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https://www.readbyqxmd.com/read/29921549/implementation-of-enhanced-recovery-after-surgery-in-a-community-hospital-an-evidence-based-approach
#1
Michele Persico, David Miller, Cassandra Way, Marsha Williamson, Kate O'Keefe, Dennis Strnatko, Fay Wright
PURPOSE: Enhanced recovery after surgery (ERAS) is an evidence-based practice protocol that has been shown to reduce cost, decrease length of stay (LOS), and improve surgical outcomes. DESIGN: An evidence-based practice improvement project with a multidisciplinary team translated the ERAS protocol into practice at a community hospital. The evidence-based practice improvement design allows integration of evidence into projects to improve clinical outcomes for patients...
June 16, 2018: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
https://www.readbyqxmd.com/read/29901538/concurrent-and-overlapping-surgery-perspectives-from-parents-of-adolescents-undergoing-spinal-posterior-instrumented-fusion-for-idiopathic-scoliosis
#2
Jessica Bryant, Alexander Markes, Tiana Woolridge, Dede Cerruti, Elizabeth Dzeng, Barbara Koenig, Mohammad Diab
STUDY DESIGN: Prospective cross-sectional survey. OBJECTIVE: To determine the perspectives of parents of patients undergoing posterior instrumented fusion for adolescent idiopathic scoliosis (AIS) regarding simultaneous surgery and trainee participation. SUMMARY OF BACKGROUND DATA: Simultaneous ("at the same time") surgery is under scrutiny by the public, government, payers and the medical community. The objective of this study is to determine the perspectives of parents of patients undergoing posterior instrumented fusion for adolescent idiopathic scoliosis...
June 12, 2018: Spine
https://www.readbyqxmd.com/read/29889707/postoperative-cognitive-dysfunction-and-noncardiac-surgery
#3
Lisbeth A Evered, Brendan S Silbert
Postoperative cognitive dysfunction (POCD) is an objectively measured decline in cognition postoperatively compared with preoperative function. POCD has been considered in the anesthetic and surgical literature in isolation of cognitive decline which is common in the elderly within the community and where it is labeled as mild cognitive impairment, neurocognitive disorder, or dementia. This narrative review seeks to place POCD in the broad context of cognitive decline in the general population. Cognitive change after anesthesia and surgery was described over 100 years ago, initially as delirium and dementia...
June 8, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29858144/use-of-ultrasound-guided-superficial-cervical-plexus-block-for-pain-management-in-the-emergency-department
#4
Ben Ho, Michael De Paoli
BACKGROUND: Although use of the superficial cervical plexus block (SCPB) by anesthesia for perioperative indications is well described, there is a paucity of research on use of SCPB in the emergency department (ED). OBJECTIVE: This prospective observational study aims to prospectively characterize the feasibility, potential for efficacy, and safety of ultrasound-guided SCPB in a convenience sample of ED patients presenting with painful conditions of the "cape" distribution of the neck and shoulder...
May 29, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29787411/perianesthetic-and-anesthesia-related-mortality-in-a-southeastern-united-states-population-a-longitudinal-review-of-a-prospectively-collected-quality-assurance-data-base
#5
Richard J Pollard, Thomas Hopkins, C Tyler Smith, Bryan V May, James Doyle, C Labron Chambers, Reese Clark, William Buhrman
BACKGROUND: Perianesthetic mortality (death occurring within 48 hours of an anesthetic) continues to vary widely depending on the study population examined. The authors study in a private practice physician group that covers multiple anesthetizing locations in the Southeastern United States. This group has in place a robust quality assurance (QA) database to follow all patients undergoing anesthesia. With this study, we estimate the incidence of anesthesia-related and perianesthetic mortality in this QA database...
