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Ashir A, Maya EG, Saiyed SR, Alimohamed TM, Jusabani MA, Abdel KA, Sadiq AM, Ali AM, Mandari FN. Postoperative Hemoglobin Drop and the Associated Factors among Elective Orthopedic Surgeries in Northern Tanzania. Adv Orthop 2024; 2024:4145592. [PMID: 38827523 PMCID: PMC11142858 DOI: 10.1155/2024/4145592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 06/04/2024] Open
Abstract
Background Having an estimated level of Hb drop in different orthopedic surgeries would help plan for surgery from pre- to postoperative periods. The aim of this study was to assess the Hb drop and the associated factors during the intraoperative period among elective orthopedic surgeries. Methods This was an analytic cross-sectional study conducted between October 2022 and March 2023, which included all patients admitted for elective orthopedic surgery who met the inclusion criteria. Data were collected before and after the patient was operated on. Information was analyzed using t-tests and ANOVA to establish the statistical significance of the Hb drop. Results A total of 195 participants were enrolled. The majority of the participants were male (62.1%), with the main etiology of symptoms being motor traffic accidents (31.8%). The most affected site was the femur (36.4%), followed by the spine (23.6%). The highest mean Hb drop was in total hip replacement surgeries (4.19 g/dL), with the overall mean Hb drop being 2.75 g/dL. A statistically significant difference was identified in diathermy use, duration of surgery, and patients with chronic illnesses. Conclusion With a mean Hb drop of 2.75 g/dL, the application of diathermy and surgeries with shorter durations resulted in a reduced Hb drop. These factors should be incorporated to minimize the drop in Hb in orthopedic surgeries. Accounting for differences in surgeries, there should not be delays in patients who have a preoperative Hb level that can sustain the mean Hb drop recorded in the study.
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Affiliation(s)
- Abdel Ashir
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Elifuraha G. Maya
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Orthopedics and Trauma, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | | | | | - Kulthum A. Abdel
- Faculty of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Abid M. Sadiq
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Ali Mohamed Ali
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Faiton Ndesanjo Mandari
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Orthopedics and Trauma, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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Rayyani S, Aljedani H, Kariri R, Alsuhim G, Madkhali M, Oraybi H, Assiri S, Alhayaza R, Madah A. Anesthesia Preferences and Outcomes in Saudi Arabian Healthcare: A Cross-Sectional Study. Cureus 2024; 16:e57340. [PMID: 38690461 PMCID: PMC11060666 DOI: 10.7759/cureus.57340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Anesthesia choice is critical in ensuring optimal surgical outcomes and patient satisfaction. We aimed to investigate anesthesia preferences, trends, and outcomes in elective surgeries within Saudi Arabian healthcare settings. METHODS A cross-sectional survey-based study was conducted among anesthesia residents and attending anesthesiologists across Saudi Arabia. Participants provided demographic information and responded to questions regarding anesthesia preferences, trends, and outcomes. Descriptive statistics were used to summarize the data, and logistic regression analysis was employed to identify factors associated with anesthesia preference. RESULTS The survey was completed by 572 healthcare professionals in Saudi Arabia. Among participants, 51.7% (n=296) preferred general anesthesia, while 48.3% (n=276) favored regional anesthesia for elective surgeries. Factors influencing anesthesia choice included patient preference, surgical complexity, and resource availability. Over half of the respondents reported an increase in regional anesthesia preference over the past five years, although some perceived inadequate training in this area. Common barriers to regional anesthesia adoption included equipment availability, patient reluctance, and limited training opportunities. Postoperative recovery was perceived as quicker with regional anesthesia by 52.3% (n=299) of participants, with postoperative nausea and vomiting being the most common complication associated with general anesthesia. Multivariable logistic regression analysis revealed that participants above 50 years had lower odds of preferring regional anesthesia, while those perceiving training adequacy in regional anesthesia as adequate had higher odds of preferring it (OR=0.64, 95% CI: 0.41-0.98, p=0.041; OR=1.58, 95% CI: 1.21-2.05, p=0.001, respectively). CONCLUSION This study provides insights into anesthesia practice patterns in Saudi Arabian healthcare settings. Individualized anesthesia care, ongoing training in regional anesthesia, and evidence-based decision-making are essential to optimize perioperative outcomes and patient satisfaction.
