practice model may be instructive regarding efficiencies to reduce costly cancellations, we also sought to identify areas for improvement. The primary outcome was percent DOS cancellations. Secondary measures include avoidable versus unavoidable DOS cancellations, patient versus hospital/provider related cancellations, and the most common reasons in each category. Material and Methods After institutional review board approval, we reviewed 12 months (July 2009-June 2010) of day of surgery cancellation data in our mixed in-and outpatient hospital surgical practice. Our suite consists of 18 operating rooms and a mix of general, urology, cardiac, ENT, plastic/reconstructive, gynecologic, transplant, orthopedic and neurosurgical cases. All of these services can and do book emergency cases. Our facility includes an emergency department, but pediatric surgery and obstetric services are not provided in our hospital. The majority of our surgical patients come from the local area, although we care for regional and even national and international

Purpose Intraoperative and postoperative hypothermia occur commonly; mild hypothermia (34-36°C) is associated with adverse events. The use of perioperative warming devices has become routine, but currently available active warming devices may be limited in certain circumstances. The vitalHEAT TM Temperature Management System provides conductive warming (circulating warm water) around a single extremity together with a vacuum that is applied to the limb. In this randomized trial, we tested the hypothesis that the vitalHEAT TM system is non-inferior to the Bair Hugger Ò during unilateral total knee arthroplasty. Methods Physical status I-III patients who were C18 yrold were eligible to participate. The patients were randomly assigned to the vitalHEAT TM system (n = 30) or to Bair Hugger Ò (n = 25) warming. Intraoperative and first recovery room temperatures were recorded in both groups. Results The baseline characteristics of the groups were similar. In terms of the primary outcome measure, i.e., sublingual temperature measured within 10 min of recovery room arrival, the vitalHEAT TM system did not meet the criterion for non-inferiority. Specifically, the confidence interval for the difference between means included the noninferiority margin (-0.5°C). In terms of the secondary measures, i.e., intraoperative esophageal temperatures, the vitalHEAT TM system also underperformed compared with the Bair Hugger Ò . Conclusions The vitalHEAT TM system may have advantages over convective warming systems because it requires a much smaller body surface area; however, in this study of warming during total knee arthroplasty, it underperformed when compared with the Bair Hugger Ò , especially around and after the time of tourniquet release. Clinical trial registration number: NCT00711867. RésuméObjectif L'hypothermie perope´ratoire et postope´ratoire est courante; l'hypothermie le´ge`re (34-36°C) est associe´e à des e´ve´nements inde´sirables. Le recours a`des appareils de re´chauffement pe´riope´ratoires est entre´dans la pratique courante, mais les appareils de re´chauffement actif actuellement disponibles sur le marche´pourraient avoir des limites dans certaines circonstances. Le Syste`me de gestion de la tempe´rature vitalHEAT TM procure un re´chauffement par conduction (circulation d'eau chaude) autour d'un seul membre avec un vide et est applique´au membre. Dans cette e´tude randomise´e, nous avons testeT

The authors describe a case of epidural hematoma in association with dextran infusion in a patient who had undergone a peripheral vascular operation with epidural analgesia. Possible mechanisms for the anticoagulant effect of dextran and guidelines for the use of anticoagulant therapy in patients undergoing epidural anesthesia are discussed.

There are no reports regarding the use of bupivacaine for suppression of tinnitus. Although previous reports studying lidocaine for this purpose have shown only a brief effect, the use of bupivacaine or a combination of lidocaine and bupivacaine, as in this case, may represent a treatment for tinnitus that is worth further investigation. There currently is no effective long-term therapy for this debilitating problem.

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Mastocytosis is a rare group of disorders with chronic and episodic mast cell release of mediators which can have systemic and cutaneous manifestations. Triggers of anaphylaxis include commonly used medications for anesthesia, analgesia, and muscle relaxation. There is little in the literature regarding local anesthesia in emergent surgery for patients with mastocytosis. This case details the use of a peripheral nerve blockade for multiple surgeries and pain control in a patient with biopsy-proven mastocytosis.

Spinal cord stimulation (formally known as dorsal column stimulation) is a minimally invasive technique of applying an electric current in the vicinity of the spinal cord. It is used primarily to treat refractory neuropathic (nerve injury) pain. Patients typically considered for treatment with this modality include those suffering from the failed back surgery syndrome, chronic regional pain syndrome (RSD and causalgia), phantom limb pain, and other neuropathic pain in the lower extremity. Upper extremity neuropathic pain has also been treated successfully with spinal cord stimulation. After an initial successful trial, permanent spinal cord stimulation is accomplished via either a percutaneously inserted polyurethane lead or a surgically inserted “paddle” lead. To power the lead, an implanted pulse generator or radio frequency receiver is inserted in a subcutaneous pocket in the low abdomen or buttock. The patient then controls the stimulator with a hand‐held device. Animal and human studies have suggested that spinal cord stimulation has multiple effects on the spinal cord and pain transmission. Outcome studies show that long‐term success with this modality is ∼ 50%. In recent years, the potential role of stimulation has expanded to include treatment of peripheral neuropathic pain such as occipital neuralgia, ischemic pain (e.g., angina and lower extremity vascular insufficiency), and stress urinary incontinence.

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