Abstract:
STUDY OBJECTIVE:The purpose of this study is to determine whether routine preoperative testing has a usefulness not previously recognized in a small preliminary study to decide if such a hypothesis might be worthy of testing in a larger study. DESIGN:Single-observer, prospective, observational study. SETTING:Tertiary-care referral center in South India that performs 11 preoperative tests on each patient. PATIENTS:One hundred twenty-seven adult patients scheduled for elective neurosurgery. INTERVENTIONS:Patients were studied to determine whether outcome was influenced by laboratory tests, which were either indicated by health history elicited by a computerized rule-based questionnaire or unindicated by patient history. MEASUREMENT AND MAIN RESULTS:Of the 1395 tests performed preoperatively, 513 (36.8%) were indicated and 882 (63.3%) were unindicated. Of 513 indicated tests, 17 (3.3%) prompted changes in patient care; 8 (0.91%) of 882 unindicated tests (P < .001) prompted changes in care. All patients with anemia, significant electrocardiographic abnormalities, or HIV infection were detected by the computerized questionnaire. Among the changes in care prompted by unindicated tests, 4 patients received diabetic therapy or counseling, and 4 patients with abnormal silhouettes on chest radiograph had nonbeneficial echocardiography. Only screening for diabetes seemed to have usefulness as a routine preoperative test in this patient population. CONCLUSION:Although the incidence of unindicated preoperative screening tests is still more than 50%, no previously unidentified benefit was found to support this persistence of unwarranted testing. The limited number of patients in this study necessitates a larger study to ensure greater certainty before such a recommendation is made to the public. If similar results in another but larger study involving similar design, simple changes in the system of preoperative care may save the health care system the considerable expense of unwarranted testing.
journal_name
J Clin Anesthjournal_title
Journal of clinical anesthesiaauthors
Mantha S,Roizen MF,Madduri J,Rajender Y,Shanti Naidu K,Gayatri Kdoi
10.1016/j.jclinane.2004.04.002subject
Has Abstractpub_date
2005-02-01 00:00:00pages
51-7issue
1eissn
0952-8180issn
1873-4529pii
S0952-8180(04)00207-7journal_volume
17pub_type
临床试验,杂志文章abstract:OBJECTIVE:To evaluate the effects of epidural, spinal, and general anesthesia on pain after lower-limb amputation. DESIGN:Cross-sectional survey. SETTING:Postamputation clinic. PATIENTS:150 patients who were evaluated one to 24 months after their lower-limb amputation. INTERVENTIONS:Patients received epidural, spin...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2006.03.021
更新日期:2006-12-01 00:00:00
abstract:STUDY OBJECTIVE:To determine how often pediatric anesthesiologists follow the American Heart Association (AHA) recommendations for the administration of prophylactic antibiotics to prevent bacterial endocarditis (BE). DESIGN:Questionnaires mailed to all members of the Society for Pediatric Anesthesia regarding their u...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/0952-8180(94)90109-0
更新日期:1994-01-01 00:00:00
abstract::A potentially life-threatening arrhythmia appeared on the preinduction electrocardiogram of an asymptomatic young woman prior to spine surgery. The patient was evaluated by electrophysiology and had a rare accessory pathway, a Mahaim Fiber. ...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2010.09.010
更新日期:2011-09-01 00:00:00
abstract:STUDY OBJECTIVE:To assess the clinical impact of paravertebral blocks (PVBs) on the immediate outcome of patients undergoing radical prostatectomy. DESIGN:Retrospective review. SETTING:Urology ward of a university medical center. MEASUREMENTS:Records of 100 consecutive patients who underwent a radical prostatectomy ...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2006.12.003
更新日期:2007-06-01 00:00:00
abstract::Myotonic dystrophy (DM), though rare, can significantly complicate anesthesia due to muscular and extra-muscular involvement. When this condition is compounded by a pheochromocytoma, anesthetizing such patients becomes extra challenging. We present a case report of a 61-year-old lady with congenital DM, with the whole...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2016.03.035
更新日期:2016-11-01 00:00:00
abstract::The right heart and great veins can be the harbinger of septic and aseptic thromboemboli, which can result in a spectrum of clinical syndromes. This report presents five distinct clinical scenarios of thromboembolization, the occurrence of which in the central circulation resulted in life-threatening sepsis and hemody...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章,评审
doi:10.1016/0952-8180(93)90071-l
更新日期:1993-11-01 00:00:00
abstract:STUDY OBJECTIVE:To ascertain the optimal dose of trimethaphan camsylate administered by intravenous (i.v.) bolus injection for the control of hypertension and tachycardia during electroconvulsive therapy (ECT). DESIGN:Prospective, double blind, within-subject study. SETTING:Treating room of the psychiatric unit of th...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0952-8180(95)00192-1
更新日期:1996-03-01 00:00:00
abstract:STUDY OBJECTIVE:To examine the acute hemodynamic effects of intravenous (i.v.) nicardipine and its ability to attenuate the hyperdynamic response to electroconvulsive therapy (ECT), when used alone or in combination with labetalol. DESIGN:Prospective, randomized, double-blind, positive-control, clinical investigation....