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Affiliation(s)
| | - Hind Aljedani
- College of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Razan Kariri
- College of Medicine, Jazan University, Jazan, SAU
| | | | | | | | - Shaima Assiri
- College of Medicine, King Khalid University, Abha, SAU
| | - Rand Alhayaza
- College of Medicine, King Khalid University, Abha, SAU
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le Roux JJ, Wakabayashi K, Jooma Z. Defining the role of thoracic spinal anaesthesia in the 21st century: a narrative review. Br J Anaesth 2023; 130:e56-e65. [PMID: 35393100 DOI: 10.1016/j.bja.2022.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 01/06/2023] Open
Abstract
Since the performance of the first thoracic spinal anaesthetic in early 1908 many anaesthetists have gained interest in this unorthodox neuraxial anaesthetic technique. The main rationale justifying its use is to prevent complications related to general anaesthesia in high-risk patient populations. There is, however, significant debate regarding this practice around the world. The main concerns are fear of iatrogenic injury to the spinal cord, cephalad spread of local anaesthetic causing a complete spinal block, and haemodynamic instability owing to blockade of cardioaccelerator sympathetic fibres. The purpose of this narrative review is to appraise the literature critically regarding thoracic spinal anaesthesia, to synthesise the available information, and to provide a summary of evidence justifying its use in modern anaesthesia.
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Affiliation(s)
- Johannes J le Roux
- Department of Anaesthesia, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
| | - Koji Wakabayashi
- Department of Anaesthesia, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Zainub Jooma
- Department of Anaesthesia, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Abate SM, Mergia G, Nega S, Basu B, Tadesse M. Efficacy and safety of wound infiltration modalities for postoperative pain management after cesarean section: a systematic review and network meta-analysis protocol. Syst Rev 2022; 11:194. [PMID: 36071535 PMCID: PMC9450460 DOI: 10.1186/s13643-022-02068-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 08/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postoperative pain after a cesarean section has negative consequences for the mother during the postoperative period. Over the years, various postoperative pain management strategies have been used following cesarean section. Opioid-based analgesics and landmark approaches have negative side effects, while ultrasound-based regional analgesia necessitates resources and experience, but various wound infiltration adjuvants are innovative with few side effects and are simple to use. The efficacy and safety of each adjuvant, however, are unknown and require further investigation. OBJECTIVE This network meta-analysis is intended to provide the most effective wound infiltration drugs for postoperative management after cesarean section. METHOD A comprehensive search will be conducted in PubMed/MEDLINE, Cochrane Library, Science Direct, CINHAL, and LILACS without date and language restrictions. All randomized trials comparing the effectiveness of wound infiltration drugs for postoperative pain management after cesarean section will be included. Data extraction will be conducted independently by two authors. The quality of studies will be evaluated using the Cochrane risk of bias tool, and the overall quality of the evidence will be determined by GRADEpro software. DISCUSSION The rate of postoperative acute and chronic pain is very high which has a huge impact on the mother, family, healthcare practitioners, and healthcare delivery. It is a basic human right to give every patient with postoperative pain treatment that is realistic in terms of resources, technique, cost, and adverse event profile. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021268774.
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Affiliation(s)
- Semagn Mekonnen Abate
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia.
| | - Getachew Mergia
- Departemnt of Obstetrics and Gynecology, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Solomon Nega
- Departemnt of Internal Medicine, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Bivash Basu
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Moges Tadesse
- School of Public Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
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Alogaili F, Abdul Ghani N, Ahmad Kharman Shah N. Prescription drug monitoring programs in the US: A systematic literature review on its strength and weakness. J Infect Public Health 2020; 13:1456-1461. [PMID: 32694082 DOI: 10.1016/j.jiph.2020.06.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/02/2020] [Accepted: 06/29/2020] [Indexed: 11/17/2022] Open
Abstract
Prescription Drug Monitoring Program (PDMP) is an electronic database that tracks the prescriptions of controlled drugs with its aims to combat the incidence of drug abuse. Although the establishment of PDMP in the US was since 2003, evidence of the impact of PDMP's strength and weakness towards its implementation is still scarce. A systematic literature review according to Preferred Reporting Items for Systematic Review (PRISMA) standard was conducted to investigate the influence of PDMP's strength in combating the incidence of drug abuse and also to review the weaknesses of PDMP that prohibit its implementation. Results from this study reveal that the implementation of PDMP has mitigated the issue of drug abuse and has increased work efficiency among healthcare practitioners. However, the implementation rate of this system is low due to its weaknesses such as limited internet access and limited access to the PDMP system. Therefore, efforts to overcome the weaknesses of PDMP need to be instituted to ensure the healthcare system could fully optimize PDMP's benefits.
