Anesthesia Management Blog




Apr
18

Anesthesia Management: FDA Okays Handheld Autoinjector for Opioid Overdose

Author : Doc Clemens

This is for our readers that treat patients with narcotics.

The US Food and Drug Administration (FDA) has approved a handheld device designed for use by family members or caregivers to deliver a single dose of naloxone to reverse suspected opioid overdose.

The device, known as Evzio (naloxone hydrochloride injection, Kaléo, Inc) can be carried in a pocket or stored in a medicine cabinet and is intended for the emergency treatment of known or suspected opioid overdose, characterized by decreased br

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Apr
18

Anesthesia Management: NSAIDs: Not as Safe as Patients May Think

Author : Doc Clemens

Editor's Note: A survey of over 9000 patients published in 2005 concluded that over-the-counter (OTC) analgesics, including nonsteroidal anti-inflammatory drugs (NSAIDs), are widely used, frequently by patients who are generally unaware of the potential for dangerous adverse side effects. Given recent concerns about use of acetaminophen products, particularly products with 500 mg or more per tablet, and the potential that patients will turn to NSAIDs as an alternative, it is more important than

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Apr
18

Anesthesia Management: Low Back Pain Top Cause of Disability Worldwide

Author : Doc Clemens

Low back pain (LBP) causes more disability globally than any other condition, according to 2 studies published in the Annals of the Rheumatic Diseases. As the world population continues to age, an urgent need exists for research to find out why and how LBP might be prevented or better managed, researchers write.

Damian Hoy, MPH, from the University of Queensland School of Population Health, Australia, and colleagues conducted systematic reviews of the prevalence, incidence, remission, duration, a

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Apr
18

Anesthesia Management: Which Parenteral Treatment Is Best for Acute Migraine?

Author : Doc Clemens

Authors: Friedman BW et al. Neurology 2014 Feb 12.

 

A randomized, double-blind, comparative-efficacy trial suggests that intravenous valproate is inferior to both metoclopramide and ketorolac for treatment of acute migraine.

Treatment for acute migraine is a common reason for emergency department (ED) visits, where adequate therapy can prevent admission for symptom control. In this study, researchers randomized 330 patients presenting to a single ED with acute migraine to receive one of three pare

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Apr
18

Anesthesia Management: Safety of Propofol as an Induction Agent for Urgent Endotracheal Intubation in the Medical Intensive Care Unit.

Author : Doc Clemens

Published in J Intensive Care Med 2014 Feb

Authors: Koenig SJet al.

 

PURPOSE:

Propofol is known to provide excellent intubation conditions without the use of neuromuscular blocking agents. However, propofol has adverse effects that may limit its use in the critically ill patients, particularly in the hemodynamically unstable patient. We report on the safety and efficacy of propofol for use as an agent for urgent endotracheal intubation (UEI) in the critically ill patients.

METHODS:

We reviewed the ou

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Apr
18

Anesthesia Management: EMLA® cream as local anesthetic for radiofrequency turbinate tissue reduction

Author : Doc Clemens

Published in Eur Arch Otorhinolaryngol. 2014 Feb

Authors: Martellucci S et al.

Abstract

Radiofrequency volumetric tissue reduction is a minimally invasive technique in the treatment of turbinate hypertrophy and is generally performed under local anesthesia. However, perioperative discomfort and pain are common side effects and studies concerning the technique of choice to anesthetize the nasal mucosa in this procedure are lacking.

The aim of this prospective controlled trial is to assess the effecti

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Apr
18

Anesthesia Management: Concentrations of remifentanil, propofol, fentanyl, and midazolam during rewarming from therapeutic hypothermia

Author : Doc Clemens

Published in Acta Anesthesiol Scand. 2014 Mar

Authors: Bjelland TW et al.

BACKGROUND:

The clearance of sedatives and analgesics may be reduced by therapeutic hypothermia. However, little is known about the concentrations of such drugs during rewarming. The aim of this study was to describe the serum concentrations of sedatives and analgesics during rewarming from therapeutic hypothermia.

METHODS:

Blood samples were collected for quantification of drug concentrations in 22 patients given analgesia/sed

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Apr
18

Anesthesia Management: Significant and Safe Shortening of the Recovery Time After Flumazenil-Reversed Midazolam Sedation

Author : Doc Clemens

Published in Dig Dis Sci. 2014 Feb

Authors: Mathus-Vliegen EM et al.

BACKGROUND:

Endoscopy under midazolam sedation requires a 2-h recovery facility.

AIM:

To study the potential of shortening patients' stay without jeopardizing patients' safety by the use of the benzodiazepine-antagonist flumazenil in the everyday practice and to investigate the feasibility of a study comparing midazolam with recovery with midazolam-flumazenil and immediate discharge.

METHODS:

Consecutive ambulatory patients referred f

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Apr
18

Anesthesia Management: Intrathecal 1% 2-chloroprocaine vs. 0.5% bupivacaine in ambulatory surgery: a prospective, observer-blinded, randomised, controlled trial

Author : Doc Clemens

Published in Acta Anesthesiol Scand. 2014 May;58(5):560-6

Authors: Camponovo C et al.

BACKGROUND:

This prospective, observer-blinded, randomised, multicentre study aimed at determining the non-inferiority of 50 mg of plain 1% 2-chloroprocaine vs. 10 mg of 0.5% plain bupivacaine in terms of sensory block onset time at T10 after spinal injection. The study hypothesis was that the difference in onset times of sensory block to T10 between the two drugs is less than 4 min.

METHODS:

One hundred and thirty

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Apr
17

Anesthesia Management: 4 Things Not to Do at a Medical Board Hearing

Author : Doc Clemens

A Letter You Never Want to Receive

You've received a letter from your state medical board, and you read that a patient has filed a complaint against you. You're sure the complaint is groundless, and you're furious that the patient went to the board instead of bringing his concerns to you.

How you respond -- or fail to respond -- to that initial letter can make a huge difference in the outcome of your case.

There are several approaches to medical board investigations that experts agree can determine

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Apr
17

Anesthesia Management: FDA Approves First ER Oxycodone Acetaminophen Combo

Author : Doc Clemens

The US Food and Drug Administration (FDA) has approved an extended-release combination of oxycodone and acetaminophen (Xartemis XR, Mallinckrodt plc), previously known as MNK-795, for the management of acute pain severe enough to require opioid treatment, and for patients for whom alternative treatment options are ineffective, not tolerated, or would otherwise be inadequate.

The drug has both immediate- and extended-release components to allow pain relief within an hour, with twice-daily dosing,

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Apr
17

Anesthesia Management: Dexmedetomidine and propofol total intravenous anesthesia for airway foreign body removal

Author : Doc Clemens

Published in Ir J Med Sci 2014 Mar

Authors: Chen K et al.

PURPOSE:

To detail our experience using dexmedetomidine in combination with propofol for airway foreign body removal in spontaneously breathing patients.

