Journal of clinical anesthesia
-
Randomized Controlled Trial Comparative Study Clinical Trial
Serum and urine inorganic fluoride levels following prolonged low-dose sevoflurane anesthesia combined with epidural block.
To determine whether serum and urine inorganic fluoride levels with prolonged (more than 7 hours) low-dose (0.8 to 2.0 vol %) sevoflurane anesthesia plus epidural anesthesia were increased as compared with isoflurane anesthesia plus epidural anesthesia. To measure the urine tubular enzymes N-acetyl-beta-glucosaminidase (NAG), alpha 1-microglobulin (alpha 1-M), and beta 2-microglobulin (beta 2-M) for renal tubular injury in both groups. ⋯ There was no increase in urinary enzymes, which are indicators of tubular injury, specific to sevoflurane. There was no postoperative renal dysfunction, as indicated by unchanged serum creatinine and blood urea nitrogen levels.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Effects of subcutaneous verapamil on the duration of local anesthetic blockade.
To determine whether a subcutaneous injection of verapamil will provide local anesthesia and whether a mixture of lidocaine and verapamil will prolong the anesthetic effect of lidocaine alone. ⋯ Verapamil injected subcutaneously provides a degree of local anesthesia. However, this effect is hampered by a local reaction at the injection site and a short duration of action. The mixture of lidocaine and verapamil provides a shorter duration of action than does lidocaine alone.
-
With the increasing focus of national attention on health care and health care costs, anesthesiologists, along with all other medical specialists, must become more cost conscious in their practice behaviors. This review describes the current concerns about health care in the United States, including a discussion of some of the forces causing the increase in health care spending. The role of anesthesiology in the increase in health care costs is discussed. ⋯ Francis Regional Medical Center, Wichita, KS, which is associated with the University of Kansas School of Medicine-Wichita). These changes resulted in a 13% reduction in anesthesia drug costs, which amounted to a savings of $127,472. The largest decreases were in anesthetic gases (16%), resulting from an increase in the use of low-flow techniques, and in muscle relaxants (26%), resulting from a switch to older lower-cost drugs.
-
To compare the relative cost-effectiveness ratios of (1) therapy with ondansetron, droperidol, and metoclopramide in the prevention of postoperative nausea and vomiting (PONV), and (2) prophylactic versus rescue therapy of PONV with these agents. ⋯ When drug costs, efficacy, and adverse events were all considered, prophylactic droperidol was more cost-effective than ondansetron, and both drugs were more cost-effective than metoclopramide. However, the expected frequency of PONV, as well as local drug acquisition costs, can significantly influence whether a particular antiemetic is cost-effective when given prophylactically or only as therapy for established PONV.
-
To determine whether the window design of pencil-point spinal needles leads to deformation under lateral or axial loading conditions. ⋯ The Sprotte needles have an inherent design weakness to lateral and axial pressure, which may result in a greater number of needle tip deformations upon needle insertion. The nature of this deformation may result in difficulty in needle withdrawal and possibly fracture of the needle tip.