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0952-8180(98)00052-x
更新日期:1998-08-01 00:00:00
abstract:STUDY OBJECTIVE:To determine the effects of fresh gas flow on inspired gas composition during low-flow anesthesia. DESIGN:Randomized trial with 2-hour observation periods in patients assigned to one of three groups. SETTING:Inpatient surgery clinic at a medical center. PATIENTS:Thirty-six patients undergoing abdomin...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0952-8180(92)90214-l
更新日期:1992-11-01 00:00:00
abstract::We present the case of a patient who first presented with unexpected difficult laryngoscopy and intubation after induction of general anesthesia. After multiple failed attempts using direct laryngoscopy, tracheal intubation was successfully performed with the Intubating Laryngeal Mask Airway. He returned to the operat...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2007.04.009
更新日期:2007-12-01 00:00:00
abstract::Homocystinuria, a rare autosomal recessive genetic disease, is generally classified into 3 types (types I-III). Extremely rare type III is from a defect of the enzyme tetrahydrofolate reductase which converts homocysteine to methionine. The anesthetic problem of type III homocystinuria is the elevation of serum homocy...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2005.01.005
更新日期:2005-11-01 00:00:00
abstract::We report the use of high-frequency oscillatory ventilation in the operating room during repair of multiple bronchopleural fistulae in a 9-year-old boy. In addition, we used principles of permissive hypercapnia to further minimize barotrauma. There were no cardiovascular consequences due to either the high-frequency v...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/S0952-8180(96)00206-1
更新日期:1997-02-01 00:00:00
abstract:STUDY OBJECTIVE:To compare the efficacy and safety of four commercial propofol solutions marketed in Israel. DESIGN:Prospective, randomized, double-blind study. SETTING:University-affiliated medical center. PATIENTS:120 ASA physical status I and II nullipara patients undergoing dilatation and curettage for interrupt...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0952-8180(01)00271-9
更新日期:2001-08-01 00:00:00
abstract:STUDY OBJECTIVES:To assess whether the year of residency in anesthesiology is associated with residents' overall perceptions of the learning environment and to evaluate the association between year of residency and each of the five domains of the Dundee Ready Education Environment Measure (DREEM) survey. DESIGN:Cross-...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2016.09.017
更新日期:2016-12-01 00:00:00
abstract::Vasoplegic syndrome (VS) is increasingly recognized as an important clinical entity in perioperative medicine. VS is characterized by significant arterial hypotension, normal or high cardiac output, low systemic vascular resistance, and increased requirements for intravenous volume and vasopressors. Tremendous variati...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章,评审
doi:10.1016/j.jclinane.2017.04.017
更新日期:2017-08-01 00:00:00
abstract::Tracheobronchopathia osteochondroplastica is a rare disorder characterized by cartilaginous or ossified submucosal nodules that project into the tracheobronchial lumen. It is typically discovered in the evaluation of chronic upper respiratory symptoms. A case of a completely asymptomatic man diagnosed with extensive d...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2013.05.010
更新日期:2013-12-01 00:00:00
abstract::A case of persistent thoracic cerebrospinal fluid cutaneous fistula in a toddler following radiographically confirmed epidural catheter placement is reported. Treatment of the fistula with a thoracic epidural blood patch was successful. ...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2012.11.012
更新日期:2013-06-01 00:00:00
abstract::We present the case report of a 49-year-old gentleman with a history of adenoid cystic carcinoma of the left nare status post curative bifrontal craniotomy, left lateral rhinotomy and medial maxillectomy, adjuvant radiotherapy, and orbital exenteration for optic neuropathy, complicated by medial wall dehiscence. His c...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2016.05.005
更新日期:2016-11-01 00:00:00
abstract::This report highlights transient Horner's syndrome and trigeminal nerve palsy following labor epidural analgesia. A 29-year-old primigravida had a lumbar epidural catheter placed for analgesia in labor. The analgesia was maintained by infusion of a dilute local anesthetic/opioid mixture and turned off after achieving ...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/s0952-8180(02)00406-3
更新日期:2002-11-01 00:00:00