CLINICAL FEATURES:

Dexmedetomidine and propofol intravenous anesthesia as a primary anesthetic was used for three pediatric patients with severe respiratory impairment due to foreign body aspiration and two elderly patients requiring airway foreign body removal by rigid bronchoscopy. All pati

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Apr
17

Anesthesia Management: ACA Grace Period Rule Could Put Physicians at Financial Risk

Author : Doc Clemens

 

Physician practices could be put at financial risk because of a little-known rule in the Affordable Care Act (ACA) that provides a 3-month grace period for consumers who do not pay their premiums on time, several national medical organizations have complained.

The

rule , published by the Centers for Medicare & Medicaid Services (CMS), grants individuals who purchase subsidized coverage through the state insurance exchanges a 90-day grace period before their coverage is cancelled for nonpayment.

Dur

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Apr
17

Anesthesia Management: Study finds overutilization of imaging for headache in U.S.

Author : Doc Clemens

Despite guidelines to control the use of CT and MRI for headaches and migraines, neuroimaging procedures are overused and cost an estimated $3.9 billion between 2007 and 2010, according to a study published in JAMA Internal Medicine.

Neuroimaging was ordered for 12% of outpatient headache visits over the four-year period and accounted for approximately $1 billion a year in healthcare costs, researchers from the University of Michigan Health System found.

Lead author Dr. Brian Callaghan and colleag

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Apr
16

Anesthesia Management: Long-Term Opioid Use Likely After 90 Days in Veterans

Author : Doc Clemens

More than 50% of veterans who receive opioids go on to use the pain medications chronically, according to a new study of data on nearly 1 million veterans who receive opioids.

This sample is the first where half of all opioid users were chronic users, defined as use for more than 90 days per year, the researchers say.

While a higher opioid dosage is a strong risk factor for chronic use, most long-term users in this population were in fact taking lower doses, around 20 mg. Of interest, mental healt

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Apr
16

Anesthesia Management: Workplace conflict: 3 techniques for managing employee disputes

Author : Doc Clemens

Disputes between employees are common and inevitable. But if left unresolved, they can disrupt your department's productivity, sap morale and even cause some good employees to quit.

Supervisors and managers don't need to become certified mediators to settle disputes. They just need to understand some basics about human behavior, practice the fine art of paying attention and serve as a neutral party who wants to resolve the problem.

Many (if not most) supervisors take the path of least resistance …

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Apr
16

Anesthesia Management: Fewer postoperative fevers: an unexpected benefit of multimodal pain management?

Author : Doc Clemens

Published in Clin Orthop Relat Res. 2014 May;472(5):1489-95

Authors: Karam JA et al.

BACKGROUND: Elevated temperatures after total joint arthroplasty (TJA) are common and can be a source of anxiety both for the patient and the surgical team. Although such fevers rarely are caused by acute infection, many patients are subjected to extensive testing for elevated body temperature after surgery. We recently implemented a multimodal pain management regimen for TJA, which includes acetaminophen, pregaba

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Apr
16

Anesthesia Management: Personalized Oxycodone Dosing: Using Pharmacogenetic Testing and Clinical Pharmacokinetics to Reduce Toxicity Risk and Increase Effectiveness

Author : Doc Clemens

Published in Pain Med. 2014 Feb

Authors: Linares OA et al.

OBJECTIVE: To develop a framework for integrating pharmacogenetics with clinical pharmacokinetics for personalized oxycodone dosing based on a patient's CYP2D6 phenotype.

DESIGN: Randomized, crossover, double-blind, placebo-controlled. Subjects were genotyped as CYP2D6 ultra-rapid metabolizer, extensive metabolizer, or poor metabolizer phenotypes. Five subjects from each phenotype were randomly selected for inclusion in our study.

SETTING: S

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Apr
16

Anesthesia Management: Hydrocodone/Acetaminophen Not Superior to Codeine/Acetaminophen for Acute Pain

Author : Doc Clemens

Hydrocodone/acetaminophen (Vicodin, AbbVie) was not superior to codeine/acetaminophen (Tylenol #3, McNeil) in acute pain relief reported by patients 24 hours after being discharged from the emergency department, according to a new study.

While Vicodin is the most popularly prescribed opioid in emergency departments, the drug and other hydrocodone combination formulations are under consideration by the US Food and Drug Administration (FDA) for rescheduling from a Schedule III drug to a more tightl

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Apr
15

Anesthesia Management: Dexamethasone, ondansetron, and their combination and postoperative nausea and vomiting in children undergoing strabismus surgery: a meta-analysis of randomized controlled trials

Author : Doc Clemens

Published in Paediatr Anaesth. 2014 May;24(5):490-8

Authors: Shen YD et al

BACKGROUND: Postoperative nausea and vomiting (PONV) is a common complication after pediatric strabismus surgery. Steroids and ondansetron (a 5-HT3 antagonist) can effectively reduce nausea, vomiting, and pain and thus might be useful agents for the prevention of PONV in pediatric patients. The aim of this study was to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the proph

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Apr
15

Anesthesia Management: Topiramate Approved for Migraine Prevention in Adolescents

Author : Doc Clemens

Now we have an effective medication for prophylaxis.

The FDA has approved the antiepileptic topiramate (Topamax) to prevent migraine in adolescents aged 12 to 17 years. It's the first drug approved for migraine prevention in this age group.

Topiramate should be taken daily, at a dose of 100 mg. Its approval was based on a randomized trial of roughly 100 adolescents: Those taking topiramate experienced a 72% decrease in migraine frequency, versus 44% among placebo recipients. Side effects included

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Apr
15

Anesthesia Management: Ondansetron Preloading with Crystalloid Infusion Reduces Maternal Hypotension during Cesarean Delivery.

Author : Doc Clemens

Published in Am J Perinatol. 2014 Feb

Authors: Wang Q et al.

The aim of the article was to investigate the effect of ondansetron

Objective preloading with crystalloid infusion after spinal anesthesia during cesarean A total of 66 parturient women scheduled for electivedelivery. Study Design caesarean sections were randomly assigned to two groups. Five minutes before spinal anesthesia, Group O patients were injected with 4mg of ondansetron, while Group S patients were injected with 5 mL physiologic

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Apr
15

Anesthesia Management: Legally sound terminations: 5 essential tips

Author : Doc Clemens

Firings may cause employees to cry, become defensive or even turn violent. Others may try to distort what happens during your firing meeting to justify a lawsuit against you.

To protect yourself legally, have someone else with you during the termination meeting so that no one can question what you say. Write a memo after the meeting summarizing what happened and have the witness sign it.

Here are five other ways to defuse fired employees' justifications for a lawsuit:

1. Keep your cool. Avoid heigh

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Apr
15

Anesthesia Billing and Collections: The efficacy of single-dose postoperative intravenous dexamethasone for pain relief after endoscopic submucosal dissection for gastric neoplasm

Author : Doc Clemens

Published in Surg Endosc. 2014 Feb 26

Authors: Lee HW et al.

BACKGROUND: Endoscopic submucosal dissection (ESD) is the gold standard technique for en bloc resection of large superficial tumors in the upper and lower gastrointestinal tract. Little is known about the management of epigastric pain after ESD of gastric neoplasms. This study investigated the utility and safety of single-dose, perioperative, intravenous dexamethasone for epigastric pain relief following ESD.

