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    by Published on 08-02-2014 08:47 AM     Number of Views: 3113 
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    Abstract


    BACKGROUND: Postpartum depression is a common psychiatric disorder in parturients after delivery. The etiology remains unclear, and multiple ...
    by Published on 07-18-2014 08:44 AM     Number of Views: 5880 
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    Registered Nurses Are Delaying Retirement, A Shift That Has Contributed To Recent Growth In The Nurse Workforce

    Abstract

    The size of the registered nurse (RN) workforce has surpassed forecasts from a decade ago, growing to 2.7 million in 2012 instead of peaking at 2.2 million. Much of the difference is the result of a surge in new nursing graduates. However, the size of the RN workforce is
    ...
    by Published on 06-21-2014 10:54 AM     Number of Views: 2476 
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    One of the great mysteries of anesthesia is how patients can be temporarily rendered completely unresponsive during surgery and then wake up again, with all their memories and skills intact. ...
    by Published on 06-07-2014 05:08 PM     Number of Views: 4185 
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    The 90 Second Case for Nurse Practitioners

    ...
    by Published on 06-02-2014 08:34 PM     Number of Views: 2902 
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    One hypothesis is that the standard of care may change throughout the day and between weekdays and weekends.

    A new study found that certain times for surgery could mean a ...
    by Published on 05-30-2014 10:01 AM     Number of Views: 2826 
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    As a profession, nurse anesthesia is at a tipping point. While recent federal legislation and changes to the U.S. Medicare program have expanded opportunities for certified registered nurse anesthetists (CRNAs) to provide care ...
    by Published on 04-21-2014 05:35 PM     Number of Views: 2949 
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    Scientists uncover hints of a novel mechanism behind general anesthetic action


    Despite decades of common use for surgeries of all kinds, the precise mechanism through which general anesthesia works on the body remains a mystery. This may come as a surprise to ...
    by Published on 04-12-2014 08:33 AM     Number of Views: 3465 
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    'Nano-Anesthesia': A New Approach to Local Anesthesia?
    Magnet-Directed Nanoparticles with Local Anesthetic Produce Effective Nerve Block in Rats

    A technique using anesthesia-containing nanoparticles—drawn to the targeted area of the body by magnets—could one day provide a useful alternative to nerve block for local anesthesia in patients, ...
    by Published on 04-05-2014 03:16 PM     Number of Views: 6937 
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    EXPAREL Use in Femoral Nerve Block for Total Knee Arthroplasty Further Supported by Additional Data from Phase 3 Pivotal Study, sNDA Submission Planned for Second Quarter 2014


    Read more here: http://www.heraldonline.com/2014/04/...#storylink=cpy

    PARSIPPANY, N.J. & CHICAGO
    Pacira Pharmaceuticals, Inc. (NASDAQ: PCRX) today announced additional Phase 3 data supporting the efficacy and safety of EXPAREL® (bupivacaine liposome injectable suspension) to achieve a femoral nerve block in patients undergoing total knee arthroplasty. The Company previously announced results of the primary efficacy endpoint, a statistically significant reduction in cumulative pain scores over 72 hours compared to placebo (P<0.0001). Secondary endpoints presented at the 39th Annual Meeting of the American Society of Regional Anesthesia and Pain Medicine (ASRA) found that a higher percentage of patients who received EXPAREL were pain-free, consumed fewer opioids and reported higher satisfaction with their pain control.

