38 results on '"Fleisher, Lee A."'
Search Results
2. The Anesthesiology Physician-Scientist Pipeline: Current Status and Recommendations for Future Growth-An Initiative of the Anesthesia Research Council.
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Emala CW Sr, Tawfik VL, Lane-Fall MB, Toledo P, Wong CA, Vavilala MS, Fleisher LA, and Wood M
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- United States, Female, Humans, Male, Benchmarking, Anesthesiology, Anesthesia, Physicians, Awards and Prizes
- Abstract
The limited number and diversity of resident physicians pursuing careers as physician-scientists in medicine has been a concern for many decades. The Anesthesia Research Council aimed to address the status of the anesthesiology physician-scientist pipeline, benchmarked against other medical specialties, and to develop strategic recommendations to sustain and expand the number and diversity of anesthesiology physician-scientists. The working group analyzed data from the Association of American Medical Colleges and the National Resident Matching Program to characterize the diversity and number of research-oriented residents from US and international allopathic medical schools entering 11 medical specialties from 2009 to 2019. Two surveys were developed to assess the research culture of anesthesiology departments. National Institutes of Health (NIH) funding information awarded to anesthesiology physician-scientists and departments was collected from NIH RePORTER and the Blue Ridge Medical Institute. Anesthesiology ranked eighth to tenth place of 11 medical specialties in the percent of "research-oriented" entering residents, defined as those with advanced degrees (Master's or PhDs) in addition to the MD degree or having published at least 3 research publications before residency. Anesthesiology ranked eighth of 11 specialties in the percent of entering residents who were women but ranked fourth of 11 specialties in the percent of entering residents who self-identified as belonging to an underrepresented group in medicine. There has been a 72% increase in both the total NIH funding awarded to anesthesiology departments and the number of NIH K-series mentored training grants (eg, K08 and K23) awarded to anesthesiology physician-scientists between 2015 and 2020. Recommendations for expanding the size and diversity of the anesthesiology physician-scientist pipeline included (1) developing strategies to increase the number of research intensive anesthesiology departments; (2) unifying the diverse programs among academic anesthesiology foundations and societies that seek to grow research in the specialty; (3) adjusting American Society of Anesthesiologists metrics of success to include the number of anesthesiology physician-scientists with extramural research support; (4) increasing the number of mentored awards from Foundation of Anesthesia Education and Research (FAER) and International Anesthesia Research Society (IARS); (5) supporting an organized and concerted effort to inform research-oriented medical students of the diverse research opportunities within anesthesiology should include the specialty being represented at the annual meetings of Medical Scientist Training Program (MSTP) students and the American Physician Scientist Association, as well as in institutional MSTP programs. The medical specialty of anesthesiology is defined by new discoveries and contributions to perioperative medicine which will only be sustained by a robust pipeline of anesthesiology physician-scientists., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 International Anesthesia Research Society.)
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- 2023
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3. Geriatric Anesthesia: Ensuring Best Care for Vulnerable Individuals.
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Fleisher LA
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- Humans, Aged, Geriatric Assessment, Anesthesia, Geriatrics
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- 2023
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4. Alzheimer's Dementia After Exposure to Anesthesia and Surgery in the Elderly: A Matched Natural Experiment Using Appendicitis.
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Silber JH, Rosenbaum PR, Reiter JG, Hill AS, Jain S, Wolk DA, Small D, Hashemi S, Niknam BA, Neuman MD, Fleisher LA, and Eckenhoff R
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- Aged, Humans, Medicare, United States, Alzheimer Disease diagnosis, Alzheimer Disease epidemiology, Anesthesia, Appendicitis surgery, Cognitive Dysfunction
- Abstract
Objective: The aim of this study was to determine whether surgery and anesthesia in the elderly may promote Alzheimer disease and related dementias (ADRD)., Background: There is a substantial conflicting literature concerning the hypothesis that surgery and anesthesia promotes ADRD. Much of the literature is confounded by indications for surgery or has small sample size. This study examines elderly patients with appendicitis, a common condition that strikes mostly at random after controlling for some known associations., Methods: A matched natural experiment of patients undergoing appendectomy for appendicitis versus control patients without appendicitis using Medicare data from 2002 to 2017, examining 54,996 patients without previous diagnoses of ADRD, cognitive impairment, or neurological degeneration, who developed appendicitis between ages 68 through 77 years and underwent an appendectomy (the ''Appendectomy'' treated group), matching them 5:1 to 274,980 controls, examining the subsequent hazard for developing ADRD., Results: The hazard ratio (HR) for developing ADRD or death was lower in the Appendectomy group than controls: HR = 0.96 [95% confidence interval (CI) 0.94-0.98], P < 0.0001, (28.2% in Appendectomy vs 29.1% in controls, at 7.5 years). The HR for death was 0.97 (95% CI 0.95-0.99), P = 0.002, (22.7% vs 23.1% at 7.5 years). The HR for developing ADRD alone was 0.89 (95% CI 0.86-0.92), P < 0.0001, (7.6% in Appendectomy vs 8.6% in controls, at 7.5 years). No subgroup analyses found significantly elevated rates of ADRD in the Appendectomy group., Conclusion: In this natural experiment involving 329,976 elderly patients, exposure to appendectomy surgery and anesthesia did not increase the subsequent rate of ADRD., Competing Interests: The authors report no conflicts of interest ., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2022
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5. Risk of Parkinson's disease after anaesthesia and surgery.