METHODS: The efficacy of intr

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Apr
15

Anesthesia Management: The efficacy of single-dose postoperative intravenous dexamethasone for pain relief after endoscopic submucosal dissection for gastric neoplasm

Author : Doc Clemens

Published in Surg Endosc. 2014 Feb 26

Authors: Lee HW et al.

BACKGROUND: Endoscopic submucosal dissection (ESD) is the gold standard technique for en bloc resection of large superficial tumors in the upper and lower gastrointestinal tract. Little is known about the management of epigastric pain after ESD of gastric neoplasms. This study investigated the utility and safety of single-dose, perioperative, intravenous dexamethasone for epigastric pain relief following ESD.

METHODS: The efficacy of intr

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Apr
14

Anesthesia Management: No Increases in Pain Seen With Opioid Dose Reductions

Author : Doc Clemens

This is for our readers who treat pain patients.

Patients receiving high doses of opioids show no worsening of pain scores or aberrant drug behaviors after significant dose reductions compared with patients who do not have dose reductions, a new study suggests.

"Despite significant reductions in their opioid doses and the fact that doses were often actually increased in the control group, the outcomes in areas of perceived functionality and aberrant behaviors were no different between the 2 groups

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Apr
14

Anesthesia Management: DEA Publishes Proposal to Reschedule Hydrocodone Products

Author : Doc Clemens

The US Drug Enforcement Administration (DEA) has published in the Federal Register a formal proposal to reschedule hydrocodone combination products (HCPs) from Schedule III to Schedule II, a move that would further increase controls on the powerful opioid painkillers.

The DEA's action follows recent recommendations to reschedule HCPs from the Assistant Secretary for Health and Human Services (HHS) and a Food and Drug Administration (FDA) advisory committee, which voted 19 to 10 for the change bac

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Apr
14

Anesthesia Management: No Difference by Injection Approach for Low Back Pain

Author : Doc Clemens

This is for our readers who perform pain management.

Transforaminal epidural steroid injections, despite being widely regarded as superior to interlaminar injections, are not significantly superior in providing pain relief or functional improvement for radiating low back pain, a new systematic review of trials shows.

"I think these findings are definitely controversial, but I have had numerous people say to me that this is in fact very consistent with their experience using these two modalities,"

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Apr
14

Anesthesia Management: Anesthesia, Surgery May Double Dementia Risk

Author : Doc Clemens

Anesthesia and surgery significantly increase the risk for dementia, new research suggests.

A large population-based study conducted by investigators at the Neurological Institute in Taipei Veterans General Hospital, in Taipei City, Republic of China, showed that the risk of developing dementia nearly doubled within 3 to 7 years of anesthesia and surgery. In addition, the average time to dementia diagnosis was shorter in patients who had anesthesia and surgery compared with their counterparts who

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Apr
14

Anesthesia Management: Epidural Prolongs Second Stage of Labor by More Than 2 Hours

Author : Doc Clemens

Duration of second-stage labor was more than 2 hours longer when epidural anesthesia was given during labor for both nulliparous and multiparous women, according to a retrospective cohort study reported in the March issue of Obstetrics & Gynecology. The duration of second-stage labor observed in the study is twice as long as typically estimated for epidurals in clinical guidelines.

"Minimizing primary cesarean delivery is a priority," write Yvonne W. Cheng, MD, PhD, from the Division of Maternal-

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Apr
14

Anesthesia Management: FDA Advisory Panel Votes Against CV Safety Claim for Naproxen

Author : Doc Clemens

In a two-day meeting of the Food and Drug Administration (FDA) Arthritis Advisory Committee (AAC) and Drug Safety and Risk Management (DSARM) Advisory Committee, just nine panel members said they believed naproxen has a lower risk of cardiovascular thrombotic events than other available nonsteroidal anti-inflammatory drugs (NSAIDs).

In contrast, 16 of the advisory panel members felt the data were insufficient to say naproxen was safer than other NSAIDs.

The panel grappled with the available eviden

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Apr
14

Anesthesia Management: 3 ways to save warring workgroups

Author : Doc Clemens

Some teams struggle to work together. Personalities clash, disagreements intensify and meetings turn into protracted turf battles.

When groups become polarized, shake up the status quo.

Chronic negativity frequently starts with only one or two employees, but it can quickly infect an entire department. When this happens, the inevitable result is reduced productivity, damaged morale and eventually increased turnover, so wise managers try to nip negativity in the bud.

Try these techniques to reverse a

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Apr
11

Anesthesia Management: Jury awards nearly $3 million in malpractice case

Author : Doc Clemens

A Missouri family hopes a nearly $3 million jury award in a medical malpractice case against a Kansas doctor and pain clinic will raise awareness of the risks and possible complications from pain injections.

Joel Burnette was 40 when he took his own life in Feburary 2013. His parents claim serious spinal injuries caused by a careless doctor at PainCARE in Overland Park, Kan., led to his suicide.

Last month a Johnson County, Kan., jury awarded Vernon and Gail Burnette of Gladstone, Mo., $2.88 milli

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Apr
11

Anesthesia Management: Defensive medicine accounts for one-third of health costs, hospital execs say

Author : Doc Clemens

I thought this was an interesting article so I wanted to share it with our followers.

Hospital administrators estimate that one-third of healthcare costs are the result of tests and treatments that aren't medically necessary and ordered defensively to prevent lawsuits, according to a new survey by Atlanta-based Jackson Healthcare.

Other highlights of the survey, which 106 hospital executives completed in early 2014, included the following:

Ninety-four percent of respondents said they believe the pr

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Apr
11

Anesthesia Management: President Obama nominates Sylvia Mathews Burwell as new HHS secretary

Author : Doc Clemens

President Barack Obama this morning nominated Sylvia Mathews Burwell to replace Kathleen Sebelius as secretary of the U.S. Department of Health & Human Services.

Sebelius--the public face of the botched HealthCare.gov rollout--stepped down from her post after five years of service.

Obama made the announcement shortly after 11 a.m. today. Obama's decision to replace Sebelius with the 48-year-old Burwell may help temper the continued bickering over the ACA, ABC News reports, as she is well-liked by

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Apr
11

Anesthesia Management: Transcutaneous electric acupoint stimulation reduces intra-operative remifentanil consumption and alleviates postoperative side-effects in patients undergoing sinusotomy

Author : Doc Clemens

Published in Br J Anaesth. 2014 Feb 26

Author: Wang H  et al.

BACKGROUND: Although opioids are widely used as analgesics in general anaesthesia, they have unpleasant side-effects and can delay postoperative recovery. Acupuncture and related techniques are effective for acute and chronic pain, and reduces some side-effects. We assessed the effect of transcutaneous electric acupoint stimulation (TEAS) on intra-operative remifentanil consumption and the incidences of anaesthesia-related side-effects.

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Apr
11

Anesthesia Management: Sebelius Resigning from HHS

Author : Doc Clemens

Health and Human Services Secretary Kathleen Sebelius will announce her resignation Friday after a five-year tenure bookended by passage of the landmark Patient Protection and Affordable Care Act and the checkered rollout of the Healthcare.gov website.

President Obama accepted Sebelius's resignation earlier this week. She is one of the president's longest-serving cabinet members.