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Affiliation(s)
- Fahd Alogaili
- Department of Information System, Faculty of Computer Science and Technology, University of Malaya, Malaysia.
| | - Norjihan Abdul Ghani
- Department of Information System, Faculty of Computer Science and Technology, University of Malaya, Malaysia
| | - Nordiana Ahmad Kharman Shah
- Department of Library & Information Science, Faculty of Computer Science and Technology, University of Malaya, Malaysia
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Prolonged Catheter Use and Infection in Regional Anesthesia: A Retrospective Registry Analysis. Anesthesiology 2019; 128:764-773. [PMID: 29420315 DOI: 10.1097/aln.0000000000002105] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Prolonged catheter use is controversial because of the risk of catheter-related infection, but the extent to which the risk increases over time remains unknown. We thus assessed the time-dependence of catheter-related infection risk up to 15 days. METHODS Our analysis was based on the German Network for Regional Anesthesia, which includes 25 centers. We considered 44,555 patients who had surgery between 2007 and 2014 and had continuous regional anesthesia as well as complete covariable details. Cox regression analysis was performed and adjusted for confounding covariables to examine the relationship between catheter duration and probability of infection-free catheter use. RESULTS After adjustment for confounding factors, the probability of infection-free catheter use decreases with each day of peripheral and epidural catheter use. In peripheral catheters, it was 99% at day 4 of catheter duration, 96% at day 7, and 73% at day 15. In epidural catheters, it was 99% at day 4 of catheter duration, 95% at day 7, and 73% at day 15. Only 31 patients (0.07%) had severe infections that prompted surgical intervention. Among these were five catheters that initially had only mild or moderate signs of infection and were left in situ; all progressed to severe infections. CONCLUSIONS Infection risk in catheter use increases over time, especially after four days. Infected catheters should be removed as soon as practical. VISUAL ABSTRACT An online visual overview is available for this article at http://links.lww.com/ALN/B683.
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Abstract
The ambulatory setting offers potential advantages for elderly patients undergoing elective surgery due to the advancement in both surgical and anesthetic techniques resulting in quicker recovery times, fewer complications, higher patient satisfaction, and reduced costs of care. This review article aims to provide a practical guide to anesthetic management of elderly outpatients. Important considerations in the preoperative evaluation of elderly outpatients with co-existing diseases, as well as the advantages and disadvantages of different anesthetic techniques on a procedural-specific basis, and recommendations regarding the management of common postoperative complications (e.g., pain, postoperative nausea and vomiting [PONV], delirium and cognitive dysfunction, and gastrointestinal dysfunction) are discussed. The role of anesthesiologists as perioperative physicians is important for optimizing surgical outcomes for elderly patients undergoing ambulatory surgery. The implementation of high-quality, evidence-based perioperative care programs for the elderly on an ambulatory basis has assumed increased importance. Optimal management of perioperative pain using opioid-sparing multimodal analgesic techniques and preventing PONV using prophylactic antiemetics are key elements for achieving enhanced recovery after surgery.
