No abstract

No abstract

We found a positive correlation between hemoglobin levels on discharge and change in quality of life scores from preoperatively to 2 mo postoperatively in patients over 65 yr old after primary hip arthroplasty.

Purpose: Postanaesthetic shivering occurs in 5-65% of patients. In addition to causing discomfort, it is associated with deleterious consequences. Our objective was to investigate the effect of 150/ag clonidine, at induction of anaesthesia, on perioperative core and peripheral temperature, incidence of postanaesthetic shivering and patients' perception of cold. Methods: Sixty ASA I or 2 patients scheduled for elective orthopaedic limb surgery were randomly allocated to group I, who received 150/Jg clonidine iv, or group 2, who received a saline bolus iv, before induction. In alI patients, anaesthesia was induced with fentanyl and propofol and maintained by spontaneous respiration (via a laryngeal mask airway) of oxygen, nitrous oxide and enflurane. Core (nasopharyngeal) and peripheral (dorsal hand) temperatures were recorded at induction and 15-rain intervals. Nurses, unaware of the treatment groups, recorded visible shivering in the recovery room, When cognitive function returned, patients were asked to grade their perception of cold on a I 0 cm linear analogue scale, higher scores indicating heat discomfort.Results: While core temperature decreased and peripheral temperature increased in both groups, there was no difference between the groups at any time. However, there was a lower incidence of shivering in the clonidine group (20% vs 66.7% P <0.00l ). Patients receiving clonidine felt warmer; thermal comfort score (median interquartile range) 5.9 (5.0-7.2) vs 5.0 (4.5-6.0), P <0.05).Conclusion: Clonidine 150 g iv at induction of anaesthesia reduces the incidence of shivering and patients' subjective perception of cold on emergence from general anaesthesia. R~sultats : Alors que la temp&ature centrale diminuait et la temp&ature pEriphErique augmentait dans les deux groupes, aucune difference if&at notEe entre les groupes. Cependant, I'incidence du flisson Etalt plus basse dans le groupe clonidine (20% vs 66,7%, P <0,00 I). La perception de chaleur Etait plus ElevEe chez les patients sous clonidine avec un score de comfort (mEdiane &art interquartile de) 5,9 (5,0-7,2) vs 5,0 (4,5-6,0), P <0,05). Conclusion : AdministrEe ~. (induction, la donidine iv r~duit rincidence du fdsson et [a sensation subjective de froid per~ue au r~veil apr~s une anesth&ie gEn&ale.

Both active treatments were superior to placebo, and the overall efficacy of two intravenous infusions of propacetamol 2 g (equivalent to 1 g of paracetamol), 5 h apart, was not statistically different from that provided by a single intramuscular injection of diclofenac 75 mg over the first 5 h post-dose and over the total 10-h study period. The safety was good.

Intra-articular tenoxicam improves postoperative analgesia in knee arthroscopyPurpose: Non Steroidal Anti-Inflammatory drugs have a well documented benef~ in the relief of postoperative pain. This study was designed to compare the analgesic effect of intra-articular tenoxicam 20 mg with intravenous tenoxicam on postoperative pain in 88 patients undergoing day case knee arthroscopy. Methods: A prospective, double blind, randomized trial was performed. All patients received a standard general anesthetic. Patients in group A received 20 mg tenoxicam made up to 40 ml with normal saline intra-articularly (io) and 2 ml normal saline iv. Patients in group B received 40 ml normal saline intra-articularly and 2 ml, 20 mg of tenoxicam, iv. Results: Both groups of patients were similar with respect to age, weight, sex and tourniquet inflation time. Patients receiving in tenoxicam had lower pain scores (at rest and upon movement) at 30, 60, 120 and 180 min postoperatively (0.8 _ 0.2 vs 2.5 _ 0.2 at rest and 1.24 _+ 0.2 vs 3.4 _+ 0.2 at movement at 60 min; P < 0.000 I). Fewer patients required additional analgesia in the first four hours postoperatively (33% vs 84%; P < 0.0000 I) and the time to first analgesia (23.7 + I 1.2 vs 9.4 _+ 0.6; P < 0.02) was longer in those receiving in tenoxicam. Conclusion: Intra-articular tenoxicam provides superior postoperative analgesia and reduces postoperative analgesic requirements compared with iv tenoxicam in patients undergoing day case knee arthroscopy.Objcctif: Les anti-inflammatoires non st&oi'diens sont des mddicaments bien reconnus pour le soulagement de la douleur postop&atoire. La pr&ente ~tude avait pour but de comparer reffet analg&ique de 20 mg de t6noxi-cam intra-articulaire ~ du t~noxicam intraveineux sur la douleur postop&atoire chez 88 patients admis en chirurgie ambulatoire pour une arthroscopie du genou. M&hode : On a proc6d~ ~ un essai prospectif, randomis6 et ~ double insu. Tous les patients ont re~u un anesth&ique g~n&al standard. Les patients du groupe A ont re~u une injection intra-articulaire (io) compos& de 20 mg de t~noxicam compl6t~ ~ 40 ml par une solution salve et 2 ml de solution sal& iv. Les patients du groupe B ont re~u 40 ml de solution sal& en injection intra-articulaire et 2 ml, 20 mg de t~noxicam, iv. R~sultats : Les deux groupes pr6sentaient des caract&istiques semblables quant ~ I'~ge, le poids, le sexe et le temps de gonflement du garrot. Les patients qui ont re~u du tfinoxicam io ont eu des scores de douleur plus bas (au repos et en mouvement) ~ 30, 60, 120 et 180 min apr~s I'intervention (0,8 + 0,2 vs 2,5 -0,2 au repos et 1,24 _+ 0,2 vs 3,4 _+ 0,2 en mouvement ~ 60 min; P < 0,0001). Moins de patients ont eu besoin d'analg&ie suppl~mentaire pendant les quatre premi&es heures postop&atoires (33 % vs 84 %; P < 0,0000 I) et le temps &oul~ avant la premi&e analg&ie (23,7 _+ I 1,2 vs 9,4 _+ 0,6 P < 0,02) a ~t~ plus long pour les patients qui ont re~u du t~noxicam in. Conclusion : Le t6noxicam intra-articulaire, compar~ au t~noxicam iv, fournit une anal...

No abstract

To address surgical complications, the World Health Organization (WHO) developed the Safe Surgery Saves Lives Checklist. With the foundation of the WHO's checklist, a robotic-specific checklist (RORCC) was developed using standardized content and face validity methods. The RORCC was implemented in a high volume gynecological (GYN) specialty group using minimally invasive robotic-assisted surgery. Data were abstracted from patients undergoing GYN procedures from four GYN surgeons at an urban, community hospital during November 16, 2010 to May 15, 2011 (pre-RORCC) n = 89 and from the period May 16, 2011 to November 16 2011 (post-RORCC) n = 121. Thirty-day readmissions pre-checklist and post-checklist were 12 and 5, respectively, which is a significant (p = 0.02) reduction. The duration of surgery was not significantly affected (p = 0.40) with pre-RORCC surgery time at 110.1 (35.7) min versus post-RORCC surgery time at 112.9 (37.4) min. This study demonstrated the feasibility of integrating an electronic, interactive, and robotic-specific checklist for gynecologic robotic-assisted surgery which resulted in a significant reduction in readmissions at the 30-day without significantly impacting operating room times.