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Apr
10

Anesthesia Management: Intradiscal Biacuplasty Provides Long-Term Improvements for Discogenic Low-Back Pain

Author : Doc Clemens

Patients who benefited from intradiscal biacuplasty (IDB) to treat discogenic low-back pain maintained initial gains in pain relief and physical function when rechecked at 1 year, according to a study presented at the 30th Annual Meeting of the American Academy of Pain Medicine (AAPM).

Furthermore, patients who were in the sham treatment group and were later offered IDB achieved the same positive results as patients in the original treatment arm.

Interest in the use of IDB is growing in connection

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Apr
10

Anesthesia Management: A comparison of remifentanil parturient-controlled intravenous analgesia with epidural analgesia: a meta-analysis of randomized controlled trials

Author : Doc Clemens

Published in Anesth Analg. 2014 Mar;118(3):598-603

Authors: Liu ZQ et al.,

BACKGROUND: Epidural analgesia is generally accepted as the most effective form of pain relief during labor. Remifentanil patient-controlled IV analgesia (PCIA), which is less invasive than epidural analgesia, may be an attractive alternative. In this meta-analysis, we compared the efficacy and safety of the 2 analgesic techniques for labor pain.

METHODS: Databases of PubMed, EMBASE, and Cochrane Library were searched indepe

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Apr
10

Anesthesia Management: Dyskinesia caused by ziconotide-baclofen combination in an adolescent affected by cerebral palsy

Author : Doc Clemens

Published in Reg Anesth Pain Med. 2014 Mar-Apr;39(2):172-3

Authors: Pozzi M et al.,

OBJECTIVE:

To report on the first case of ziconotide-induced dyskinesia. Ziconotide, a synthetic peptide analogue of the ω-conotoxin MVIIA that blocks selectively N-type voltage-sensitive calcium channels, has been used in intrathecal administration for 30 years. Ziconotide is a drug of choice for chronic pain because of its efficacy and flexibility because it can substitute or complement other intrathecal therapies

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Apr
10

Anesthesia Management: Immediate Analgesic Effect of 8% Lidocaine Applied to the Oral Mucosa in Patients with Trigeminal Neuralgia

Author : Doc Clemens

Published in Pain Med. 2014 Feb

Authors: Niki Y et al

BACKGROUND:

Trigeminal nerve block is widely used for trigeminal neuralgia (TN), though with much painful procedure and potential serious complications. The pain of TN occurs most frequently in the second and the third divisions of the trigeminal nerve, which are distributed in intraoral mucous membrane as well as face skin. Here, we examined the response to intraoral application of 8% lidocaine (LDC) in patients with oral TN pain in a double-bl

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Apr
10

Anesthesia Management: Effects of Remifentanil on In-Hospital Mortality and Length of Stay Following Clipping of Intracranial Aneurysm

Author : Doc Clemens

Published in J Neurosurg Anesthesiol. 2014 Feb

Authors: Uchida K et al.,           BACKGROUND: Remifentanil is an ultrashort-acting µ-opioid receptor agonist and is especially suitable for neuroanesthesia. We previously reported that general anesthesia with remifentanil for brain tumor resection was associated with lower postoperative mortality and shorter postoperative length of stay (LOS) when compared with surgeries without remifentanil. This phenomenon may also exist during clipping of intrac

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Apr
09

Anesthesia Management: Response surface model predictions of wake-up time during scoliosis surgery

Author : Doc Clemens

Published in Anesth Analg. 2014 Mar;118(3):546-53

Authors: Ting CK et al.  BACKGROUND: With the use of previously published data, new sevoflurane-remifentanil interaction models of various degrees of sedation were created and adapted to desflurane-fentanyl by using minimal alveolar concentration and opioid equivalencies. These models were used to predict return of responsiveness in patients undergoing scoliosis surgery during a wake-up test. Our hypothesis was that one of the interaction models w

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Apr
09

Anesthesia Management: Prehospital Cooling to 33 Degrees After Cardiac Arrest?

Author : Doc Clemens

The study "Targeted Temperature Management at 33°C versus 36°C After Cardiac Arrest," by Nielsen and colleagues and published in the New England Journal of Medicine. 

Despite widespread adoption of the therapy, there is relatively little rigorously derived supporting clinical evidence for induction of therapeutic hypothermia after cardiac arrest. This outstanding multicenter randomized controlled trial (RCT) compared a temperature target of 33°C to 36°C for 28 hours (followed by maintenance of a

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Apr
09

Anesthesia Management: Back problems? Skip the imaging, skip the surgery

Author : Doc Clemens

Back pain is a huge global problem that ranks among the top 10 causes of disability. Medicine has leapt to the rescue with billions of dollars worth of imaging and surgery to treat the suffering.

However, neither option does patients much good most of the time, and it's time to standardize care for the patient's sake, said Total Radiology keynote speaker Dr. Michael Modic at last month's 2014 Arab Health meeting in Dubai, United Arab Emirates.

The huge cost of back pain care is unsustainable over

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Apr
09

Anesthesia Management: 5 keys for continuous improvement so your competition doesn’t pass you by

Author : Doc Clemens

We all know the old saying, “If it ain’t broke, don’t fix it.” Really? That might work for a kitchen appliance, but for workplace processes and procedure, it doesn’t work at all.

To set yourself apart from other managers and position yourself to move into a leadership position, you need to ignite your “improvement gene.”

We all know people who love to tinker with things — trying to make them better, bigger, faster, more efficient, easier to use. That’s what “innovation” is and it’s different than

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Apr
08

Anesthesia Management: Communication key to strong HCAHPS

Author : Doc Clemens

How hospitals can act upon their HCAHPS results

Since 2008 when the Centers for Medicare & Medicaid Services (CMS) first implemented the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for U.S. hospitals, the scores from these surveys have become increasingly more important to hospital executives as a measure of quality. Indeed, they are now used to determine 30 percent of the total incentive offered to hospitals under the Hospital Value Based Purchasing program (

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Apr
08

Anesthesia Management: Feds recoup $4.3B from fraudsters

Author : Doc Clemens

HHS, Justice action teams recover $8 for every dollar put into investigations

The federal government recovered a record $4.3 billion last year from fraudsters trying to dupe federal health programs, or those who sought payments to which they were not entitled, according to a report released this week. The report also showed that the feds recouped $8.10 for very dollar spent on investigations over the last three years, its highest average return.

In 2012, the Health Care Fraud and Abuse Control Pro

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Apr
08

Anesthesia Management: A 10-step 'prescription' to create a happier workforce

Author : Doc Clemens

The best employees love their jobs, consistently give all they can, have good relationships with co-workers, find their work meaningful and leave work each day with a sense of accomplishment.

Too bad there aren't more workers like that. In fact, most employees feel stressed, doubtful about job security and less invested in their companies and careers. You can and should do something about it.

he happiness of your organization's employees is an important driver of workplace productivity.

A recent He

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Apr
08

Anesthesia Management: 4 areas to watch to reduce billing costs

Author : Doc Clemens

Getting paid can be costly for groups

Like all businesses offering a service, groups need to get paid. However, getting paid can be a costly proposition.

A group must work hard to process claims and collect payments and in that process risks wasting valuable resources.

