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PubMedDate not supplied

A pharmacoeconomic analysis of neuromuscular blocking agents in the operating room.

A cost-minimization analysis was performed to compare the direct costs of various neuromuscular blocking agents (NMBAs) in procedures of specific durations. Secondary objectives were to review the role of the NMBAs studied with respect to their place on our hospital formulary, and to develop a pharmacoeconomic methodology to be applied to other formulary decisions. Patients were stratified according to estimated length of surgical procedure; group 1 (55 patients) included surgeries estimated to take less than 2 hours, and group 2 (55 patients) included those estimated to be 2-4 hours long. Patients were then randomized to one of three intermediate-acting NMBAs: atracurium, vecuronium, or rocuronium. Anesthesia records were used to obtain all anesthetic agents administered in the operating room, and drug costs were calculated from hospital drug acquisition costs as of December 1994. Postanesthesia care unit (PACU) costs were estimated from patient charges and converted to costs using our hospital's cost-to-charge ratio. Costs that were common to all study treatments or unrelated to the use of NMBAs were excluded from the analysis. Two time-adjusted costs were calculated to determine the cost of neuromuscular blockade/hour and the total anesthesia drug costs/hour. In group 1 there were no statistical differences in NMBA cost/hour, anesthesia cost/hour, or PACU times or costs. In group 2, a significant difference was found in NMBA cost/case between atracurium ($54.23 +/- 41.26, mean +/- SD) and vecuronium ($31.95 +/- 15.33, p = 0.046). Atracurium was also significantly more costly than either vecuronium or recuronium/hour ($21.95 +/- 7.42 vs $14.39 +/- 7.02 and $16.07 +/- 8.15, respectively, p = 0.011) and anesthesia cost/hour ($28.77 +/- 7.43 vs $ 22.82 +/- 7.46 and $23.32 +/- 6.54, respectively, p = 0.03). There were no differences in PACU times or costs. Based on these results, vecuronium or rocuronium is preferred over atracurium in procedures with an estimated duration of 2-4 hours. In the patient population evaluated, there were no significant cost differences among the three NMBAs in surgeries with an estimated duration of less than 2 hours.

Adult↗
PubMed1996

Angioscopy in the operating room.

Angioscopy has been used in the superficial femoral artery for many years, as well as in the control of vascular surgery procedures. It is more reliable than angiography, which often misses such features as intimal flaps, residual valves in "in situ" vein bypasses or persisting thrombus after embolectomy. As fluid irrigation allows visualization of the iliac arteries, and as smaller atraumatic fibres allow safe visualization of the tibial arteries, new fields are opened for the use of angioscopy in peripheral vascular disease. This technique has been proved to be useful: (1) as a diagnostic tool, (2) as a control device in new endovascular procedures (percutaneous angioplasty, atherectomy and stents), and (3) as a therapeutic tool (thromboembolectomy, simplification of bypass procedures). In a modern operating room, angioscopy does not replace angiography, but these two imaging techniques are complementary, as they help the surgeon to provide the patients with a less invasive vascular surgery.

Angiography↗
PubMed2003

Cold ischaemia time added to kidneys can be minimized by completing the final cross-match before organs are taken from the operating room.

UNLABELLED: Minimizing the amount of cold ischaemia time (CIT) added to cadaveric kidneys before their transplantation is an important goal since longer CIT is associated with worse long-term graft outcome. Our organ procurement organization (OPO) and HLA laboratories have taken the approach of performing the histocompatibility testing, including the final cross-match, as early in the donor process as possible. METHODS: The data in this study were collected from all consecutive final cross-matches done for cadaveric kidney (n = 113) and simultaneous pancreas + kidney (SPK) (n = 25) transplants done with organs recovered from donors in the Midwest Transplant Network OPO from 1 January 2001 to 9 May 2002. We evaluated the time the final cross-match was completed from when the kidneys from that donor were taken from the operating room (OR) and compared that time with CIT. RESULTS: For kidney transplants, 72% of the final cross-matches were complete before the kidneys were taken from the OR. The CIT of that group (10.4 +/- 3.8 h) was significantly lower than that of the group of kidney transplant patients whose final cross-match was done after the kidneys were taken from the OR (15.5 +/- 5.8 h) (P < 0.001). Similarly, for SPK transplants, 88% of the final cross-matches were completed before the organs left the OR and the CIT of that group (10.2 +/- 3.4 h) was less than in the group whose final cross-match was done after the organs left the OR (14.3 +/- 4.8 h) (P > 0.1). CONCLUSIONS: These data show that the practice of completing the final cross-match as early in the donor process as possible helps to minimize the amount of cold ischaemia time added to the kidneys and pancreata before transplantation. That should reduce the detrimental influence that longer CIT has on short- and long-term function in kidney as well as SPK transplantation.

Cold Temperature↗
PubMed1981

Transcutaneous PCO2 monitoring on adult patients in the ICU and the operating room.

Studies were performed on 44 patients who were monitored continuously with transcutaneous carbon dioxide (PtcCO2) sensors. The patients were monitored intermittently with arterial and mixed venous blood gases and full hemodynamic and oxygen transport data. Twenty of the studies were performed intraoperatively. A total of 411 data sets revealed a correlation coefficient, r, between arterial and transcutaneous PCO2 of 0.80 when the patients were not in low flow shock, i.e., cardiac index (CI) greater than 1.5 L/min x M2. On the basis of these data, the authors have found the normal arterial-transcutaneous carbon dioxide gradient, delta CO2, (delta CO2 = PtcCO2 -- PaCO2) to be 23 +/- 11 torr. The PtcCO2 monitor was found to be a valuable trend monitor of arterial CO2 tensions of adults during adequate cardiac function in the ICU and the operating room. Twenty-four data sets were collected while 3 patients were monitored during severe shock (CI less than 1.5 L/min x M2). PtcCO2 trended inversely with changes in CI during shock and did not follow PaCO2 (r = --0.85). During shock, delta CO2 = 61 %/- 25 torr. The severity of shock could be roughly determined by comparing the PtcCO2 values with arterial CO2 tensions.

Adult↗