Outcomes for 41 260 pediatric surgical patients with opioid-free anesthesia: One center's experience.

Background: Opioid use is common and associated with side effects and risks. Consequently, analgesic strategies to reduce opioid utilization have been developed. Regional anesthesia and multimodal strategies are central tenets of enhanced recovery pathways and facilitate reduced perioperative opioid use.

Lean methodology in quality improvement.

Measurement of quality and improvement in medicine has existed since Florence Nightingale's time. In modern times, medicine has sought to learn from other high-reliability industries such as aviation and nuclear power, where errors can result in catastrophic outcomes. Lean is a unique quality improvement strategy that seeks to improve both quality and safety by driving out waste and, where possible, standardizing work practices.

Perioperative acute kidney injury: impact and recent update.

Purpose Of Review: Acute kidney injury (AKI) is common in hospitalized patients and is a major risk factor for increased length of stay, morbidity, and mortality in postoperative patients. There are multiple barriers to reducing perioperative AKI - the etiology is multi-factorial and the diagnosis is fraught with issues. We review the recent literature on perioperative AKI and some considerations for anesthesiologists that examine the far-reaching effects of AKI on multiple organ systems.

A Comparison of the Minimal-Touch Technique and the Eversion Technique for Microvascular Anastomosis in a Rat Model.

 During microvascular anastomosis, needle placement is facilitated by inserting the tips of the forceps into the lumen of the vessel, rather than grasping and everting the luminal wall, to minimize trauma to the vessel. This study examines whether the vessel wall can be grasped and everted during microvascular anastomosis without compromising surgical outcomes.  A total of 20 Sprague-Dawley rats weighing between 252 and 483 g were used.

Effect of white adipose tissue flap and insulin-like growth factor-1 on nerve regeneration in rats.

Adipose tissue-derived stem cells and insulin-like growth factor-1 (IGF-1) have shown potential to enhance peripheral nerve regeneration. The purpose of this study was to investigate the effect of an in vivo biologic scaffold, consisting of white adipose tissue flap (WATF) and/or IGF-1 on nerve regeneration in a crush injury model. Forty rats all underwent a sciatic nerve crush injury and then received: a pedicled WATF, a controlled local release of IGF-1, both treatments, or no treatment at the injury site.

Palliative surgery for head and neck cancer with extensive skin involvement.

Objectives/hypothesis: To evaluate the role of regional and free tissue transfer for the palliative management of head and neck cancer with extensive skin involvement.

Study Design: Case Series.

Methods: A retrospective review was performed of patients treated for head and neck cancer with involvement of the skin at the Mount Sinai Medical Center over a 5-year period (2006-2010).

Incentive spirometry for the tracheostomy patient.

Objective: To determine the feasibility of developing and using a customized incentive spirometer device for patients who have undergone a tracheostomy procedure.

Study Design: The authors performed a prospective case series approved by the institutional review board.

Setting: Academic medical center.

A systematic review of head and neck cancer quality of life assessment instruments.

Although quality of life (QOL) is an important treatment outcome in head and neck cancer (HNC), cross-study comparisons have been hampered by the heterogeneity of measures used and the fact that reviews of HNC QOL instruments have not been comprehensive to date. We performed a systematic review of the published literature on HNC QOL instruments from 1990 to 2010, categorized, and reviewed the properties of the instruments using international guidelines as reference. Of the 2766 articles retrieved, 710 met the inclusion criteria and used 57 different head and neck-specific instruments to assess QOL.