Here are some solutions to groups to help contain costs related to billing and determine how and where cash is being burned. 

The four areas groups need to watch in order to control the costs related to billing.

1. Staffing. Achieving

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Apr
08

Anesthesia Management: Moody's upgrades hospital outlook

Author : Doc Clemens

Uncertainty over Medicare payment rates, 'two-midnight' rule hang over sector

Because health system operators reacted quickly to manage payment cuts and lower patient volumes, Moody’s Investors Service has upgraded its for-profit hospital outlook to positive from stable.

Since last year, when hospitals felt the sting of Medicare reimbursement, sequestration cuts and lower admissions, large hospital systems have modified their service mix or gotten out of unprofitable businesses or locations, makin

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Apr
07

Anesthesia Management: Reputation still skews hospital assessments

Author : Doc Clemens

This is another article I wanted to share with our followers.

Hospital reputations play an outsized role in both quality assessments and day-to-day operations, experts said.

For example, when organizations negotiate managed care contracts, "[i]t's a lot easier at a prestigious hospital than it is at a community hospital, even if your outcomes are as good, and that's disappointing," Bill Bithoney, M.D., former chief of general pediatrics primary care at Boston Children's Hospital said.

A January Hea

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Apr
07

Anesthesia Management: Wellpoint CEO: Technology, smartphones will shape healthcare's future

Author : Doc Clemens

I thought this was interesting so I wanted to share it with our readers.

Many people hold the future of healthcare in their hands--or in their pockets.

Smartphone technology, social media and data mining will drive change and shift the future of healthcare, said Wellpoint, Inc. Chief Executive Officer Joseph Swedish, the Malcolm T. MacEachern Memorial Lecturer at the American College of Healthcare Executives Congress in Chicago last week.

"In just a single generation there's been a fundamental shif

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Apr
07

Anesthesia Management: Healthcare spending growth highest in a decade

Author : Doc Clemens

Healthcare spending grew at a 5.6 percent annual rate in the fourth quarter of 2013, according to the U.S. Department of Commerce's Bureau of Economic Analysis report.

The growth, a 10-year high, is driven in large part by $8 billion more in hospital revenue, which was more than the prior four quarters combined.

As a result, the U.S. Commerce Department revised overall fourth-quarter economic growth upwards to 2.6 percent.

The healthcare spending makeup also changed since past decades, according to

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Apr
07

Anesthesia Management: New Atrial Fibrillation Guideline Incorporates New Oral Anticoagulants, Catheter Ablation

Author : Doc Clemens

A new guideline for the management of atrial fibrillation (AF) incorporates important information about the new oral anticoagulants and catheter ablation for the treatment of AF symptoms.

The guideline was released Friday by the American Heart Association, the American College of Cardiology, and the Heart Rhythm Society.

Perhaps the biggest change since the previous 2006 guideline has been the introduction of new oral anticoagulants, including dabigatran, rivaroxaban, and apixaban, which can be us

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Apr
07

Anesthesia Management: 6 Stats on Employed Physicians' Satisfaction

Author : Doc Clemens

Nearly two-thirds — 64 percent — of employed physicians are likely to recommend employment over self-employment to their fellow physicians, according to data from the Medscape Employed Physicians Report 2014.

This shows many physicians employed by hospitals, large physician groups or places like community health centers, though they have some issues with their situation, are still pleased overall with employment.

Other responses to Medscape's survey further reveal employed physicians' satisfaction

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Apr
04

Anesthesia Management: A randomized comparison of the efficacy of 2 techniques for piriformis muscle injection: ultrasound-guided versus nerve stimulator with fluoroscopic guidance

Author : Doc Clemens

Published in Reg Anesth Pain Med. 2014 Mar-Apr;39(2):126-32

Authors: Fowler IM  et al

BACKGROUND: Piriformis muscle injections are most often performed using fluoroscopic guidance; however, ultrasound (US) guidance has recently been described extensively in the literature. No direct comparisons between the 2 techniques have been performed. Our objective was to compare the efficacy and efficiency of fluoroscopic- and US-guided techniques.

METHODS: A randomized, comparative trial was carried out to c

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Apr
04

Anesthesia Management: Increase in intraocular pressure is less with propofol than with sevoflurane during laparoscopic surgery in the steep Trendelenburg position

Author : Doc Clemens

Published in Can J Anaesth. 2014 Apr;61(4):322-329

Authors: Yoo YC et al

BACKGROUND: Intraocular pressure is increased during laparoscopic surgeries performed in a steep Trendelenburg position. This study compared the effects of propofol with those of sevoflurane on intraocular pressure in patients undergoing robot-assisted laparoscopic radical prostatectomy in a 30° Trendelenburg position.

METHODS: Sixty-six patients were randomly allocated to a maintenance anesthetic consisting of remifentanil an

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Apr
04

Anesthesia Management: Transversus abdominis plane block to ameliorate postoperative pain outcomes after laparoscopic surgery: a meta-analysis of randomized controlled trials

Author : Doc Clemens

Published in Anesth Analg. 2014 Feb;118(2):454-63

Authors: De Oliveira GS Jr et al.

BACKGROUND: Transversus abdominis plane (TAP) block has been used as a multimodal strategy to optimize postoperative pain outcomes; however, it remains unclear which type of surgical procedures can benefit from the administration of a TAP block. Several studies have examined the effect of the TAP block on postoperative pain outcomes after laparoscopic surgical procedures and generated conflicting results. Our main

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Apr
04

Anesthesia Management: 4 Characteristics of Poorly Performing Hospitals

Author : Doc Clemens

I thought this was something our followers would want to read.

Hospitals that are forced to close their doors often have similar characteristics, according to the Medicare Payment Advisory Commission's annual report to Congress.

MedPAC outlined four common traits of poorly performing hospitals, many of which consequently have weak financial metrics.

1. Low occupancy rate. Hospitals that closed in 2012 had an average occupancy rate of 27 percent in 2011. Compare that to their nearby competing hospit

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Apr
04

Anesthesia Management: CT, MRI overused for headaches

Author : Doc Clemens

Visits to a doctor or emergency room for a headache or migraine are resulting in too many brain scans at a significant cost to healthcare systems, according to researchers from the University of Michigan Medical School.

Brian Callaghan, a University of Michigan neurologist, and colleagues reported in a research letter published in JAMA Internal Medicine that one in eight medical visits for headaches result in a scan at a total cost of about $1 billion per year.

In the letter, the researchers point

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Apr
03

Anesthesia Management: Anesthetic drugs and onset of malignant hyperthermia

Author : Doc Clemens

Published in Anesth Analg. 2014 Feb;118(2):388-96

Authors: Visoiu M et al.  BACKGROUND: The time between the beginning of anesthetic administration and recognition of the first sign of malignant hyperthermia (MH) (MH onset time) could differ among anesthetic drugs.

METHODS: We examined the time of the first signs of suspected MH, anesthetic drugs administered, subject age, and year of event in Adverse Metabolic/Musculoskeletal Reaction to Anesthesia reports in the North American Malignant Hyperthe

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Apr
03

Anesthesia Management: Systemic lidocaine to improve quality of recovery after laparoscopic bariatric surgery: a randomized double-blinded placebo-controlled trial

Author : Doc Clemens

Published in Obes Surg. 2014 Feb;24(2):212-8

Authors: De Oliveira GS Jr et al.

