Saturday, December 1, 2007
Anesthesiology: Predictors of Postoperative Acute Renal Failure
-
Printer Friendly|#| Trackback
Predictors of Postoperative Acute Renal Failure after Noncardiac Surgery in Patients with Previously Normal Renal Function
"Background: The authors investigated the incidence and risk factors for postoperative acute renal failure after major noncardiac surgery among patients with previously normal renal function.
Methods: Adult patients undergoing major noncardiac surgery with a preoperative calculated creatinine clearance of 80 ml/min or greater were included in a prospective, observational study at a single tertiary care university hospital. Patients were followed for the development of acute renal failure (defined as a calculated creatinine clearance of 50 ml/min or less) within the first 7 postoperative days. Patient preoperative characteristics and intraoperative anesthetic management were evaluated for associations with acute renal failure. Thirty-day, 60-day, and 1-yr all-cause mortality was also evaluated.
Results: A total of 65,043 cases between 2003 and 2006 were reviewed. Of these, 15,102 patients met the inclusion criteria; 121 patients developed acute renal failure (0.8%), and 14 required renal replacement therapy (0.1%). Seven independent preoperative predictors were identified (P < 0.05): age, emergent surgery, liver disease, body mass index, high-risk surgery, peripheral vascular occlusive disease, and chronic obstructive pulmonary disease necessitating chronic bronchodilator therapy. Several intraoperative management variables were independent predictors of acute renal failure: total vasopressor dose administered, use of a vasopressor infusion, and diuretic administration. Acute renal failure was associated with increased 30-day, 60-day, and 1-yr all-cause mortality.
Conclusions: Several preoperative predictors previously reported to be associated with acute renal failure after cardiac surgery were also found to be associated with acute renal failure after noncardiac surgery. The use of vasopressor and diuretics is also associated with acute renal failure."
Saturday, November 24, 2007
Catalogs Clogging Your Mailbox?
-
Printer Friendly|#| Trackback
I am convinced that the fact that two of our letter carriers have gone on disability is in large part due to the number of mail order catalogs we receive each day at home. For a while I was actually calling companies to ask we be taken off their list. Now I've found something better--Catalogchoice.org.
"The mission of Catalog Choice is to reduce the number of repeat and unsolicited catalog mailings, and to promote the adoption of sustainable industry best practices. We aim to accomplish this by freely providing the Catalog Choice services to both consumers and businesses. Consumers can indicate which catalogs they no longer wish to receive, and businesses can receive a list of consumers no longer wanting to receive their catalogs."
I've declined twenty catalogs so far and can't wait for today's mail to arrive so I can decline some more!
Friday, November 16, 2007
Find Big Files in OS X
-
Printer Friendly|#| Trackback
I just found a nifty freeware application for OS X to help scan my hard disk and graphically represent the file sizes present. It seems to run well on OS X, too. From the developer:
"GrandPerspective is a utility application for Mac OS X that graphically displays the disk usage of a file system."
I asked it to look at my documents folder and found a 1.5 GB file associated with an app I tried out but then deleted:
Though it's a free app, donation are appreciated, I'm sure.
Saturday, November 10, 2007
Sums up my experience regarding tight glycemic control in non-diabetics
-
Printer Friendly|#| Trackback
"A stupid man's report of what a clever man says can never be accurate, because he unconsciously translates what he hears into something he can understand."
--Bertrand Russell
Sunday, October 28, 2007
Up the Creek Without an OS X 10.5 Paddle
-
Printer Friendly|#| Trackback
The new version of Mac OS X has been released. Yea! And, although it will be delivered to my door at home Monday, I'm at a conference on a small island in a state that doesn't have a single Apple Store (South Carolina--who knew?). Poor planning on my part.
Note to self: always check conference dates for conflict with major apple announcement dates or OS update releases. Stupid. Stupid. Stupid.
Monday, October 15, 2007
At least somebody thinks having a doctor around is good....