    This randomized, double blind, placebo controlled study evaluated 278 patients who received either a femoral nerve block with EXPAREL or a placebo. A femoral nerve block provides pain control for the anterior (front) of the knee; in this trial there was no pain medication provided at the time of surgery for the posterior (back) of the knee, which explains the lack of a significant difference in time to first opioid rescue between the two study groups. In addition to pain scores through 72 hours, investigators also measured total opioid consumption through 72 hours, time to first opioid rescue, patient satisfaction with pain control and safety.
    The key findings are summarized below:

    • A 24 percent reduction in total opioid use in the EXPAREL group (P<0.05); there was no significant difference between groups in the time to first opioid rescue
    • A greater number of patients who were “extremely satisfied” with pain control in the EXPAREL group vs. placebo group at day 7 (55 percent vs. 43 percent) and day 30 (65 percent vs. 50 percent)
    • A statistically significantly higher percentage of “pain-free” patients in the EXPAREL group (~50 percent vs. 40 percent for placebo group at 60 hours; [P<0.05])
    • Safety was comparable between the EXPAREL and placebo groups, with similar numbers of patients displaying a normal ability to do a 20-meter walk test and similar physician satisfaction with return of motor function

    Five additional studies evaluating the use of EXPAREL in transversus abdominis plane infiltration and nerve block will also be presented at the ASRA meeting.
    About Pacira
    Pacira Pharmaceuticals, Inc. (NASDAQ: PCRX) is a specialty pharmaceutical company focused on the clinical and commercial development of new products that meet the needs of acute care practitioners and their patients. The company’s current emphasis is the development of non-opioid products for postsurgical pain control, and its lead product, EXPAREL® (bupivacaine liposome injectable suspension), was commercially launched in the United States in April 2012. EXPAREL and two other products have utilized the Pacira proprietary product delivery technology DepoFoam®, a unique platform that encapsulates drugs without altering their molecular structure and then releases them over a desired period of time. Additional information about Pacira is available at www.pacira.com.
    About EXPAREL®
    EXPAREL (bupivacaine liposome injectable suspension) is indicated for single-dose infiltration into the surgical site to produce postsurgical analgesia. The product combines bupivacaine with DepoFoam, a proven product delivery technology that delivers medication over a desired time period. EXPAREL represents the first and only multivesicular liposome local anesthetic that can be utilized in the peri- or postsurgical setting in the same fashion as current local anesthetics. By utilizing the DepoFoam platform, a single dose of EXPAREL delivers bupivacaine over time, providing analgesia with reduced opioid requirements for up to 72 hours. Pivotal studies have demonstrated the safety and efficacy of EXPAREL in patients undergoing bunionectomy or hemorrhoidectomy procedures and additional studies are underway to further demonstrate the safety and efficacy in other procedures. Additional information is available at www.EXPAREL.com.
    Important Safety Information
    EXPAREL is contraindicated in obstetrical paracervical block anesthesia. EXPAREL has not been studied for use in patients younger than 18 years of age. Non-bupivacaine-based local anesthetics, including lidocaine, may cause an immediate release of bupivacaine from EXPAREL if administered together locally. The administration of EXPAREL may follow the administration of lidocaine after a delay of 20 minutes or more. Other formulations of bupivacaine should not be administered within 96 hours following administration of EXPAREL. Monitoring of cardiovascular and neurological status, as well as vital signs should be performed during and after injection of EXPAREL as with other local anesthetic products. Because amide-type local anesthetics, such as bupivacaine, are metabolized by the liver, EXPAREL should be used cautiously in patients with hepatic disease. Patients with severe hepatic disease, because of their inability to metabolize local anesthetics normally, are at a greater risk of developing toxic plasma concentrations. In clinical trials, the most common adverse reactions (incidence greater-than or equal to 10%) following EXPAREL administration were nausea, constipation, and vomiting.
    Please see the full Prescribing Information for more details available athttp://www.exparel.com/pdf/EXPAREL_Prescribing_Information.pdf.

    Read more here: http://www.heraldonline.com/2014/04/...#storylink=cpy
    ...
    by Published on 01-23-2014 10:08 AM     Number of Views: 8879 
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    SO recently this was posted on facebook.



    This total load of excrement comes from the silber study done in 2000. Its not even a relevant study but has alot of issues besides that.

    First anesthesia was not the intent of the study and it never was about providers and mortality. It was done in ONE state (PA) and was about something totally different. The original authors required the ASA to change the name for their "massaged" study and the ASA shopped over 20 journals who all refused to publish it because of its glaring inaccuracies and frankly non-existent science.

