Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2021
Comparative StudyDeveloping a Clinical Prediction Score: Comparing Prediction Accuracy of Integer Scores to Statistical Regression Models.
Researchers often convert prediction tools built on statistical regression models into integer scores and risk classification systems in the name of simplicity. However, this workflow discards useful information and reduces prediction accuracy. We, therefore, investigated the impact on prediction accuracy when researchers simplify a regression model into an integer score using a simulation study and an example clinical data set. ⋯ Converting a regression model to an integer score decreases model performance considerably. Therefore, we recommend developing a regression model that incorporates all available information to make the most accurate predictions possible, and using the unaltered regression model when making predictions for individual patients. In all cases, researchers should be mindful that they correctly validate the specific model that is intended for clinical use.
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Anesthesia and analgesia · Jun 2021
Observational StudyFactors Associated With Postadenotonsillectomy Unexpected Admissions in Children.
Postadenotonsillectomy unexpected admission remains an important challenge. Unexpected admissions can be quite frightening, increase health care burden, and cause unnecessary suffering in children and families. Identifying factors associated with postadenotonsillectomy unexpected admissions using a pragmatic approach could lead to a shift in the assessment and management of children presenting for adenotonsillectomy. ⋯ Overall, our study shows the factors that contribute to unexpected admissions postadenotonsillectomy. Identification of both modifiable and nonmodifiable factors associated with unexpected admissions after adenotonsillectomy will enable appropriate risk mitigation.
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Anesthesia and analgesia · Jun 2021
Randomized Controlled Trial Multicenter StudyParental Psychosocial Factors Moderate Opioid Administration Following Children's Surgery.
This investigation aimed to examine the impact of parental psychosocial variables on the administration of opioids to young children experiencing postoperative pain. ⋯ These results suggest the need to identify parents who experience high levels of perceived stress and trait anxiety and use appropriate interventions to manage stress and anxiety. This may ensure children receive optimal amounts of pain medication following surgery.
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Anesthesia and analgesia · Jun 2021
Randomized Controlled Trial Comparative StudyPhrenic Nerve Block at the Azygos Vein Level Versus Sham Block for Ipsilateral Shoulder Pain After Video-Assisted Thoracoscopic Surgery: A Randomized Controlled Trial.
Ipsilateral shoulder pain (ISP) is a common problem after pulmonary surgery. We hypothesized that phrenic nerve block (PNB) at the azygos vein level, near the location of the surgical operation, would be effective for reducing ISP. Our primary aim was to assess the effect of PNB on postoperative ISP, following video-assisted thoracic surgery (VATS). ⋯ Azygos vein level PNB did not significantly affect the incidence of ISP after VATS.
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Anesthesia and analgesia · Jun 2021
Randomized Controlled Trial Observational StudyFree Hemoglobin Ratio as a Novel Biomarker of Acute Kidney Injury After On-Pump Cardiac Surgery: Secondary Analysis of a Randomized Controlled Trial.
Cardiac surgery with cardiopulmonary bypass (CPB) is associated with a high risk of postoperative acute kidney injury (AKI). Due to limitations of current diagnostic strategies, we sought to determine whether free hemoglobin (fHb) ratio (ie, levels of fHb at the end of CPB divided by baseline fHb) could predict AKI after on-pump cardiac surgery. ⋯ Results from this exploratory, hypothesis-generating retrospective, observational study shows that fHb ratio at the end of CPB might be used as a novel, widely applicable biomarker for AKI. The use of fHb ratio might help for an early detection of AKI, compared with prediction based only on urinary biomarkers.