Abstract:
BACKGROUND:Computerized reviews of patient data promise to improve patient care through early and accurate identification of at-risk and well patients. The significance of sampling strategy for patient vital signs data is not known. In the instance of the surgical Apgar score (SAS), we hypothesized that larger sampling intervals would improve the specificity and overall predictive ability of this tool. METHODS:We used electronic intraoperative data from general and vascular surgical patients in a single-institution registry of the American College of Surgeons National Surgical Quality Improvement Program. The SAS, consisting of lowest heart rate, lowest mean arterial blood pressure, and estimated blood loss between incision and skin closure, was calculated using 5 methods: instantaneously and using intervals of of 5 and 10 minutes with and without interval overlap. Major complications including death were assessed at 30 days postoperatively. RESULTS:Among 3000 patients, 272 (9.1%) experienced major complications or death. As the sampling interval increased from instantaneous (shortest) to 10 minutes without overlap (largest), the sensitivity, positive predictive value, and negative predictive value did not change significantly, but significant improvements were noted for specificity (79.5% to 82.9% across methods, P for trend <0.001) and accuracy (76.0% to 79.3% across methods, P for trend <0.01). In multivariate modeling, the predictive utility of the SAS as measured by the c-statistic nearly increased from Δc = +0.012 (P = 0.038) to Δc = +0.021 (P < 0.002) between the shortest and largest sampling intervals, respectively. Compared with a preoperative risk model, the net reclassification improvement and integrated discrimination improvement for the shortest versus largest sampling intervals of the SAS were net reclassification improvement 0.01 (P = 0.8) vs 0.06 (P = 0.02), and for integrated discrimination improvement, they were 0.008 (P < 0.01) vs 0.015 (P < 0.001). CONCLUSIONS:When vital signs data are recorded in compliance with American Society of Anesthesiologists' standards, the sampling strategy for vital signs significantly influences performance of the SAS. Computerized reviews of patient data are subject to the choice of sampling methods for vital signs and may have the potential to be optimized for safe, efficient patient care.
journal_name
Anesth Analgjournal_title
Anesthesia and analgesiaauthors
Hyder JA,Kor DJ,Cima RR,Subramanian Adoi
10.1213/ANE.0b013e3182a46d6dsubject
Has Abstractpub_date
2013-12-01 00:00:00pages
1338-46issue
6eissn
0003-2999issn
1526-7598pii
ANE.0b013e3182a46d6djournal_volume
117pub_type
杂志文章abstract:BACKGROUND:Propofol-evoked injection site pain is not observed with fospropofol. We hypothesized that unlike propofol, fospropofol does not activate the irritant receptor, transient receptor potential 1 (TRPA1). METHODS:We tested the hypothesis using electrophysiology and behavioral studies. RESULTS:Our data demonstr...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e318258b9db
更新日期:2012-10-01 00:00:00
abstract::Spontaneous ventilation may offer advantages over controlled mechanical ventilation (CMV), but increase in work of breathing may diminish its usefulness. During general anesthesia, respiratory depression and increased work of breathing often preclude spontaneous ventilation, and patients then receive CMV. We compared ...