May 21, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29754874/preoperative-screening-for-obstructive-sleep-apnea-and-outcomes-in-pacu
#6
Jill Setaro, Ruth Reinsel, Dana Brun
PURPOSE: Practice guidelines from the perianesthesia community suggest that preoperative identification of patients with obstructive sleep apnea (OSA) and standardized longer observation in postanesthesia care unit (PACU) promotes safety after general anesthesia. The purpose of this study was to determine if longer monitoring of patients with OSA in the PACU improves patient outcomes after general anesthesia. DESIGN: Evidence-based best practices literature review...
May 10, 2018: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
https://www.readbyqxmd.com/read/29732167/bugs-in-the-program-can-pregnancy-drugs-and-smoking-disturb-molecular-reprogramming-of-the-fetal-germline-increasing-heritable-risk-for-autism-and-neurodevelopmental-disorders
#7
Jill Escher
In a seeming paradox, the prevalence of autism spectrum disorder (ASD) has surged, while at the same time research has pointed to the strong heritability of this neurodevelopmental pathology. Here an autism research philanthropist suggests a biological phenomenon of exogenously induced 'gamete disruption' that could reconcile these seemingly contradictory observations. Mining information from her own family history and that of her fellow autism parents, while also engaging with the scientific community, she proposes that a subset of the autisms may be rooted in a variety of molecular glitches in parental gametes induced by certain acute exposures during the parents' own fetal or neonatal development...
April 2018: Environmental Epigenetics
https://www.readbyqxmd.com/read/29624026/preoperative-anxiety-and-implications-on-postoperative-recovery-what-we-can-do-to-change-our-history
#8
Dusica M Stamenkovic, Nemanja K Rancic, Milan B Latas, Vojislava Neskovic, Goran M Rondovic, Jennifer D Wu, Davide Cattano
Preoperative anxiety can influence the intensity of postoperative pain and anesthesia and analgesia requirement. In certain types of surgery, anxiety may even increase postoperative morbidity and mortality. The goal of this narrative review is to remind anesthesiologists that anxiety measurement using specific tools can be done in clinical practice, to present the implications of preoperative anxiety on postoperative patient recovery, and to acknowledge the importance of a dedicated anesthesia plan in the management of anxious adult patients...
April 5, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29608321/management-of-pregnancy-sensitized-with-anti-inb-with-monocyte-monolayer-assay-and-maternal-blood-donation
#9
Raj Shree, Kimberly K Ma, Lay S Er, Meghan Delaney
Maternal red blood cell (RBC) alloantibodies can cause hemolytic disease of the fetus and newborn (HDFN). Although much is described about common antibodies associated with HDFN, management of a pregnancy complicated by a maternal rare antibody presents several challenges related to assessment of fetal anemia risk, availability of blood for transfusion to the mother and/or the fetus or newborn if needed, and planning for delivery in the case of maternal hemorrhage. Here we report the laboratory medicine workup of a patient who presented for obstetrical care in the United States in the third trimester and had a rare antibody (anti-Inb)...
January 2018: Immunohematology
https://www.readbyqxmd.com/read/29607171/enhanced-recovery-after-thoracic-surgery-reduces-discharge-on-highly-dependent-narcotics
#10
Min P Kim, Edward Y Chan, Leonora M Meisenbach, Razvan Dumitru, Jessica K Brown, Faisal N Masud
Background: There is large prescription drug epidemic in United States. We want to determine if ERATS (enhanced recovery after thoracic surgery) program can reduce discharge on highly dependent narcotics. Methods: We performed a retrospective analysis of prospectively collected data on patients who underwent lung resection and foregut procedures on thoracic surgery service over an 8-month time period. Patients underwent preoperative conditioning instructions, multimodal non-narcotic pharmaceutical usage, total intravenous anesthesia (TIVA) and minimizing highly addictive narcotics during the post-operative period...
