Re-engineering the operating room using variability methodology to improve health care value.

Background: Variability in flow of patients through operating rooms has a dramatic impact on a hospital's performance and finances. Natural variation (uncontrollable) and artificial variation (controllable) differ and require different resources and management. The aim of this study was to use variability methodology for a hospital's surgical services to improve operational performance.

Correlates of myalgia in electroconvulsive therapy.

Myalgias are common in patients treated with electroconvulsive therapy (ECT). The mechanism of this side effect is unknown. Two commonly postulated etiologies are the motor activity during the convulsion and the fasciculations induced by succinylcholine.

Anesthesia outcomes in a randomized double-blind trial of sevoflurane and thiopental for induction of general anesthesia in electroconvulsive therapy.

The purpose of the study was to compare hemodynamics and postanesthetic tolerability of sevoflurane versus thiopental in electroconvulsive therapy (ECT). The design was a randomized double-blind trial in the ECT suite of a tertiary referral medical center. Thirty-one patients were randomized to either sevoflurane or thiopental induction of anesthesia for up to 6 of each subject's ECT treatments.

Seizure length with sevoflurane and thiopental for induction of general anesthesia in electroconvulsive therapy: a randomized double-blind trial.

In general, seizure length does not correlate with clinical outcome with electroconvulsive therapy (ECT), but whether markedly short seizures are still therapeutic is unknown. Furthermore, seizure length effects on clinical outcome in ECT may be different among the various anesthetic agents available. Several studies have investigated the use of inhalational anesthesia in ECT with sevoflurane.

The clinical utility of inhalational anesthesia with sevoflurane in electroconvulsive therapy.

Anesthesia in electroconvulsive therapy (ECT) almost always is induced with intravenous agents, typically barbiturates, etomidate, or propofol. There are, however, circumstances in which an inhalational agent would be preferable for induction of general anesthesia. These uncommon clinical scenarios include severe needle stick phobia, agitation preventing insertion of an intravenous catheter, and poor tolerance of intravenous induction agents.

Twelve-lead high-frequency QRS electrocardiography during anesthesia in healthy subjects.

Analysis of the high-frequency (HF) components of the QRS complex has been shown to be a more sensitive indicator of myocardial ischemia and infarction than conventional ST segment analysis in settings outside of the operating room. In this study, we documented the effect of general anesthesia on HF QRS analysis in healthy patients as the first step in determining the potential of this technique for monitoring anesthetized patients. HF QRS electrocardiograms (ECGs) were obtained from all 12 ECG leads in 30 healthy subjects before and after the induction of anesthesia.