Lina Lander

A Prospective Comparison of Procedural Sedation and Ultrasound-guided Interscalene Nerve Block for Shoulder Reduction in the Emergency Department

OBJECTIVES Emergency physicians (EPs) are beginning to use ultrasound (US) guidance to perform regional nerve blocks. The primary objective of this study was to compare length of stay (LOS) in patients randomized to US-guided interscalene block or procedural sedation to facilitate reduction of shoulder dislocation in the emergency department (ED). The secondary objectives were to compare one-on-one health care provider time, pain experienced by the patient during reduction, and patient satisfaction between the two groups. METHODS This was a prospective, randomized study of patients presenting to the ED with shoulder dislocation. The study was conducted at an academic Level I trauma center ED with an annual census of approximately 80,000. Patients were eligible for the study if they were at least 18 years of age and required reduction of a shoulder dislocation. A convenience sample of patients was randomized to either traditional procedural sedation or US-guided interscalene nerve block. Procedural sedation was performed with etomidate as the sole agent. Interscalene blocks were performed by hospital-credentialed EPs using sterile technique and a SonoSite MicroMaxx US machine with a high-frequency linear array transducer. Categorical variables were evaluated using Fishers exact test, and continuous variables were analyzed using the Wilcoxon rank sum test. RESULTS Forty-two patients were enrolled, with 21 patients randomized to each group. The groups were not significantly different with respect to sex or age. The mean (±SD) LOS in the ED was significantly higher in the procedural sedation group (177.3 ± 37.9 min) than in the US-guided interscalene block group (100.3 ± 28.2 minutes; p < 0.0001). The mean (±SD) one-on-one health care provider time was 47.1 (±9.8) minutes for the sedation group and 5 (±0.7) minutes for the US-guided interscalene block group (p < 0.0001). There was no statistically significant difference between the two groups in patient satisfaction or pain experienced during the procedure. There were no significant differences between groups with respect to complications such as hypoxia or hypotension (p = 0.49). CONCLUSIONS In this study, patients undergoing shoulder dislocation reduction using US-guided interscalene block spent less time in the ED and required less one-on-one health care provider time compared to those receiving procedural sedation. There was no difference in pain level or satisfaction when compared to procedural sedation patients.

Tracheotomy outcomes and complications: A national perspective

To provide national level data on frequency of tracheotomy and complication rate and in‐hospital mortality following tracheotomy.

Thyroidectomy Outcomes A National Perspective

Objectives Describe trends and outcomes of patients undergoing thyroidectomy. Study Design and Setting Retrospective search of national inpatient database. Subjects and Methods The Nationwide Inpatient Sample 2009 was searched using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for thyroidectomy. Data extraction included patient demographics, hospital characteristics, and associated diagnoses. Subgroup analysis was performed on mortalities; bivariate and multivariate analysis was used to examine predictors of complications. Results In the United States, 59,478 patients were admitted and underwent thyroidectomy in 2009. Their mean (SD) age was 53.0 (16.4) years. Mean (SD) length of stay was 3.0 (6.9) days, and mean (SD) total charges was

Polysomnographic Variables Predictive of Adverse Respiratory Events After Pediatric Adenotonsillectomy

39,236 (

Pediatric acute mastoiditis in the post–pneumococcal conjugate vaccine era

73,679). Total thyroidectomy was performed in 53.6% of patients; 33.2% underwent unilateral lobectomy. Most common thyroid disorders included nontoxic nodular goiter (36.0%) and malignant neoplasm (30.3%). There were 363 (0.61%) mortalities, with a mean (SD) age of 65.5 (15.2) years, length of stay of 13.9 (15.2) days, and total charges of

Comparison of infection rates among ultrasound-guided versus traditionally placed peripheral intravenous lines

218,855 (

Upper extremity disability in workers with hand–arm vibration syndrome

191,977). Of all patients, 6.18% had hypocalcemia and 0.77% had hypoparathyroidism; the incidence of vocal cord paresis was 0.85% unilaterally and 0.34% bilaterally. Multivariate analysis revealed predictors of complications following thyroid surgery were female sex (P = .0001), total thyroidectomy procedure (P < .0001), hospital location and teaching status (P = .0060), hospital bed size (P = .0054), type of thyroid disorder, and underlying patient comorbidities. Conclusion Reporting of normative data for thyroidectomy facilitates comparison. Hospitalizations for patients undergoing thyroidectomy require significant resource utilization. Predictors of complications include female sex, type of thyroid disorder and procedure, hospital location and teaching status, hospital bed size, and patient comorbidities.