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Rojas-Gómez MF, Blanco-Dávila R, Tobar Roa V, Gómez González AM, Ortiz Zableh AM, Ortiz Azuero A. Regional anesthesia guided by ultrasound in the pudendal nerve territory. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2017.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Anestesia regional guiada por ultrasonido en territorio del nervio pudendo. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rca.2017.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Regional anesthesia guided by ultrasound in the pudendal nerve territory☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1097/01819236-201707000-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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12
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Moliner Velázquez S, Rubio Haro R, De Andrés Serrano C, De Andrés Ibáñez J. Regional analgesia in postsurgical critically ill patients. ACTA ACUST UNITED AC 2016; 64:144-156. [PMID: 27939017 DOI: 10.1016/j.redar.2016.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 09/19/2016] [Accepted: 09/21/2016] [Indexed: 10/20/2022]
Abstract
Regional analgesia intrinsically, based on its physiological effects, is routinely used for the perioperative treatment of pain associated with surgical procedures. However, in other areas such as the non-surgical treatment of acute pain for patients in a critical condition, it has not been subjected to specific prospective studies. If we confine ourselves to the physiological effects of the nerve block, in a situation of stress, the indications for regional anaesthesia in this group of patients extend to the management of a wide variety of medical as well as postsurgical conditions, of trauma patients and of other painful procedures performed in the patient's bed. The critical patient certainly must be analyzed individually as their own primary conditions is of vital importance, as well as any associated conditions they have developed that can potentially increase the risk of systemic toxicity or morbidity, such as, coagulopathies, infection, immunosuppressive states, sedation and problems associated with mechanical ventilation. This review aims to assess the role of regional analgesia in critically ill patients, placing it within the algorithm decision tree of the professional responsible for patients in critical care units, all based on the evidence of potential benefits according to the published literature.
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Affiliation(s)
- S Moliner Velázquez
- Servicio de Anestesia, Reanimación y Unidad Multidisciplinar de Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - R Rubio Haro
- Facultad de Medicina, Universidad de Valencia, Valencia, España
| | | | - J De Andrés Ibáñez
- Servicio de Anestesia, Reanimación y Unidad Multidisciplinar de Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España; Departamento de Cirugía, Facultad de Medicina, Universidad de Valencia, Valencia, España.
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Moore JE, Rathouz PJ, Havlena JA, Zhao Q, Dailey SH, Smith MA, Greenberg CC, Welham NV. Practice variations in voice treatment selection following vocal fold mucosal resection. Laryngoscope 2016; 126:2505-2512. [PMID: 26972900 PMCID: PMC5018919 DOI: 10.1002/lary.25911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 12/17/2015] [Accepted: 01/14/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVES/HYPOTHESIS To characterize initial voice treatment selection following vocal fold mucosal resection in a Medicare population. STUDY DESIGN Retrospective analysis of a large, nationally representative Medicare claims database. METHODS Patients with > 12 months of continuous Medicare coverage who underwent a leukoplakia- or cancer-related vocal fold mucosal resection (index) procedure during calendar years 2004 to 2009 were studied. The primary outcome of interest was receipt of initial voice treatment (thyroplasty, vocal fold injection, or speech therapy) following the index procedure. We evaluated the cumulative incidence of each postindex treatment type, treating the other treatment types as competing risks, and further evaluated postindex treatment utilization using the proportional hazards model for the subdistribution of a competing risk. Patient age, sex, and Medicaid eligibility were used as predictors. RESULTS A total of 2,041 patients underwent 2,427 index procedures during the study period. In 14% of cases, an initial voice treatment event was identified. Women were significantly less likely to receive surgical or behavioral treatment compared to men. From age 65 to 75 years, the likelihood of undergoing surgical treatment increased significantly with each 5-year age increase; after age 75 years, the likelihood of undergoing either surgical or behavioral treatment decreased significantly every 5 years. Patients with low socioeconomic status were significantly less likely to undergo speech therapy. CONCLUSION The majority of Medicare patients do not undergo voice treatment following vocal fold mucosal resection. Further, the treatments analyzed here appear disproportionally utilized based on patient sex, age, and socioeconomic status. Additional research is needed to determine whether these observations reflect clinically explainable differences or disparities in care. LEVEL OF EVIDENCE 2c. Laryngoscope, 126:2505-2512, 2016.
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Affiliation(s)
- Jaime E Moore
- Division of Otolaryngology, Department of Surgery , University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Paul J Rathouz
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Jeffrey A Havlena
- Division of General Surgery, Department of Surgery , University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Qianqian Zhao
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Seth H Dailey
- Division of Otolaryngology, Department of Surgery , University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
- Wisconsin Surgical Outcomes Research Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
- Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Maureen A Smith
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
- Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Caprice C Greenberg
- Division of General Surgery, Department of Surgery , University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
- Wisconsin Surgical Outcomes Research Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
- Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Nathan V Welham
- Division of Otolaryngology, Department of Surgery , University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A..
