Preoperative sleep apnea screening protocol reduces medical emergency team activation in patients with atrial fibrillation.

Study Objectives: The association of in-hospital medical emergency team activation (META) among patients with atrial fibrillation (AF) at risk for obstructive sleep apnea (OSA) is unclear. This study evaluates the performance of the DOISNORE50 sleep questionnaire as an OSA screener for patients with AF and determines the prevalence of META among perioperative patients with underlying AF who have a diagnosis or are at risk for OSA.

Methods: A prospective perioperative cohort of 2,926 patients with the diagnosis of AF was assessed for DOISNORE50 questionnaire screening.

Reduction in medical emergency team activation among postoperative surgical patients at risk for undiagnosed obstructive sleep apnea.

Study Objectives: Obstructive sleep apnea (OSA) is an under-recognized condition that results in morbidity and mortality. Postoperative complications, including medical emergency team activation (META), are disproportionally increased among surgical patients at risk for OSA. A systematic approach is needed to improve provider recognition and treatment, but protocols that demonstrate improvement in META are lacking.

DOISNORE50: a perioperative sleep questionnaire predictive of obstructive sleep apnea and postoperative medical emergency team activation. A learning health system approach to sleep questionnaire development and screening.

Study Objectives: Patients with obstructive sleep apnea (OSA) have a disproportionate increase in postoperative complications and medical emergency team activation (META). We previously introduced DOISNORE50 (iseases, bserved apnea, nsomnia, noring, eck circumference > 18 inches, besity with BMI > 32, = are you male, xcessive daytime sleepiness, = age ≥ 50) from sleep questionnaire ISNORED using features associated with increased odds of META in perioperative patients. Performance of DOISNORE50 (DOISNORE) had yet to be tested.

Hypokalemic Periodic Paralysis Masquerading as a Compressive Neuraxial Lesion Following Lumbar Epidural Placement in a Parturient: A Case Report.

We report the management of a parturient with undiagnosed hypokalemic periodic paralysis (HOKPP) who underwent epidural analgesia for labor, complicated by an unintentional dural puncture, and the eventual use of epidural anesthesia for cesarean delivery. Following discharge, she represented with lower extremity paresis. After being evaluated for a compressive neuraxial lesion, she made a full recovery following potassium repletion.

Preoperative Sleep Questionnaires Identify Medical Emergency Team Activation in Older Adults.

Unlabelled: Patients with obstructive sleep apnea (OSA) have increased postoperative complications that are important for patient safety and healthcare utilization. Questionnaires help identify patients at risk for OSA; however, among older adults who preoperatively self-administered OSA questionnaires, the frequency of postoperative Medical Emergency Team Activation (META), rapid response, code blue, code stroke, is unknown.

Objectives: Identify whether having OSA questionnaires completed by patients is feasible in the preoperative clinic.

Preoperative Laboratory Testing.

Obtaining routine preoperative laboratory tests increases health care costs and has been listed, by the Choosing Wisely Campaign, as one of the top 5 practices anesthesiologists should avoid. Routine testing without clinical indication is not cost-effective and could cause harm and unnecessary delays. Abnormal findings are more likely to be false positive and costly to pursue, introduce new risks, and increase anxiety for the patient.

A Prospective Comparison of Intraluminal and Extraluminal Placement of the 9-French Arndt Bronchial Blocker in Adult Thoracic Surgery Patients.

Objective: To compare the standard intraluminal approach with the placement of the 9-French Arndt endobronchial blocker with an extraluminal approach by measuring the time to positioning and other relevant intraoperative and postoperative parameters.

Design: A prospective, randomized, controlled trial.

Setting: University hospital.

Residual Enoxaparin Activity, Anti-Xa Levels, and Concerns About the American Society of Regional Anesthesia and Pain Medicine Anticoagulation Guidelines.

Currently, the American Society of Regional Anesthesia and Pain Medicine (ASRA) anticoagulation guidelines recommend that before the performance of a neuraxial procedure a minimum of 24 hours should elapse following a treatment dose of enoxaparin (1 mg/kg twice daily or 1.5 mg/kg once daily). The guidelines have since their inception also consistently recommended against the routine use of anti-Xa level monitoring for patients receiving enoxaparin.

Physicians Report Sleep Apnea Infrequently in Older and Older Vulnerable Adults.

Objectives: To determine how often outpatient physician visits detect sleep apnea (SA) in older persons in the United States.

Design: Retrospective Analysis.

Setting: US non hospital and hospital based clinics.

Stimulation of hypoxia-inducible factor-1 alpha (HIF-1alpha) protein in the adult rat testis following ischemic injury occurs without an increase in HIF-1alpha messenger RNA expression.

Hypoxia-inducible factor 1 (HIF-1) is a transcription factor composed of alpha and beta subunits. Stabilized from proteasome degradation and activated by hypoxia, HIF-1 stimulates expression of hypoxia-sensitive genes that mediate oxygen homeostasis in many tissues. Our hypothesis is that HIF-1 is involved in the cellular response to hypoxia in the ischemic testis.