BACKGROUND: Few multimodal strategies to minimize postoperative pain and improve recovery have been examined in morbidly obese patients undergoing laparoscopic bariatric surgery. The main objective of this study was to evaluate the effect of systemic intraoperative lidocaine on postoperative quality of recovery when compared to saline.

METHODS: The study was a prospective randomized, double-blinded placebo-controlled cli

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Apr
03

Anesthesia Management: Topiramate Approved for Migraine Prevention in Adolescents

Author : Doc Clemens

The FDA has approved the antiepileptic topiramate (Topamax) to prevent migraine in adolescents aged 12 to 17, the agency announced on Friday. It's the first drug approved for migraine prevention in this age group.

Topiramate should be taken daily, at a dose of 100 mg. Its approval was based on a randomized trial of roughly 100 adolescents: those taking topiramate experienced a 72% decrease in migraine frequency, versus 44% among placebo recipients.

Side effects included paresthesia, upper respirat

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Apr
03

Anesthesia Management: How are Employed Physicians Paid?

Author : Doc Clemens

Employed physicians tend to be paid under three main salary arrangements, according to the Medscape Employed Physicians Report 2014.

The most common arrangements are:

• Straight salary: 46 percent

• Base salary plus productivity targets (formula only): 33 percent

• Base salary plus productivity targets (formula plus bonus ladder): 13 percent

Other, less common payment methodologies include base salary plus yearly bonus, base salary plus overtime and compensation plus a percentage of collections, acco

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Apr
03

Anesthesia Management: Hospital Prices Up 1.3% Year-Over-Year in February

Author : Doc Clemens

The producer price index for acute-care hospitals increased 1.3 percent between February 2013 and February 2014, according to figures from the Bureau of Labor Statistics.

Overall hospital prices also went up by 0.4 percent between January and February.

The PPI for hospitals measures "changes in actual or expected reimbursement received for services across the full range of payer types," according to the American Hospital Association. "This includes the negotiated contract rate from the payer plus

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Apr
03

Anesthesia Management: Interested story

Author : Doc Clemens

Here is a very interesting fact that I thought was very interesting so I wanted to share it with my blogging fans. 

In Newport Oregon, Karen Butler went for dental surgery in November 2009 and awoke from the procedure a changed woman and not just with better teeth.  Butler emerged from sedation speaking a curious blend of British Isle tones.  It seems Butler, now 56, is one of the fewer than 100 people ever to be diagnosed with foreign accent syndrome.  The condition typically is associated with

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Apr
02

Anesthesia Management: 9 ways to lead so people follow

Author : Doc Clemens

What skills does a great leader possess? Charisma, while inspiring, tends to fade over time. And strong-willed bosses who try to intimidate may seem formidable at first, but employees often resist tyrants.

To model yourself on the most effective leaders, exhibit these nine traits:

1. Articulate a vision—and act on it. Look past the status quo to see a better future and help others picture it. Then plunge into action, knowing that you'll face obstacles and failures along the way.

2. Stay poised amid

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Apr
02

Anesthesia Management: Updated guidelines for the prevention of intravascular catheter-related bloodstream infection

Author : Doc Clemens

Here is a blog based on the clinical practice of anesthesia.  The Centers for Disease Control and Prevention (CDC) and the Healthcare Infection Control Practice Advisory Committee have realized updated guidelines for the prevention of intravascular catheter-related bloodstream infection. 

The new guidelines which replace the recommendations published in 2002, place a heavy emphasis on the education and training of health care personnel, using chlorhexidine scrubs for skin antisepsis, ensuring a m

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Apr
02

Anesthesia Management: Employment Strategies

Author : Doc Clemens

Today I am going to discuss employee contracts for those facilities that have decided that employing the anesthesia providers is the best option of the employment strategies for running a department.

Here are three recommended components of an employee contracts:

1) For shareholder and partnership anesthesiologists * An employment agreement* A deferred compensation agreement * A corporate stock agreement

2) Non shareholder anesthesiologists typically will not have a deferred compensation or corpora

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Apr
02

Anesthesia Management: Obama Quietly Signs SGR Patch Bill

Author : Doc Clemens

The new law delays both the implementation of the ICD-10 code set and the so-called two-midnight rule, which affects hospital reimbursements. The law also includes critical funding extensions for rural hospitals.

President Barack Obama late Tuesday night quietly signed a bill rushed through Congress in the last five days. It delays for one year a 24% cut in Medicare reimbursements mandated under the Sustainable Growth Rate funding formula. It also delays for one year the ICD-10 coding set impleme

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Apr
01

Anesthesia Management: 7 Must-Have Skills for C-Suite Success

Author : Doc Clemens

Executive leaders, no matter the industry they lead in, tend to share a certain set of skills that make them successful. Seven main traits have risen to the top as necessary for success in the C-suite.

The following seven traits were gathered in a 2010 survey of senior consultants for a global executive search firm and shared in detail in a Harvard Business Review article. They represent what companies frequently cite as a requirement for C-level executives.

1. Leadership2. Strategic thinking and

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Apr
01

Anesthesia Management: FDA accepts Avanir's inhaled migraine treatment application

Author : Doc Clemens

California drugmaker Avanir Pharmaceuticals (AVNR) touted the FDA's acceptance of its application for an inhaled migraine treatment after a pivotal trial.

The inhaled, dry-powder sumatriptan treatment, which makes use of Avanir partner OptiNose's bidirectional nasal technology, is now set for a review date in November this year.

In July of last year, Avanir offered PA-based OptiNose $20 million up front with another $90 million in milestone and sales target payments on the line. In late 2012, the

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Apr
01

Anesthesia Management: Nationwide Recall of Etomidate Underway

Author : Doc Clemens

Agila Specialties Private Limited, a subsidiary of Mylan Inc, has initiated a voluntary nationwide recall to the hospital/user level of 10 lots of etomidate injection 2 mg/mL because of multiple potential problems.

Etomidate is a short-acting intravenous anesthetic agent packaged in glass vials in 10- and 20-mL volumes.

The recalled lots of etomidate were manufactured in Warsaw, Poland; bear a Pfizer label; and were sent to distributors, retailers, hospitals, pharmacies, and/or clinics in the Unit

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Apr
01

Anesthesia Management: Inhaled Steroids Do Not Prevent Wheezing in Children with Upper Respiratory Tract Infections

Author : Doc Clemens

Authors: Clavenna A et al., Pediatrics 2014 Mar 133:e505

A 10-day course of nebulized beclomethasone did not reduce the rate of subsequent wheezing compared with placebo.

Investigators assessed the efficacy of nebulized beclomethasone in preventing wheezing and minimizing symptoms of upper respiratory infection (URI) in children aged 1 to 5 years presenting with viral URI to one of 40 Italian pediatric clinics.

In a randomized, double-blind trial, 525 children (mean age, 2 years) received 400 µg of

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Apr
01

Anesthesia Management: 8 Key Trends in Healthcare False Claims and Antitrust Litigation

Author : Doc Clemens

The government's enforcement efforts within the healthcare industry have substantially increased in recent years. Here are eight key trends concerning False Claims and Antitrust litigation.