- Wisconsin Surgical Outcomes Research Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A..
- Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A..
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Perioperative Ultrasound: The challenge of applying an old technology in new clinical settings. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2016. [DOI: 10.1016/j.rcae.2016.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Rojas-Gómez MF, Bonilla-R AJ. Ultrasonido perioperatorio: el reto de aplicar una vieja tecnología en nuevos escenarios clínicos. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2016. [DOI: 10.1016/j.rca.2016.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Abstract
Abstract
Background
Catheter-related infection is a serious complication of continuous regional anesthesia. The authors tested the hypothesis that single-dose antibiotic prophylaxis is associated with a lower incidence of catheter-related infections.
Methods
Our analysis was based on cases in the 25-center German Network for Regional Anesthesia database recorded between 2007 and 2014. Forty thousand three hundred sixty-two surgical patients who had continuous regional anesthesia were grouped into no antibiotic prophylaxis (n = 15,965) and single-dose antibiotic prophylaxis (n = 24,397). Catheter-related infections in each group were compared with chi-square test after 1:1 propensity-score matching. Odds ratios (ORs [95% CI]) were calculated with logistic regression and adjusted for imbalanced variables (standardized difference more than 0.1).
Results
Propensity matching successfully paired 11,307 patients with single-dose antibiotic prophylaxis (46% of 24,397 patients) and with 11,307 controls (71% of 15,965 patients). For peripheral catheters, the incidence without antibiotics (2.4%) was greater than with antibiotic prophylaxis (1.1%, P < 0.001; adjusted OR, 2.02; 95% CI, 1.49 to 2.75, P < 0.001). Infections of epidural catheters were also more common without antibiotics (5.2%) than with antibiotics (3.1%, P < 0.001; adjusted OR, 1.94; 95% CI, 1.55 to 2.43, P < 0.001).
Conclusions
Single-dose antibiotic prophylaxis was associated with fewer peripheral and epidural catheter infections.
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Bomberg H, Kubulus C, Herberger S, Wagenpfeil S, Kessler P, Steinfeldt T, Standl T, Gottschalk A, Stork J, Meissner W, Birnbaum J, Koch T, Sessler DI, Volk T, Raddatz A. Tunnelling of thoracic epidural catheters is associated with fewer catheter-related infections: a retrospective registry analysis. Br J Anaesth 2016; 116:546-53. [PMID: 26994232 DOI: 10.1093/bja/aew026] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Catheter-related infections are a serious complication of continuous thoracic epidural analgesia. Tunnelling catheters subcutaneously may reduce infection risk. We thus tested the hypothesis that tunnelling of thoracic epidural catheters is associated with a lower risk of catheter-related infections. METHODS Twenty-two thousand, four hundred and eleven surgical patients with continuous thoracic epidural analgesia included in the German Network for Regional Anaesthesia registry between 2007 and 2014 were grouped by whether their catheters were tunnelled (n=12 870) or not (n=9541). Catheter-related infections in each group were compared with Student's unpaired t and χ(2) tests. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated with logistic regression, adjusting for potential confounding factors, including age, ASA physical status score, use of catheter for ≥4 days, multiple skin puncture, hospital, and surgical department. RESULTS There were fewer catheter-related infections in patients with tunnelled catheters (4.5 vs 5.5%, P<0.001). Mild infections were also less common (4.0 vs 4.6%, P=0.009), as were moderate infections (0.4 vs 0.8%, P<0.001). After adjustment for potential confounding factors, tunnelling remained an independent prevention for any grade of infection (adjusted OR 0.51, 95% CI 0.42-0.61, P<0.001) and for mild infections (adjusted OR 0.54, 95% CI 0.43-0.66, P<0.001) and moderate and severe infections (adjusted OR 0.44, 95% CI 0.28-0.70, P=0.001). CONCLUSION Tunnelling was associated with a lower risk of thoracic epidural catheter-related infections.