-
Printer Friendly|#| Trackback
Micromat, publisher of TechTool Pro (own it!) has released Syphone, an OS X applications which allows you to 'view, save, and backup' SMS messages. This is handy for when you have a particularly funny series of text messages like this:
CDC Creates New Flu Web Site
-
Printer Friendly|#| Trackback
The CDC has created a new web site with influenza-related information that is a) informative and b) pretty. Take a look: http://www.cdc.gov/flu/ .
Sunday, October 14, 2007
Administrators, there are Six Sigma specialists already at your hospital
-
Printer Friendly|#| Trackback
Six sigma. Lean six sigma. High reliability organizations. Hospital administrators seem to drool over this stuff. Many are willing to go out and spend lots of money on six sigma consultants to come in to their hospitals and integrate the buzz words.
What many hospital administrators don't realize (or conveniently forget) is that anesthesiology is a six sigma specialty within medicine. That is, there are fewer than six mishaps per million events. That safety attitude is ingrained in us from the first day or residency. We live and breath six sigma and evidence-based medicine.
So, hospital administrator, the next time an endocrinologist comes to you with a plan to give insulin to non-critically ill, non-diabetic patients with a blood glucose over 120 right before their general anesthetic and the entire group of anesthesiologist says 'I don't think that's a very good idea,' pause, take a deep breath, and listen to what they have to say.
Six sigma is a way of thinking. Six sigma trumps three sigma any day of the week.
Thursday, September 27, 2007
Transfer Password Wallet Entries to iPhone
-
Printer Friendly|#| Trackback
I've been a long time user of Password Wallet from Zelznick Scientific Software. A password manager with 448-bit keys, it can launch url's and autofill usernames and passwords. Love it.
This morning they announced the availability of Password Wallet for iPhone. I purchased and installed it right away. It's slick, so I thought I'd post some screenshots. After exporting my selected Password Wallet records to Safari as a bookmarklet, I synced my iPhone with iTunes. I next went to that bookmarklet:
After entering my (correct) password I saw:
Selecting one of the records yielded (username and password erased, of course).
Monday, September 24, 2007
The Latest In Controlling OR Heat Loss
-
Printer Friendly|#| Trackback
Keeping patients warm in the operating room can be a challenge. On call two weekends ago I had an 'Aha' moment--give them knit caps! Below is the protype--a scullcap made from 6 inch stockinette.
[note: this photo was taken with an iPhone!]
Saturday, September 15, 2007
Tool of the Trade: Lidocaine
-
Printer Friendly|#| Trackback
Dr. Wes' post on the proper way to inject lidocaine got me to thinking about how I do it and I think I have some tips to share, too. I inject lidocaine in people's back while they're in labor, in their groins, necks, and arm pits when I do blocks, and of course in their hands and arms when I place IV's. (I inject it into their IV's, too, but there's no trick to that, really.)
When I have time, I like to add about a one fourth volume of bicarbonate to the lidocaine I'm injecting. (This doesn't work with bupivicaine as it will cause it to precipitate out.) I've testing this on myself, on nurses in labor, and in patients in labor and I am convinced this removes most of the burning sensation that comes with injecting lidocaine.
After having selected my injection site and cleaned it (with alcohol, betadine, chloraprep, duraprep, etc.) I wait for the prep to dry so that the prepping agent doesn't cause any stinging. I place a drop of lidocaine on the skin and insert the needle through the drop of lidocaine to make contact with the skin (after warning the patient, of course). This works, not because it numbs the skin under the drop (you need a eutectic mixture of local anesthetics for that) but because it caries some lidocaine in on the tip of the needle. I inject while inserting the needle intradermally. You should inject slowly, advance slowly, and see a skin wheal if it's truly an intradermal injection. This is easiest on horizontal surfaces but can also be done on a vertical surface like a back. In my opinion the wrong way to do inject lidocaine is the way tuberculin skin test are often placed: jab in the tiny needle (ouch!) inject the antigen quickly (ouch!).
When I watch trainees inject lidocaine I often see them stop to aspirate to make sure they're not in a blood vessel. This is unnecessary a) if you keep the tip of the needle moving and b) because the total dose of lidocaine in the 3cc syringe is not enough to cause toxicity even if injected intravascularly. We now return you to your regularly scheduled programming...
