Abstract:
BACKGROUND:Medical errors exact an inordinate toll on healthcare costs. One of the most publicized and analyzed type of medical error is wrong-site surgery. Yet, despite the burgeoning number of procedures performed, no literature exists on wrong-site pain management injections. The purpose of this study was to estimate the relative incidence and determine the causes of wrong-site pain management procedures. METHODS:Quality improvement records were examined during a 2-yr period from four civilian academic teaching hospitals, three military treatment facilities, and three private practices, for "sentinel" events involving wrong-site pain management procedures. A total of 13 cases (incidence 0.027%; 95% CI 0.01-0.05%) were identified from approximately 48,941 collective procedures of which 52.4% were deemed to be "at risk" for the occurrence. Root cause analyses were then conducted to determine the origin of each error. RESULTS:The 13 cases included five wrong-side transforaminal epidural steroid injections, six other wrong-side injections, and two wrong-level minimally invasive surgical procedures. In only one case was the "universal protocol" completely followed, and in nine procedures, multiple lapses occurred in protocol. Three patients had bilateral pathology, and in seven cases, the patient knew at the time that the wrong side was being injected. In no instance did any technical, legal, or professional consequences ensue from the error. CONCLUSIONS:Wrong-site nerve blocks occur more frequently in pain management centers than has previously been acknowledged. Adaptation of the universal protocol to nerve blocks and strict adherence to widely accepted guidelines may prevent wrong-site interventional pain procedures.
journal_name
Anesthesiologyjournal_title
Anesthesiologyauthors
Cohen SP,Hayek SM,Datta S,Bajwa ZH,Larkin TM,Griffith S,Hobelmann G,Christo PJ,White Rdoi
10.1097/ALN.0b013e3181cf892dsubject
Has Abstractpub_date
2010-03-01 00:00:00pages
711-8issue
3eissn
0003-3022issn
1528-1175pii
00000542-201003000-00034journal_volume
112pub_type
杂志文章,多中心研究相关文献
ANESTHESIOLOGY文献大全abstract:BACKGROUND:The surface membrane Ca(2+)-adenosine triphosphatase and Na(+)-Ca(2+) exchanger transport Ca(2+) out of the ventricular myocyte, competing for cytosolic Ca(2+) with the Ca(2+)-adenosine triphosphatase located in the sarcoplasmic reticulum. In this study the authors examined the effects of halothane, isoflura...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200206000-00027
更新日期:2002-06-01 00:00:00
abstract::Recent reports have described resistance to pancuronium-induced neuromuscular blockade in patients chronically receiving anticonvulsants. This study examines the pharmacokinetics and pharmacodynamics of metocurine (MTC) in 12 patients undergoing craniotomy--six on chronic phenytoin therapy and six comparable controls....
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198509000-00009
更新日期:1985-09-01 00:00:00
abstract:BACKGROUND:In vitro studies have shown that isoflurane, enflurane, and halothane inhibit the hypoxic pulmonary vasoconstriction (HPV) with essentially the same potency. The aim of this study is to compare the effects of sevoflurane and isoflurane on HPV in constant-flow perfused rabbit lungs. METHODS:Constant-flow per...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-199312000-00026
更新日期:1993-12-01 00:00:00
abstract::The effect of halothane, at clinically relevant concentrations on the ability of human polymorphonuclear leukocytes (PMNL) to kill the most frequently isolated gram-negative organisms responsible for human bacteremias, Escherichia coli and Klebsiella pneumoniae, was studied. Exposure of PMNL to 0.75 per cent halothane...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198155060-00009
更新日期:1981-12-01 00:00:00
abstract::Minute ventilation (VE), tidal volume (VT), carbon dioxide elimination (VCO2), and end-tidal (PETCO2) and arterial CO2 tensions (PaCO2) were measured in 39 anesthetized infants and children with body weights ranging from 3.1 to 31 kg. Eighteen children had normal cardiopulmonary function, seven had acyanotic congenita...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198702000-00010
更新日期:1987-02-01 00:00:00
abstract:BACKGROUND:Memory function under anesthesia is undesired but may arise from light hypnosis as well as stress-enhanced learning during surgery. The bispectral index (BIS, Aspect Medical Systems, Norwood, MA) is a monitor of hypnotic state that can help to avoid light hypnosis (i.e., BIS above 60). This study tested the ...