    Silber Study in Medical Care (this is not the one published in Anesthesiology they like to quote but the ACTUAL study they based it off of)


    [Silber, JH, Williams, SV, Krakauer, H, Schwartz, JS. “Hospital
    and Patient Characteristics Associated With Death After
    Surgery. A Study of Adverse Occurrence and Failure to Rescue.”
    Medical Care. 1992;30:615.]


    The Silber study examined the death rate, adverse occurrence rate, and failure rate of 5,972 Medicare patients undergoing two fairly low-risk procedures —elective cholecystectomy and transurethral prostatectomy.

    The study did not discuss any anesthesia provider except physician anesthesiologists; the study did not even mention CRNAs. The study, therefore, had nothing to do with CRNAs and did not compare the outcomes of care of nurse anesthetists to those of anesthesiologists.

    The study did not address any aspect of CRNA practice; it certainly did not explore the issue of whether CRNAs should be physician supervised.

    The Silber study was a pilot study, i.e., a study to demonstrate the feasibility of performing a more definitive study concerning patients developing medical complications following surgery. It would be inappropriate to formulate public policy based on the Silber study; the study does not address CRNAs, and cannot be considered conclusive even about the issues that it does address.

    The Silber study states, at page 625:

    This pilot project examined ideas that, to our knowledge, have not been examined previously, and more work is needed before ...
    by Published on 01-21-2014 03:35 PM     Number of Views: 2913 
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    Meta-analysis of secure randomised controlled trials of β-blockade to prevent perioperative death in non-cardiac surgery

    Abstract

    Background Current European and American guidelines recommend the perioperative initiation of a course of β-blockers in those at risk of cardiac events undergoing high- or intermediate-risk surgery or vascular surgery. The Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography (DECREASE) family of trials, the bedrock of evidence for this, are no longer secure. We therefore conducted a meta-analysis of randomised controlled trials of β-blockade on perioperative mortality, non-fatal myocardial infarction, stroke and hypotension in non-cardiac surgery using the secure data.
    Methods The randomised controlled trials of initiation of β-blockers before non-cardiac surgery were ...
    by Published on 11-15-2013 03:31 PM     Number of Views: 2405 
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    Researchers at Washington University School of Medicine in St. Louis and Imperial College London have identified the site where the widely used anesthetic drug propofol binds to receptors in the brain to sedate patients during surgery.


    Until now, it hasn’t been clear how propofol connects with brain cells to induce anesthesia. The researchers believe the findings, reported online in the journal ...
    by Published on 10-24-2013 07:15 PM     Number of Views: 2324 
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    New Research May Help Spare Patients 'Accidental Awareness' During Surgery
    Study found certain type of brain activity signals the brain has gone 'to sleep'

    A new study offers insight into what happens in the brain when a person is given anesthesia, and the finding could help spare patients the traumatic experience of becoming aware of their own surgery. ...
    by Published on 10-21-2013 03:34 PM     Number of Views: 9203 
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    Sedation for outpatient endoscopy procedures had similar outcomes when certified registered nurse anesthetists (CRNAs) managed the protocol with or without anesthesiologist supervision, a review of more than 100,000 patient records showed.


    Overall adverse event rates were low, and none of the most common or serious adverse events occurred more often when CRNAs handled sedation by themselves or with an anesthesiologist.


    "In a large ambulatory endoscopy center with more than 100,000 total procedures there were no differences in adverse outcomes using two different propofol sedation models -- CRNA-MD and CRNA alone," Murtaza Parekh, MD, of Raleigh Endoscopy Center in North Carolina, reported here at the American College of Gastroenterology meeting.


    "In the end, MD supervision did not significantly impact safety outcomes with propofol in our ambulatory endoscopy center. These conclusions correlate [with previous studies] showing that propofol sedation is as safe, if not safer, than conscious sedation."


    The study had its genesis in the growing use of propofol sedation during endoscopy procedures. Recent estimates suggest propofol sedation might account for a majority of endoscopy procedures by 2015, Parekh noted.


