POSTOPERATIVE delirium occurs in 5–15% of patients after noncardiac surgery1,2and is associated with a 3- to 11-fold increase mortality during the subsequent 6 months.3–5Accordingly, there an increasing need examine clinical risk factors identify individuals prophylactic intervention.2Although for postoperative vary between studies, preoperative age, depression, alcohol use, medical comorbidities, and cognitive impairment appear confer greater delirium.6Recent evidence suggests that...

Postoperative delirium is associated with increased morbidity and mortality. Preexisting cognitive impairment depression have been frequently cited as important risk factors for this complication. This prospective cohort study was designed to determine whether individuals who perform poorly on preoperative tests and/or exhibited depressive symptoms would be at high the development of postoperative delirium.One hundred nondemented patients, aged 50 yr older, scheduled undergo major, elective...

Background Administrative or quality improvement registries may not contain the elements needed for investigations by trauma researchers. International Classification of Diseases Program Injury Categorisation (ICDPIC), a statistical program available through Stata, is powerful tool that can extract injury severity scores from ICD-9-CM codes. We conducted validation study use ICDPIC in research. Methods retrospective cohort 40 418 patients with using large regional registry. ICDPIC-generated...

Aside from direct effects on neurotransmission, inhaled and intravenous anesthetics have immunomodulatory properties. In vitro mouse model studies suggest that propofol inhibits, while isoflurane increases, neuroinflammation. If these findings translate to humans, they could be clinically important since neuroinflammation has detrimental neurocognitive function in numerous disease states.To examine whether differentially modulate cytokines were measured a secondary analysis of cerebrospinal...

Trauma care in the general population has largely become protocol-driven, with an emphasis on fast and efficient treatment, good team communication at all levels of including prehospital care, initial resuscitation, intensive rehabilitation. Most available literature trauma focused adults, allowing potential to apply concepts from adult pediatric care. But there remain issues that will always be specific patients may not translate adults. Several new devices such as intraosseous (IO) needle...

To ascertain the degree of variation, by state acute care hospitalization, in outcomes associated with traumatic brain injury (TBI) an adult population.All hospitals 21 states United States year 2010.Adult (> 18 years) patients (N = 95 546) admitted to a hospital moderate or severe TBI.Retrospective cohort study using data from State Inpatient Databases Agency for Healthcare Research and Quality's Cost Utilization Project.Inpatient mortality discharge inpatient rehabilitation.The adjusted...

Approximately 45,000 individuals are hospitalized annually for burn treatment. Rehabilitation after hospitalization can offer a significant improvement in functional outcomes. Very little is known nationally about rehabilitation burns, and practices may vary substantially depending on the region based observed Medicare post-hospitalization spending amounts. This study was designed to measure variation utilization by state of patients with injury. retrospective cohort used collected data over...

Objective To describe the variation in surgical gastrostomy tube (SGT) placement premature infants among neonatal intensive care units (NICUs) United States. Study Design We identified 8,781 discharged from 114 NICUs Pediatrix Medical Group 2010 to 2012. The outcome of interest was SGT prior discharge home an NICU. Unadjusted proportions and adjusted risk estimates were calculated quantify observed individual NICUs. Results occurred 360 (4.1%) infants. Across NICUs, any ranged none 45 up...

BACKGROUND: In adults undergoing cardiopulmonary bypass surgery, oral intubation is typically preferred over nasal due to reduced risk of sinusitis and infection. children, more common sometimes perceived benefits less postoperative sedation a lower for accidental extubation. This study sought describe the practice in pediatric population surgery assess risks/benefits route against an one. METHODS: Patients <18 years age Society Thoracic Surgeons Congenital Heart Surgery Database between...

Thrombocytopenia and acute kidney injury (AKI) are common following pediatric cardiac surgery with cardiopulmonary bypass (CPB). However, the relationship between postoperative nadir platelet counts AKI has not been investigated in population. Our objective was to investigate this examine independent predictors of AKI.After IRB approval, we performed a retrospective review institution's medical records database.This study at single institution over 5-year period.We included patients <21...

Multi-institutional databases and registries have proliferated over the last decade in all specialties of medicine. They may be especially helpful low-frequency/high-acuity fields such as pediatric congenital heart diseases. The Society Thoracic Surgeon’s Congenital Heart Surgery Database (STSCHSD) is largest single data set for disease population includes contemporaneous from 120 programs United States (and several outside States), capturing greater than 98% cardiac surgical procedures...

Symptomatic women with angina are more likely to have ischemia no obstructive coronary arteries (INOCA) compared men. In both men and women, the finding of INOCA is not benign associated adverse cardiovascular events, including myocardial infarction, heart failure hospitalizations. Women a lower quality life men, but they often falsely reassured because lack artery disease (CAD) perception low risk. Coronary microvascular dysfunction (CMD) key pathophysiologic contributor INOCA, non-invasive...

Use of autotransfusion systems to collect, wash, and concentrate shed blood during surgical procedures is a widely used method for reducing postoperative anemia the need transfusions. The aim this study was evaluate CATSmart Continuous Autotransfusion System wash program performance with small (200 or 700 mL) large volumes (1,000 determine non-inferiority C.A.T.S plus system. Human whole collected in citrate phosphate dextrose, diluted, divided into two aliquots be processed as pair using...

We present a case of 3-month-old female with Wolf-Hirschhorn syndrome (WHS) undergoing general anesthesia for laparoscopic gastrostomy tube placement focus on airway management. WHS is rare 4p microdeletion resulting in multiple congenital abnormalities, including craniofacial deformities. Microcephaly, micrognathia, and glossoptosis are common features patients risk factors pediatric that potentially difficult to intubate. discuss strategies preparation management patient requiring...

Summary Background Infants with congenital heart disease often require feeding tube placement to supplement oral intake. Gastrostomy tubes may be placed by either surgical or percutaneous endoscopic methods, but there is currently no data comparing outcomes of these procedures in this population. Aims The aim our retrospective study was investigate the perioperative between 2 groups determine if are clinically significant differences. Methods We reviewed charts all infants at a single...

Background. Thoracic epidural catheters provide the best quality postoperative pain relief for major abdominal and thoracic surgical procedures, but placement is one of most challenging procedures in repertoire an anesthesiologist. Most patients presenting a procedure that would benefit from catheter have already had high resolution imaging may be useful to assist catheter. Methods. This retrospective study used data 168 examine association predictive power epidural-skin distance (ESD) on...

Neuromyelitis optica (NMO), or Devic’s disease, is an idiopathic severe demyelinating disease that preferentially affects the optic nerve and spinal cord. Neuraxial anesthesia in women with multiple sclerosis widely accepted, but reports of use neuraxial patients NMO are scarce. We report case a morbidly obese primigravida undergoing planned cesarean delivery at 32 weeks’ gestation due to acute exacerbation NMO, managed anesthesia. Other than increased intraoperative hyperalgesia requiring...

Electronic medical records can generate a wealth of information regarding compliance with perioperative clinical guidelines as well patient outcomes. Utilizing this to provide resident physicians measures their own performance may positively impact residents' performance. We hypothesize that providing residents objective individual adherence evidence based postoperative nausea and vomiting (PONV) management protocols will improve standardized treatment methods.We conducted retrospective...

Intraoperative ventilatory failure is not an uncommon complication; however, acute endotracheal obstruction by a foreign body or blood clot can be difficult to quickly discriminate from other causes. Once the diagnosis made, quick action needed restore ventilation. The ultimate solution exchange tube; there ways of resolving this in situations where reintubation would unsafe. This case report discusses such event infant with multiple airway challenges including retropharyngeal and anterior...