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Outpatient anesthesia

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https://www.readbyqxmd.com/read/28429926/the-efficacy-of-intraurethral-lidocaine-in-optical-internal-urethrotomy-for-anterior-urethral-stricture-a-multicenter-study
#1
Nedim Y Cem, Yıldız Yildiray, Cem Ö Berat, Melih S Mehmet, Gökhan D Ömer, Metin H Ahmet, Özyuvalı Ekrem, Ayyıldız Ali
BACKGROUND: Male anterior urethral strictures can be treated successfully with the help of optical internal urethrotomy (OIU) and is usually performed under general or regional anaesthesia. In this study, we determined the efficacy of intraurethral lidocaine in OIU for anterior urethral stricture in an outpatient setting. METHODS: 157 patients with anterior urethral strictures underwent OIU under local urethral anaesthesia with lidocaine. Optical urethrotomy was performed with a cold-cutting knife...
April 20, 2017: Minerva Urologica e Nefrologica, the Italian Journal of Urology and Nephrology
https://www.readbyqxmd.com/read/28419032/formal-physical-therapy-after-total-hip-arthroplasty-is-not-required-a-randomized-controlled-trial
#2
Matthew S Austin, Brian T Urbani, Andrew N Fleischman, Navin D Fernando, James J Purtill, William J Hozack, Javad Parvizi, Richard H Rothman
BACKGROUND: The value of formal physical therapy after total hip arthroplasty is unknown. With substantial changes that have occurred in surgical and anesthesia techniques, self-directed therapy may be efficacious in restoring function to patients undergoing total hip arthroplasty. METHODS: We conducted a single-center, randomized trial of 120 patients undergoing primary, unilateral total hip arthroplasty who were eligible for direct home discharge. The experimental group followed a self-directed home exercise program for 10 weeks...
April 19, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28413736/targeted-intraspinal-radiofrequency-ablation-for-lumbar-spinal-stenosis
#3
Robert E Jacobson, Michelle Granville, Jesse Hatgis DO
INTRODUCTION: By using a combination of magnetic resonance imaging (MRI) and computed tomography (CT) of the lumbar spine, it is possible to distinguish between spinal stenosis caused by bone compression and specific soft tissue epidural intraspinal lesions that cause localized spinal canal stenosis and neural compression. Examples include facet cysts and yellow ligament hypertrophy. Many of these patients are elderly with medical comorbidities that make open surgery problematic. MATERIALS & METHODS: This is a study of patients with predominantly soft tissue stenosis being treated with targeted intraspinal radiofrequency (RF) heat ablation...
March 10, 2017: Curēus
https://www.readbyqxmd.com/read/28413268/novel-propofol-derivatives-and-implications-for-anesthesia-practice
#4
REVIEW
Aiden Y Feng, Alan D Kaye, Rachel J Kaye, Kumar Belani, Richard D Urman
Propofol (2,6-diisopropylphenol) is the most commonly used intravenous agent for induction of anesthesia. It is also used for maintenance of anesthesia and sedation in both Intensive Care Units and outpatient procedural settings. Its success in the clinical setting has been a result of its rapid onset, short duration of action, and minimal side effects despite disadvantages associated with its oil emulsion formulation. Early attempts to alter the standard emulsion or to develop new formulations with cyclodextrins and micelles to resolve issues with pain upon injection, the need for antimicrobial agents, and possible hyperlipidemia have mostly failed...
January 2017: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/28399047/assessing-quality-and-safety-in-pediatric-supracondylar-humerus-fracture-care
#5
Christopher A Iobst, Matthew Stillwagon, Deidre Ryan, Eric Shirley, Steven L Frick
BACKGROUND: Recently, there has been an emphasis on improving quality, safety, and value in the delivery of health care in the United States. The American Board of Orthopedic Surgery (ABOS) has developed a performance improvement questionnaire (PIQ) for orthopaedic surgeons managing pediatric supracondylar humerus fracture (PSCHF). Using the supracondylar PIQ as a guide, this study evaluates the process of measuring the outcomes and variations in care to PSCHF patients among pediatric orthopaedic surgeons...