I. False Claims Trends

1. The number of False Claims cases is growing

The number of cases being filed against healthcare providers pursuant to the False Claims Act is growing. Most notable is the increase in qui tam or whistle-blower cases, in which private citizens are permitted to file lawsuits alleging false

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Apr
01

Anesthesia Management: 54 Statistics on Hospital Medicare Margins

Author : Doc Clemens

Hospitals are usually underpaid by Medicare, which reimburses organizations under the inpatient and outpatient prospective payment systems. The most recent figure of -5.4 percent means that hospitals, on average, are paid a little less than 95 cents for every dollar they spend taking care of a Medicare patient.

Medicare margins were better for critical access hospitals, which are paid 101 percent of allowable costs and are not on the IPPS and OPPS. Major teaching hospitals also continued to fare

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Mar
31

Anesthesia Management: Majority of Physician Practices Avoiding ACOs, Study Finds

Author : Doc Clemens

The results of a study published in the Health Services Research journal show the majority of physician practices have not joined accountable care organizations.

Researchers surveyed 1,183 physician practices. They found that 35 percent of the physician groups have already  joined an ACO or plan to join one soon, and 60 percent have not joined an ACO and have no plans of joining one.

 Researchers also found physician groups who have already joined an ACO are more likely to have 100 or more physici

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Mar
31

Anesthesia Management: CMS to Investigate Improper PQRS, eRx Program Incentive Payments

Author : Doc Clemens

CMS has announced a four-year project to evaluate payments made through its Physician Quality Reporting System and Electronic Prescribing incentive programs, with the goal of identifying and recouping improperly awarded funds.

"Data submission, processing and reporting will be analyzed for potential errors, inconsistencies and gaps that are related to data handling, program requirements and clinical quality measure specifications of PQRS and eRx program," according to the notice. CMS will then co

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Mar
31

Anesthesia Management: The Good & The Bad: 20 Things Physicians Like, Dislike About Hospital Employment

Author : Doc Clemens

Most hospital-employed physicians don't miss the business of running a practice, but many do miss having some say in decision-making, according to the Medscape Employed Physicians Report 2014.

For the report, physicians were asked to list the top three disadvantages and the top three benefits they find in hospital employment. Below are the findings.

10 Top DisadvantagesLimited influence in decision-making — 45 percentMore limited income potential — 44 percentToo many rules — 34 percentLess control

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Mar
28

Anesthesia Management: Benzodiazepine, Opioid Prescribing Rises in Primary Care

Author : Doc Clemens

Benzodiazepines are being prescribed alone and in combination with opioids in increasing rates at primary care practices across the nation, according to new research.

The trend is particularly alarming in light of the association between benzodiazepine-opioid combinations and prescription drug deaths, said coauthor Ming-Chih Kao, PhD, MD, a clinical assistant professor at Stanford University Medical Center in Cupertino, California.

"Statistics show that from 1999 to 2006, there was a 250% increase

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Mar
28

Anesthesia Management: Analgesic efficacy of caudal dexamethasone combined with ropivacaine in children undergoing orchiopexy

Author : Doc Clemens

Published in Br J Anaesth. 2014 Feb

Authors: Kim EM et al.

BACKGROUND: Epidural administration of dexamethasone might reduce postoperative pain in adults. We evaluated whether a caudal block of 0.1 mg kg-1 dexamethasone combined with ropivacaine improves analgesic efficacy in children undergoing day-case orchiopexy.

METHODS: This randomized, double-blind study included 80 children aged 6 months to 5 yr who underwent day-case, unilateral orchiopexy. Patients received either 1.5 ml kg-1 of 0.15% ropi

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Mar
28

Anesthesia Management: Increase in prominence of electrocardiographic J waves after a single dose of propofol in a patient with early ventricular repolarisation

Author : Doc Clemens

Published in Anaesthesia. 2014 Feb;69(2):170-5

Authors: Takaishi K et al.

AbstractJ waves appear on an electrocardiogram as an elevation of the J point in the terminal portion of the QRS complex. J waves are often benign, but may be associated with malignant ventricular arrhythmias.

In some cases, such problems appear to have been precipitated by propofol infusions. We observed a sudden increase in J waves and profound hypotension following a single intravenous dose of propofol in an 84-year-old wo

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Mar
28

Anesthesia Management: Awake intubation and awake prone positioning of a morbidly obese patient for lumbar spine surgery

Author : Doc Clemens

Published in Anaesthesia. 2014 Feb;69(2):166-9Authors: Douglass J et al.

AbstractWe describe the awake fibreoptic intubation followed by awake prone positioning of a woman weighing 180 kg with body mass index of 62 kg.m(-2) requiring emergency lumbar discectomy for cauda equina syndrome.

This approach was taken to overcome difficulties in transfering an anaesthetised patient on to the operating table.

Following topical anaesthesia with lidocaine and low-dose remifentanil infusion, oral intubation w

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Mar
28

Anesthesia Management: Direct Comparison of the Effect of Desflurane and Sevoflurane on Intraoperative Motor-evoked Potentials Monitoring

Author : Doc Clemens

Published in J Neurosurg Anesthesiol. 2014 Jan 30

Authors: Chong CT et al.

BACKGROUND: During spinal surgery, intraoperative monitoring of motor-evoked potentials (MEPs) is a useful means of assessing the intraoperative integrity of corticospinal pathways. However, MEPs are known to be particularly sensitive to the suppressive effects of inhalational halogenated anesthetic agents.

OBJECTIVE: To investigate the effects of increasing end-tidal concentrations of desflurane and sevoflurane anesthesia i

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Mar
28

Anesthesia Management: Comparison of propofol and volatile agents for maintenance of anesthesia during elective craniotomy procedures: systematic review and meta-analysis

Author : Doc Clemens

Published in Can J Anaesth. 2014 Apr;61(4):347-356

Authors: Chui, J et al.

BACKGROUND: Both propofol and volatile anesthetics are commonly used for maintenance of anesthesia in patients undergoing neurosurgical procedures. The effects of these two classes of drugs on cerebral hemodynamics have been compared in many clinical trials The objectives of this review were to evaluate the cerebral hemodynamic effects, operative conditions, recovery profiles, postoperative complications, and neurological o

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Mar
28

Anesthesia Management: Opioid-free total intravenous anaesthesia reduces postoperative nausea and vomiting in bariatric surgery beyond triple prophylaxis

Author : Doc Clemens

Published in Br J Anesth. 2014 Feb 18

Authors: Ziemann-Gimmel et al. 

BACKGROUND:

Patients undergoing bariatric surgery are at high risk of postoperative nausea and vomiting (PONV). Despite triple PONV prophylaxis, up to 42.7% of patients require antiemetic rescue medication (AERM).

METHODS:

This prospective, randomized study was conducted from November 2011 to October 2012. In the Classic group (n=59), patients underwent general anaesthesia with volatile anaesthetics and opioids. In the Total i.v. a

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Mar
28

Anesthesia Management: Troponin T Elevation Predicts Mortality After Noncardiac Surgery

Author : Doc Clemens

The Vascular vents In noncardiac Surgery patIents cOhort evaluatioN (VISION) Writing Group., Anesthesiology 2014 Mar 120:564

At 30 days, mortality was 10% among patients with myocardial injury after noncardiac surgery.