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Affiliation(s)
- H Bomberg
- Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine
| | - C Kubulus
- Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine
| | - S Herberger
- Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine
| | - S Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, University Medical Centre, Homburg/Saar, Germany
| | - P Kessler
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Orthopaedic University Hospital, Frankfurt, Germany
| | - T Steinfeldt
- Department of Anaesthesiology and Intensive Care Therapy, Philipps University Marburg, Marburg, Germany
| | - T Standl
- Department of Anaesthesia, Intensive and Palliative Care Medicine, Academic Hospital Solingen, Solingen, Germany
| | - A Gottschalk
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Friederikenstift Hannover, Hannover, Germany
| | - J Stork
- Centre for Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, Hamburg D-20246, Germany
| | - W Meissner
- Department of Anaesthesiology and Intensive Care, Jena University Hospital, Jena, Germany
| | - J Birnbaum
- Department of Anaesthesiology and Operative Intensive Care Medicine, Charité Campus Virchow Klinikum and Campus Mitte, Charité University Medicine Berlin, Berlin, Germany
| | - T Koch
- Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
| | - D I Sessler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue P77, Cleveland, OH 44195, USA
| | - T Volk
- Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine
| | - A Raddatz
- Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine
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Perioperative Ultrasound: The challenge of applying an old technology in new clinical settings☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2016. [DOI: 10.1097/01819236-201644040-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Fischer B, Bosch OD. Does regional anaesthesia improve outcome after surgery? ANAESTHESIA AND INTENSIVE CARE MEDICINE 2015. [DOI: 10.1016/j.mpaic.2015.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bomberg H, Albert N, Schmitt K, Gräber S, Kessler P, Steinfeldt T, Hering W, Gottschalk A, Standl T, Stork J, Meißner W, Teßmann R, Geiger P, Koch T, Spies CD, Volk T, Kubulus C. Obesity in regional anesthesia--a risk factor for peripheral catheter-related infections. Acta Anaesthesiol Scand 2015; 59:1038-48. [PMID: 26040788 DOI: 10.1111/aas.12548] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 03/09/2015] [Accepted: 04/07/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND Obesity is believed to increase the risk of surgical site infections and possibly increase the risk of catheter-related infections in regional anesthesia. We, therefore, analyzed the influence of obesity on catheter-related infections defined within a national registry for regional anesthesia. METHODS The German Network for Regional Anesthesia database with 25 participating clinical centers was analyzed between 2007 and 2012. Exactly, 28,249 cases (13,239 peripheral nerve and 15,010 neuraxial blocks) of patients ≥ 14 years were grouped in I: underweight (BMI 13.2-18.49 kg/m(2) , n = 597), II: normal weight (BMI 18.5-24.9 kg/m(2) , n = 9272), III: overweight (BMI 25.0-29.9 kg/m(2) , n = 10,632), and IV: obese (BMI 30.0-70.3 kg/m(2) , n = 7,744). The analysis focused on peripheral and neuraxial catheter-related infections. Differences between the groups were tested with non-parametric ANOVA and chi-square (P < 0.05). Binary logistic regression was used to compare obese, overweight, or underweight patients with normal weight patients. Odds ratios (OR and 95% confidence interval) were calculated and adjusted for potential confounders. RESULTS Confounders with significant influence on the risk for catheter-related infections were gender, age, ASA score, diabetes, preoperative infection, multiple skin puncture, and prolonged catheter use. The incidence (normal weight: 2.1%, obese: 3.6%; P < 0.001) and the risk of peripheral catheter-related infection was increased in obese compared to normal weight patients [adjusted OR: 1.69 (1.25-2.28); P < 0.001]. In neuraxial sites, the incidence of catheter-related infections differed significantly between normal weight and obese patients (normal weight: 3.2%, obese: 2.3%; P = 0.01), whereas the risk was comparable [adjusted OR: 0.95 (0.71-1.28); P = 0.92]. CONCLUSION This retrospective cohort study suggests that obesity is an independent risk factor for peripheral, but not neuraxial, catheter-related infections.
