Patient classification system: an optimization approach.

A patient classification system was developed integrating a patient acuity instrument with a computerized nursing distribution method based on an optimization algorithm. The objective was to minimize the total number of nursing personnel used by optimally assigning the nursing staff to meet the acuity needs of the various clinical units in the hospital. The validity of the model to assign staff was established by a 30-day comparison with the existing manual method of assignment.

A comparison of thromboelastogram and template bleeding time in the evaluation of platelet function after aspirin ingestion.

Study Objective: To compare template bleeding time (TBT) with thromboelastography (TEG) in human subjects after aspirin ingestion.

Design: Healthy volunteers were given a single 650 mg dose of aspirin or a dose of 650 mg of aspirin on three successive days. TBT and TEG studies were performed prior to aspirin ingestion and 4, 24, 72, and 168 hours after ingestion.

Total hip arthroplasty. An investigation of factors related to postoperative urinary retention.

The predisposing factors to urinary retention in patients undergoing hip arthroplasty were investigated by a review of the charts of 272 patients. Age, sex, surgeon, choice and duration of anesthesia, volume of fluid replacement, and use of postoperative intramuscular narcotics did not correlate significantly with urinary retention. However, urinary retention increased from 24% to 62% with the use of epidural morphine for postoperative pain management.

Tourniquet-induced hypertension.

The anaesthetic records of 600 patients undergoing lower limb surgery were reviewed to determine the frequency of intraoperative arterial hypertension (defined as a 30% incision). The overall frequency of hypertension during operation in 500 patients to whom a tourniquet was applied during surgery was 11%. The probability of hypertension was increased if the patient was elderly, had cardiac enlargement shown by x-ray or e.

Perioperative management of diabetes mellitus.

Hourly plasma glucose concentrations in 191 diabetic patients undergoing 200 operations were measured. The glucose infusion rate was controlled. Insulin-taking diabetics given no insulin or a fraction of their usual dose preoperatively developed rising plasma glucose concentrations beginning with the start of operation.

Vocal cord function following short term endotracheal intubation.

This study was undertaken to determine whether brief periods of vocal cord paralysis might commonly occur as a result of tracheal intubation. The vocal cords of 100 patients were examined prior to and after intubation for operation. Although soft tissue trauma was observed in nearly all patients none had evidence of vocal cord paralysis.

Nitroprusside and the duration of tubocurarine and pancuronium.

Seventy-six patients in whom sodium nitroprusside was administered in order to induce hypotension received either 0.2 mg/kg tubocurarine or 0.04 mg/kg pancuronium bromide.

The influence of succinylcholine on the duration of pancuronium neuromuscular blockade.

Question has been raised as to whether the use of succinylcholine (SCh) to facilitate endotracheal intubation might influence the duration of subsequently used pancuronium. The authors studied the duration of pancuronium in 67 adult patients by measuring muscle response to nerve stimulation. Thirty-seven of these patients were given prior SCh while the remaining 30 were not.

Azathioprine: effects on neuromuscular transmission.

The neuromuscular effects of azathioprine were examined in the in-vivo cat soleus muscle preparation. In concentrations ranging from 10 to 1,000 mug/kg, administered intra-arterially, the agent caused motor axons to fire repetitively and produced a dose-related increase in the force of contraction. The drug reversed neuromuscular blockage produced by d-tubocurarine and potentiated the neuromuscular blockade produced by succinylcholine.

Anaesthesia for dwarfs and other patients of pathological small stature.

Sixty-nine anaesthetics were administered to 29 patients of pathological proportionate and disproportionate small stature. The anaesthetic course in most cases was uncomplicated. The few complications noted were similar in type and severity to those found in normal size patients undergoing similar anaesthesia and operative procedures.