms arise in complement (C) activation-related pseudoallergy, a hypersensitivity reaction to particulate drugs and agents. ⋯ ILE causes clinically significant hemodynamic changes in pigs, in concert with significant increases in the plasma thromboxane concentration. However, the in vitro tests did not confirm involvement of the complement system in human sera, leaving the underlying mechanism of these findings in doubt. Nonetheless, the observed hemodynamic and biochemical effects of ILE serve as a caveat that the pig is not an ideal model for the study of interventions involving ILE.