Kent S. Pearson

A cost/benefit analysis of randomized invasive monitoring for patients undergoing cardiac surgery

The aim of this study was to determine the effect of choice of invasive monitoring on cost, morbidity, and mortality in cardiac surgery. Two hundred and twenty-six adults undergoing elective cardiac surgery were initially assigned at random to receive either a central venous pressure monitoring catheter (group I), a conventional pulmonary artery (PA) catheter (group II), or a mixed venous oxygen saturation (S&OV0540;O2) measuring PA catheter (group III). If the attending anesthesiologist believed that the patient initially randomized to group I should have a PA catheter, that patient was then reassigned to receive either a conventional PA catheter (group IV) or S&OV0540;O2 measuring PA catheter (group V). The total costs were defined as the total amount billed to the patient for the catheter used; the professional cost of its insertion; and the determinations of cardiac output, arterial blood gas tensions, hemoglobin level, and hematocrit. Mean total monitoring and laboratory costs in Group I (

Airway Fire during Jet Ventilation for Laser Excision of Vocal Cord Papillomata

591 ± 67) were statistically significantly (P < 0.05) less than costs in Group II (

Continuous Enteral Feeding and Short Fasting Periods Enhance Perioperative Nutrition in Patients with Burns

856 ± 231). Further, mean monitoring and laboratory costs in Group II were statistically significantly (P < 0.05) less than those in Group III (

NEUROMUSCULAR AND CARDIOVASCULAR EFFECTS OF MIVACURIUM CHLORIDE (BWB1090U) DURING NITROUS OXIDE-FENTANYL-THIOPENTONE AND NITROUS OXIDE-HALOTHANE ANAESTHESIA

1128 ± 759). Patients in group IV incurred mean total costs of

A prospective study to select and evaluate anesthesiology residents: Phase I, the critical incident technique

986 ± 578, while those in group V had mean total costs of

Assessment of an interactive learning system with sensorized manikin head for airway management instruction

1126 ± 382 (NS). There were no significant differences between any of the groups with respect to length of stay in the intensive care unit, morbidity, or mortality. We conclude that use of a central venous pressure monitoring catheter was justified in low risk cardiac surgical patients, and that when PA catheters were used, additional costs were incurred. Additionally, monitoring of S&OV0540;O2 adds significant cost to that incurred with routine PA catheter use, but produces no discernible difference in patient outcome.

EMERGENCY INFORMED CONSENT

Supraglottic jet ventilation (SJV) is effective in providing both adequate oxygenation and ventilation for patients undergoing laser surgery.1 One purported major advantage of SJV, in addition to providing an unobstructed operative field, is the elimination of extraneous combustible material, specifically the endotracheal tube, from the airway. This is a report of an airway fire associated with SJV and a carbon dioxide laser. An errant laser strike ignited the surgeons latex glove outside the oropharynx. The resultant burning vapors were entrained into the airway. The burning oxygen-enriched mixture was spread by exhalation around the laryngoscope and under the soaking wet “protective” draping, igniting the patients mustache and causing facial burns.

Did monitoring standards influence outcome

Both retrospective and prospective analyses of the effects of various fasting regimens were carried out on the achievement of calculated caloric needs of patients with severe burns. The records of patients who received enteral feedings while undergoing burn debridements were divided into three groups and retrospectively analyzed to determine the effect that duration of fasting had an achievement of caloric needs and on the risks of aspiration. Patients in two other groups were prospectively studied to determine the safety and efficacy of stopping continuous enteral feedings 1 and 4 hours before surgery, respectively. Techniques of airway management and anesthetic induction were left to the discretion of the attending anesthesiologist. In the retrospective analysis, patients in group I, who fasted for 2 hours achieved 28% of their calculated 24-hour caloric goals compared with 11% in those who fasted for 2 to 8 hours (group II) and 6% in those who fasted for more than 8 hours (group III) before surgery (p less than 0.001). In the prospective portion of the study, patients who fasted for 1 hour before anesthesia was induced achieved 30% of their caloric needs, whereas those who fasted for 4 hours achieved 15% of their target nutritional needs (p = 0.0001). No patient had evidence of pulmonary aspiration. We conclude that controlled enteral feedings and shortened preoperative fasting periods can safely enhance nutritional support in patients with burns.