abstract:STUDY OBJECTIVE:To compare the hemodynamic effects of two different concentrations of pentastarch hydroxyethyl starch (HES; 200/0.5) solutions with a 4% human albumin solution for fluid resuscitation. DESIGN:Open-label, randomized, controlled study. SETTING:Medical-surgical intensive care unit. PATIENTS:34 consecuti...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jclinane.2008.05.022
更新日期:2008-11-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate and compare the efficacy of various pretreatment agents to attenuate or prevent opioid-induced muscle rigidity using a well-established, previously described clinical protocol. DESIGN:Prospective, controlled, single-blind, partially randomized study. SETTING:Large medical center. PATIENTS...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0952-8180(94)90087-6
更新日期:1994-11-01 00:00:00
abstract::Recent pharmacologic evidence supports the importance of the integrity of the endothelium in modulating vascular reactivity. The endothelial cells produce one or more endothelium derived relaxing factor(s) or EDRF that cause relaxation of vascular smooth muscle cells through production of cyclic guanosine monophosphat...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章,评审
doi:10.1016/0952-8180(88)90033-5
更新日期:1988-01-01 00:00:00
abstract::Although digoxin remains one of the most widely prescribed drugs in the United States, potential pharmacodynamic and pharmacokinetic interactions between this compound and other drugs, diseases, and events commonly encountered in the perioperative period remain largely unappreciated. Furthermore, the therapeutic benef...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章,评审
doi:10.1016/0952-8180(92)90170-6
更新日期:1992-09-01 00:00:00
abstract::Administration of vecuronium by infusion is an increasingly common technique, both in the operating room and in the intensive care unit (ICU), for patients requiring prolonged neuromuscular blockade and mechanical ventilation. The major advantage of vecuronium over older neuromuscular blocking agents is its rapid excr...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/0952-8180(90)90107-e
更新日期:1990-07-01 00:00:00
abstract:STUDY OBJECTIVE:To determine the effects of dexmedetomidine premedication on the minimum alveolar concentration of sevoflurane for tracheal intubation (MACTI) in children. DESIGN:Prospective, randomized, clinical comparison study. SETTING:Operating room of an academic hospital. PATIENTS:90 pediatric, ASA physical st...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jclinane.2013.12.012
更新日期:2014-06-01 00:00:00
abstract:STUDY OBJECTIVE:To determine the significance of pain and other symptoms on the recovery process after ambulatory surgery, by surveying pain, analgesic use, and related aspects of recovery in the first 48 hours after discharge from an ambulatory surgery unit. DESIGN:Prospective, observational, surveillance survey. PA...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2003.08.004
更新日期:2004-05-01 00:00:00
abstract:STUDY OBJECTIVE:To quantify global coagulation and establish normal ranges for the celite-activated thrombelastograph (TEG) in healthy pediatric patients. DESIGN:Prospective observational study. SETTING:Operating suite of a university-based hospital. PATIENTS:110 healthy pediatric patients in four age groups and 25 ...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章
doi:10.1016/s0952-8180(00)00238-5
更新日期:2001-02-01 00:00:00
abstract:STUDY OBJECTIVE:To investigate intracuff pressure changes in the ProSeal Laryngeal Mask Airway (PLMA) during 50% nitrous oxide (N₂O) anesthesia. DESIGN:Prospective, randomized study. SETTING:Operating room of a university-affiliated hospital. PATIENTS:40 ASA 1 and 2 children, aged 2 to 6 years, weighing 10-20 kg, un...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jclinane.2010.09.004
更新日期:2011-05-01 00:00:00
abstract:STUDY OBJECTIVES:To evaluate the effects of fentanyl on the cardiorespiratory system in elderly patients undergoing cataract surgery with phacoemulsification method. DESIGN:Randomized, prospective, double-blind study. SETTING:University hospital. PATIENTS:70 ASA physical status I, II, and III patients (>60 years) wh...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/j.jclinane.2003.05.008
更新日期:2004-03-01 00:00:00
abstract::The initial written examination of the American Board of Anesthesiology, a division of the American Board of Surgery, was given on March 28, 1939. For all anesthesiologists, this date has double significance. First, what was meant by anesthesiology as a medical specialty was defined through the questions posed on the ...
journal_title:Journal of clinical anesthesia
pub_type: 历史文章,杂志文章
doi:10.1016/0952-8180(92)90226-q
更新日期:1992-11-01 00:00:00