Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2016
Comparing Policies for Case Scheduling Within 1 Day of Surgery by Markov Chain Models.
In previous studies, hospitals' operating room (OR) schedules were influenced markedly by decisions made within a few days of surgery. At an academic hospital, 46% of ORs had their last case scheduled or changed within 1 working day of surgery, and a private hospital had 64%. Many of these changes were for patients who were admitted before surgery (i.e., inpatient cases). In this study, we investigate the impact on OR productivity of how cases are scheduled within 1 working day before the day of surgery. ⋯ Scheduling office decision making within 1 day before surgery should be based on statistical forecasts of expected total OR workload (i.e., forecasts that include the addition of non-elective cases and the subtraction of cases that cancel). As long as a case is not scheduled into overutilized time when less overutilized time could be achieved in another OR, and cases are considered in descending sequence of scheduled durations, the differences in overutilized time and productivity among the scheduling policies are small. Cognitive bias in staff scheduling causes a significant reduction in productivity, but the differences among scheduling policies are nearly the same as when there is no bias.
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Anesthesia and analgesia · Feb 2016
Postoperative Pain Management in Children of Hispanic Origin: A Descriptive Cohort Study.
It has been established that pain is frequently undertreated in children following outpatient surgery. Very few studies, however, have investigated this phenomenon in ethnically diverse populations. ⋯ Despite experiencing significant postoperative pain, Hispanic children assessed in this study received suboptimal analgesic therapy at home.
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Anesthesia and analgesia · Feb 2016
Use of Tranexamic Acid Is Associated with Reduced Blood Product Transfusion in Complex Skull Base Neurosurgical Procedures: A Retrospective Cohort Study.
Compared with other procedures, complex skull base neurosurgery has the potential for increased intraoperative blood loss yet coagulation near eloquent cranial structures should be minimized. The safety and efficacy of the antifibrinolytic, tranexamic acid in elective neurosurgical procedures is not known. Our primary objective was to determine the relationship between the use of tranexamic acid and transfusion at our institution. Our secondary objective was to determine the incidence of adverse events associated with the use of tranexamic acid. ⋯ Our results demonstrate that tranexamic acid use is associated with reduced transfusion rates in our study population, with no apparent increase in seizure or thrombotic complications. Our data support the need for further randomized clinical trials to evaluate the efficacy and safety of tranexamic acid on perioperative blood loss during complex skull base neurosurgery.
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Anesthesia and analgesia · Feb 2016
Nitrite Reduces Ischemia-Induced Ventricular Arrhythmias by Attenuating Connexin 43 Dephosphorylation in Rats.
Ventricular arrhythmias induced by ischemic heart disease are the main cause of sudden cardiac death. Ischemia can cause life-threatening arrhythmias by modulating connexin 43 (Cx43), a principal cardiac gap junction channel protein. The present study investigates whether nitrite can attenuate ischemia-induced ventricular arrhythmias and dephosphorylation of Cx43 in a rat model. ⋯ Nitrite may have attenuated acute ischemia-induced ventricular arrhythmias and Cx43 dephosphorylation in rats. Nitric oxide, which might be generated by xanthine oxidoreductase via nitrite reduction, appears to play a crucial role in this antiarrhythmic effect.
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Anesthesia and analgesia · Feb 2016
Development and Validation of a Morphologic Obstructive Sleep Apnea Prediction Score: The DES-OSA Score.
Obstructive sleep apnea (OSA) is a common and underdiagnosed entity that favors perioperative morbidity. Several anatomical characteristics predispose to OSA. We developed a new clinical score that would detect OSA based on the patient's morphologic characteristics only. ⋯ DES-OSA is a simple score for detecting OSA patients. Its originality relies on its morphologic nature. Derived from a European population, it may prove useful in a preoperative setting, but it has still to be compared with other screening tools in a general surgical population and in other ethnic groups.