Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Jul 2014
Randomized Controlled TrialAdherence to guidelines for the management of local anesthetic systemic toxicity is improved by an electronic decision support tool and designated "reader".
A hardcopy or paper cognitive aid has been shown to improve performance during the management of simulated local anesthetic systemic toxicity (LAST) when given to the team leader. However, there remains room for improvement to ensure a system that can achieve perfect adherence to the published guidelines for LAST management. Recent research has shown that implementing a checklist via a designated reader may be of benefit. Accordingly, we sought to investigate the effect of an electronic decision support tool (DST) and designated "Reader" role on team performance during an in situ simulation of LAST. ⋯ In a prospective, randomized single-blinded study, a designated Reader with an electronic DST improved adherence to guidelines in the management of an in situ simulation of LAST. Such tools are promising in the future of medicine, but further research is needed to ensure the best methods for implementing them in the clinical arena.
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Reg Anesth Pain Med · Jul 2014
Clinical Accuracy and Safety Using the SynchroMed II Intrathecal Drug Infusion Pump.
We evaluated the infusion accuracy and device-related safety of implantable drug infusion pumps in subjects with chronic pain or severe spasticity. ⋯ The pump accurately delivered intrathecal medication in the clinical setting of this study. Adverse events were similar in nature and severity to those described in the product labeling and literature.
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Reg Anesth Pain Med · Jul 2014
Comparative StudyComparison Between Digital Subtraction Angiography and Real-time Fluoroscopy to Detect Intravascular Injection During Lumbar Transforaminal Epidural Injections.
Infrequent but serious complications of transforaminal epidural steroid injection (TFESI) are thought to be due to inadvertent intravascular injection (embolization of corticosteroid particulates via the vertebral or thoracolumbar radiculomedullary arteries). Recent studies suggest that real-time fluoroscopy often fails to detect intravascular injection and that digital subtraction angiography (DSA) may help reduce the incidence of accidental vascular injection. The goal of this prospective study was to evaluate the sensitivity of real-time fluoroscopy versus DSA in detecting intravascular injection during TFESI. ⋯ Digital subtraction angiography is superior to real-time fluoroscopy for detecting intravascular injections.