Higher occurrence of nausea and vomiting after total hip arthroplasty using general versus spinal anesthesia: an observational study.

BACKGROUND: Under the assumption that postoperative nausea and vomiting (PONV) may occur after total hip arthroplasty (THA) regardless of the anesthetic technique used, it is not clear whether general (GA) or spinal (SA) anesthesia has higher causal effect on this occurrence. Conflicting results have been reported. METHODS: In this observational study, we selected all elective THA interventions performed in adults between 1999 and 2008 in a Swiss orthopedic clinic under general or spinal anesthesia. To assess the effect of anesthesia type on the occurrence of PONV, we used the propensity score and matching methods, which allowed us to emulate the design and results of an RCT. RESULTS: Among 3922 procedures, 1984 (51 %) patients underwent GA, of which 4.1 % experienced PONV, and 1938 underwent SA, of which 3.5 % experienced PONV. We found that the average treatment effect on the treated, i.e. the effect of anesthesia type for a sample of individuals that actually received spinal anesthesia compared to individuals who received GA, was ATET = 2.00 % [95 % CI, 0.78-3.19 %], which translated into an OR = 1.97 [95 % CI 1.35; 2.87]. CONCLUSION: This suggests that the type of anesthesia is not neutral regarding PONV, general anesthesia being more strongly associated with PONV than spinal anesthesia in orthopedic surgery

The rejection of industrial democracy by Berle and Means and the emergence of the ideology of managerialism.

One distinctive feature of the American variant of capitalism is the near absence of any of the industrial democracy institutions found in many European firms. This article examines ideology as a factor behind the absence of industrial democracy institutions in the United States. It focuses on the early 1930s, when the ideology of managerialism was being formulated by Adolf Berle and Gardiner Means, the authors of a book that had a well-documented influence on American business culture. As the article shows, many American firms in the 1910s and 1920s experimented with worker representation systems that contemporaries called industrial democracy. Berle and Means were aware of these moves to democratize the American workplace, but they rejected all forms of industrial democracy. The article advances an explanation for their rejection and thereby contributes to our understanding why the United States did not take the path towards democracy within companies