The Fascia Iliaca Block as the Primary Intraoperative Anesthesia for Hip Fracture Surgery: A Preliminary Study.

Background: Early surgical intervention for hip fractures in the elderly has proven efficacious. However, surgical delays commonly occur in this patient population due to comorbid conditions that put these patients at a high risk for hypotension-related complications of general or neuraxial anesthesia or anticoagulants that delay the safe use of neuraxial anesthesia.

Questions/purposes: The questions/purposes of this study are (1) to investigate if a fascia iliaca block in conjunction with light to moderate sedation could provide adequate analgesia throughout open surgery for intertrochanteric hip fractures (AO/OTA 31-1) without requiring conversion to general anesthesia with airway support and (2) to assess its perioperative complication profile.

Improvement in Outcomes of Major Obstetric Hemorrhage Through Systematic Change.

Objective: To report the outcomes over 14 years of sustained systematic institutional focus on the care of women with major obstetric hemorrhage, defined as estimated blood loss greater than 1,500 mL.

Methods: A retrospective cohort study of women with major obstetric hemorrhage at our hospital from 2000 to 2014 compares baseline conditions (age, multiparity, prior cesarean delivery, morbidly adherent placenta), morbidity (lowest mean temperature, lowest mean pH, coagulopathy, hysterectomy), and mortality among three time periods (period 1=January 2000 to December 2001, period 2=January 2002 to August 2005, period 3=September 2005 to December 2014). We also describe the systematic changes that helped to sustain our improved outcomes.

Prophylactic vs therapeutic blood patch for obstetric patients with accidental dural puncture--a randomised controlled trial.

Epidural blood patch is a standard treatment for obstetric patients experiencing a severe post-dural puncture headache. Patients who sustained an accidental dural puncture during establishment of epidural analgesia during labour or at caesarean delivery were randomly assigned to receive a prophylactic epidural blood patch or conservative treatment with a therapeutic epidural blood patch if required. Eleven of 60 (18.

Improving hospital systems for the care of women with major obstetric hemorrhage.

Objective: When 2 maternal deaths due to hemorrhage occurred at New York Hospital Queens in 2000-2001, a multidisciplinary team implemented systemic change. Our objective was to improve outcomes of episodes of major obstetric hemorrhage.

Methods: We report outcomes before (2000-2001) and after (2002-2005) the introduction of a patient safety program aimed at improving the care of women with major obstetric hemorrhage.

Bupivacaine 0.01% and/or epinephrine 0.5 microg/ml improve epidural fentanyl analgesia after cesarean section.

Background: The authors studied the addition of bupivacaine and epinephrine, separately and together, to epidural fentanyl to determine whether this improved postcesarean analgesia and reduced the incidence of side effects.

Methods: After elective cesarean section, 100 parturient patients who received fentanyl (3 microg/ml) epidurally for 48 h were allocated randomly in a double-blinded manner to four groups to receive, in addition to the study solution, 0.01% bupivacaine, 0.