The Ochsner journal
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The Ochsner journal · Jan 2011
Implementation of an Anesthesia Information Management System (AIMS).
During the administration of anesthesia, the anesthesia provider has historically created a paper record, charted manually, that included extensive patient care-related data (vital signs, other parameters, etc) and commentaries. DocuSys, a proprietary anesthesia information management system (AIMS), creates an electronic version of the anesthesia record and provides additional information. It electronically captures data from clinical monitors and other sources, including scheduling applications and laboratory computers. ⋯ Data can be made available from a single case or, more important, from thousands of cases to analyze variables such as efficiency of services, adherence to best practices, patient outcomes, and clinical research. The AIMS was deployed at the main campus of the Ochsner Health System on March 26, 2009. In this article, we discuss the issues involved in the AIMS implementation process: the successes, surprises, and continued challenges.
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The Ochsner journal · Jan 2011
Epidural Anesthesia for Cesarean Delivery in a Patient With Severe Pulmonary Artery Hypertension and a Right-to-Left Shunt.
A 38-year-old woman with severe pulmonary artery hypertension and a right-to-left shunt of unknown etiology presented at 32 weeks' gestational age. Determination of the cause of her pulmonary hypertension by transesophageal echocardiography was delayed until after delivery secondary to anesthetic risk. ⋯ Transesophageal echocardiography after delivery revealed a patent foramen ovale, indicating a diagnosis of idiopathic pulmonary artery hypertension and a very poor prognosis. Differentiating between Eisenmenger syndrome and idiopathic pulmonary artery hypertension may not be important for determining the optimal anesthetic management of patients with pulmonary hypertension but is important in assessing long-term prognosis.
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The Ochsner journal · Jan 2011
Comparison of extended-release epidural morphine with femoral nerve block to patient-controlled epidural analgesia for postoperative pain control of total knee arthroplasty: a case-controlled study.
Because newer anticoagulation strategies for total knee replacement present potentially increased risk of neuraxial analgesia, there is movement away from using patient-controlled epidural analgesia (PCEA) for pain control. This concern opens the door for other regional modalities in postoperative analgesia, including the use of extended-release epidural morphine (EREM) combined with a femoral nerve block (FNB). ⋯ The VAS scores at 24 and 48 hours indicate that EREM and FNB provide comparable analgesia to PCEA. The trend toward shorter PACU times represents an opportunity for cost-identification analysis. The study data are limited by their observational nature and the small number of patients involved; nevertheless, this study demonstrates a therapeutic equivalence to PCEA that may be more cost effective.
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Hypothermia, defined as a core body temperature less than 36°C (96.8°F), is a relatively common occurrence in the unwarmed surgical patient. A mild degree of perioperative hypothermia can be associated with significant morbidity and mortality. A threefold increase in the frequency of surgical site infections is reported in colorectal surgery patients who experience perioperative hypothermia. As part of the Surgical Care Improvement Project, guidelines aim to decrease the incidence of this complication. ⋯ Monitoring of body temperature and avoidance of unintended perioperative hypothermia through active and passive warming measures are the keys to preventing its complications.
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The Ochsner journal · Jan 2011
Comparison of ultrasound and nerve stimulation techniques for interscalene brachial plexus block for shoulder surgery in a residency training environment: a randomized, controlled, observer-blinded trial.
The ability to provide adequate intraoperative anesthesia and postoperative analgesia for orthopedic shoulder surgery continues to be a procedural challenge. Anesthesiology training programs constantly balance the time needed for procedural education versus associated costs. The administration of brachial plexus anesthesia can be facilitated through nerve stimulation or by ultrasound guidance. The benefits of using a nerve stimulator include a high incidence of success and less cost when compared to ultrasonography. Recent studies with ultrasonography suggest high success rates and decreased procedural times, but less is known about the comparison of these procedural times in training programs. We conducted a prospective, randomized, observer-blinded study with inexperienced clinical anesthesia (CA) residents-CA-1 to CA-3-to compare differences in these 2 guidance techniques in patients undergoing interscalene brachial plexus block for orthopedic surgery. ⋯ On the basis of our results with inexperienced residents, we found that using US in guiding the interscalene approach to the brachial plexus significantly shortened the duration of intervals in conduction of the block and onset of anesthesia when compared with NS; moreover, these times could have significant cost savings for the institution. Finally, the use of US technology in an academic medical center facilitates safe, cost-effective, quality care.