Articles: anesthesia.
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The wide-awake local anesthesia no tourniquet (WALANT) technique, which is based on the local infiltration of lidocaine and epinephrine, is widely used in hand and wrist surgery. However, few studies have been conducted on the cost-benefit analysis of phalanx fracture surgery using the WALANT technique. This study aimed to investigate the clinical condition, as well as the time spent for anesthesia and operation. We also performed an economic analysis to compare general anesthesia, local anesthesia with a tourniquet, and the WALANT technique for plate fixation of phalanx fractures. ⋯ Open reduction with plate fixation of phalanx fractures using the WALANT technique or local anesthesia was cost-effective compared with general anesthesia. Patients who underwent phalanx fracture surgery using the WALANT technique experienced less pain on the first postoperative day because of the adequate tumescent technique and not using a tourniquet during surgery.
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Observational Study
Intraoperative high and low blood pressures are not associated with delirium after cardiac surgery: A retrospective cohort study.
To evaluate the associations between high and low intraoperative time-weighted average mean arterial pressures before, during and after cardiopulmonary bypass on postoperative delirium. ⋯ This large single-center cohort analysis found no evidence that exposure to high or low blood pressures during various intraoperative phases of cardiac surgery are associated with postoperative delirium.
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Many seriously ill patients undergo surgical interventions. Palliative care clinicians may not be familiar with the nuances involved in perioperative care, however they can play a valuable role in enabling the delivery of patient-centered and goal-concordant perioperative care. ⋯ Palliative care clinicians may also be called upon to direct discussions around perioperative management of modified code status orders and to engage around the goal-concordance of proposed interventions. This article, written by a team of surgeons and anesthesiologists, many with subspecialty training in palliative medicine and/or ethics, offers ten tips to support palliative care clinicians and facilitate comprehensive discussion as they engage with patients and clinicians considering surgical interventions.
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Anaesth Intensive Care · Jan 2025
Association of medical emergency team activation in the 24-hour postoperative period with length of stay and in-hospital mortality.
Medical emergency team (MET) activations were designed to improve patient safety and outcomes by providing timely and specialised care to patients experiencing clinical deterioration. The primary objective of this study was to describe the association between MET events in the early (24-h) postoperative period and in-hospital mortality as well as length of stay. A retrospective data linkage study was performed of prospectively collected data from patient administrative data and the MET database at Launceston General Hospital located in Tasmania, Australia. ⋯ Notably, staff concern as a trigger for MET activation was associated with a hazard nearly as great as chest pain. Other MET triggers that reached statistical significance were bleeding, respiratory rate more than 36/min, peripheral oxygen saturations less than 84% and systolic blood pressure less than 80 mmHg. Despite being frequent, MET events should be regarded as a serious marker of an adverse patient journey that may warrant higher resource allocation.
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EEG-based DoA monitoring is a powerful tool for ensuring the optimal balance between maintaining unconsciousness and preventing excessive sedation during procedures. Understanding the role, indications, equipment, and troubleshooting of EEG-based DoA monitoring is necessary for the effective use of this tool in clinical decision-making.