AANA journal
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A 1992 General Accounting Office (GAO) study on costs of anesthesia found that anesthetics administered by anesthesia care teams (ACTs) were more costly than those administered by Certified Registered Nurse Anesthetists (CRNAs) or anesthesiologists practicing alone. In 1994, Medicare implemented a single payment system in response to the GAO report and recommendations by the Physician Payment Review Commission. Restructuring of many anesthesia departments has followed. ⋯ Anesthesiologists provided most preoperative and postoperative care, while nurse anesthetists administered the majority of anesthetics. Anesthesiologists and nurse anesthetists in this study agreed in their perceptions that more than 70% of these cases did not need medical direction. Logistical regression of variables was used to construct a predictive equation for cases where providers perceived that medical direction was beneficial.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
Oral midazolam versus meperidine, atropine, and diazepam: a comparison of premedicants in pediatric outpatients.
An effective premedicant minimizes the emotional trauma children experience when facing surgery and may facilitate a smoother induction with fewer airway complications. In a randomized, double-blind study, the preoperative sedative effects and the postoperative recovery profiles of two oral pediatric premedicants were compared. Children (n = 102) were randomly assigned to receive 0.5 mg/kg midazolam or .2 mL/kg of a combination of meperidine 6.0 mg/mL, atropine 0.08 mg/mL, and diazepam 0.6 mg/mL 15-45 minutes before separation from parents. ⋯ Midazolam subjects initially arrived in the PACU sleepier than pediatric anesthesia medicine subjects, but all other recovery scores were similar. There were no differences in analgesic requirements, side effects, or time to discharge between groups. We conclude that both premedicants are effective in most children, but that midazolam may offer more effective sedation in younger, distressed children.
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The authors discuss their experience with chloroprocaine for epidural anesthesia in five pediatric patients. While bupivacaine remains the most commonly used local anesthetic in children, recent reports of toxicity document the risks of this agent. The major advantage of chloroprocaine is its rapid metabolism, which thereby minimizes the risks of toxicity, especially in patients with preexisting problems such as young age or underlying hepatic dysfunction, which may limit the metabolism of local anesthetics of the amide class. ⋯ Adequate intraoperative conditions were achieved in all five patients. No complications related to chloroprocaine epidural anesthesia were noted. This initial experience suggests that chloroprocaine offers an acceptable alternative to bupivacaine for epidural anesthesia in the pediatric population.