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Jain S, Rosenbaum PR, Reiter JG, Hill AS, Wolk DA, Hashemi S, Fleisher LA, Eckenhoff R, and Silber JH
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- Humans, Anesthesia adverse effects, Anesthesiology, Parkinson Disease
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- 2022
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6. Patient Involvement in Anesthesia Decision-making: A Qualitative Study of Knee Arthroplasty.
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Graff V, Clapp JT, Heins SJ, Chung JJ, Muralidharan M, Fleisher LA, and Elkassabany NM
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- Academic Medical Centers, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Patient Participation statistics & numerical data, Qualitative Research, United States, Anesthesia methods, Arthroplasty, Replacement, Knee, Clinical Decision-Making methods, Patient Participation methods
- Abstract
Background: Calls to better involve patients in decisions about anesthesia-e.g., through shared decision-making-are intensifying. However, several features of anesthesia consultation make it unclear how patients should participate in decisions. Evaluating the feasibility and desirability of carrying out shared decision-making in anesthesia requires better understanding of preoperative conversations. The objective of this qualitative study was to characterize how preoperative consultations for primary knee arthroplasty arrived at decisions about primary anesthesia., Methods: This focused ethnography was performed at a U.S. academic medical center. The authors audio-recorded consultations of 36 primary knee arthroplasty patients with eight anesthesiologists. Patients and anesthesiologists also participated in semi-structured interviews. Consultation and interview transcripts were coded in an iterative process to develop an explanation of how anesthesiologists and patients made decisions about primary anesthesia., Results: The authors found variation across accounts of anesthesiologists and patients as to whether the consultation was a collaborative decision-making scenario or simply meant to inform patients. Consultations displayed a number of decision-making patterns, from the anesthesiologist not disclosing options to the anesthesiologist strictly adhering to a position of equipoise; however, most consultations fell between these poles, with the anesthesiologist presenting options, recommending one, and persuading hesitant patients to accept it. Anesthesiologists made patients feel more comfortable with their proposed approach through extensive comparisons to more familiar experiences., Conclusions: Anesthesia consultations are multifaceted encounters that serve several functions. In some cases, the involvement of patients in determining the anesthetic approach might not be the most important of these functions. Broad consideration should be given to both the applicability and feasibility of shared decision-making in anesthesia consultation. The potential benefits of interventions designed to enhance patient involvement in decision-making should be weighed against their potential to pull anesthesiologists' attention away from important humanistic aspects of communication such as decreasing patients' anxiety., (Copyright © 2021, the American Society of Anesthesiologists. All Rights Reserved.)
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- 2021
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7. Geriatric Anesthesia: Ensuring the Best Perioperative Care for Older Adults.
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Fleisher LA
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- Aged, Aged, 80 and over, Humans, Perioperative Care, Anesthesia, Anesthesiology trends, Geriatrics trends
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- 2019
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8. Ambulatory Anesthesia: The Innovating Edge of Perioperative Medicine?
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Fleisher LA
- Subjects
- Ambulatory Care Facilities, Ambulatory Surgical Procedures trends, Anesthesiology, Perioperative Care trends, Ambulatory Surgical Procedures methods, Anesthesia methods, Perioperative Care methods
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- 2019
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9. Failure to Debrief after Critical Events in Anesthesia Is Associated with Failures in Communication during the Event.
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Arriaga AF, Sweeney RE, Clapp JT, Muralidharan M, Burson RC 2nd, Gordon EKB, Falk SA, Baranov DY, and Fleisher LA
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- Anesthesia methods, Anesthesiology methods, Humans, Anesthesia standards, Anesthesiology standards, Clinical Competence standards, Communication, Medical Errors prevention & control, Patient Care Team standards
- Abstract
What We Already Know About This Topic: Debriefing after an actual critical event is an established good practice in medicine, but a gap exists between principle and implementation., What This Article Tells Us That Is New: Failure to debrief after critical events is common among anesthesia trainees and likely anesthesia teams. Communication breakdowns are associated with a high rate of the failure to debrief., Background: Debriefing after an actual critical event is an established good practice in medicine, but a gap exists between principle and implementation. The authors' objective was to understand barriers to debriefing, characterize quantifiable patterns and qualitative themes, and learn potential solutions through a mixed-methods study of actual critical events experienced by anesthesia personnel., Methods: At a large academic medical center, anesthesiology residents and a small number of attending anesthesiologists were audited and/or interviewed for the occurrence and patterns of debriefing after critical events during their recent shift, including operating room crises and disruptive behavior. Patterns of the events, including event locations and event types, were quantified. A comparison was done of the proportion of cases debriefed based on whether the event contained a critical communication breakdown. Qualitative analysis, using an abductive approach, was performed on the interviews to add insight to quantitative findings., Results: During a 1-yr period, 89 critical events were identified. The overall debriefing rate was 49% (44 of 89). Nearly half of events occurred outside the operating room. Events included crisis events (e.g., cardiac arrest, difficult airway requiring an urgent surgical airway), disruptive behavior, and critical communication breakdowns. Events containing critical communication breakdowns were strongly associated with not being debriefed (64.4% [29 of 45] not debriefed in events with a communication breakdown vs. 36.4% [16 of 44] not debriefed in cases without a communication breakdown; P = 0.008). Interview responses qualitatively demonstrated that lapses in communication were associated with enduring confusion that could inhibit or shape the content of discussions between involved providers., Conclusions: Despite the value of proximal debriefing to reducing provider burnout and improving wellness and learning, failure to debrief after critical events can be common among anesthesia trainees and perhaps anesthesia teams. Modifiable interpersonal factors, such as communication breakdowns, were associated with the failure to debrief.