February 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29588995/the-adjunctive-application-of-transcranial-direct-current-stimulation-in-the-management-of-de-novo-refractory-epilepsia-partialis-continua-in-adolescent-onset-polg-related-mitochondrial-disease
#11
Yi Shiau Ng, Henriette van Ruiten, H Ming Lai, Rebecca Scott, Venkateswaran Ramesh, Karen Horridge, Robert W Taylor, Doug M Turnbull, Gráinne S Gorman, Robert McFarland, Mark R Baker
Focal status epilepticus in POLG -related mitochondrial disease is highly refractory to pharmacological agents, including general anesthesia. We report the challenges in managing a previously healthy teenager who presented with de novo epilepsia partialis continua and metabolic stroke resulting from the homozygous p.Ala467Thr POLG mutation, the most common pathogenic variant identified in the Caucasian population. We applied transcranial direct current stimulation (tDCS; 2 mA; 20 min) daily as an adjunctive therapy because her focal seizures failed to respond to five antiepileptic drugs at maximal doses...
March 2018: Epilepsia Open
https://www.readbyqxmd.com/read/29580593/multimodal-perioperative-analgesia-regimen-to-improve-patient-outcomes-after-total-knee-arthroplasty-a-multidisciplinary-quality-improvement-project
#12
Rebecca E Donahue, George R Bradbury, Michael E Zychowicz, Virginia C Muckler
PURPOSE: The primary aim of this quality improvement project was to improve mobilization for patients after total knee arthroscopy by developing and implementing a standardized, evidence-based, multimodal analgesia regimen and patient-educational video. Secondary outcomes included opioid consumption, pain, and length of stay. DESIGN: A pre-post implementation design was used to compare two independent samples. METHODS: Patients were screened based on inclusion and exclusion criteria 1-2 weeks before surgery...
April 2018: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
https://www.readbyqxmd.com/read/29550366/using-animal-models-to-evaluate-the-functional-consequences-of-anesthesia-during-early-neurodevelopment
#13
Susan E Maloney, Catherine E Creeley, Richard E Hartman, Carla M Yuede, Charles F Zorumski, Vesna Jevtovic-Todorovic, Krikor Dikranian, Kevin K Noguchi, Nuri B Farber, David F Wozniak
Fifteen years ago Olney and colleagues began using animal models to evaluate the effects of anesthetic and sedative agents (ASAs) on neurodevelopment. The results from ongoing studies indicate that, under certain conditions, exposure to these drugs during development induces an acute elevated apoptotic neurodegenerative response in the brain and long-term functional impairments. These animal models have played a significant role in bringing attention to the possible adverse effects of exposing the developing brain to ASAs when few concerns had been raised previously in the medical community...
March 14, 2018: Neurobiology of Learning and Memory
https://www.readbyqxmd.com/read/29547428/global-surgery-system-strengthening-it-is-all-about-the-right-metrics
#14
David A Watters, Glenn D Guest, Viliami Tangi, Mark G Shrime, John G Meara
Progress in achieving "universal access to safe, affordable surgery, and anesthesia care when needed" is dependent on consensus not only about the key messages but also on what metrics should be used to set goals and measure progress. The Lancet Commission on Global Surgery not only achieved consensus on key messages but also recommended 6 key metrics to inform national surgical plans and monitor scale-up toward 2030. These metrics measure access to surgery, as well as its timeliness, safety, and affordability: (1) Two-hour access to the 3 Bellwether procedures (cesarean delivery, emergency laparotomy, and management of an open fracture); (2) Surgeon, Anesthetist, and Obstetrician workforce >20/100,000; (3) Surgical volume of 5000 procedures/100,000; (4) Reporting of perioperative mortality rate; and (5 and 6) Risk rates of catastrophic expenditure and impoverishment when requiring surgery...
April 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29547422/anesthesia-development-in-mongolia-strengthening-anesthesia-practice-in-mongolia-through-education-and-continuing-professional-development
#15
Ganbold Lundeg, Amanda Baric, David C Pescod, Keith Pescod
Anesthesia in Mongolia has undergone a period of major development over the past 17 years, thanks to the work of the Mongolian Society of Anesthesiologists (MSA) and the support of the World Federation of Societies of Anaesthesiologists and the Australian Society of Anaesthetists. The specialty has made major advances in training and in its standing among medical specialties in Mongolia. The MSA has produced members who are leaders in the development of anesthesia as well as emergency medicine and critical care...
