17 de outubro de 2012

An Apgar Score for Surgery
Atul A Gawande, Mary R Kwaan, Scott E Regenbogen,
Stuart A Lipsitz, Michael J Zinner.
Department of Health Policy and Management,
Harvard School of Public Health, Boston, MA, USA.
 
2007 Feb;204(2):201-8. Epub 2006 Dec 27.
 
BACKGROUND:

Surgical teams have not had a routine, reliable measure of patient condition at the end of an operation.We aimed to develop an Apgar score for the field of surgery, an outcomes score that teams could calculate at the end of any general or vascular surgical procedure to accurately grade a patient’s condition and chances of major complications or death.


STUDY DESIGN:

We derived our surgical score in a retrospective analysis of data from medical records and the National Surgical Quality Improvement Program for 303 randomly selected patients undergoing colectomy at Brigham and Women’s Hospital, Boston. The primary outcomes measure was incidence of major complication or death within 30 days of operation.We validated the score in two prospective, randomly selected cohorts: 102 colectomy patients and 767 patients undergoing general or vascular operations at the same institution.


RESULTS:

A 10-point score based on a patient’s estimated amount of blood loss, lowest heart rate, and lowest mean arterial pressure during general or vascular operations was significantly associated with major complications or death within 30 days (p < 0.0001; c-index 0.72). Of 767 general and vascular surgery patients, 29 (3.8%) had a surgical score < 4. Major complications or death occurred in 17 of these 29 patients (58.6%) within 30 days. By comparison, among 220 patients with scores of 9 or 10, only 8 (3.6%) experienced major complications or died (relative risk 16.1; 95% CI, 7.6–34.0; p < 0.0001).
 
CONCLUSIONS:

A simple score based on blood loss, heart rate, and blood pressure can be useful in rating the condition of patients after general or vascular operations. 
 
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11 de outubro de 2012

Artigo recomendado: Regional Anesthesia for Total Joint Arthroplasty

David A. Provenzano, Eugene R. Viscusi

Anesthesiology News Special Edition - October 2012 - P.59-64

Patients undergoing total joint arthroplasty (TJA) experience high levels of pain after surgery that often interferes with their functional recovery and sleep patterns in the postoperative period. In one study, patients undergoing total hip arthroplasty (THA) and total Knee arthroplasty (TKA) reported mean worst pain severities of 7.6 and 8.1 on a 10-point scale, respectively. Numerous techniques have been developed for anesthesia and analgesia in a effort optimize perioperative pain control, patient satisfaction, and functional recovery. Because clinician preference strongly influences patient selection and decision making, anesthesiologists and orthopedic surgeons must understand the current literature and level of evidence for each technique. This article provides and updated review of the evidence for regional anesthesia for TJA surgery with an emphasis on the risks and benefits of each technique for intraoperative anesthesia and postoperative analgesia.

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8 de outubro de 2012

Artigo recomendado: For Shoulder Block, Site May Not Matter for Pt Satisfaction

Michael Vlessides

Clinical Anesthesiology ISSUE: SEPTEMBER 2012 | VOLUME: 38:9

San Diego—Brachial plexus blockade is known to provide superior postoperative pain control after shoulder arthroscopy, but few data point to the best approach to the nerve network.

Perhaps it does not matter after all. New evidence shows that patients perceive no difference in pain control or satisfaction with either a supraclavicular or interscalene block. Even so, the investigators, from the Hospital for Special Surgery, in New York City, noted that supraclavicular block might be preferable for its propensity to be less disruptive to hemidiaphragmatic function. Paralysis of the diaphragm during surgery has been linked to increased postoperative morbidity.

“Shoulder surgery is well known to be one of the most painful surgeries, particularly in the ambulatory setting where patients may or may not have appropriate education about when to take pain medications,” said Stephen Haskins, MD, chief resident at NewYork-Presbyterian/Weill Cornell Medical Center in New York City, who helped conduct the study. “At the Hospital for Special Surgery, about 90% of these surgeries are done under brachial plexus block, so we decided to look more closely for any differences in postoperative pain control and patient satisfaction based on the specific approach we utilized.”

Dr. Haskins and his colleagues performed a prospective cohort trial on 100 patients undergoing ambulatory arthroscopic shoulder surgery under brachial plexus block. Patients completed an online or phone survey on postoperative day 2 or 3, during which they assessed postoperative pain, along with their level of satisfaction with the analgesia, the duration of the nerve block and the pain education they received before surgery.

The majority of the blocks—73%—were performed using the supraclavicular approach, which is typical at the researchers’ institution, Dr. Haskins said. Most consisted of a combination of mepivacaine and bupivacaine, he added.

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5 de outubro de 2012

Artigo recomendado: Anesthesia Depth Not Linked to Post-op Outcomes

David Wild

Clinical Anesthesiology, ISSUE: OCTOBER 2012 - VOLUME: 38:10

Lighter anesthesia does not reduce the incidence of postoperative morbidity and short-term mortality in patients undergoing noncardiac surgery, researchers have found.

The randomized controlled study, which undercuts previous reports, also failed to reveal higher inflammatory levels among more deeply anesthetized patients. The researchers were scheduled to present their results at the 2012 annual meeting of the American Society of Anesthesiologists (abstract 1200).

“While previous work suggests that maintaining a lighter plane of anesthesia provides short-term benefits such as faster recovery, better hemodynamic control and reduced respiratory complications, nausea and vomiting and duration of hospitalization, it does not appear to prevent major morbidity,” said lead investigator Basem Abdelmalak, MD, associate professor in the Department of General Anesthesiology and Outcomes Research at the Cleveland Clinic, in Ohio.

The results are part of the DeLiT (Design and Organization of the Dexamethasone, Light Anesthesia and Tight Glucose Control) trial, a randomized, single-center analysis of the effects that dexamethasone, glucose control and, in this case, depth of anesthesia have on perioperative inflammation and complications in surgery patients.

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1 de outubro de 2012

Artigo recomendado: Anesthesia Method Suggests Possible Cure For Post-trauma Stress


Michael Vlessides

Clinical Anesthesiology - ISSUE: SEPTEMBER 2012 | VOLUME: 38:9

Treatment options for patients with post-traumatic stress disorder (PTSD) are by no means universally effective. From yoga to sleep therapy, pharmacotherapy to traditional counseling, reported rates of improvement are only between 20% and 30%. But an Illinois anesthesiologist believes a staple of pain medicine—the stellate ganglion nerve block—may prove to be the standard of care for PTSD.

Eugene Lipov, MD, medical director of Advanced Pain Centers in Hoffman Estates, Ill., said stellate ganglion blocks are effective in the overwhelming majority of patients with PTSD that he has treated.

Dr. Lipov said the genesis of the therapy came in 2004, when he treated a woman with severe hot flashes who also had complex regional pain syndrome (CRPS).

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http://www.anesthesiologynews.com/ViewArticle.aspx?d=Clinical%2bAnesthesiology&d_id=1&i=September+2012&i_id=882&a_id=21544&tab=MostRead



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