المؤلفون: David P. Martin, MD, PhD, Mary E. Warner, MD, Rebecca L. Johnson, MD, Marlea A. Judd, APRN, CRNA, DNP, Michael T. Walsh, MD, Andrew C. Hanson, BS, Darrell R. Schroeder, MS, Christopher M. Burkle, MD, JD

المصدر: Mayo Clinic Proceedings: Innovations, Quality & Outcomes, Vol 2, Iss 3, Pp 234-240 (2018)

مصطلحات موضوعية: Medicine (General), R5-920

الوصف: Objective: To test the hypothesis that patients dismissed alone in a sedation dismissal process (SDP) have no greater risk of adverse outcome compared with those who were dismissed with a responsible adult. Patients and Methods: We compared 2441 SDP patients undergoing 2703 procedures with 4923 unique control patients who underwent 5133 procedures between June 1, 2012, and March 31, 2017. Results: The rate of unplanned readmission related to the procedure was 0.11% (n=9), and there was no difference between SDP (0.07%) and controls (0.14%). Similarly, there was no difference in complication rates between SDP patients and controls when restricting to “all causes” unplanned readmissions within 24 hours and unplanned readmissions related to procedure. Conclusion: With proper preparation, short-acting anesthetic/sedation medications, and sound clinical judgment, the presence of a responsible adult escort is not associated with reduced risk following discharge after ambulatory anesthesia. This practice may lessen the hardships reported by patients in needing to obtain an escort and the inconveniences and delays experienced by ambulatory procedural facilities when patients arrive without a designated escort.

وصف الملف: electronic resource

Relation: http://www.sciencedirect.com/science/article/pii/S2542454818300493; https://doaj.org/toc/2542-4548

URL الوصول: https://doaj.org/article/0643c1d3399c4a59832252e303c99ad7

المؤلفون: Adam W. Amundson, MD, David A. Olsen, MD, Hugh M. Smith, MD, PhD, Laurence C. Torsher, MD, David P. Martin, MD, PhD, Julie K. Heimbach, MD, James Y. Findlay, MB, ChB

المصدر: Mayo Clinic Proceedings: Innovations, Quality & Outcomes, Vol 2, Iss 2, Pp 186-193 (2018)

مصطلحات موضوعية: Medicine (General), R5-920

الوصف: Objective: To investigate whether the addition of liposomal bupivacaine abdominal wall blocks to a multimodal analgesic regimen improves postoperative numeric rating scale pain scores and reduces opioid consumption in patients undergoing living liver donation. Patients and Methods: We conducted a single-center, retrospective review of patients who underwent living liver donation from January 1, 2011, through February 19, 2016, and received multimodal analgesia with (block group) or without (control group) abdominal wall blockade. The block solution consisted of liposomal bupivacaine (266 mg) mixed with 30 mL of 0.25% bupivacaine. Both groups received intrathecal hydromorphone. Main outcome measures were pain scores, opioid requirements, time to full diet, and bowel activity. Results: Postoperative day 0 pain scores were significantly better in the block group (n=29) than in the control group (n=48) (2.4 vs 3.5; P=.002) but were not significantly different on subsequent days. Opioid requirements were significantly decreased for the block group in the postanesthesia care unit (0 vs 9 mg oral morphine equivalents; P=.002) and on postoperative day 0 (7 vs 18 mg oral morphine equivalents; P=.004). Median (interquartile range) time to full diet was 23 hours (14-30 hours) in the block group and 38 hours (24-53 hours) in the control group (P=.001); time to bowel activity was also shorter in the block group (45 hours [38-73 hours] vs 67 hours [51-77 hours]; P=.01). Conclusion: Abdominal wall blockade with liposomal bupivacaine after donor hepatectomy provides an effective method of postoperative pain control and decreases time to full diet and bowel activity.