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- 2019
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10. Decision Aids Are a Solution, but to Which Problem?
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Clapp JT, Fleisher LA, and Lane-Fall MB
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- Decision Support Techniques, Humans, Patient Participation, Anesthesia, Anesthesiology
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- 2019
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11. Quality Anesthesia: Medicine Measures, Patients Decide.
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Fleisher LA
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- Anesthesia adverse effects, Anesthesia mortality, Humans, Perioperative Care standards, Quality Improvement, Anesthesia standards, Anesthesiology standards
- Abstract
Quality has been defined by six domains: effective, equitable, timely, efficient, safe, and patient centered. Quality of anesthesia care can be improved through measurement, either through local measures in quality improvement or through national measures in value-based purchasing programs. Death directly related to anesthesia care has been reduced, but must be measured beyond simple mortality. To improve perioperative care for our patients, we must take shared accountability for all surgical outcomes including complications, which has traditionally been viewed as being surgically related. Anesthesiologists can also impact public health by being engaged in improving cognitive recovery after surgery and addressing the opiate crisis. Going forward, we must focus on what patients want and deserve: improved patient-oriented outcomes and satisfaction with our care. By listening to our patients and being engaged in the entire perioperative process, we can make the greatest impact on perioperative care.
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- 2018
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12. What Can the Use of Anesthesia Services for Endoscopy in the Veterans Health Administration Teach Us About Appropriate Care?
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Fleisher LA
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- Endoscopy, Gastrointestinal, Outpatients, United States, United States Department of Veterans Affairs, Veterans Health, Anesthesia, Veterans
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- 2017
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13. A 1966 Anesthetic Administered by Robert D. Dripps, M.D., Demonstrated His Experimental Style of Clinical Care.
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Johnstone RE and Fleisher LA
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- History, 20th Century, Humans, Male, Philadelphia, Anesthesia history, Anesthesiology history, Anesthetics history
- Abstract
Robert D. Dripps, M.D. (1911 to 1973), helped found academic anesthesiology. Newly reviewed teaching slides from the University of Pennsylvania (Philadelphia, Pennsylvania) contain six anesthesia records from 1965 to 1967 that involved Dripps. They illustrate the clinical philosophy he taught-to consider administration of each anesthetic a research study. Intense public criticism in 1967 for improper experimentation on patients during anesthesia changed his clinical and research philosophies and teaching.
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- 2016
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14. Feasibility of Report Cards for Measuring Anesthesiologist Quality for Cardiac Surgery.
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Glance LG, Hannan EL, Fleisher LA, Eaton MP, Dutton RP, Lustik SJ, Li Y, and Dick AW
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- Aged, Anesthesia adverse effects, Anesthesia economics, Anesthesia mortality, Clinical Competence standards, Comorbidity, Coronary Artery Bypass adverse effects, Coronary Artery Bypass economics, Coronary Artery Bypass mortality, Data Collection economics, Databases, Factual, Delivery of Health Care economics, Feasibility Studies, Female, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis Implantation economics, Heart Valve Prosthesis Implantation mortality, Hospital Mortality, Humans, Logistic Models, Male, Middle Aged, New York, Odds Ratio, Outliers, DRG, Postoperative Complications mortality, Practice Patterns, Physicians' standards, Process Assessment, Health Care economics, Quality Indicators, Health Care economics, Reimbursement, Incentive standards, Retrospective Studies, Risk Assessment, Risk Factors, Severity of Illness Index, Time Factors, Treatment Outcome, Anesthesia standards, Coronary Artery Bypass standards, Data Collection standards, Delivery of Health Care standards, Heart Valve Prosthesis Implantation standards, Process Assessment, Health Care standards, Quality Indicators, Health Care standards
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Background: In creating the Merit-Based Incentive Payment System, Congress has mandated pay-for-performance (P4P) for all physicians, including anesthesiologists. There are currently no National Quality Forum-endorsed risk-adjusted outcome metrics for anesthesiologists to use as the basis for P4P., Methods: Using clinical data from the New York State Cardiac Surgery Reporting System, we conducted a retrospective observational study of 55,436 patients undergoing cardiac surgery between 2009 and 2012. Hierarchical logistic regression modeling was used to examine the variation in in-hospital mortality or major complications (Q-wave myocardial infarction, renal failure, stroke, and respiratory failure) among anesthesiologists, controlling for patient demographics, severity of disease, comorbidities, and hospital quality., Results: Although the variation in performance among anesthesiologists was statistically significant (P = 0.025), none of the anesthesiologists in the sample was classified as a high- or low-performance outliers. The contribution of anesthesiologists to outcomes represented 0.51% of the overall variability in patient outcomes (intraclass correlation coefficient [ICC] = 0.0051; 95% confidence interval [CI], 0.002-0.014), whereas the contribution of hospitals to patient outcomes was 2.90% (ICC = 0.029; 95% CI, 0.017-0.050). The anesthesiologist median odds ratio (MOR) was 1.13 (95% CI, 1.08-1.24), suggesting that the variation between anesthesiologist was modest, whereas the hospital MOR was 1.35 (95% CI, 1.25-1.48). In a separate analysis, the contribution of surgeons to overall outcomes represented 1.76% of the overall variability in patient outcomes (ICC = 0.018, 95% CI, 0.010-0.031), and the surgeon MOR was 1.26 (95% CI, 1.19-1.37). Twelve of the surgeons were identified as performance outliers., Conclusions: The impact of anesthesiologists on the total variability in cardiac surgical outcomes was probably about one-fourth as large as the surgeons' contribution. None of the anesthesiologists caring for cardiac surgical patients in New York State over a 3+ year period were identified as performance outliers. The use of a performance metric based on death or major complications for P4P may not be feasible for cardiac anesthesiologists.