journal_title:Anesthesiology
pub_type: 杂志文章,随机对照试验
doi:10.1097/ALN.0b013e3181b05f0b
更新日期:2009-09-01 00:00:00
abstract::This study examined whether pain or stress can enhance the analgesic effects of spinally administered opiates. The experiments determined the effects of mechanically produced pain and of the stress of being restrained on the analgesic effects of 0.63 microgram of epidural sufentanil in rats using a tail-withdrawal pro...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198807000-00004
更新日期:1988-07-01 00:00:00
abstract:BACKGROUND:Oral clonidine may influence plasma glucose and lipid homeostasis by modulating endocrinologic responses to surgical stress. The effect of oral clonidine premedication on plasma glucose and lipid homeostasis associated with exogenous glucose infusion were investigated in children undergoing minor surgery. M...
journal_title:Anesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000542-199804000-00011
更新日期:1998-04-01 00:00:00
abstract:BACKGROUND:Vascular endothelium plays an important role in the regulation of vascular tone. Volatile anesthetics have been shown to attenuate endothelium-mediated relaxation in conductance arteries, such as aorta. However, significant differences in volatile anesthetic pharmacology between these large vessels and the s...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-199501000-00024
更新日期:1995-01-01 00:00:00
abstract::The authors have previously attributed the mechanism for the 50-67% decrease in the required dose of thiopental for induction of anesthesia in aged human patients to a decrease in the initial distribution volume for thiopental. Using a larger group of patients and volunteers studied in the laboratory, the authors have...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-199003000-00003
更新日期:1990-03-01 00:00:00
abstract::The pharmacokinetics, biodisposition, and neuromuscular blocking properties of 3-desacetylvecuronium were studied in 17 adult cats. Animals were divided into three groups: five cats with kidney failure induced by bilateral ligation of the renal pedicles, six cats with galactosamine-induced fulminant hepatitis, and six...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-199106000-00013
更新日期:1991-06-01 00:00:00
abstract::Anesthetic induction with propofol commonly results in hypotension. This study explored potential mechanisms contributing to hypotension by recording cardiovascular responses including sympathetic neural activity from patients during induction of anesthesia with propofol (2.5 mg.kg-1 plus 200 micrograms.kg-1.min-1) or...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-199205000-00010
更新日期:1992-05-01 00:00:00
abstract:BACKGROUND:Isoflurane has been said to be more ventilatory depressant than halothane. However, data for comparing the respiratory effects of halothane and isoflurane in humans are insufficient at this time. The aim of this study was to extend our understanding of the nature of the central, as opposed to peripheral, ven...
journal_title:Anesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000542-199409000-00007
更新日期:1994-09-01 00:00:00
abstract::The use of isoflurane in patients with coronary artery disease remains controversial because of the possibility of "coronary steal". In this study, the effects of isoflurane and halothane on global and regional myocardial blood flow and metabolism were compared, and the relationship between steal-induced myocardial is...
journal_title:Anesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000542-199111000-00006
更新日期:1991-11-01 00:00:00
abstract:BACKGROUND:Mutations in the ryanodine type 1 receptor (RyR1) are causative for malignant hyperthermia. Studies in human B lymphocytes have shown that measurement of RyR1-mediated intracellular Ca(2+) (Ca(2+)(i)) release can differentiate between normal and malignant hyperthermia-susceptible individuals. The authors hav...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200606000-00014
更新日期:2006-06-01 00:00:00
abstract:BACKGROUND:Occasionally, emergency perioperative pacing is necessary. Transcutaneous cardiac pacing is noninvasive, safe, and readily available. Its feasibility and hemodynamic effects during thoracic surgery and one-lung ventilation have not been established. METHODS:Twenty anesthetized patients (aged 25-70 yr) witho...
