ISSN:0003-3022    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background:Although some anesthesiologists use oral sedatives or parental presence during induction of anesthesia (PPIA) to treat preoperative anxiety in children, others may use these interventions simultaneously (e.g., sedatives and PPIA). The purpose of this investigation was to determine whether this approach has advantages over treating children with sedatives alone.Methods:The child’s and the parental anxiety throughout the perioperative period was the primary endpoint of the study. Parental satisfaction was the secondary endpoint. Subjects (n = 103) were assigned randomly to one of two groups: a sedative group (0.5 mg/kg oral midazolam) or a sedative and PPIA group. Using standardized measures of anxiety and satisfaction, the effects of the interventions on the children and parents were assessed. Statistical analysis (varimax rotation) of the satisfaction questionnaire items resulted in two factors that described satisfaction of the separation process and satisfaction of the overall care provided.Results:Anxiety in the holding area, at entrance to the operating room, and at introduction of the anesthesia mask did not differ significantly between the two groups (F[2,192] = 1.26,P= 0.28). Parental anxiety after separation, however, was significantly lower in the sedative and PPIA group (F[2,93] = 4.46,P= 0.037). Parental satisfaction with the overall care provided (−0.28 ± 1.2vs.0.43 ± 0.26,P= 0.046) and with the separation process (−0.30 ± 1.2vs.0.47 ± 0.20,P= 0.03) was significantly higher among the sedative and PPIA group compared with the sedative group.Conclusions:PPIA in addition to 0.5 mg/kg oral midazolam has no additive effects in terms of reducing a child’s anxiety. Parents who accompanied their children to the operating room, however, were less anxious and more satisfied.

ISSN:0003-3022    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background:The impact of anesthetic choice on postoperative mortality and morbidity has not been determined with certainty.Methods:The authors evaluated the effect of type of anesthesia on postoperative mortality and morbidity in a retrospective cohort study of consecutive hip fracture patients, aged 60 yr or older, who underwent surgical repair at 20 US hospitals between 1983 and 1993. The primary outcome was defined as death within 30 days of the operative procedure. The secondary outcomes were postoperative 7-day mortality, postoperative myocardial infarction, postoperative pneumonia, postoperative congestive heart failure, and postoperative change in mental status. Numerous comorbid conditions were controlled for individually and by several comorbidity indices using logistic regression.Results:General anesthesia was used in 6,206 patients (65.8%) and regional anesthesia in 3,219 patients (3,078 spinal anesthesia and 141 epidural anesthesia). The 30-day mortality rate in the general anesthesia group was 4.4%, compared with 5.4% in the regional anesthesia group (unadjusted odds ratio = 0.80; 95% confidence interval = 0.66–0.97). However, the adjusted odds ratio for general anesthesia increased to 1.08 (0.84–1.38). The adjusted odds ratios for general anesthesiaversusregional anesthesia for the 7-day mortality was 0.90 (0.59–1.39) and for postoperative morbidity outcomes were as follows: myocardial infarction: adjusted odds ratio = 1.17 (0.80–1.70); congestive heart failure: adjusted odds ratio = 1.04 (0.80–1.36); pneumonia: adjusted odds ratio = 1.21 (0.87–1.68); postoperative change in mental status: adjusted odds ratio = 1.08 (0.95–1.22).Conclusions:The authors were unable to demonstrate that regional anesthesia was associated with better outcome than was general anesthesia in this large observational study of elderly patients with hip fracture. These results suggest that the type of anesthesia used should depend on factors other than any associated risks of mortality or morbidity.

ISSN:0003-3022    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background:In an era of growing economic constraints on healthcare delivery, anesthesiologists are increasingly expected to understand cost analysis and evaluate clinical practices. Postoperative nausea and vomiting (PONV) are distressing for patients and may increase costs in an ambulatory surgical unit. The authors compared the cost-effectiveness of four prophylactic intravenous regimens for PONV:—4 mg ondansetron, 0.625 mg droperidol, 1.25 mg droperidol, and placebo.Methods:Adult surgical outpatients at high risk for PONV were studied. Study drugs were administered intravenously within 20 min of induction of nitrous oxide–isoflurane or enflurane anesthesia. A decision-tree analysis was used to group patients into 12 mutually exclusive subgroups based on treatment and outcome. Costs were calculated for the prevention and treatment of PONV. Cost-effectiveness analysis was performed for each group.Results:Two thousand sixty-one patients were enrolled. Efficacy data for study drugs have been previously reported, and the database from that study was used for pharmacoeconomic analysis. The mean–median total cost per patient who received prophylactic treatment with 4 mg ondansetron, 0.625 mg droperidol, 1.25 mg droperidol, and placebo were $112 or $16.44, $109 or $0.63, $104 or $0.51, and $164 or $51.20, respectively (P= 0.001, active treatment groupsvs.placebo). The use of a prophylactic antiemetic agent significantly increased patient satisfaction (P< 0.05). Personnel costs in managing PONV and unexpected hospital admission constitute major cost components in our analysis. Exclusion of nursing labor costs from the calculation did not alter the overall conclusions regarding the relative costs of antiemetic therapy.Conclusion:The use of prophylactic antiemetic therapy in high-risk ambulatory surgical patients was more effective in preventing PONV and achieved greater patient satisfaction at a lower cost compared with placebo. The use of 1.25 mg droperidol intravenously was associated with greater effectiveness, lower costs, and similar patient satisfaction compared with 0.625 mg droperidol intravenously and 4 mg ondansetron intravenously.

ISSN:0003-3022    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Background:Nonselective &agr;2-adrenergic receptor (&agr;2AR) agonists (e.g.,clonidine) mediate antinociception in part through &agr;2ARs in spinal cord dorsal horn; however, use of these agents for analgesia in humans is limited by unwanted sedation and hypotension. The authors previously demonstrated &agr;2a≈ &agr;2b>>> &agr;2cmRNA in human spinal cord dorsal horn cell bodies. However, because 20% of dorsal horn &agr;2ARs derive from cell bodies that reside in the associated dorsal root ganglion (DRG), it is important to evaluate &agr;2AR expression in this tissue as well. Therefore, the authors evaluated the hypothesis that &agr;2bmRNA, &agr;2cmRNA, or both are present in human DRG.Methods:Molecular approaches were used to determine &agr;2AR expression in 28 human DRGs because of low overall receptor mRNA expression and small sample size. After creation of synthetic competitor cDNA and establishment of amplification conditions with parallel efficiencies, competitive reverse transcription polymerase chain reaction was performed using RNA isolated from human DRG.Results:Overall expression of &agr;2AR mRNA in DRG is low but reproducible at all spinal levels. &agr;2band &agr;2cAR subtype mRNAs predominate (&agr;2b≈ &agr;2c), accounting for more than 95% of the total &agr;2AR mRNA in DRG at all human spinal nerve root levels.Conclusions:Predominance of &agr;2band &agr;2cAR mRNA in human DRG is distinct from &agr;2AR mRNA expression in cell bodies originating in human spinal cord dorsal horn, where &agr;2aand &agr;2bpredominate with little or absent &agr;2cexpression. These findings also highlight species heterogeneity in &agr;2AR expression in DRG. If confirmed at a protein level, these findings provide an additional step in unraveling mechanisms involved in complex neural pathways such as those for pain.

ISSN:0003-3022    

出版商:OVID    

年代:2000

数据来源: OVID