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Items 1 - 15 of 15 |
One page. |
Amateur dentistry and the anesthesiologist.
Leyland JT.
Publication Types:
PMID: 15448568 [PubMed - in process]
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"Oily" streak formation on aspiration of cerebrospinal fluid into local anesthetic solution: its significance in the combined spinal-epidural technique.
Arya VK, Malhotra SK.
Publication Types:
PMID: 15448565 [PubMed - in process]
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Three arguments regarding a paradigm of general anesthesia.
Mashour GA.
Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. gmashour@partners.org
PMID: 15448561 [PubMed - in process]
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Three arguments regarding a paradigm of general anesthesia.
Plourde G.
Publication Types:
PMID: 15448560 [PubMed - in process]
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Anesthesia and multiorgan protein remodeling.
Futterer CD, Maurer MH, Kuschinsky W, Waschke KF.
* Faculty of Clinical Medicine Mannheim, Mannheim, Germany. c.fuetterer@pio1.uni-heidelberg.de
PMID: 15448551 [PubMed - in process]
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Anesthesia and multiorgan protein remodeling.
Heerdt PM.
Publication Types:
PMID: 15448550 [PubMed - in process]
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Excitation-contraction coupling in the heart and the negative inotropic action of volatile anesthetics.
Hanley PJ, ter Keurs HE, Cannell MB.
Institut fur Normale und Pathologische Physiologie, Universitat Marburg, Deutschhausstrasse 2, 35037 Marburg, Germany. hanley@mailer.uni-marburg.de
PMID: 15448535 [PubMed - in process]
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Influence of the type of anesthesia provider on costs of labor analgesia to the Texas Medicaid program.
Abouleish AE, Prough DS, Vadhera RB.
Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX 77555-0591, USA. aaboulei@utmb.edu
BACKGROUND: The Texas Medicaid Program (Medicaid) defines billable time for labor analgesia as face-to-face time; therefore, anesthesia providers determine billed time. The authors' goal was to determine the influence of anesthesia providers on labor analgesia costs billed to Medicaid. METHODS: Under the Freedom of Information Act, Medicaid provided data on claims paid for 6 months in 2001 for labor analgesia administered during the course of a vaginal delivery. Claims were either time based (codes 00946 or 00955) or a flat fee (codes 26311 or 26319). Using modifiers, the authors grouped time-based claims as either anesthesiologist group or certified registered nurse anesthetist (CRNA) group. The cost to Medicaid was based on the 2001 fee schedule. The conversion factor was 18.21 USD per American Society of Anesthesiologists unit. The flat-fee reimbursement was 152.50 USD. CRNA services were paid at 85% of the fee schedule. Average time per time claim, percent of providers with more than 4 h of billed time, and cost per claim were determined for each group. Providers with more than 120 claims (> 20 claims/month) were considered high-volume. RESULTS: The database included 21,378 claims (anesthesiologist group: 12,698 claims from 219 providers; CRNA group: 8,680 claims from 117 providers). For time-based claims, the average time per case was significantly higher in the CRNA group (146 min) than in the anesthesiologist group (105 min). The CRNA group cost to Medicaid (225.11 USD) was 19% more per claim than the anesthesiologist group (189.26 USD). The difference in cost per claim was greater among high-volume providers--213.10 USD for the CRNA group versus 168.76 USD for the anesthesiologist group. If a flat-fee program were instituted using the average cost per claim for all groups (203.81 USD), the Texas Medicaid program would save more than 500,000 USD annually. CONCLUSIONS: The costs of labor analgesia billed to Texas Medicaid were 19% to 26% less per patient when provided by anesthesiologists than by CRNAs, despite lower per-unit reimbursement of CRNAs.
PMID: 15448534 [PubMed - in process]
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Popliteal sciatic perineural local anesthetic infusion: a comparison of three dosing regimens for postoperative analgesia.
Ilfeld BM, Thannikary LJ, Morey TE, Vander Griend RA, Enneking FK.
Department of Anesthesiology, University of Florida, 1600 SW Archer Road, Gainesville, FL 32610-0254, USA. bilfeld@ufl.edu
BACKGROUND: This randomized, double-blind study investigated the efficacy of continuous and patient-controlled ropivacaine infusion via a popliteal sciatic perineural catheter in ambulatory patients undergoing moderately painful orthopedic surgery of the foot or ankle. METHODS: Preoperatively, patients (n = 30) received a posterior popliteal sciatic perineural catheter and nerve block. Postoperatively, patients were discharged home with a portable infusion pump delivering 0.2% ropivacaine (500 ml) in one of three dosing regimens: the basal group (12-ml/h basal rate, 0.05-ml patient-controlled bolus dose), the basal-bolus group (8-ml/h basal rate, 4-ml bolus dose), or the bolus group (0.3-ml/h basal rate, 9.9-ml bolus dose). RESULTS: The bolus group experienced an increase in baseline pain, breakthrough pain incidence and intensity, and sleep disturbances compared with the other two groups (P < 0.05 for all comparisons). Compared with the basal-bolus group, the basal group experienced an increase in these outcome measures only after local anesthetic reservoir exhaustion, which occurred earlier than in the other two groups (P < 0.05 for all comparisons). Satisfaction scores did not differ among the three groups. CONCLUSIONS: This study demonstrates that when providing analgesia with 0.2% ropivacaine via a popliteal sciatic perineural catheter after moderately painful surgery of the foot or ankle, a continuous infusion is required to optimize infusion benefits. Furthermore, adding patient-controlled bolus doses allows for a lower continuous basal rate and decreased local anesthetic consumption and thereby increases the duration of infusion benefits when in an ambulatory environment with a limited local anesthetic reservoir.