    A Cochrane review published in 2008 and revised in 2011 showed that propofol sedation in colonoscopy procedures was associated with shorter recovery and discharge times as compared with procedures performed using opiates and benzodiazepines. Procedure time and complication rates did not differ by the type of sedation used. Moreover patient satisfaction was higher with propofol than with the other two sedation modalities.


    A review of worldwide experience with propofol sedation during endoscopy showed that propofol sedation had a superior safety record as compared with opiates and benzodiazepines administered by endoscopists.


    Several gastroenterology organizations published a position paper that showed similar safety with propofol and conventional sedation, shorter recovery times, and equivalent or improved patient satisfaction with propofol sedation.


    "However, the elephant in the room is the warning in the propofol package insert, stating that it should only be administered by someone trained in the administration of general anesthesia. This presented a big quandary when my endoscopy group decided to use propofol sedation in 2008.


    "We felt we had three options: an anesthesiologist in every room, a CRNA with anesthesiologist supervision, and a CRNA with a gastroenterologist in the room as the supervisor," Parekh said.


    Parekh reported findings from a retrospective review of 106,000 ambulatory endoscopy procedures performed with propofol sedation from October 2008 through August 2013. They focused on two administration protocols: CRNA with anesthesiologist supervision versus CRNA alone (except for the gastroenterologist). Adverse events were documented from patient records and from follow-up telephone calls placed to each patient within 24 hours after the procedure.


    There were 70,436 procedures done by a CRNA with anesthesiologist supervision and 36,483 by a CRNA alone. Except for the presence or absence of an anesthesiologist, the same propofol sedation protocol was used for ...
    by Published on 10-20-2013 01:41 PM     Number of Views: 5992 
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    For patients undergoing breast cancer surgery, paravertebral block combined with general anesthesia is associated with decreased local and metastatic ...
    by Published on 10-09-2013 11:59 AM     Number of Views: 2247 
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    In patients who had received a stent, the factors most strongly associated with major adverse cardiac events (MACE) following noncardiac surgery included a nonelective indication, a history of recent myocardial infarction (MI), and an elevated cardiac risk, researchers found.


    In an adjusted model, the three strongest predictors of MACE were nonelective surgery (OR 4.77, 95% CI 4.07-5.59), a history of MI in the 6 months before surgery (OR 2.63, 95% CI 2.32-2.98), ...
    by Published on 09-01-2013 01:54 PM     Number of Views: 3045 
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    A new study suggests that ketamine may be used by people wanting to reduce their symptoms of depression in less than 24 hours, according to Daily Mail.
    Ketamine is an anesthesia commonly used on veterinary medicine. ...
    by Published on 08-02-2013 07:12 AM     Number of Views: 4562 
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    Older patients who undergo anesthesia and surgery have a significantly increased risk for dementia, a large population-based study shows.


    Investigators at Taipei Veterans General Hospital in Taiwan found that patients older than 50 years who underwent anesthesia for the first time had nearly a 2-fold ...
    by Published on 07-17-2013 10:06 AM     Number of Views: 4393 
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    2. Legal,
    3. Pharmacology,
    4. Politics,
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    FDA deals Merck another setback for anesthesia drug sugammadex
    By John Carroll and Ryan McBride


    Merck's ($MRK) struggling R&D group has been hit with yet another delay in its long and costly quest to gain an FDA approval ...
    by Published on 05-24-2013 05:34 AM     Number of Views: 2509 
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    Exposure to general anesthesia during medical procedures after age 45 years is not a risk factor for dementia, results of a new study suggest.


    The lack of association between anesthesia and dementia was also quite robust in several of the study's sensitivity analyses exploring factors such as the timing of anesthetic exposure before the dementia diagnosis and the age at the time of anesthetic exposure, researchers report.


    "The message from this paper is very simple: Anesthesia is not a risk for dementia," said one of the study authors David S. Knopman, MD, Department of Neurology, Mayo Clinic, Rochester, ...
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