Articles: outcome.
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Careful preoperative screening of candidates for indwelling drug administration systems for the relief of intractable pain can help to exclude patients who will not benefit from this technology and predict efficacy in others. Unfortunately, bias on the part of both the treating physician and the patient can inappropriately skew the results of subjective or improperly controlled trials and lead to the implantation of drug administration systems in patients who will not benefit from chronic intrathecal narcotic administration. The author and his coworkers have designed a quantitative, crossover, double-blind paradigm for screening patients who might otherwise be deemed eligible for chronic intraspinal narcotic administration. ⋯ Sixteen (80%) of 20 patients with pain related to cancer underwent pump implantation, whereas only six (60%) of the 10 patients with pain of nonmalignant origin were so treated. Sixteen of the patients (72%) have reported good to excellent relief after pump implantation; this includes 12 (75%) of the 16 patients with pain related to cancer and four (66%) of the six patients with pain of nonmalignant origin. This screening paradigm thus appears to be both reliable and easily applied and promises to be of assistance in the selection of patients appropriate for this mode of therapy.
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Int J Obstet Anesth · Jan 1997
Low dose epidural bupivacaine/fentanyl infusion does not mask uterine rupture.
A patient is described in whom the symptoms and signs of uterine rupture were not masked by combined spinal epidural analgesia with an epidural infusion of 0.1% bupivacaine and 1.5 microg ml(-l) fentanyl. Early recognition of the dehiscence of a previous caesarean section scar resulted in an excellent neonatal and maternal outcome.
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In the intensive care unit (ICU) setting, the combination of mechanical ventilation and renal replacement therapy (RRT) has been associated with prolonged length of hospital stay, high cost of care and poor outcome. We gathered outcome data on patients who had severe renal dysfunction on transfer to our regional weaning center (RWC) for attempted weaning from prolonged mechanical ventilation (PMV). We screened the admission laboratory values of 1077 patients transferred to our RWC over an 8-year period. We reviewed the medical records of patients with serum creatinine > 2.5 mg/dl. ⋯ Patients who require PMV and RRT have a very poor prognosis. The small number of patients with renal insufficiency not requiring RRT had a more favorable hospital outcome and mortality, but long-term survival remained poor.
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Int J Obstet Anesth · Jan 1997
Spinal anesthesia versus intravenous sedation for transvaginal oocyte retrieval: reproductive outcome, side-effects and recovery profiles.
Transvaginal ultrasonically guided oocyte retrieval is commonly performed as part of in vitro fertilization efforts. The impact of anesthetic management on patient outcome from this procedure has not been well characterized. At our institution, patients are offered a choice of either heavy intravenous sedation or spinal anesthesia with minimal or no sedatives. ⋯ The intravenous sedation group required a significantly longer period until recovery room discharge criteria were met (P = 0.03), and were more likely to have postoperative emetic episodes (46% versus 6% in the spinal anesthesia group: P < 0.01). Two unplanned hospital admissions occurred in the intravenous sedation group: both were related to uncontrolled nausea and vomiting. We conclude that spinal anesthesia may have advantages over intravenous sedation for oocyte retrieval.