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- 2016
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15. Providing value in ambulatory anesthesia.
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Fosnot CD, Fleisher LA, and Keogh J
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- Ambulatory Surgical Procedures, Humans, Patient Satisfaction, Practice Guidelines as Topic, Ambulatory Care methods, Anesthesia methods, Anesthesia standards
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Purpose of Review: The purpose of this review is to discuss current practices and changes in the field of ambulatory anesthesia, in both hospital and ambulatory surgery center settings. New trends in ambulatory settings are discussed and a review of the most current and comprehensive guidelines for the care of ambulatory patients with comorbid conditions such as postoperative nausea and vomiting (PONV), obstructive sleep apnea and diabetes mellitus are reviewed. Future direction and challenges to the field are highlighted., Recent Findings: Ambulatory anesthesia continues to be in high demand for many reasons; patients and surgeons want their surgical procedures to be swift, involve minimal postoperative pain, have a transient recovery time, and avoid an admission to the hospital. Factors that have made this possible for patients are improved surgical equipment, volatile anesthetic improvement, ultrasound-guided regional techniques, non-narcotic adjuncts for pain control, and the minimization of PONV. The decrease in time spent in a hospital also decreases the risk of wound infection, minimizes missed days from work, and is a socioeconomically favorable model, when possible. Recently proposed strategies which will allow surgeons and anesthesiologists to continue to meet the growing demand for a majority of surgical cases being same-day include pharmacotherapies with less undesirable side-effects, integration of ultrasound-guided regional techniques, and preoperative evaluations in appropriate candidates via a telephone call the night prior to surgery. Multidisciplinary communication amongst caregivers continues to make ambulatory settings efficient, safe, and socioeconomically favorable.It is also important to note the future impact that healthcare reform will have specifically on ambulatory anesthesia. The enactment of the Patient Protection and Affordable Care Act of 2010 will allow 32 million more people to gain access to preventive services that will require anesthesia such as screening colonoscopies. With this projected increase in the demand for anesthesia services nationwide comes the analysis of its financial feasibility. Some early data looking at endoscopist-administered sedation conclude that it offers higher patient satisfaction, there were less adverse effects than anesthesiologist-administered sedation, and is economically advantageous. This and future retrospective studies will help to guide healthcare policymakers and physicians to come to a conclusion about providing ambulatory services for these millions of patients., Summary: Ambulatory anesthesia's popularity continues to rise and anesthetic techniques will continue to morph and adapt to the needs of patients seeking ambulatory surgery. Alterations in already existing medications are promising as these modifications allow for quicker recovery from anesthesia or minimization of the already known undesirable side-effects. PONV, pain, obstructive sleep apnea, and chronic comorbidities (hypertension, cardiac disease, and diabetes mellitus) are perioperative concerns in ambulatory settings as more patients are safely being treated in ambulatory settings. Regional anesthesia stands out as a modality that has multiple advantages to general anesthesia, providing a minimal recovery period and a decrease in postanesthesia care unit stay. The implementation of the Affordable Healthcare Act specifically affects ambulatory settings as the demand and need for patients to have screening procedures with anesthesia. The question remains what the best strategy is to meet the needs of our future patients while preserving economically feasibility within an already strained healthcare system.
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- 2015
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16. Providing Value in Ambulatory Anesthesia in 2015.
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Fosnot CD, Fleisher LA, and Keogh J
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- Humans, Ambulatory Surgical Procedures, Anesthesia standards, Anesthesiology standards, Postoperative Complications prevention & control
- Abstract
Ambulatory anesthesia's popularity continues to increase and techniques continue to adapt to the needs of patients. Alterations in existing medications are promising. Postoperative nausea and vomiting, pain, obstructive sleep apnea, and chronic comorbidities are concerns in ambulatory settings. Regional anesthesia has multiple advantages over general anesthesia. The implementation of the Affordable Health Care Act specifically affects ambulatory settings as the demand and need for patients to undergo screening procedures with anesthesia. The question remains what the best strategy is to meet the needs of our future patients while preserving economic feasibility within an already strained health care system., (Copyright © 2015 Elsevier Inc. All rights reserved.)
