Ple ASA ase V Boo isit u th # s a 102 t 3
Society for Airway Management annual meeting issue
The Independent Monthly Newspaper for Anesthesiologists AnesthesiologyNews.com • S e p t e m b e r 2 0 1 1 • Volume 37 Number 9
Speeding Hip Surgery Cost Effective
H
ealth care costs associated with hip fractures in the United States total $10.3 billion to $15.2 billion annually, and the one-year mortality rate for these patients is between 12% and 37%. The death rate increases substantially if the time from hospital admission to surgery exceeds 48 hours (Can J Anesth 2008;55:146-154). Implementing ways to shorten the time to surgery would likely result in improved patient outcomes, but at what cost? A new study (J Bone Joint Surg Am 2011;93: 1326-1334) evaluated the hypothetical cost-effectiveness of reducing the
The Good Catch Awards
Program Encourages Reporting Accidents Waiting To Happen
A
new system that encourages every clinician to report situations that put patients at risk appears to be succeeding. Within 24 months, the new program, based at Johns Hopkins Medicine, in Baltimore, distributed 27 socalled “Good Catch Awards” (Table, page 14) to clinicians who reported situations that resulted in changes that were potentially lifesaving, including a national recall of improperly labeled drugs that had caused look-alike medication errors. The concept of the program is based on the idea that one person is rarely at fault; rather, it is a faulty system, said Justin Hamrick, MD, a third-year anesthesia resident at the institution. As a result, raising
see hip page 26
see catch page 14
Pre-op Nerve Damage a Cause Of Post-Herniorrhaphy Pain?
INside 09 | PRN For would-be residents, a good first impression is more important than they realize.
Study offers alternative theory of pain after inguinal hernia repair: neuritis, not operative trauma San Francisco—As many as onethird of patients who undergo primary inguinal hernia repair may have preexisting nerve damage, according to a new study presented at the 2011 annual meeting of the American Hernia Society. The study won the Fruchard Award for best poster and was published in Hernia (2011;15:393-398). The finding suggests a significant shift in the cause-andeffect paradigm that has defined
post-herniorrhaphy pain, said the study’s lead author, Robert Wright, MD, a private practice surgeon at Meridian Surgery Center in
16 | CLinical Anesthesiology
Puyallup, Wash. Dr. Wright’s results indicate that a sizeable fraction of the post-herniorrhaphy pain seen in patients may be the result of preexisting nerve damage, rather than operative trauma. “We have always considered the pain associated with the hernia as a visceral pinch or a muscular pain; we haven’t considered nerve damage,” said Dr. Wright, who added that many patients
Multimodal analgesia and TAP block a winning combination.
24 | Policy & Management Assessing the impact of Kentucky’s opioid script monitoring program.
36 | Pain Medicine Analgesic requirements—and costs—after TKA are higher for women.
42 | technology “4-D” ultrasound helps guide placement of central lines.
see hernia page 32
Ronald D. Miller, Manuel C. Pardo, Jr.
Newproducts
Arrow® ErgoPack™ from Teleflex, see pages 22 and 24.
McMahonMedicalBooks.com Basics of Anesthesia
Innovian® Anesthesia 4.0 from Dräger, see pages 9 and 28.
see page 39
SorbaView® SHIELD from Centurion Medical Products, see pages 6, 7 and 38.