April 10, 2017: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/28390888/liposomal-bupivacaine-mixture-has-similar-pain-relief-and-significantly-fewer-complications-at-less-cost-compared-to-indwelling-interscalene-catheter-in-total-shoulder-arthroplasty
#6
William J Weller, Michael G Azzam, Richard A Smith, Frederick M Azar, Thomas W Throckmorton
BACKGROUND: The efficacy and costs of indwelling interscalene catheter (ISC) and liposomal bupivacaine (LBC), with and without adjunctive medications, in patients with primary shoulder arthroplasty are a source of current debate. METHODS: In 214 arthroplasties, 156 patients had ISC and 58 had LBC injections that were mixed with morphine, ketorolac, and 0.5% bupivacaine with epinephrine. Charts were reviewed for visual analog scale pain scores, oral morphine equivalent (OME) usage, major complications, and costs...
March 16, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28346253/a-retrospective-case-matched-cost-comparison-of-surgical-treatment-of-melanoma-and-nonmelanoma-skin-cancer-in-the-outpatient-versus-operating-room-setting
#7
Ryan P Johnson, Niraj Butala, Murad Alam, Naomi Lawrence
BACKGROUND: To date, no study has used authentic billing data in a case-control matched fashion to examine the cost of treating skin cancer in different settings. OBJECTIVE: To compare the cost of surgical treatment of skin cancer in the outpatient versus operating room setting using matched cases based on patient and skin cancer characteristics. METHODS: ICD-9 diagnosis codes for skin cancers were used to find patients who had a malignant excision current procedural terminology code in the operating room setting during 2010 to 2014...
March 23, 2017: Dermatologic Surgery: Official Publication for American Society for Dermatologic Surgery [et Al.]
https://www.readbyqxmd.com/read/28336421/percutaneous-planter-fasciitis-release-under-local-anesthesia-a-prospective-study
#8
Ramji Lal Sahu
PURPOSE: Plantar fasciitis is the most common cause of pain on the bottom of the heel. It occurs when the strong band of the tissue supporting the arch of foot becomes irritated and inflamed. The majority of patients can be treated conservatively but some resistant cases need surgery eventually. This study aims to evaluate the outcome results of percutaneous planter fascia release under local anesthesia for chronic planter fasciitis. METHODS: This prospective study was conducted in the Department of Orthopaedic Surgery in the School of Medical Science and Research, Sharda University, India from December 2010 to December 2013...
April 2017: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/28333299/bilateral-breast-reduction-without-opioid-analgesics-a-comparative-study
#9
Fereydoun Don Parsa, Justin Cheng, Brad Stephan, Nikki Castel, Leslie Kim, Daniel Murariu, Alan A Parsa
Background: Breast reduction has traditionally been performed under general anesthesia with adjunct opioid use. However, opioids are associated with a wide variety of adverse effects, including nausea, vomiting, constipation, postoperative sedation, dizziness, and addiction. Objectives: This study compares bilateral breast reduction using a multimodal opioid-free pain management regimen vs traditional general anesthesia with adjunct opioids. Methods: A total of 83 female patients were enrolled in this study...
March 3, 2017: Aesthetic Surgery Journal
https://www.readbyqxmd.com/read/28328759/topical-ropivacaine-in-prevention-of-post-tonsillectomy-pain-in-adults
#10
Hanna Kaisa Tolska, Annika Takala, Karin Blomgren, Katri Hamunen, Vesa Kontinen
BACKGROUND: Post-tonsillectomy pain is 1 of the most intense postoperative pain conditions. However, optimal and sufficient postoperative analgesic treatment remains unclear. We investigated the effect of topical ropivacaine for post-tonsillectomy pain in 160 adult outpatient surgery patients over 2 postoperative weeks. METHODS: At the end of tonsillectomy, 2 swabs soaked in either 1% ropivacaine or saline were packed into the tonsillar beds for 5 minutes. We used ibuprofen and a combination of acetaminophen (500 mg)-codeine (30 mg) tablets as postoperative analgesics for 2 weeks...