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- 2015
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17. Geriatric Anesthesia: Can We Achieve the Goal of Returning our Elderly to Baseline or Improved Function?
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Fleisher LA
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- Aged, Aged, 80 and over, Goals, Humans, Anesthesia trends, Anesthesiology trends, Geriatrics trends
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- 2015
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18. The impact of anesthesiologists on coronary artery bypass graft surgery outcomes.
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Glance LG, Kellermann AL, Hannan EL, Fleisher LA, Eaton MP, Dutton RP, Lustik SJ, Li Y, and Dick AW
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- Aged, Anesthesia methods, Anesthesia mortality, Comorbidity, Coronary Artery Bypass mortality, Female, Hospital Mortality, Humans, Logistic Models, Male, Multivariate Analysis, New York, Odds Ratio, Postoperative Complications mortality, Postoperative Complications prevention & control, Retrospective Studies, Risk Assessment, Risk Factors, Treatment Outcome, Workforce, Anesthesia adverse effects, Anesthesiology methods, Clinical Competence, Coronary Artery Bypass adverse effects, Physician's Role, Postoperative Complications etiology
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Background: One of every 150 hospitalized patients experiences a lethal adverse event; nearly half of these events involves surgical patients. Although variations in surgeon performance and quality have been reported in the literature, less is known about the influence of anesthesiologists on outcomes after major surgery. Our goal of this study was to determine whether there is significant variation in outcomes between anesthesiologists after controlling for patient case mix and hospital quality., Methods: Using clinical data from the New York State Cardiac Surgery Reporting System, we conducted a retrospective observational study of 7920 patients undergoing isolated coronary artery bypass graft surgery. Multivariable logistic regression modeling was used to examine the variation in death or major complications (Q-wave myocardial infarction, renal failure, stroke) across anesthesiologists, controlling for patient demographics, severity of disease, comorbidities, and hospital quality., Results: Anesthesiologist performance was quantified using fixed-effects modeling. The variability across anesthesiologists was highly significant (P < 0.001). Patients managed by low-performance anesthesiologists (corresponding to the 25th percentile of the distribution of anesthesiologist risk-adjusted outcomes) experienced nearly twice the rate of death or serious complications (adjusted rate 3.33%; 95% confidence interval [CI], 3.09%-3.58%) as patients managed by high-performance anesthesiologists (corresponding to the 75th percentile) (adjusted rate 1.82%; 95% CI, 1.58%-2.10%). This performance gap was observed across all patient risk groups., Conclusions: The rate of death or major complications among patients undergoing coronary artery bypass graft surgery varies markedly across anesthesiologists. These findings suggest that there may be opportunities to improve perioperative management to improve outcomes among high-risk surgical patients.
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- 2015
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19. Ambulatory anesthesia.
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Fleisher LA
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- Humans, Ambulatory Surgical Procedures methods, Anesthesia methods
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- 2014
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20. Cardiac anesthesia. Foreward.
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Fleisher LA
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- Humans, Anesthesia methods, Cardiac Surgical Procedures methods
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- 2013
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21. Thoracic Anesthesia. Foreword.
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Fleisher LA
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- Humans, Anesthesia methods, Thoracic Surgical Procedures methods
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- 2012
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22. Estimating anesthesia time using the medicare claim: a validation study.
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Silber JH, Rosenbaum PR, Even-Shoshan O, Mi L, Kyle FA, Teng Y, Bratzler DW, and Fleisher LA
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- Aged, Female, Humans, Insurance Claim Review, Male, Regression Analysis, Time Factors, United States, Anesthesia, Medicare
- Abstract
Introduction: Procedure length is a fundamental variable associated with quality of care, though seldom studied on a large scale. The authors sought to estimate procedure length through information obtained in the anesthesia claim submitted to Medicare to validate this method for future studies., Methods: The Obesity and Surgical Outcomes Study enlisted 47 hospitals located across New York, Texas, and Illinois to study patients undergoing hip, knee, colon, and thoracotomy procedures. A total of 15,914 charts were abstracted to determine body mass index and initial patient physiology. Included in this abstraction were induction, cut, close, and recovery room times. This chart information was merged to Medicare claims that included anesthesia Part B billing information. Correlations between chart times and claim times were analyzed, models developed, and median absolute differences in minutes calculated., Results: Of the 15,914 eligible patients, there were 14,369 for whom both chart and claim times were available for analysis. For these 14,369, the Spearman correlation between chart and claim time was 0.94 (95% CI 0.94, 0.95), and the median absolute difference between chart and claim time was only 5 min (95% CI: 5.0, 5.5). The anesthesia claim can also be used to estimate surgical procedure length, with only a modest increase in error., Conclusion: The anesthesia bill found in Medicare claims provides an excellent source of information for studying surgery time on a vast scale throughout the United States. However, errors in both chart abstraction and anesthesia claims can occur. Care must be taken in the handling of outliers in these data.
