The prophylactic use of oxytocin after cesarean delivery has been shown to reduce maternal blood loss by 40 50%, yet there remains significant clinical deviation in how the medication is dosed. In January, 2021, Defense Health Agency issued Procedural Instruction 6025.35 entitled Guidance for Implementation Postpartum Hemorrhage Bundle. This directive established a set processes and procedures risk assessment treatment postpartum hemorrhage, including new standardized protocol vaginal...

The four individual cases presented include three clinical scenarios in which the operating surgeon, on behalf of surgical patient, desired focal “conduction analgesia” without motor block to facilitate postoperative physical examination and/or immediate advancement therapy/ambulation objectives during early convalescence. authors at two centers opted for available pharmacologic motor-sparing nerve blocks (entailing motor–sensory fiber analgesia using typical local anesthetics) as opposed...

ABSTRACT Introduction Tonsillectomy ranks high among the most common pediatric surgical procedures in United States. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen, are routinely prescribed to manage post-tonsillectomy pain, but may carry risk of hemorrhage. Materials and Methods This retrospective, longitudinal, secondary-data analysis study compared incidence surgically managed hemorrhage (sPTH) patients ibuprofen at Brooke Army Medical Center (BAMC) after tonsillectomy...

Objectives: The objective of this study was to determine the difference in anesthesia-controlled time (ACT) between subspecialty-trained pediatric anesthesiologists and general during esophagogastroduodenoscopy (EGD) colonoscopy. We hypothesized would demonstrate a shorter ACT compared anesthesiologists. Methods: conducted retrospective analysis endoscopy cases requiring endotracheal anesthesia within our sedation unit from 2017 2020. Demographic procedural variables were collected assessed...

Sleep disturbance is a modifiable risk factor that, when reduced, may improve subacute postsurgical outcomes (e.g., pain-related impact). Evidence also indicates that pain and sleep have bidirectional longitudinal relationship before to (sub) acutely after surgery. The objective of the present study examine degree which disturbances behavior uni- or relationships in sample patients undergoing sports orthopedic In this observational, cohort study, participants ( = 296) were adult (ages 18+)...

Objective: Contrasted with open laparotomy, the risk-benefit ratio of epidural anesthesia in laparoscopic surgery frequently disfavors its use. The presence abdominal sepsis also affects utilization concerns about risks abscess and hypotension. In unplanned conversion to postoperative pain control becomes more difficult. We discuss rectus sheath blocks liposome bupivacaine as a component multimodal analgesia patient from perforated appendix. Case Report: A 33-year-old healthy male Soldier...

Per Joint Trauma System guidelines, military anesthesiologists are expected to be ready lead an Acute Pain Service with regional anesthesia in combat casualty care. However, practice volume has not been assessed the military. The objective of this study was assess utilization among current residents and graduates U.S. anesthesiology residency programs.All former active duty program residents, trained at any four programs between 2013 2019, were anonymously surveyed about their practice....

ABSTRACT Introduction Enhanced Recovery After Surgery (ERAS) protocols have shown significant benefits in multiple areas including early mobilization, improved pain control, and oral intake. Deficient nutritional states may compromise the operative outcomes. Several essential vitamins, e.g., B12, C, D, E, demonstrated anti-inflammatory properties promote wound healing. Given low risk of multivitamin supplementation potential benefits, we hypothesized that adding a to our institution’s ERAS...

The anesthesiology in-training exam (ITE) is a 200-item multiple-choice assessment completed annually by physician residents. Because all matriculated U.S. Department of Defense (DoD) residents are "hired" the DoD after residency graduation, it important to ensure that ITE performance, as proxy for core competencies achievement, maximized. Graduated resident program files from 2013 2020 were queried age, sex, matriculant status (medical student vs. other), medical school (Uniformed Services...

<title>Abstract</title> Background The prophylactic use of oxytocin after fetal delivery has been shown to reduce maternal blood loss by 40–50%, yet there remains significant clinical deviation in how the medication is dosed. In January, 2021, Defense Health Agency (DHA) issued Procedural Instruction 6025.35 entitled Guidance for Implementation Postpartum Hemorrhage Bundle. This directive established a set processes and procedures risk assessment treatment postpartum hemorrhage (PPH),...

Postsurgical opioid utilization may be directly and indirectly associated with a range of patient-related surgery-related factors, above beyond pain intensity. However, most studies examine postsurgical without accounting for the multitude co-occurring relationships among predictors. Therefore, this study aimed to identify factors in first 2 weeks after arthroscopic surgery relationship between discharge prescription doses acute outcomes. In prospective longitudinal observational study, 110...

Abstract Aim This study aims to evaluate the overall incidence of abuse code documentation in medical records patients assigned female, and relationships between patient characteristics, healthcare utilization (e.g., visits, emergency room opioid prescription receipts), diagnoses received year following documentation. Subject methods Records female record were evaluated this observational, retrospective study, which a non-research determination by Brooke Army Medical Center Institutional...

ABSTRACT Introduction Meta-analytic findings and clinical practice guidance recommend pharmacological (e.g., pregabalin, duloxetine, milnacipran) non-pharmacological exercise sleep hygiene) interventions to reduce symptoms improve quality of life in people living with fibromyalgia. However, some these therapies may lack robust evidence as their efficacy, have side effects that outweigh benefits, or carry risks. Although the annual prevalence fibromyalgia active duty service members was...

Satisfaction with social roles and activities is an important outcome for postsurgical rehabilitation quality of life but not commonly assessed.To evaluate longitudinal patterns the Patient-Reported Outcomes Measurement Information System (PROMIS) Social Roles Activities measure, including how it relates to other biopsychosocial factors, before up 6 months after sports-related orthopaedic surgery.Cohort study (diagnosis); Level evidence, 3.Participants (N = 223) who underwent knee shoulder...

Abstract Background This case demonstrates the severe electrolyte derangements that may present after a common therapy such as bowel preparation for an outpatient procedure and rare yet potential detrimental outcomes of those abnormalities. It also highlights implications long QT syndrome regarding pharmacology treatment. Case presentation We 48 year-old female with (LQTS) leading to Torsades de Pointes (TdP), pulseless ventricular fibrillation, unsynchronized defibrillation in post...

Abstract Background To examine factors associated with post-Cesarean section analgesic prescription variation at hospital discharge in patients who are opioid naïve; and relationships between pre-Cesarean patient care-level morphine equivalent dose (MED) on outcomes (e.g., probability of refill within 30 days) across a large healthcare system. Methods The Walter Reed Institutional Review Board provided an exempt determination, waiver consent, HIPAA authorization for research use the present...