وصف الملف: electronic resource

Relation: http://www.sciencedirect.com/science/article/pii/S2542454818300250; https://doaj.org/toc/2542-4548

URL الوصول: https://doaj.org/article/d7aa56f8ccd945e9b4936ce52995f944

المؤلفون: Mary Ellen Warner, MD, David P. Martin, MD, Eli Muchtar, MD, Juraj Sprung, MD, PhD, Toby N. Weingarten, MD, Mark A. Warner, MD

المصدر: Mayo Clinic Proceedings: Innovations, Quality & Outcomes, Vol 2, Iss 1, Pp 26-29 (2018)

مصطلحات موضوعية: Medicine (General), R5-920

الوصف: Objective: To determine the risks and outcomes of providing sedation to febrile patients scheduled for bone marrow aspiration or biopsy procedures. Patients and Methods: During the 4-year period from January 1, 2013, through December 31, 2016, data from the periprocedural courses of 12,134 consecutive patients in an outpatient procedure center at a large tertiary medical center were collected retrospectively and analyzed to determine whether febrile patients undergoing bone marrow aspiration and/or biopsy with propofol sedation present a unique patient safety risk. Results: Eighty-four patients (0.7%) had preprocedural temperatures of greater than or equal to 38.3°C. Of these, 6 required unanticipated hospital admission for sustained hypoxemia and symptoms suggesting pneumonia. All 6 of these patients had a productive cough and room air oxygen saturations of less than 92% before their procedures. These 6 patients were diagnosed during their hospitalizations with either confirmed or presumed community-acquired pneumonia. All recovered without pulmonary sequelae. Only 2 of the other 78 febrile patients required unanticipated hospital admission, for both general weakness and dehydration. Conclusion: Our findings suggest that patients who are febrile and who also have productive coughs and oxyhemoglobin saturations by pulse oximetry of less than 92% would be best served with outpatient evaluation of their pulmonary symptoms before undergoing their elective bone marrow aspiration procedures. In contrast, febrile patients without pulmonary symptoms fare well.

وصف الملف: electronic resource

Relation: http://www.sciencedirect.com/science/article/pii/S2542454817301273; https://doaj.org/toc/2542-4548

URL الوصول: https://doaj.org/article/f584c66691e24eac8ec1bfe1f134db32

المؤلفون: David P. Martin, Eli Muchtar, Mark A. Warner, Mary E. Warner, Toby N. Weingarten, Juraj Sprung

المصدر: Mayo Clinic Proceedings: Innovations, Quality & Outcomes, Vol 2, Iss 1, Pp 26-29 (2018)

مصطلحات موضوعية: lcsh:R5-920, Weakness, Productive Cough, medicine.diagnostic_test, business.industry, Sedation, medicine.disease, Hypoxemia, 03 medical and health sciences, Pulse oximetry, Pneumonia, 0302 clinical medicine, medicine.anatomical_structure, 030202 anesthesiology, Anesthesia, Biopsy, medicine, Bone marrow, medicine.symptom, lcsh:Medicine (General), business, 030217 neurology & neurosurgery

الوصف: Objective To determine the risks and outcomes of providing sedation to febrile patients scheduled for bone marrow aspiration or biopsy procedures. Patients and Methods During the 4-year period from January 1, 2013, through December 31, 2016, data from the periprocedural courses of 12,134 consecutive patients in an outpatient procedure center at a large tertiary medical center were collected retrospectively and analyzed to determine whether febrile patients undergoing bone marrow aspiration and/or biopsy with propofol sedation present a unique patient safety risk. Results Eighty-four patients (0.7%) had preprocedural temperatures of greater than or equal to 38.3°C. Of these, 6 required unanticipated hospital admission for sustained hypoxemia and symptoms suggesting pneumonia. All 6 of these patients had a productive cough and room air oxygen saturations of less than 92% before their procedures. These 6 patients were diagnosed during their hospitalizations with either confirmed or presumed community-acquired pneumonia. All recovered without pulmonary sequelae. Only 2 of the other 78 febrile patients required unanticipated hospital admission, for both general weakness and dehydration. Conclusion Our findings suggest that patients who are febrile and who also have productive coughs and oxyhemoglobin saturations by pulse oximetry of less than 92% would be best served with outpatient evaluation of their pulmonary symptoms before undergoing their elective bone marrow aspiration procedures. In contrast, febrile patients without pulmonary symptoms fare well.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::678cf5d3dc36cba6990ba79e149889ae
https://doi.org/10.1016/j.mayocpiqo.2017.11.003