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- 2011
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23. Current topics in anesthesia for head and neck surgery. Foreword.
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Fleisher LA
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- Anesthetics, Head and Neck Neoplasms surgery, Humans, Minimally Invasive Surgical Procedures, Anesthesia, Anesthesiology trends, Head surgery, Neck surgery, Otorhinolaryngologic Surgical Procedures trends
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- 2010
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24. Cutting-edge topics in pediatric anesthesia. Foreword.
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Fleisher LA
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- Humans, Anesthesia, Hospitals, Pediatric
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- 2009
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25. Anesthesia outside the operating room. Foreword.
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Fleisher LA
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- Humans, Operating Rooms, Ambulatory Surgical Procedures, Anesthesia
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- 2009
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26. Is there value in obtaining a patient's willingness to pay for a particular anesthetic intervention?
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Macario A and Fleisher LA
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- Cost-Benefit Analysis, Humans, Quality-Adjusted Life Years, Anesthesia economics, Anesthesia psychology, Patients psychology
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- 2006
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27. Preoperative evaluation.
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Fleisher LA
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- Humans, Anesthesia, Preoperative Care
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- 2004
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28. Perioperative risk: how can we study the influence of provider characteristics?
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Fleisher LA and Anderson GF
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- Anesthesia Department, Hospital organization & administration, Humans, Intraoperative Complications mortality, Medicare, Risk Assessment, Surgical Procedures, Operative mortality, Anesthesia mortality, Health Personnel, Intraoperative Complications epidemiology
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- 2002
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29. Anesthesia in High-Risk Surgical Patients with Uncommon Disease
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Gold, Andrew K., Mandelbaum, Tam, Fleisher, Lee A., Aseni, Paolo, editor, Grande, Antonino Massimiliano, editor, Leppäniemi, Ari, editor, and Chiara, Osvaldo, editor
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- 2023
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30. Adherence to recommended practices for perioperative anesthesia care for older adults among US anesthesiologists: results from the ASA Committee on Geriatric Anesthesia-Perioperative Brain Health Initiative ASA member survey
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Deiner, Stacie, Fleisher, Lee A, Leung, Jacqueline M, Peden, Carol, Miller, Thomas, and Neuman, Mark D
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Biomedical and Clinical Sciences ,Clinical Sciences ,Aging ,Brain Disorders ,Health Services ,Acquired Cognitive Impairment ,Dementia ,Clinical Research ,Cancer ,Mental Health ,Management of diseases and conditions ,7.1 Individual care needs ,Neurological ,Geriatrics ,Anesthesia ,Cognition ,Frailty ,ASA Committee on Geriatric Anesthesia and the ASA Perioperative Brain Health Initiative ,Clinical sciences - Abstract
BackgroundWhile specific practices for perioperative care of older adults have been recommended, little is known regarding adherence by US physician anesthesiologists to such practices. To address this gap in knowledge, the ASA Committee on Geriatric Anesthesia and the ASA Perioperative Brain Health Initiative undertook a survey of ASA members to characterize current practices related to perioperative care of older adults.MethodsWe administered a web-based questionnaire with items assessing the proportion of practice focused on delivery of care to older adults, adherence to recommended practices for older surgical patients, resource needs to improve care, and practice characteristics.ResultsResponses were collected between May 24, 2018, and June 29, 2018. A total of 25,587 ASA members were invited to participate, and 1737 answered at least one item (6.8%). 96.4% of respondents reported that they had cared for a patient aged 65 or older within the last year. 47.1% of respondents (95% confidence interval, 44.6%, 49.7%) reported using multimodal analgesia among patients aged 65 and older at least 90% of the time, and 25.5% (95% CI, 23.3%, 27.7%) provided preoperative information regarding postoperative cognitive changes at least 90% of the time. Over 80% of respondents reported that preoperative screening for frailty or dementia, postoperative screening for delirium, and preoperative geriatric consultation occurred in fewer than 10% of cases. Development of practice guidelines for geriatric anesthesia care and expansion of web-based resources were most frequently prioritized by respondents as initiatives to improve care in this domain.DiscussionMost survey respondents reported providing anesthesia care to older adults, but adherence to recommended practices varied across the six items assessed. Reported rates of screening for common geriatric syndromes, such as frailty, delirium, and dementia, were low among survey respondents. Respondents identified multiple opportunities for ASA initiatives to support efforts to improve care for older surgical patients.
- Published
- 2020
31. Non-Operating Room Anesthesia E-Book
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Fleisher, Lee A., Weiss, Mark S., Fleisher, Lee A., and Weiss, Mark S.