journal_title:Anesthesiology
pub_type: 临床试验,杂志文章
doi:10.1097/00000542-199310000-00013
更新日期:1993-10-01 00:00:00
abstract:BACKGROUND:Isoflurane administration is known to increase extracellular dopamine (DA) concentration. Because the dopamine transporter (DAT) is a key regulator of DA, it is likely affected by isoflurane. This study investigates the hypothesis that isoflurane inhibits DA reuptake by causing DAT to be trafficked into the ...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200302000-00021
更新日期:2003-02-01 00:00:00
abstract::A constantly coupled bigeminal arrhythmia was induced in dogs anesthetized with thiopental-halothane by infusion of epinephrine (1 microgram.kg-1.min-1). The site of origin of the abnormal beat was localized to the interventricular septum by bipolar recordings from the left and right ventricular epicardium and two sit...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198208000-00006
更新日期:1982-08-01 00:00:00
abstract::To study the cerebral protective effects of hypothermia in arterial hypoxia, anesthetized (70% N2O), mechanically ventilated rats were cooled to a body temperature of 27 C. Hypoxia was induced by decreasing the oxygen content in the inspired gas mixture either to 6-7 per cent or to 2.5-3 per cent. This reduced mean Pa...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-197601000-00006
更新日期:1976-01-01 00:00:00
abstract:BACKGROUND:The authors evaluated optimal adrenergic support using norepinephrine, dopamine, and dobutamine in a clinically relevant model of septic shock. METHODS:Twenty-eight mature, female, anesthetized sheep (weight, 30.5 +/- 3.6 kg) underwent cecal ligation and perforation and were randomized into four groups of s...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200304000-00015
更新日期:2003-04-01 00:00:00
abstract::Systolic pressure variation (SPV) is defined as the difference between the maximum and minimum values of systolic blood pressure following a single positive pressure breath. An increase in the SPV is known to occur clinically during hypovolemia. This study aims to quantify SPV during graded hemorrhage in ventilated do...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198710000-00009
更新日期:1987-10-01 00:00:00
abstract:BACKGROUND:Activation of the gamma-aminobutyric acidA (GABAA) receptor-ionophore complex has been reported as a possible molecular mechanism of the anesthetic action of propofol. Augmentation of GABA-induced inhibitory transmission has also been suggested as a mechanism. Because data describing this latter mechanism in...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-199410000-00026
更新日期:1994-10-01 00:00:00
abstract:BACKGROUND:Intravenous infusion of lidocaine decreases postoperative pain and speeds the return of bowel function. The authors therefore tested the hypothesis that perioperative lidocaine infusion facilitates acute rehabilitation protocol in patients undergoing laparoscopic colectomy. METHODS:Forty patients scheduled ...
journal_title:Anesthesiology
pub_type: 杂志文章,随机对照试验
doi:10.1097/00000542-200701000-00007
更新日期:2007-01-01 00:00:00
abstract:BACKGROUND:The permutation entropy, the approximate entropy, and the index of consciousness are some of the most recently studied electroencephalogram-derived indexes. In this work, a thorough comparison of these indexes was performed using propofol anesthesia in a rabbit model. METHODS:Six rabbits were anesthetized w...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0b013e318222ac02
更新日期:2011-08-01 00:00:00
abstract::This study was designed to assess the relationship between MAC and hypertension. To this purpose, MAC of halothane was determined in fully inbred spontaneously hypertensive rats (SHR) and Wistar Kyoto rats (WKY). Because MAC determination was performed in animals whose lungs were mechanically ventilated, the adequacy ...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-199005000-00013
更新日期:1990-05-01 00:00:00
abstract::Clinical studies have reported that body core temperature decreases during prolonged surgery and anesthesia. Although this finding has been attributed primarily to increased heat loss resulting from exposure of body cavities and infusion of cold solutions, it is generally recognized that anesthesia interferes with the...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-199204000-00011
更新日期:1992-04-01 00:00:00
abstract:BACKGROUND:The lightwand may be useful as an alternative for tracheal intubation during a rapid-sequence induction of anesthesia in the presence of a full stomach. This study was undertaken to assess the effect of application of cricoid pressure on the success of lightwand intubation. METHODS:Sixty adult female patien...
journal_title:Anesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000542-200102000-00015
更新日期:2001-02-01 00:00:00
abstract:BACKGROUND:A focal cortical cryogenic brain injury has been reported to reduce the brain pentobarbital concentrations needed to prevent movement in response to pain in rats. This occurred despite any apparent behavioral changes in the awake animals. To determine whether this was true with other anesthetics, the authors...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-199307000-00020
更新日期:1993-07-01 00:00:00
abstract:BACKGROUND:The incidence of awareness has been reported to be higher in children than in adults. Accurately assessing awareness in children is difficult, and the lack of a specific measure of awareness makes it difficult to determine exactly how many and why children are aware. The aim of this study was to determine th...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0b013e3181862a20
更新日期:2008-10-01 00:00:00
abstract::To determine whether anesthesiologists, because of prolonged exposure to halothane or other inhalational anesthetics, might have higher death rates from all causes, from cancer, and from hepatic or renal disease than other physicians, the mortality rates of male and female members of the American Society of Anesthesio...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-197909000-00003
更新日期:1979-09-01 00:00:00