Effect of a Rapid Response Team on the Incidence of In-Hospital Mortality.

Background: Approximately half of the life-limiting events, such as cardiopulmonary arrests or cardiac arrhythmias occurring in hospitals, are considered preventable. These critical events are usually preceded by clinical deterioration. Rapid response teams (RRTs) were introduced to intervene early in the course of clinical deterioration and possibly prevent progression to an event.

Anesthetic Management and 30-Day Outcomes After Renal Autotransplantation.

Renal autotransplantation is a complex procedure performed for various indications such as treatment of renal vascular and urologic lesions and loin pain hematuria syndrome (LPHS). Because of the rarity of the procedure, few reports have been published, and little is known about anesthetic management and postoperative outcomes of patients with LPHS. The goal of this study was to review and describe all cases of renal autotransplantation performed at Cleveland Clinic during a specified period, focusing on anesthetic management and postoperative 30-day outcomes.

Continuous transversus abdominis plane block catheter analgesia for postoperative pain control in renal transplant.

Purpose: Continuous transversus abdominis plane (TAP) block using a catheter has proven its usefulness in reducing opioid requirements and pain scores after lower abdominal surgery. However, there are no reports of its successful use after renal transplant. We tested the hypothesis that continuous TAP block would retrospectively reduce opioid requirement, nausea score and hospital stay after renal transplant surgery.

Alvimopan, a peripherally acting μ-opioid receptor antagonist, is associated with reduced costs after radical cystectomy: economic analysis of a phase 4 randomized, controlled trial.

Purpose: We evaluated the effect of alvimopan treatment vs placebo on health care utilization and costs related to gastrointestinal recovery in patients treated with radical cystectomy in a randomized, phase 4 clinical trial.

Materials And Methods: Resource utilization data were prospectively collected and evaluated by cost consequence analysis. Hospital costs were estimated from 2012 Medicare reimbursement rates and medication wholesale acquisition costs.

Fenoldopam and renal function after partial nephrectomy in a solitary kidney: a randomized, blinded trial.

Objective: To test the hypothesis that fenoldopam administration ameliorates ischemic injury, preserving the glomerular filtration rate and serum creatinine postoperatively after partial nephrectomy in patients with a solitary kidney.

Materials And Methods: Fenoldopam is a short-acting dopamine-1 receptor agonist that might provide renal protection during ischemic stress. A total of 90 patients with a solitary functioning kidney who were undergoing partial nephrectomy were randomized to fenoldopam or placebo in a double-blind protocol.

The association of preoperative statin use and acute kidney injury after noncardiac surgery.

Background: Our objective was to examine the association between preoperative statin therapy and the incidence of postoperative acute kidney injury (AKI) in patients undergoing elective noncardiac surgery.

Methods: We analyzed the electronic records of 57,246 patients who had elective noncardiac surgery at the Cleveland Clinic Main Campus between December 2004 and March 2010. Patients were divided into 2 groups depending on preoperative therapy with statin drugs.

Assessment of an anesthesiology academic department mentorship program.

Background: Mentorship is perceived as important for academic department development. The purpose of this study was to survey physicians in an academic anesthesiology department before and after the initiation of a formal mentorship program to evaluate the impact of the program over a 1-year period.

Methods: The effectiveness of establishing a mentorship program to promote career advancement was prospectively and anonymously evaluated by 52 anesthesiologists in an academic, tertiary care facility with a large residency program (>130 residents).

Anesthetic considerations for robotic prostatectomy: a review of the literature.

Since the first robotic prostatectomy in 2000, the number of prostatectomies performed using robot-assisted laparoscopy has been increasing. As of 2009, 90,000 robotic radical prostatectomies were performed worldwide, and 80% of all radical prostatectomies performed in the United States were performed robotically. Robotic prostatectomy is becoming more common globally because of the many advantages offered to patients, primarily due to the minimally invasive nature of the procedure.

Upper and middle trunk brachial plexopathy after robotic prostatectomy.

We describe 3 patients who developed injury of upper and middle brachial plexus trunks during robotic-assisted prostatectomy, and review factors potentially associated with this type of injury. Three patients underwent robotic-assisted prostatectomy. Surgical exposure was facilitated by steep head-down tilt position.

Blood storage duration and biochemical recurrence of cancer after radical prostatectomy.

Objective: To test the hypothesis that perioperative transfusion of allogeneic and autologous red blood cells (RBCs) stored for a prolonged period speeds biochemical recurrence of prostate cancer after prostatectomy.

Patients And Methods: We evaluated biochemical prostate cancer recurrence in men who had undergone radical prostatectomy and perioperative blood transfusions from July 6, 1998, through December 27, 2007. Those who received allogeneic blood transfusions were assigned to nonoverlapping "younger," "middle," and "older" RBC storage duration groups.

Shock-wave lithotripsy of renal stones situated adjacent to electronic nerve stimulators.

Shock-wave lithotripsy is commonly employed for the treatment of nephrolithiasis in the pediatric patient population. This report describes such treatment of a patient with electronic nerve stimulators that were located in close proximity to bilateral renal pelvic stones. Precautions and considerations of shock-wave lithotripsy in this context are discussed.

The impact of current antiemetic practices on patient outcomes: a prospective study on high-risk patients.

Background: In this prospective, multicenter, observational study, we evaluated the incidence and time course of postoperative nausea and vomiting (PONV), assessed prophylactic and rescue antiemetic use in high-risk patients, and determined population-based effectiveness of antiemetics, including the impact of American Society of Anesthesiologists (ASA) and American Society of Perianesthesia Nurses (ASPAN) guideline compliance.

