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
Prevalence of Malignant Hyperthermia Diagnosis in New York State Ambulatory Surgery Center Discharge Records 2002 to 2011.
Malignant hyperthermia (MH) is a rare yet potentially fatal pharmacogenetic disorder triggered by exposure to inhaled anesthetics and the depolarizing neuromuscular blocking drug succinylcholine. Epidemiologic research on MH is largely limited to inpatients. In this study, we examined the prevalence of recorded MH diagnosis in patients discharged from ambulatory surgery centers (ASCs). ⋯ The prevalence of recorded MH diagnosis in ASC patients is approximately 1 per 500,000 and varies considerably with surgical procedures.
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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
A Technical Evaluation of Wireless Connectivity from Patient Monitors to an Anesthesia Information Management System During Intensive Care Unit Surgery.
Surgical procedures performed at the bedside in the neonatal intensive care unit (NICU) at The Children's Hospital of Philadelphia were documented using paper anesthesia records in contrast to the operating rooms, where an anesthesia information management system (AIMS) was used for all cases. This was largely because of logistical problems related to connecting cables between the bedside monitors and our portable AIMS workstations. We implemented an AIMS for documentation in the NICU using wireless adapters to transmit data from bedside monitoring equipment to a portable AIMS workstation. ⋯ Two wireless cases exhibited brief periods of data loss; one case had an extended data gap because of adapter power failure. In comparison, in a control group of 30 surgical cases in which wired connections were used, there were no data gaps. The wireless AIMS provided a simple, unobtrusive, portable alternative to paper records for documenting anesthesia records during NICU bedside procedures.
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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.