Journal of clinical anesthesia
-
Multicenter Study Observational Study
Lack of generalizability of observational studies' findings for turnover time reduction and growth in surgery based on the State of Iowa, where from one year to the next, most growth was attributable to surgeons performing only a few cases per week.
Three observational studies at large teaching hospitals found that reducing turnover times resulted in the surgeons performing more cases. We sought to determine if these findings are generalizable to other hospitals, because, if so, reducing turnover times may be an important mechanism for hospitals to use for growing caseloads. ⋯ Most (≥50%) annual growth in surgery, both based on the number of total inpatient and outpatient surgical cases, and on the total outpatient RVU's, was attributable to surgeons who performed 2 or fewer cases per week at each hospital statewide during the preceding year. Therefore, the strategic priority should be to assure that the many low-caseload surgeons have access to convenient OR time (e.g., by allocating sufficient OR time, and assigning surgeon blocks, in a mathematically sound, evidence-based way). Although reducing turnover times and anesthesia-controlled times to promote growth will be beneficial for a few surgeons, the effect on total caseload will be small.
-
Letter Case Reports
Anesthetic management for laparoscopic sleeve gastrectomy to a child.
-
Letter Case Reports
Takotsubo cardiomyopathy complicating thoracoabdominal aortic aneurysm repair.
We describe the management of a patient with symptomatic spinal cord hypoperfusion after thoracoabdominal aortic aneurysm repair, where the neurological insult and associated emotional stress precipitated Takotsubo cardiomyopathy. Transthoracic Echocardiography showed akinetic mid and apical left ventricular segments, while basal segments were spared. ⋯ Excess catecholamines have been postulated as a contributing mechanism to the disease, therefore, catecholamines were avoided to prevent further myocardial injury. Takotsubo cardiomyopathy is associated with serious morbidity and mortality, which highlights the importance of early recognition and proper management for complete recovery of both cardiac and neurologic functions.
-
Letter Clinical Trial
Lidocaine post-nasal dripping (LPND): An easy way for awake nasal intubation.