Methods: Eligible patients undergoing elective laparoscopic or major plastic surgery possessed two or more of the following Apfel PONV risk factors: female gender, history of PONV or motion sickness, and nonsmoking status. Antiemetic use, emetic episodes, severity of nausea, and functional interference due to PONV were documented during the first 72 h after surgery.

Correlation between loss of renal function and loss of renal volume after partial nephrectomy for tumor in a solitary kidney.

Purpose: We assessed the correlation between reduced renal function and parenchymal volume following partial nephrectomy.

Materials And Methods: In 21 of 42 patients with tumors in a solitary kidney who were enrolled in a study measuring function before and after surgery underwent computerized tomography, and measurement of the glomerular filtration rate and estimated glomerular filtration rate (the latter at baseline and 2 to 6 months) before and after surgery. A segmentation algorithm was used to measure renal parenchymal volume.

Ethical issues surrounding high-risk kidney recipients: implications for the living donor.

Evaulating patients for living kidney donor transplantation involving a recipient with significant medical issues can create an ethical debate about whether to proceed with surgery. Donors must be informed of the surgical risk to proceed with donating a kidney and their decision must be a voluntary one. A detailed informed consent should be obtained from high-risk living kidney donor transplant recipients as well as donors and family members after the high perioperative risk potential has been explained to them.

Upper extremity arteriovenous fistula does not affect pulse oximetry readings.

Aim: Arteriovenous fistula (AVF) is usually surgically created in a patient's upper extremity to provide adequate blood flow during haemodialysis. Blood flow distal to an AVF is altered and theoretically could change pulse oximetry (SpO2) reading, systemic blood pressure and skin temperature. The authors conducted a prospective case-control study to measure changes in these parameters in the upper extremity of patients who have had an AVF.

The effect of epidural vs intravenous analgesia for posterior spinal fusion surgery.

Background: The study objective was to compare epidural vs intravenous postoperative analgesia in posterior spinal fusion surgery patients.

Methods: This prospective, double-blinded, randomized study was performed in a tertiary care teaching hospital involving 31 American Society of Anesthesiologists physical status I and II adolescent/young adult patients scheduled for elective posterior spinal fusion surgery for idiopathic scoliosis. Patients were divided into three treatment groups according to the epidural solution infused: group 1 (n = 10) 0.

Preoperative autologous donation versus cell salvage in the avoidance of allogeneic transfusion in patients undergoing radical retropubic prostatectomy.

Unlabelled: There are many methods for preventing allogeneic blood administration during radical retropubic prostatectomy, and many of these methods have been compared with each other, but no studies have compared preoperative autologous donation (PAD) and cell salvage (CS). In this study, we evaluated these two methods in patients undergoing radical retropubic prostatectomy. In a prospective cohort model, allogeneic exposure in patients from one surgeon who routinely had his patients donate blood before surgery was compared with that in patients from a different surgeon who predominantly used CS.

Transurethral resection syndrome after bladder perforation.

The use of irrigating solutions is essential for distension of mucosal surfaces and visualization of the surgical field during resectoscopic resection of bladder tumors (TURBT). TURBT resection may be complicated with bladder perforation associated with intraperitoneal extravasation of irrigant fluid, which may rarely evolve in specific hydroelectrolyte imbalance characterized with hyponatremia, intravascular volume deficit, and renal impairment. We report four cases of TURBT syndrome during bladder surgery complicated by bladder perforation and discuss issues relevant to pathophysiology, diagnosis, and treatment of this rare condition.

Diaspirin-crosslinked hemoglobin reduces blood transfusion in noncardiac surgery: a multicenter, randomized, controlled, double-blinded trial.

Unlabelled: In this randomized, prospective, double-blinded clinical trial, we sought to investigate whether diaspirin-crosslinked hemoglobin (DCLHb) can reduce the perioperative use of allogeneic blood transfusion. One-hundred-eighty-one elective surgical patients were enrolled at 19 clinical sites from 1996 to 1998. Selection criteria included anticipated transfusion of 2-4 blood units, aortic repair, and major joint or abdomino-pelvic surgery.

Effect of diaspirin crosslinked hemoglobin (DCLHb HemAssist) during high blood loss surgery on selected indices of organ function.

Background: The safety of the hemoglobin based oxygen carrier diaspirin crosslinked hemoglobin (DCLHb) has been reported only in the low (50-200 mg/kg) dose range [Przybelski. R.J.

Nephron-sparing nephrectomy for giant renal angiomyolipoma associated with lymphangioleiomyomatosis.

Renal angiomyolipomas are benign tumors known to occur sporadically and in association with genetic syndromes, including tuberous sclerosis and lymphangioleiomyomatosis. Surgical removal or radiographic embolization of angiomyolipomas larger than 4 cm is usually indicated because of an increased risk of spontaneous hemorrhage. We describe successful nephron-sparing surgery for a giant angiomyolipoma and discuss relevant management issues in a patient with lymphangioleiomyomatosis who had previously undergone bilateral pulmonary transplantation.

The effect of dopamine on renal function in solitary partial nephrectomy surgery.

Purpose: Dopamine continues to be used for preventing and treating acute renal failure. We determined the effects of dopamine on postoperative renal function in patients with a solitary kidney undergoing partial nephrectomy.

Materials And Methods: We performed a prospective randomized controlled study at a tertiary care referral center involving 24 patients with a solitary kidney undergoing partial nephrectomy secondary to malignancy.