PMID: 15448531 [PubMed - in process]
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Local anesthetics reduce mortality and protect against renal and hepatic dysfunction in murine septic peritonitis.
Gallos G, Jones DR, Nasr SH, Emala CW, Lee HT.
Department of Anesthesiology, Columbia University, 630 West 168th Street, New York, NY 10032-3784, USA.
BACKGROUND: Mortality from sepsis frequently results from multiple organ injury and dysfunction. Cecal ligation and puncture is an established murine model of septic peritonitis that produces septic shock characterized by an initial hyperinflammatory response. In addition to their anesthetic properties, local anesthetics have been shown to attenuate inflammatory responses both in vivo and in vitro. In the current study, the ability of local anesthetic infusions to protect against sepsis-induced mortality, as well as renal and hepatic dysfunction after cecal ligation and puncture, was investigated. METHODS: C57BL/6 mice received mini-osmotic pumps containing saline (vehicle), 10% lidocaine, or 1% bupivacaine and were subjected to cecal ligation and puncture. Twenty-four hours after cecal ligation and puncture, renal and hepatic functions were assessed as well as markers of inflammation (proinflammatory cytokine protein and mRNA concentrations and myeloperoxidase activity). Renal apoptosis and 7-day survival was also assessed. RESULTS: Mice treated with lidocaine or bupivacaine infusion showed improved survival and had significantly lower plasma creatinine, aspartate aminotransferase, and alanine aminotransferase concentrations compared with mice receiving vehicle alone. Significant reduction in plasma tumor necrosis factor-alpha and keratinocyte-derived chemokine, as well as reductions in myeloperoxidase activity, intracellular adhesion molecule-1 protein expression, mRNA concentrations of proinflammatory markers, and apoptosis were observed in renal cortices from both local anesthetic groups. CONCLUSIONS: The current data demonstrate that local anesthetic infusions confer a protective effect in mice from septic peritonitis by attenuating the hyperacute inflammatory response. This suppression resulted in improved mortality and less progression to acute kidney and liver injury and dysfunction.
PMID: 15448523 [PubMed - in process]
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This month in anesthesiology.
Henkel G.
PMID: 15448510 [PubMed - in process]
Comment on:
Hypertension and perioperative risk.
Palmer J.
Publication Types:
PMID: 15251997 [PubMed - indexed for MEDLINE]
Comment on:
Chronic adhesive arachnoiditis.
Aldrete JA.
Publication Types:
PMID: 15251994 [PubMed - indexed for MEDLINE]
Conscious sedation of children with propofol is anything but conscious.
Reeves ST, Havidich JE, Tobin DP.
Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina 29425, USA. reevess@musc.edu
OBJECTIVE: To determine the depth of sedation required for bone marrow aspiration and intrathecal injection of chemotherapeutic agents in children using a bispectral (BIS) index monitor and clinical assessment by an independent observer. METHODS: Sixteen children who were undergoing 19 intrathecal chemotherapy and bone marrow aspirations were enrolled in the study. Their ages ranged from 23 months to 190 months with a mean of 79 months. The BIS index was recorded every 5 minutes by an independent observer. The patients received only intravenous propofol for sedation. There were no complications during the procedures. RESULTS: The mean BIS score was 62.8+/- 9.6. The mean low BIS score was 29.7 +/- 13.7, indicating a level of deep sedation and/or general anesthesia was necessary to induce the desired stated of consciousness that would permit the practitioner to perform the procedure. The average dose of propofol was 166 +/- 47 microg/kg/min. Mean Aldrete score for level of consciousness was 0.9 +/- 0.4, indicating a depressed level of consciousness. The mean activity level was 1.0+/- 0.4, indicating impaired movement. CONCLUSIONS: Children who undergo conscious sedation with propofol for intrathecal chemotherapy and bone marrow aspiration demonstrate BIS values and clinical assessments consistent with deep sedation. Because of an increased risk of adverse events when children undergo deep sedation, appropriate parental informed consent, age-appropriate resuscitative equipment, and skilled anesthesia personnel should be present for rescue in the event of cardiovascular and respiratory complications from deep sedation.
PMID: 15231976 [PubMed - indexed for MEDLINE]
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Abstracts of the XXIII annual European Society of Regional Anesthesia Congress. Athens, Greece, 8-11 September 2004.
[No authors listed]
Publication Types:
PMID: 15452963 [PubMed - indexed for MEDLINE]
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