May 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28325486/mri-utilization-and-the-associated-use-of-sedation-and-anesthesia-in-a-pediatric-aco
#11
Joshua C Uffman, Dmitry Tumin, Vidya Raman, Arlyne Thung, Brent Adler, Joseph D Tobias
BACKGROUND AND OBJECTIVES: MRI is commonly used in the pediatric population and often requires sedation or general anesthesia to complete. This study used data from a pediatric accountable care organization (ACO) to investigate trends in MRI utilization and in the requirement for anesthesia to complete MRI examinations. METHODS: The Partners for Kids (PFK) ACO claims database was queried for MRI examination encounters involving patients 0 to 18 years old from 2009 to 2014, with utilization expressed as encounters per 10,000 PFK members-months...
March 15, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28285395/two-techniques-for-assessing-postoperative-voiding-function-a-randomized-trial
#12
Erinn M Myers, Catherine A Matthews, Andrea K Crane, AnnaMarie Connolly, Jennifer M Wu, Elizabeth J Geller
INTRODUCTION AND HYPOTHESIS: Post-operative voiding dysfunction is common after sling placement and is assessed with a voiding trial (VT) before discharge. We hypothesized that an operating room (OR) initiated retrograde VT (OR-fill) would decrease time to discharge compared with a post-anesthesia care unit (PACU) initiated retrograde VT (PACU-fill). METHODS: This was a parallel non-blinded randomized trial, of women undergoing outpatient sling surgery at a university hospital...
March 11, 2017: International Urogynecology Journal
https://www.readbyqxmd.com/read/28277258/continuous-versus-single-shot-brachial-plexus-block-and-their-relationship-to-discharge-barriers-and-length-of-stay
#13
Matthew Thompson, Robert Simonds, Bryce Clinger, Kristen Kobulnicky, Adam P Sima, Laura Lahaye, N Douglas Boardman
BACKGROUND: Brachial plexus block has been associated with improved pain control and decreased length of stay in patients undergoing upper extremity arthroplasty. Continuous delivery is associated with a shorter length of stay; however, comparisons to single-shot delivery in this setting are scarce. As the paradigm shifts to outpatient arthroplasty in the era of bundled payments, there exists a strong impetus to identify the most effective mode of analgesia associated with the least risk to patients...
October 26, 2016: Journal of Shoulder and Elbow Surgery
https://www.readbyqxmd.com/read/28257388/anterior-suprascapular-nerve-block-versus-interscalene-brachial-plexus-block-for-shoulder-surgery-in-the-outpatient-setting-a-randomized-controlled-patient-and-assessor-blinded-trial
#14
Martin Wiegel, Bernhard Moriggl, Peter Schwarzkopf, David Petroff, Andreas W Reske
BACKGROUND AND OBJECTIVES: The interscalene brachial plexus block (ISB), a potent option to control pain after shoulder surgery, has notable adverse effects. The anterior suprascapular nerve block (SSNB) might provide comparable analgesia and cause less grip-strength impairment. These characteristics were studied in this randomized controlled patient- and assessor-blinded trial. METHODS: Outpatients were randomized to single-shot ultrasound-guided SSNB (10 mL ropivacaine 1%) or ISB (20 mL ropivacaine 0...
May 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28252572/pharmacogenetics-of-ketamine-induced-emergence-phenomena-a-pilot-study
#15
Edwin N Aroke, Sybil L Crawford, Jennifer R Dungan
BACKGROUND: Up to 55% of patients who are administered ketamine experience an emergence phenomena (EP) that closely mimics schizophrenia and increases their risk of injury; however, to date, no studies have investigated genetic association of ketamine-induced EP in healthy patients. OBJECTIVES: The aim of the study was to investigate the feasibility and sample sizes required to explore the relationship between CYP2B6*6 and GRIN2B single-nucleotide polymorphisms and ketamine-induced EP...
