Pain Management With lnterventional Spine Therapy in Patients With Spinal Cord Injury: A Case Series

Abstract

Background/Objective: Chronic pain is common in patients with spinal cord injury (SCI). Any newstrategy that is effective in treating this problem would be welcomed by this patient population.

Methods: A case series is presented of SCI with neuropathic pain. In these 3 cases, interventional spinetherapy is used as a diagnostic and/or therapeutic tool in the management of pain.

Results: In the cases presented, interventional spine therapy proved useful in identifying the patient's paingenerator. In most cases, the intervention was effective in reducing pain for a long enough period to serve asan effective pain management strategy. Other associated problems, such as spasticity, were similarlyreduced.

Conclusion: lnterventional spine therapy should be considered as a tool in the armamentarium of any SCIphysician managing their patient's chronic pain.     

Blood Utilization After Primary Total Joint Arthroplasty in a Large Hospital Network

Background

Since a study in orthopedic hip fracture patients demonstrated that a liberal hemoglobin (Hb) threshold does not improve patient morbidity and mortality relative to a restrictive Hb threshold, the standard of care in total joint arthroplasty (TJA) should be examined to understand the variability of red blood cell (RBC) transfusion following TJA.

Questions/purposes

The study aimed to answer the following questions: (1) What is the blood utilization rate after primary TJA for individual surgeons within a large hospital network? (2) What is the comparison of hospital charges, length of stay (LOS), and discharge locations among TJA patients who were and were not transfused?

Methods

A retrospective study was conducted on 3,750 primary total knee arthroplasties (TKAs) and 2,070 primary total hip arthroplasties (THAs), and data was retrospectively collected over a 15-month period on the number of RBCs transfused per patient, along with demographic and cost details. The number of patients who received at least 1 RBC unit and the number of RBCs transfused per patient was calculated and stratified by surgeon.

Results

In the postoperative period, 19.3% TKA patients and 38.5% THA patients received a RBC transfusion. Transfusion rates following TJA varied widely between surgeons (TKA 4.8–63.8%, THA 4.3–86.8%). Transfused TKA patients received an average of 1.65 ± 0.03 RBCs, and THA patients received an average of 1.97 ± 0.14 RBCs. LOS and hospital charges for blood transfusion patients were higher than nontransfused patients.

Conclusion

Blood utilization after primary TJA varies greatly among surgeons, suggesting that resources may be misallocated. These findings highlight the need to standardize RBC transfusion practice following TJA.

Electronic supplementary material

The online version of this article (doi:10.1007/s11420-013-9327-y) contains supplementary material, which is available to authorized users.     

不能气管插管不能氧合状态的紧急处理策略

背景 不能气管插管不能氧合状态(“cannot intubate,cannot oxygenate”situation,CICO)是指气管插管失败的同时采用无创方法不能维持患者满意的氧合,是麻醉和急诊治疗中的紧急情况之一.在CICO状态时,为了避免缺氧性脑损害甚至死亡的发生,应立即实施紧急经皮气道. 目的 介绍与CICO状态有关的一些知识. 内容 重点阐述CICO的发生率和原因、具有CICO状态危险患者的麻醉管理、常用的紧急经皮气道技术、紧急经皮气道技术的并发症、再氧合后患者的处理和紧急经皮气道技术的培训. 趋向 明确高危因素和制定合理的麻醉处理方案是降低CICO发生率和严重性的合理路径.为了挽救CICO患者的生命,除了所需的合适设备之外,更重要的是要具有经过良好培训的专业人员,其能够在患者发生不可逆性脑损伤或死亡前作出实施紧急经皮气道技术的决定,并且能够迅速成功地实施紧急经皮气道技术.     

Operative terminology and post-operative management approaches applied to hepatic surgery:Trainee perspectives

Outcomes in hepatic resectional surgery(HRS) have improved as a result of advances in the understanding of hepatic anatomy,improved surgical techniques, and enhanced peri-operative management.Patients are generally cared for in specialist higher-level ward settings with multidisciplinary input during the initial post-operative period,however,greater acceptance and understanding of HRS has meant that care is transferred,usually after 24-48 h,to a standard ward environment.Surgical trainees will be presented with such patients either electively as part of a hepatobiliary firm or whilst covering the service on-call,and it is therefore important to acknowledge the key points in managing HRS patients.Understanding the applied anatomy of the liver is the key to determining the extent of resection to be undertaken.Increasingly,enhanced patient pathways exist in the post-operative setting requiring focus on the delivery of high quality analgesia,careful fluid balance,nutrition and thromboprophlaxis.Complications can occur including liver,renal and respiratory failure,hemorrhage,and sepsis,all of which require prompt recognition and management.We provide an overview of the relevant terminology applied to hepatic surgery,an approach to the post-operative management,and an aid to developing an awareness of complications so as to facilitate better confidence in this complex subgroup of general surgical patients.     

Management of the complications of tissue expansion during a 5-year period (2005–2010)

Abstract

We report our experience of using tissue expansion where we deal particularly with complications and their management. Forty patients had tissue expanded during a 5-year period (2005-2010). Indications included reconstruction of a scar (after a burn, after injury, or postoperative), congenital naevi, microtia, and breast reconstruction after mastecomy. Of the 50 expanders inserted, complications occurred in 12 (10 patients). Exposure and perforation of the expander were the most common complications, followed by infection, seroma, and local pain. In all cases, complications were managed successfully either by conservative treatment or by a single procedure. The reconstructive plan ended in an acceptable aesthetic result in 9 of the 10 complicated areas. The insertion of multiple expanders over extensive scar tissue and particularly over the lower limb, is associated with high morbidity. Selection of patients, identification of high-risk sites, and suggestions for treatment are important. When complications occur, immediate management usually results in a successful outcome.     

Assessing production characteristics, influential factors and administrative policies in a multicenter dental organization

BackgroundIn multicenter service organizations, managers often make centralized decisions without considering the effects of differing production characteristics and influential factors on each center.MethodsIn this study, the author examines differences in production characteristics and factors that influence production, as well as their likely effect on policy formulation, in a large, six-center dental group in the Chicago area.ResultsThe results of the study show that the six centers (in two groups) exhibited two distinct production patterns, with three having logarithmic distributions and three having normal distributions. Production differences between the groups likely resulted from differences in managed care, staffing and dental procedures performed.ConclusionsInstead of being monolithic, the organization exhibited two types of centers, each with its own production characteristics and factors that influenced production.Practice ImplicationsThe study results suggest that large service corporations and partnerships would benefit from conducting analyses of production characteristics and factors that influence production before making policy decisions that affect the entire organization.