This is what to remember in health reform: We are all one patient
As a physician, I am often discouraged when I turn on the news and read about the state of health care in our country. I can see all 397 sides of the debate and some truth in all sides. The enormous cost of medicine is overwhelming to comprehend for patients and families and even to those of us in medicine. I think it is important to know all that goes into the complex care of one patient. I am an anesthesiologist, but there is no way I could do my job without a large team. Each of us plays a role in the care of one patient. I am part of a team of people whose sole job every day is to care for you, our patient. In surgery, we start preparing well in advance, from the people who prepare the proper instruments and stock the drawers so in a second’s notice I have what I need to save your life, to the schedulers who triage add-on cases and bump elective cases to take care of life-threatening events. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Patients regularly overestimate the amount postoperative pain they will experience after surgery; the overestimate is particularly apparent with regional anesthesia.Medscape Medical News
BOSTON (CBS) – It’s estimated that 1 in 9 women in the United States develops postpartum depression, and the time of year a new mom gives birth may make a difference. Looking at the medical records of more than 20,000 women, researchers at Brigham and Women’s Hospital found that moms who gave birth in the spring or winter had a lower risk of postpartum depression compared to moms who gave birth in the fall or summer They also found that women who were obese, non-white, and did not get an epidural or other anesthesia during delivery appeared to be more likely to develop postpartum depression.
Abstract: In 2014, the American Society of Regional Anesthesia and Pain Medicine in collaboration with the European Society of Regional Anaesthesia and Pain Therapy convened a group of experts to compare pathways for anesthetic and analgesic management for patients undergoing total knee arthroplasty in North America and Europe and to develop a practice pathway. This review is intended to be an analysis of the current literature to assist individuals and institutions in designing a pathway for total knee arthroplasty that is based on existing evidence and expert recommendation and may be customized according to individual settings.
Abstract: Chronic pain following median sternotomy is common after cardiac surgery. If left untreated, chronic sternal pain can reduce quality of life, affecting sleep, mood, activity level, and overall satisfaction. This has a significant societal effect given the large number of cardiac surgeries annually. Although a number of pathophysiologic processes and risk factors are assumed to contribute, the exact cause and major risk factors remain unknown. Moreover, the treatment of chronic poststernotomy pain is often inadequate, relying on opioids and other medications that provide minimal benefit to the patient and have sig...
Conclusions: Accepted theories of the etiology of PDPH need to be revised. This article marks the first time that arachnoid layer damage has been quantified. Dural fibers tend to have sufficient “memory” to close back the hole created by a spinal needle, whereas arachnoid has diminished capacity to do so. The pathogenesis of PDPH and its resolution algorithm are a far more complex process that involves many more “stages” of development than hitherto imagined.
Background and Objectives: Psoas blocks are an alternative to femoral nerve blocks and have the potential advantage of blocking the entire lumbar plexus. However, the psoas muscle is located deeply, making psoas blocks more difficult than femoral blocks. In contrast, while femoral blocks are generally easy to perform, the inguinal region is prone to infection. We thus tested the hypothesis that psoas blocks are associated with more insertion-related complications than femoral blocks but have fewer catheter-related infections. Methods: We extracted 22,434 surgical cases from the German Network for Regional Anesthesia regis...
Conclusions: Injection of 10 mL of dye into the distal part of the AC spreads into the popliteal fossa and colors the popliteal plexus and the genicular branch of the posterior obturator nerve.
Background and Objectives: Adductor canal block (ACB) is popular for knee analgesia because of its favorable effect on quadriceps strength. The aim of this study was to find the minimum volume of local anesthetic, which can be injected into the ACB that would result in quadriceps weakness. Methods: This nonrandomized study used an up-and-down sequential allocation design. Twenty-six patients scheduled to undergo arthroscopic knee surgery received an ultrasound-guided ACB preoperatively. The initial volume of ropivacaine 0.5% injected was 30 mL, which was subsequently increased or decreased by 2 mL, depending on whether th...
Conclusions: Ultrasound-guided serratus plane block spread in the craniocaudal direction is more widespread with 40 mL than with 20 mL of 0.375% ropivacaine. The time until the first postoperative analgesic rescue dose was not extended by a larger volume of injection. Clinical Trials Registration: UMIN Clinical Trials Registry (identifier UMIN000016549).
Conclusions: Ultrasound-guided regional anesthesia knowledge and skills significantly improved with simulation training. The acquired UGRA skills may be transferred to the clinical setting; however, further studies are required to confirm these changes translate to improved patient outcomes.