March 2017: Nursing Research
https://www.readbyqxmd.com/read/28251526/management-of-patients-on-abuse-deterrent-opioids-in-the-ambulatory-surgery-setting
#16
REVIEW
Nalini Vadivelu, Daniel Chang, Leandro Lumermann, Thomas Suchy, Matthew M Burg, Manuel L Fontes
PURPOSE OF REVIEW: The use of prescription opioids for acute and chronic pain has become more prevalent than ever, and concurrent with the increased prescribing of opioids, there has been a steady increase in opioid abuse. Abuse is commonly associated with physical or chemical manipulation of the original opiate to provide more rapid onset of the active ingredient. RECENT FINDINGS: This growing national public health concern has led to the development of various abuse-deterring opioids with the intent of decreasing the diversion of opioids from their prescribed use...
February 2017: Current Pain and Headache Reports
https://www.readbyqxmd.com/read/28251524/pain-management-of-patients-with-substance-abuse-in-the-ambulatory-setting
#17
REVIEW
Nalini Vadivelu, Alice M Kai, Vijay Kodumudi, Richard Zhu, Roberta Hines
PURPOSE OF REVIEW: Abuse of illicit substances and prescription opioids is a growing problem that presents challenges for pain management in the inpatient and outpatient setting. With future patient care models shifting toward shorter hospital stays and more same-day surgeries, it is crucial that clinicians learn to manage this patient population and strike a balance between the overtreatment of pain that can subsequently worsen tolerance and addiction, and the undertreatment of pain that can lead to pseudoaddiction...
February 2017: Current Pain and Headache Reports
https://www.readbyqxmd.com/read/28243888/assessing-the-impact-of-state-opt-out-policy-on-access-to-and-costs-of-surgeries-and-other-procedures-requiring-anesthesia-services
#18
John E Schneider, Robert Ohsfeldt, Pengxiang Li, Thomas R Miller, Cara Scheibling
In 2001, the U.S. government released a rule that allowed states to "opt-out" of the federal requirement that a physician supervise the administration of anesthesia by a nurse anesthetist. To date, 17 states have opted out. The majority of the opt-out states cited increased access to anesthesia care as the primary rationale for their decision. In this study, we assess the impact of state opt-out policy on access to and costs of surgeries and other procedures requiring anesthesia services. Our null hypothesis is that opt-out rule adoption had little or no effect on surgery access or costs...
December 2017: Health Economics Review
https://www.readbyqxmd.com/read/28243748/pilot-study-comparing-post-anesthesia-care-unit-length-of-stay-in-moderately-and-severely-obese-children
#19
Hina Walia, Onur Balaban, Megan Jacklen, Dmitry Tumin, Vidya Raman, Joseph D Tobias
OBJECTIVE: Obesity is a risk factor for surgical complications in adults and children. Differences in postsurgical outcomes according to severity of obesity [moderate: 95-98th age-gender-specific body mass index (BMI) percentile versus severe: ≥99th percentile] in children remain unclear. This study compared post-anesthesia care unit (PACU) stay and hospital admission between severely obese children and moderately obese children undergoing surgery. METHODS: In a retrospective review over a 6-month period, obese children, 2-18 years of age undergoing surgery were identified...
February 27, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28235538/perioperative-opioid-administration-in-children-with-and-without-developmental-delay-undergoing-outpatient-dental-surgery
#20
Erin R Conner, Erica D Musser, Kelsey M Colpitts, Dean L Laochamroonvorapongse, Jeffrey L Koh
STUDY OBJECTIVE: Prior research has indicated that children with developmental delay (DD) experience qualitative and quantitative differences in health care (Boulet et al., 2009). In the perioperative setting, there is concern that children with DD may be more likely to experience postoperative complications including agitation and nausea/vomiting than typically developing patients (TDP). Differences in the administration and dosage of perioperative opioids may contribute to this, however, empirical investigations are lacking...
February 2017: Journal of Clinical Anesthesia
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