- Subjects
- Anesthesia
- Abstract
The demand for anesthesiologists outside of the operating room continues to grow as the number of minimally invasive procedures proliferates and the complexity of diagnostic procedures undertaken outside of the OR increase. Non-Operating Room Anesthesia is an easy-to-access, highly visual reference that facilitates an in-depth understanding of NORA procedures and protocols needed to minimize risk and complications and to maximize growth opportunities. Effectively assess and manage risks and differences in procedures through in-depth discussions addressing the unique challenges and issues associated with non-traditional settings. Review the most recent knowledge with updated coverage of the use of the electrophysiology lab (EPL) and cardiac catheterization laboratory (CCL) in the care of the critically ill patient; patient assessment; and anesthetic considerations. Prepare for varying anesthetic conditions in non-OR settings with in-depth discussions on communication, management, and laboratory preparation for anticipated concerns or complications. Glean all essential, up-to-date, need-to-know information about NORA with coverage that surpasses the depth and scope of review articles and other references. Focus on the practical guidance you need thanks to a user-friendly color-coded format, key points boxes, drug descriptions, checklist boxes (for monitors, equipment, and drugs), and over 400 color photos that help you visualize each procedure and setting.
- Published
- 2015
32. Essência da Prática Anestésica
- Author
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Fleisher, Lee A., Roizen, Michael F., Fleisher, Lee A., and Roizen, Michael F.
- Subjects
- Anesthesia
- Abstract
Problemas, causas, comorbidades e implicações anestésicas de mais de 600 tópicos clínicos, entre doenças, procedimentos, medicamentos e medicina alternativa. As últimas implicações anestésicas em relação a doenças coexistentes, procedimentos, medicamentos e terapias alternativas e complementares, incluindo a cobertura de miopatia mitocondrial, ablação de fibrilação atrial, craniotomia com o paciente acordado, neurocirurgia estereotáxica, neuroproteção, dexmedetomidina e outros tópicos recentes. Formato coerente que aborda um único tópico clínico em cada página, com uma revisão de seus problemas, causas, comorbidades e implicações anestésicas. Texto cuidadosamente padronizado, que destaca as considerações anestésicas mais importantes em cada tópico. Abrangência confiável e moderna de uma equipe internacional de especialistas que discute condições comuns e raras e como tratá-las.
- Published
- 2014
33. An ICU Preanesthesia Evaluation Form Reduces Missing Preoperative Key Information
- Author
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Liu Renyu, Chuy Katherine, Fleisher Lee, and Yan Zhe
- Subjects
Final version ,Icu patients ,medicine.medical_specialty ,Computer science ,business.industry ,medicine.disease ,Bioinformatics ,Intensive care unit ,Article ,law.invention ,Anesthesiology and Pain Medicine ,law ,Anesthesia ,Emergency medicine ,Key (cryptography) ,medicine ,Medical emergency ,business ,Preanesthesia evaluation - Abstract
A comprehensive preoperative evaluation is critical for providing anesthetic care for patients from the intensive care unit (ICU). There has been no preoperative evaluation form specific for ICU patients that allows for a rapid and focused evaluation by anesthesia providers, including junior residents. In this study, a specific preoperative form was designed for ICU patients and evaluated to allow residents to perform the most relevant and important preoperative evaluations efficiently.The following steps were utilized for developing the preoperative evaluation form: 1) designed a new preoperative form specific for ICU patients; 2) had the form reviewed by attending physicians and residents, followed by multiple revisions; 3) conducted test releases and revisions; 4) released the final version and conducted a survey; 5) compared data collection from new ICU form with that from a previously used generic form. Each piece of information on the forms was assigned a score, and the score for the total missing information was determined. The score for each form was presented as mean ± standard deviation (SD), and compared by unpairedOf 52 anesthesiologists (19 attending physicians, 33 residents) responding to the survey, 90% preferred the final new form; and 56% thought the new form would reduce perioperative risk for ICU patients. Forty percent were unsure whether the form would reduce perioperative risk. Over a three month period, we randomly collected 32 generic forms and 25 new forms. The average score for missing data was 23 ± 10 for the generic form and 8 ± 4 for the new form (P = 2.58E-11).A preoperative evaluation form designed specifically for ICU patients is well accepted by anesthesia providers and helped to reduce missing key preoperative information. Such an approach is important for perioperative patient safety.
- Published
- 2012
34. Commentary: What Conclusions Can We Draw from Recent Analyses of Anesthesia Provider Model and Patient Outcomes?
- Author
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Neuman, Mark D., Schwartz, J. Sanford, and Fleisher, Lee A.
- Subjects
ANESTHESIA ,MEDICAL research ,MEDICAL care ,REGRESSION analysis ,MULTIVARIATE analysis - Abstract
The article offers the authors' comment on a study that explores the relationship between anesthesia provider credentials and maternal outcomes conducted by A.F. Minnick and J. Needleman. According to authors the researchers have employed multivariable regression techniques to examine an important and challenging clinical and policy research question. It is stated that this study cannot support definitive conclusions about the relative safety of differing anesthesia provider models.
- Published
- 2010
- Full Text
- View/download PDF
35. Risk stratification.
- Author
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Vernick, William and Fleisher, Lee A.
