Anesthesia Uncertainties pepper the healthcare landscape, but the shift to value-based care is expected to continue, even though momentum may slow under the current administration. That means perioperative services leaders must continue to explore new care delivery options such as the perioperative surgical home (sidebar, p 17). “The demand for value…
Editor's Note Discharge from the postanesthesia care unit (PACU) without assessment of lower limb motor function after spinal anesthesia for total hip or knee arthroplasty did not increase length of hospital stay or readmissions but significantly reduced time in the PACU (0.40 vs 1.56 hours), this study finds. This multicenter…
Editor's Note Ketamine does not decrease delirium or lower levels of pain in older adults after major surgery and might cause harm by inducing hallucinations and nightmares, this study finds. A total of 672 patients were randomly assigned to a placebo group (222 patients), a 0.5 mg/kg ketamine group (227),…
Editor's Note The Food and Drug Administration (FDA) on April 27 issued a Safety Alert saying the agency had approved label changes on the use of general anesthetic and sedation drugs in children younger than 3 years. The changes include: A new warning that exposure to these drugs for lengthy…
Editor's Note The combination of femoral and sciatic nerve blocks is the overall best approach to pain management after total knee arthroplasty, finds this meta-analysis. The best five modalities for pain at rest were: femoral/obturator, femoral/sciatic/obturator, lumbar plexus/sciatic, femoral/sciatic, and fascia iliaca compartment blocks. For reducing opioid consumption, the best…
Editor's Note Conscious sedation is a safe and viable option for anesthesia in patients having transcatheter aortic valve replacement (TAVR), finds this study. The use of conscious sedation rather than general anesthesia was associated with: similar rates of adverse events (1.5% in both groups) shortened ICU (30 vs 96 hours)…
Editor's Note Non-OR anesthesia (NORA) is a growing component of anesthesiology practice in the US, this study finds. The proportion of NORA cases overall increased from 28.3% in 2010 to 35.9% in 2014, and the proportion of NORA outpatient cases increased from 69.7% to 73.3%. Colonoscopy was the most common…
Editor's Note Opting out of the Medicare rule that requires anesthesia to be administered with physician supervision has little or no effect on access to inpatient or outpatient surgery, this study finds. The researchers also found that opting out does not reduce costs, and in fact increases costs for inpatient…
Editor's Note Nerve blocks in total knee patients were associated with statistically significant reductions in length of stay and readmissions, but no difference in emergency department visits or in-hospital falls, this Canadian study finds. In the analysis of 178,214 patients, adjusted: mean hospital stay was 4.7 days for patients with…
When leaders at Memorial Healthcare, a 154-bed community hospital in Owosso, Michigan, wanted to get a jump on preparing for bundled payments, they chose to focus on total hip and knee surgery. Creating a perioperative surgical home (PSH) for this patient population paid off in enhanced patient satisfaction and reductions…