journal_title:Anesthesia and analgesia
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doi:10.1213/00000539-199208000-00003
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000287660.29297.7b
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abstract:BACKGROUND:The extent to which insufflation of oxygen into the posterior pharynx during laryngoscopy prolongs adequate saturation in infants and small children remains unknown. Therefore, we compared oxygen saturation over time in preoxygenated small children with and without posterior pharynx oxygen insufflation. MET...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000001189
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abstract:BACKGROUND:We have shown previously that either echocardiographic indices of diastolic dysfunction or increased preoperative brain natriuretic peptide (BNP) predict postoperative atrial fibrillation (POAF). Because these 2 predictors of POAF have not been evaluated together, our goal was to further elucidate their conc...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000001471
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abstract:BACKGROUND:There is a pronounced learning curve for the technique of ultrasound-guided regional anesthesia. Practicing with a simulator model has been shown to speed the acquisition of these skills for various ultrasound-guided procedures. However, commercial models for ultrasound-guided regional anesthesia may be too ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3181cc558b
更新日期:2010-04-01 00:00:00
abstract:BACKGROUND:Human immunodeficiency virus (HIV)-related painful sensory neuropathies primarily consist of the HIV infection-related distal sensory polyneuropathy and antiretroviral toxic neuropathies. Pharmacotherapy provides only partial relief of pain in patients with HIV/acquired immune deficiency syndrome because lit...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000000729
更新日期:2015-06-01 00:00:00
abstract::The routine preoperative evaluation of pediatric patients often includes a history, physical examination, complete blood count, and urinalysis (UA). We retrospectively reviewed the records of 486 elective surgeries in children to determine the role of abnormal preoperative laboratory test results in perioperative mana...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1990-02-01 00:00:00
abstract::Changes in cardiac output in response to augmenting cardiac contractility, preload, and heart rate during enflurane anesthesia were examined in 12 open-chested dogs. Cardiac contractility was assessed by the slope of the end-systolic pressure-volume relation (Emax). Dobutamine (3, 6, and 9 micrograms.kg-1.min-1) was a...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-199111000-00014
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journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2003-09-01 00:00:00
abstract:BACKGROUND:The cerebral perfusion pressure that denotes the lower limit of cerebral blood flow autoregulation (LLA) is generally considered to be equivalent for reductions in arterial blood pressure (ABP) or increases in intracranial pressure (ICP). However, the effect of decreasing ABP at different levels of ICP has n...
journal_title:Anesthesia and analgesia
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doi:10.1213/ane.0b013e3181964848
更新日期:2009-04-01 00:00:00
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journal_title:Anesthesia and analgesia
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doi:10.1213/ane.0b013e31819f1985
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abstract:BACKGROUND:There have been numerous studies published on the ProSeal laryngeal mask airway (PLMA). However, few have investigated its utility in a large practice setting. We sought to gather comprehensive data about the characteristics, efficacy, and safety of its use by a representative group of anesthesiologists work...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e318189ac84
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journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
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更新日期:2004-08-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ane.0b013e318172f992
更新日期:2008-08-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3181f334b8
更新日期:2010-11-01 00:00:00
abstract:UNLABELLED:The visual analog scale (VAS) is a tool widely used to measure pain, yet controversy surrounds whether the VAS score is ratio or ordinal data. We studied 52 postoperative patients and measured their pain intensity using the VAS. We then asked them to consider different amounts of pain (conceptually twice as ...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1097/00000539-199912000-00038
更新日期:1999-12-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
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journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1213/00000539-199111000-00002
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199605000-00024
更新日期:1996-05-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1986-01-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1986-05-01 00:00:00
abstract::Hepatic blood flow and the oxygen supply/uptake relation were studied in 19 miniature pigs using labeled microspheres. Changes in hepatic arterial blood flow and portal blood flow, as well as total hepatic blood flow during halothane anesthesia were more closely associated with changes in mean arterial pressure (MAP) ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1987-10-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-199507000-00009
更新日期:1995-07-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:2002-01-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章,meta分析,评审
doi:10.1213/ANE.0000000000002069
更新日期:2017-12-01 00:00:00
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journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1987-11-01 00:00:00
abstract:UNLABELLED:We performed in vitro studies to investigate the potential interaction of benzodiazepines with cloned human opioid receptor subtypes. Midazolam, chlordiazepoxide, and diazepam directly displaced [(3)H]-diprenorphine binding from kappa and delta receptors, but not mu receptors, whereas flumazenil was inactive...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200108000-00024
更新日期:2001-08-01 00:00:00
abstract::The hemodynamic effects of an induction dose of propofol, 2.5 mg/kg, or etomidate, 0.3 mg/kg, were studied in eight dogs. In addition, cardiodynamic changes were measured using a left ventricular catheter and needle force probes. Propofol was associated with significant decreases in systolic (19.9%) and diastolic (25....
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1989-07-01 00:00:00