April 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29519719/oral-nitroglycerin-solution-may-be-effective-for-esophageal-food-impaction
#16
Benjamin A Willenbring, Callie K Schnitker, Samuel J Stellpflug
BACKGROUND: Esophageal food impaction is a common illness presenting to emergency departments (ED), and is frequently resistant to pharmacologic therapy. Several medications have been promoted for this indication, but so far have not proven effective. Endoscopic removal is frequently required to resolve the impaction, resulting in risks from anesthesia and the physical procedure, and in prolonged hospital stay for recovery. Oral nitroglycerin solution was recently used in two such cases and may represent a new therapeutic option...
May 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29513208/use-of-and-access-to-deep-sedation-and-general-anesthesia-for-dental-patients-a-survey-of-ontario-dentists
#17
Andrew Adams, Carilynne Yarascavitch, Carlos Quiñonez, Amir Azarpazhooh
OBJECTIVE: This study aims to assess barriers to the use of deep sedation/general anesthesia (DS/GA) identified by dentists in Ontario. METHODS: An email invitation to a web-based survey was distributed to all licensed dentists and specialists who have provided an email address to the provincial regulator (n = 5507). Descriptive and regression analyses were performed to explore practice and demographic factors associated with the use of DS/GA. RESULTS: The response rate was 18...
July 2017: Journal—Canadian Dental Association, Journal de L'Association Dentaire Canadienne
https://www.readbyqxmd.com/read/29496300/a-retrospective-analysis-of-factors-associated-with-anesthetic-case-duration-for-cesarean-deliveries
#18
M J Harris, R A Gabriel, R P Dutton, R D Urman
INTRODUCTION: Accurately predicting cesarean delivery case duration is an integral component of designing appropriate workflow protocols and ensuring adequate provider availability. Our primary objective was to describe the variability of case duration, based on factors that we hypothesized would be influential, such as hospital facility type, United States region, time of day, case volume, and patient and provider characteristics. METHODS: We analyzed hospital-, patient-, and provider-level variables from the National Anesthesia Clinical Outcomes Registry, a voluntary registry created to share anesthesia-related data and outcomes...
May 2018: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/29485967/report-of-the-third-heart-surgery-forum-scientific-sessions-zagreb-croatia-december-6-8-2017-conference-highlights
#19
Michael S Firstenberg, Tom C Nguyen, Harold Roberts, Mark M Levinson, Igo Rudez
The Heart Surgery Forum is an online community dedicated to topics related to all aspects of cardiothoracic surgery. It consists of an informative website (www.hsforum.com), a traditional indexed journal both in print and online, and an email-based "list-serv" for discussion of surgical cases and techniques. The email list-serv, "OpenHeart-L" (The Forum) is composed of surgeons and allied specialties (perfusion, anesthesia, nursing). Dr. Mark Levinson (USA) started The Forum originally in 1995...
February 26, 2018: Heart Surgery Forum
https://www.readbyqxmd.com/read/29411032/association-of-preoperatively-diagnosed-patent-foramen-ovale-with-perioperative-ischemic-stroke
#20
Pauline Y Ng, Andrew K-Y Ng, Balachundhar Subramaniam, Sara M Burns, Fanny Herisson, Fanny P Timm, Cand Med, Maira I Rudolph, Cand Med, Flora Scheffenbichler, Cand Med, Sabine Friedrich, Cand Med, Timothy T Houle, Deepak L Bhatt, Matthias Eikermann
Importance: Perioperative stroke is a major complication for patients undergoing surgery. Patent foramen ovale (PFO) represents a possible anatomical link between venous thrombosis and stroke. Objective: To determine whether a preoperatively diagnosed PFO is associated with increased risk of perioperative ischemic stroke. Design, Setting, and Participants: Retrospective cohort study from Massachusetts General Hospital and 2 affiliated community hospitals between January 1, 2007, and December 31, 2015...
February 6, 2018: JAMA: the Journal of the American Medical Association
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