Risk factors for desaturation after tonsillectomy

OBJECTIVE To determine polysomnographic (PSG) variables that may potentially predict adverse respiratory events after pediatric adenotonsillectomy. DESIGN Retrospective, case-control study. SETTING Free-standing academic tertiary-care pediatric hospital. PATIENTS The study included 1131 patients undergoing adenotonsillectomy by 2 attending surgeons. There were no exclusion criteria. MAIN OUTCOME MEASURES Variables from preoperative PSGs were analyzed to determine predictors of postoperative respiratory complications. Logistic regression analysis was performed. RESULTS A total of 151 patients (13.4%) underwent preoperative PSG. Twenty-three of these patients (15.2%) had adverse respiratory events. The primary adverse event was desaturation requiring supplemental oxygen therapy, with 1 case of postobstructive pulmonary edema. Patients with adverse events had a significantly higher apnea-hypopnea index) (31.8 vs 14.1; P = .001), higher hypopnea index (22.6 vs 8.9; P = .004), higher body mass index (z score, 1.43 vs 0.70; P = .02), and lower nadir oxygen saturation (72% vs 84%; P <.001). Patients with adverse events had a prolonged hospital course (odds ratio, 32.1; 95% confidence interval, 7.8-131.4). There were no differences in age or other PSG variables. There were no intubations or mortalities. CONCLUSIONS Polysomnography may be used to predict which patients are at higher risk for adverse respiratory events after adenotonsillectomy. Such knowledge is valuable for planning optimal postoperative management and intraoperative anesthesia. Predictors of increased respiratory complications include apnea-hypopnea index, hypopnea index, body mass index, and nadir oxygen saturation.

Incidence of laryngospasm and bronchospasm in pediatric adenotonsillectomy

To determine whether the characteristics of acute mastoiditis in children have changed in the post–heptavalent pneumococcal conjugate vaccine (PCV7) era.

Aspirated foreign bodies in pediatric patients, 1968–2010: A comparison between the United States and other countries

Objective. The purpose of this study was to compare infection rates of peripheral intravenous (IV) lines placed under ultrasound guidance with traditionally placed IV lines. Methods. We conducted a retrospective review of emergency department (ED) and hospital records of adult patients who had a peripheral IV line placed in the ED and were admitted to the hospital over a 1‐year period. This study took place at a level I academic urban ED with an annual census of 75,000. All admitted patients with a peripheral IV placed under ultrasound guidance in the ED were identified. Control patients had a traditional landmark approach. Emergency department nurses followed standard aseptic precautions when inserting both ultrasound‐guided as well as traditionally placed IV lines. Researchers reviewed all parts of the medical record, including ED and inpatient notes. Descriptive statistics and χ2 and Fisher exact tests were used in data evaluation. Results. A total of 402 patients who had peripheral IV lines placed under ultrasound guidance were compared with 402 matched control patients. In the ultrasound‐guided IV group, the mean time between insertion to catheter removal was 2.6 days compared with 2.4 days in the traditional group (P = .03). There were 2 documented infections in the ultrasound group and 3 in the traditional group, yielding infection rates of 5.2 per 1000 in the ultrasound‐guided IV group and 7.8 per 1000 in the traditional approach group. There was no statistically significant difference between infection rates in the two groups (P = .68). Conclusions. Both traditional and ultrasound‐guided approaches had low infection rates, suggesting that there is no increased risk of infection with ultrasound guidance for peripheral IV lines.