Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2017
Observational StudyFactors Influencing Quality of Pain Management in a Physician Staffed Helicopter Emergency Medical Service.
Pain is frequently encountered in the prehospital setting and needs to be treated quickly and sufficiently. However, incidences of insufficient analgesia after prehospital treatment by emergency medical services are reported to be as high as 43%. The purpose of this analysis was to identify modifiable factors in a specific emergency patient cohort that influence the pain suffered by patients when admitted to the hospital. ⋯ In the studied specific Swiss cohort, nontrauma patients, patients on secondary missions, patients treated only for a short time at the scene before transport, patients who receive no analgesic, and treatment by a female physician may be risk factors for insufficient pain management. Patients suffering pain at the scene (NRS > 3) should receive an analgesic whenever possible. Patients with severe pain at the scene (NRS ≥ 8) may benefit from the combination of ketamine with an opioid. The finding about sex differences concerning analgesic administration is intriguing and possibly worthy of further study.
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Anesthesia and analgesia · Jul 2017
Anesthetic Management for Percutaneous Minimally Invasive Fetoscopic Surgery of Spina Bifida Aperta: A Retrospective, Descriptive Report of Clinical Experience.
Minimally invasive fetoscopic surgery for spina bifida aperta is a new therapeutic approach to preserve neurologic function by protecting exposed neural tissue. The anesthetic management is of paramount importance for the success of the procedure. ⋯ As illustrated by this retrospective analysis of 61 cases, these goals can be reliably achieved. The clinical protocol is presented as a supplemental digital content to this manuscript (Supplemental Digital Content 1, http://links.lww.com/AA/B733).
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Anesthesia and analgesia · Jul 2017
Observational StudyPostoperative Respiratory Complications in Patients at Risk for Obstructive Sleep Apnea: A Single-Institution Cohort Study.
Obstructive sleep apnea (OSA) is a prevalent condition that is associated with early postoperative respiratory complications (PRCs). As the majority of patients with OSA are undiagnosed, preoperative screening remains the most efficient method to identify suspected OSA. ⋯ We report that suspected OSA based on the PSAP score is independently associated with increased risk of early PRC. Specific anesthetic agents are independently associated with early PRC, pointing to the potential for examining risk modification through these exposures in future studies.
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Anesthesia and analgesia · Jul 2017
Cancellation of Elective Cases in a Recently Opened, Tertiary/Quaternary-Level Hospital in the Middle East.
Case cancellations have a negative financial impact due to revenue loss and the potential costs of underutilized time. The goals of this study at a recently opened hospital in the Middle East were to measure the cancellation rates for elective surgical or endoscopic cases and to identify the reasons for cancellation. ⋯ Cultural norms and patient no-shows on the day of surgery accounted for the majority of case cancellations. Understanding local factors on hospital functions may be vital for organizations expanding into new geographic areas.
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Anesthesia and analgesia · Jul 2017
Observational StudyProtective Lung Ventilation and Morbidity After Pulmonary Resection: A Propensity Score-Matched Analysis.
Protective lung ventilation (PLV) during one-lung ventilation (OLV) for thoracic surgery is frequently recommended to reduce pulmonary complications. However, limited outcome data exist on whether PLV use during OLV is associated with less clinically relevant pulmonary morbidity after lung resection. ⋯ In this prospective observational study, we found no differences in the incidence of pneumonia and/or ARDS between patients undergoing lung resection with tidal volumes <8 or ≥8 mL/kg. Our data suggest that when fluid restriction and peak airway pressures are limited, the clinical impact of PLV in this patient population is small. Future randomized trials are needed to better understand the benefits of a small tidal volume strategy during OLV on clinically important outcomes.