Perioperative myocardial ischemia often goes undetected. In this multicenter, prospective cohort study, researchers sought to establish criteria for myocardial injury after noncardiac surgery (MINS) that would predict 30-day mortality. About 15,000 patients (age, greater than 45) wh

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Mar
28

Anesthesia Management: CHIME official 'not optimistic' about SGR/ICD-10 Senate vote

Author : Doc Clemens

Reaction to Thursday's voice vote by the House to approve a temporary, one-year fix to the sustainable growth rate--as well as a delay of at least one year on ICD-10 implementation--has been mixed from both industry groups and legislators. The Senate is expected to vote Monday on the legislation.

Jeff Smith, director of federal relations for the College of Healthcare Information Management Executives--which opposes a delay--said that he thought the outcome caught a lot of people off guard, partic

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Mar
27

Anesthesia Management: Docs to House members: Oppose payment patch

Author : Doc Clemens

The American Medical Association (AMA) took the dramatic step of opposing a short-term "doc fix" bill Wednesday with just days left before a 24-percent pay cut is scheduled to hit Medicare physicians. The AMA urged House members to oppose the legislation, set for a vote on Thursday, because it would extend the Medicare provider sequester, among other reasons.

The group has been pushing Congress to act on a bipartisan, bicameral framework that would rid Medicare of the sustainable growth rate (SGR

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Mar
27

Anesthesia Management: Cedars-Sinai teams with U.S. military for 'OR of the future'

Author : Doc Clemens

I thought this was interesting so I wanted to share it with our followers.

 

Cedars-Sinai Medical Center, in partnership with the U.S. military, will design an "operating room of the future" that aims to enable emergency medical teams to quicken their responses to life-threatening injuries.

The project, called "OR 360," will involve technology like movable walls and equipment for flexible use and an iPhone app that provides diagnostic information about blood pressure and vital signs, according to a

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Mar
27

Anesthesia Management: Noninvasive Continuous Arterial Pressure Monitoring

Author : Doc Clemens

Authors: Wagner JY et al., Scand J Trauma Resusc Emerg Med 2014 Jan 29; 22:8

A finger cuff device compares well with the traditional oscillometric method and provides continuous BP monitoring.

Accurate, continuous arterial blood pressure (BP) monitoring usually requires arterial catheterization. A new finger cuff device uses a vascular unloading technique for continuous, noninvasive BP monitoring. The cuff emits infrared light, with transmission through the finger dependent on blood volume in the

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Mar
27

Anesthesia Management: Failed Intubation in the ED Might Delay Return of Spontaneous Circulation

Author : Doc Clemens

Authors: Kim J et al., Resuscitation 2014 Feb 10;

A Korean study suggests failed intubation is an independent risk factor for reduced effectiveness of advanced cardiac life support.

Although prehospital advanced airway management is standard in the U.S., it has not been proven effective and is not performed in some countries. Researchers in a Korean city that provides only basic life support in the prehospital setting retrospectively studied all adults with nontraumatic out-of-hospital cardiac arr

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Mar
27

Anesthesia Management: High Incidence of Hypotension After Emergent Intubations

Author : Doc Clemens

Authors: Green R et al., CJEM 2014 Jan 1; 16:69

The incidence was 110 cases per 1000 intubations in this meta-analysis of emergent in-hospital intubations, but substantial heterogeneity among studies limits drawing conclusions.

Researchers performed a meta-analysis to better understand definitions, risk factors, and the incidence of post-intubation hemodynamic instability (PIHI). They identified 18 randomized trials and observational studies that included 6459 emergent, adult intubations outside o

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Mar
27

Anesthesia Management: Second-Generation Supraglottic Airway Is More Successful for Prehospital Intubations

Author : Doc Clemens

Authors: Middleton PM et al., Resuscitation 2014 Mar 1;

Compared with a laryngeal mask, the i-gel supraglottic airway had a higher insertion success rate in an Australian prehospital system.

Does the type of supraglottic airway make a difference? Investigators prospectively randomized 51 patients with out-of-hospital cardiac arrest to insertion of either the i-gel supraglottic airway or the Portex Soft Seal Laryngeal Mask by paramedics in a single Australian ambulance service. Both groups received

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Mar
27

Anesthesia Management: Prehospital Airway Management in Adults: Is Intubation the Best Strategy?

Author : Doc Clemens

Authors: McMullan J et al., Resuscitation 2014 Feb 18;

In a retrospective registry review of adults with out-of-hospital cardiac arrest, outcomes were better with no advanced airway placement.

Prehospital endotracheal intubation is performed for adult patients with out-of-hospital cardiac arrest in most U.S. emergency medical systems (EMS), but does it improve outcomes compared with bag-valve-mask (BVM) ventilation or placement of a supraglottic airway? To find out, researchers analyzed one year o

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Mar
26

Anesthesia Management: BREAKING: House readies for short-term SGR fix

Author : Doc Clemens

The House of Representatives has reached a deal to delay physician Medicare reimbursement cuts under the sustainable growth rate (SGR) formula for another year.

The last-minute agreement will likely disappoint physician, most of whom support a previous bipartisan deal to permanently repeal the emuch hated payment formula. But that deal hit a snag this month when lawmakers inserted measures in the bil tying it to a delay in the Affordable Care Act's mandate requiring all individuals to obtain heal

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Mar
26

Anesthesia Management: ICD-10 transition may cause information loss, financial trouble

Author : Doc Clemens

Just as organizations learned the costs of implementing ICD-10 were likely higher than previously realized, now there is a new headache on the horizon: The transition to ICD-10 may also lead to information and financial losses, according to a study published in the Journal of Oncology Practice.

To anticipate challenges providers might face during the transition, researchers from the University of Illinois at Chicago examined hematology-oncology diagnosis codes because they have fewer ICD-10 codes

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Mar
26

Anesthesia Management: FDA Recalls McKesson's Anesthesia Software Following Erroneous Patient-Matching

Author : Doc Clemens

The Food and Drug Administration has issued a Class I recall of McKesson Technologies Anesthesia Care software following an incident of a patient's data appearing in another patient's record.

McKesson had previously filed a Class II recall voluntarily last March following the incident, and issued a corrective patch to 10 affected customers. In a statement, McKesson states no patient harm resulted from the incident, and the company is closely monitoring the software.

Class I is the FDA's highest l

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Mar
26

Anesthesia Management: Long-Term Evaluation of Opioid Treatment in Fibromyalgia

Author : Doc Clemens

Published in Clin J Pain Jan 2014

Authors: Peng X et al.,

OBJECTIVES:

In a 12-month observational study, we evaluated the effect of opioid use on outcomes in 1700 adult patients with fibromyalgia (FM).

METHODS:

Data were evaluated using propensity-score-matching after patients were divided into cohorts based on their baseline medication use:(1) taking an opioid (concurrent use of tramadol was permitted); (2) taking tramadol (but no opioids); and (3) not taking opioids or tramadol. Changes in outcomes

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