- Subjects
SURGICAL complications ,CORONARY disease ,HEALTH risk assessment ,DECISION making ,THERAPEUTICS ,MYOCARDIAL revascularization ,ADRENERGIC beta blockers ,CORONARY heart disease prevention ,CORONARY heart disease treatment ,PREVENTION of surgical complications ,TREATMENT of surgical complications ,ALGORITHMS ,ELECTROCARDIOGRAPHY ,EXERCISE tests ,RISK assessment ,PREDICTIVE tests ,PERIOPERATIVE care - Abstract
Perioperative cardiac complications pose the greatest risk to the estimated 100 million people undergoing non-cardiac surgery each year. Most of these complications are related to underlying pre-existing coronary artery disease (CAD). For over 40 years researchers have been studying perioperative cardiac risk and how best to estimate it. The goal of improved risk stratification is important for allowing accurate informed decision-making, both by the patient and their physicians. Risk stratification has taken on an important role in clinical decision-making, helping physicians decide in which patients additional medical therapies, such as coronary revascularization or perioperative beta-blockers, are necessary. Meta-analysis has found a significant improvement in the positive predictive value (PPV) for perioperative cardiac outcome with stress testing over that with clinical risk score alone. However, evidence is mounting that with the use of perioperative beta-blockers, the majority of intermediate and high-risk patients can safely undergo even major vascular surgery without further cardiac testing. [Copyright &y& Elsevier]
- Published
- 2008
- Full Text
- View/download PDF
36. 2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery
- Author
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Fleisher, Lee A., Beckman, Joshua A., Brown, Kenneth A., Calkins, Hugh, Chaikof, Elliot L., Fleischmann, Kirsten E., Freeman, William K., Froehlich, James B., Kasper, Edward K., Kersten, Judy R., Riegel, Barbara, and Robb, John F.
- Published
- 2009
- Full Text
- View/download PDF
37. A comparison of the remifentanil and fentanyl adverse effect profile in a multicenter phase IV study
- Author
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Joshi, Girish P., Warner, David S., Twersky, Rebecca S., and Fleisher, Lee A.
- Subjects
- *
ANESTHESIA , *DRUG side effects - Abstract
: Study objectiveTo compare the frequency of adverse effects of remifentanil and fentanyl in a large and diverse patient population.: DesignProspective, randomized, open-label study.: SettingMulticenter study including academic and community hospitals.: Patients2,438 adult patients (1,496 outpatients and 942 inpatients) scheduled for elective surgical procedures under general endotracheal anesthesia of at least 30-minute duration.: InterventionsPatients were randomly assigned to receive either intravenous (IV) remifentanil (n = 1,229) 0.5 μg/kg/min for induction and tracheal intubation followed by an infusion rate of 0.25 μg/kg/min or fentanyl (n = 1,209) administered according to the anesthesiologist’s usual practice. Anesthesia was maintained with propofol and/or isoflurane (with or without nitrous oxide) titrated according to protocol. Transition analgesia with either morphine or fentanyl was administered in the remifentanil and, at the anesthesiologist’s discretion, in the fentanyl group.: MeasurementsThe overall nonspecific and specific (i.e., opioid-related) adverse effects were recorded.: Main resultsRemifentanil was associated with more intraoperative hypotension than fentanyl (p< 0.05). All four cases (0.3%) of muscle rigidity occurred in the remifentanil-treated outpatients. There were no significant differences between the two drugs with respect to other adverse events (i.e., episodes of hypertension, bradycardia, respiratory depression, and apnea).: ConclusionsIn the doses used, both remifentanil and fentanyl have a similar frequency of adverse effects except for the higher frequency of hypotension associated with the use of remifentanil. [Copyright &y& Elsevier]
- Published
- 2002
- Full Text
- View/download PDF
38. The association of intraoperative neuraxial anesthesia on anticipated admission to the intensive care unit
- Author
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Kaufmann, Sandra C., Wu, Christopher L., Pronovost, Peter J., Jermyn, Roland M., and Fleisher, Lee A.
- Subjects
- *
NEUROPHYSIOLOGIC monitoring , *INTENSIVE care units , *POSTOPERATIVE care , *ANESTHESIA - Abstract
: Study objectiveTo determine whether use of intraoperative neuraxial anesthesia would decrease the frequency of ICU admission postoperatively in orthopedic patients.: DesignRetrospective chart review.: SettingUniversity hospital.: MeasurementsWe reviewed the data from all patients who underwent elective total knee or hip replacements from January 1, 1999 to September 30, 2000 and were preoperatively scheduled for ICU admission following surgery. We recorded patient demographic data, presence of comorbidities, intraoperative data, and location of postoperative recovery.: Main resultsOf the 361 patients having total knee and hip replacements, 88 patients were scheduled for postoperative ICU admission. Forty-five patients underwent neuraxial (epidural or spinal) anesthesia, 38 patients received general anesthesia, and 5 patients received a combination of both neuraxial and general anesthesia. Patients who received neuraxial anesthesia had a significantly lower rate of actual ICU admission when compared with those who received intraoperative general anesthesia (11/45 or 24% vs. 22/38 or 58%, p = 0.002). Patients who received neuraxial anesthesia had shorter anesthesia and surgical times when compared with those who received general anesthesia.: ConclusionsIntraoperative neuraxial anesthesia in higher-risk patients undergoing elective hip or knee replacement surgery is associated with a decrease in anticipated ICU admission postoperatively. A causal relationship cannot be determined with this type of study and further research is needed to better understand this association. [Copyright &y& Elsevier]
- Published
- 2002
- Full Text
- View/download PDF
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