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Affiliation(s)
- H. Bomberg
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine; University of Saarland; Saarland University Medical Center; Homburg Germany
| | - N. Albert
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine; University of Saarland; Saarland University Medical Center; Homburg Germany
| | - K. Schmitt
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine; University of Saarland; Saarland University Medical Center; Homburg Germany
| | - S. Gräber
- Department of Biostatistics and Medical Informatics; Institute for Epidemiology; University of Saarland; Saarland University Medical Center; Homburg Germany
| | - P. Kessler
- Department of Anesthesiology, Intensive Care and Pain Medicine; Orthopedic University Hospital; Frankfurt Germany
| | - T. Steinfeldt
- Department of Anesthesiology and Intensive Care Therapy; Philipps University Marburg; Marburg Germany
| | - W. Hering
- Department of Anesthesiology; St. Marien-Krankenhaus Siegen; Siegen Germany
| | - A. Gottschalk
- Department of Anesthesiology, Intensive Care- and Pain Medicine; Friederikenstift Hannover; Hannover Germany
| | - T. Standl
- Department of Anesthesia, Intensive and Palliative Care Medicine; Academic Hospital Solingen; Solingen Germany
| | - J. Stork
- Department of Anesthesiology; Center of Anesthesiology and Intensive Care Medicine; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - W. Meißner
- Department of Anesthesiology and Intensive Care; Friedrich-Schiller University Hospital; Jena Germany
| | - R. Teßmann
- Department of Anesthesiology, Intensive Care and Pain Therapy; Berufsgenossenschaftliche Unfallklinik; Frankfurt am Main Germany
| | - P. Geiger
- Department of Anesthesiology, Intensive Care and Pain Therapy; University and Rehabilitation Clinics; Ulm Germany
| | - T. Koch
- Department of Anesthesiology, Intensive Care and Pain Therapy; Carl Gustav Carus University Hospital; Technische Universität Dresden; Dresden Germany
| | - C. D. Spies
- Department of Anesthesiology and Operative Intensive Care Medicine; Charité Campus Virchow Klinikum and Campus Mitte; Charité University Medicine Berlin; Berlin Germany
| | - T. Volk
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine; University of Saarland; Saarland University Medical Center; Homburg Germany
| | - C. Kubulus
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine; University of Saarland; Saarland University Medical Center; Homburg Germany
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Alvarez Escudero J, Calvo Vecino JM, Veiras S, García R, González A. Clinical Practice Guideline (CPG). Recommendations on strategy for reducing risk of heart failure patients requiring noncardiac surgery: reducing risk of heart failure patients in noncardiac surgery. ACTA ACUST UNITED AC 2015; 62:359-419. [PMID: 26164471 DOI: 10.1016/j.redar.2015.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 05/04/2015] [Indexed: 12/29/2022]
Affiliation(s)
- J Alvarez Escudero
- Professor and Head of the Department of Anesthesiology, University Hospital, Santiago de Compostela, La Coruña, Spain
| | - J M Calvo Vecino
- Professor and Head of the Department of Anesthesiology, University Hospital, Santiago de Compostela, La Coruña, Spain; Associated Professor and Head of the Department of Anesthesiology, Infanta Leonor University Hospital, Complutense University of Madrid, Madrid, Spain.
| | - S Veiras
- Department of Anesthesiology, University Hospital, Santiago de Compostela, La Coruña, Spain
| | - R García
- Department of Anesthesiology, Puerta del Mar University Hospital. Cadiz, Spain
| | - A González
- Department of Anesthesiology, Puerta de Hierro University Hospital. Madrid, Spain
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Barriga AP, Navarro JR. Clinical case report: respiratory depression following intrathecal opioid administration. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2012. [DOI: 10.1016/s2256-2087(12)40015-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Reporte de caso clínico: depresión respiratoria por opioide intratecal. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2012. [DOI: 10.1016/s0120-3347(12)70015-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Clinical case report: respiratory depression following intrathecal opioid administration. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2012. [DOI: 10.1097/01819236-201240010-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Clinical case report: respiratory depression following intrathecal opioid administration. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2012. [DOI: 10.1097/01819236-201240010-00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Affiliation(s)
- Adrian Bosenberg
- Faculty Health Sciences, Department Anesthesiology and Pain Management, Seattle Children's Hospital, University Washington, Seattle, WA 98105, USA.
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