Efficiency of spinal anesthesia versus general anesthesia for lumbar spinal surgery: a retrospective analysis of 544 patients.

BACKGROUND: Previous studies have shown varying results in selected outcomes when directly comparing spinal anesthesia to general in lumbar surgery. Some studies have shown reduced surgical time, postoperative pain, time in the postanesthesia care unit (PACU), incidence of urinary retention, postoperative nausea, and more favorable cost-effectiveness with spinal anesthesia. Despite these results, the current literature has also shown contradictory results in between-group comparisons. MATERIALS AND METHODS: A retrospective analysis was performed by querying the electronic medical record database for surgeries performed by a single surgeon between 2007 and 2011 using procedural codes 63030 for diskectomy and 63047 for laminectomy: 544 lumbar laminectomy and diskectomy surgeries were identified, with 183 undergoing general anesthesia and 361 undergoing spinal anesthesia (SA). Linear and multivariate regression analyses were performed to identify differences in blood loss, operative time, time from entering the operating room (OR) until incision, time from bandage placement to exiting the OR, total anesthesia time, PACU time, and total hospital stay. Secondary outcomes of interest included incidence of postoperative spinal hematoma and death, incidence of paraparesis, plegia, post-dural puncture headache, and paresthesia, among the SA patients. RESULTS: SA was associated with significantly lower operative time, blood loss, total anesthesia time, time from entering the OR until incision, time from bandage placement until exiting the OR, and total duration of hospital stay, but a longer stay in the PACU. The SA group experienced one spinal hematoma, which was evacuated without any long-term neurological deficits, and neither group experienced a death. The SA group had no episodes of paraparesis or plegia, post-dural puncture headaches, or episodes of persistent postoperative paresthesia or weakness. CONCLUSION: SA is effective for use in patients undergoing elective lumbar laminectomy and/or diskectomy spinal surgery, and was shown to be the more expedient anesthetic choice in the perioperative setting

Phenotype Variant Brugada Pattern: An Early Sign of Propofol Infusion Syndrome

This report demonstrates the first case of inferior phenotype variant Brugada Pattern (BP) as the presenting sign of Propofol Infusion Syndrome (PRIS). A 65-year-old male in respiratory failure receiving four consecutive days of high dose propofol developed ST elevations, hyperkalemia, and lactatemia. ST elevations noted were sharply down-sloping presenting in inferior leads.1 Hyperkalemia was treated and propofol discontinued. This therapy resulted in improvement in EKG and favorable outcome. This case supports three conclusions: the existence of inferior variant BP, BP may be a strong initial sign of PRIS, and early recognition and action stopping propofol leads to favorable outcome in PRIS.1-4 INTRODUCTION Propofol Infusion Syndrome (PRIS), once thought only to occur in children, has gained popularity in recent years due to its high morbidity and mortality in adults as well. Due to heightened awareness and detection bias, the incidence of PRIS is increasing. The cause of PRIS, hypothesized to be either by direct mitochondrial chain inhibition or dysfunctional fatty acid metabolism, remains unclear.3 Since the infancy of the syndrome, cardiac conduction abnormalities and refractory bradycardia hhave been its hallmarks. Case reports have in fact linked PRIS to the sodium channelopathy Brugada Syndrome (BS) known to cause malignant dysrhythmias and sudden death.2,4 ST elevation in a sharp down-sloping so called Brugada like pattern may be a strong initial sign of PRIS.3 Many different presentations of PRIS have been described in the literature but the most consistent known finding is the use of high dose propofol infusion for long duration.5 This risk factor often occurs in critically ill patients requiring propofol therapy for increased intracranial pressure.2,5 Other known findings include metabolic acidosis, lactemia, Acute Renal Failure (ARF), hyperkalemia, elevated triglycerides (TAG), and rhabdomyolysis.5 Early detection and cessation of propofol is the only known method to improve outcome in PRIS.6 Therefore, discovering methods for early detection is imperative

Lack of Utility and Excess Cost of Routine Perioperative Hematologic Testing in Patients Undergoing Elective Neurosurgical Procedures of the Spine

Objective To prospectively conduct a mock trial among 100% (minimum n=200) of elective neurosurgery spine patients to estimate the total projected cost, savings, risk, and feasibility of a redefined/restricted lab testing protocol over the next 12 monthshttps://jdc.jefferson.edu/patientsafetyposters/1116/thumbnail.jp

Establishing Cost-effective Management of Postoperative Urinary Retention after Spine Surgery

Goal Our goal is to develop evidence-based guidelines that: streamline the order/timing of interventions in patients who develop PUR after spine surgery identify those at high-risk of long-term urinary retention that require further workup minimize the rate of PUR –goal is to reduce to 3.5% in FY 2019 and determine the cost savings from our intervention when applied to all surgerieshttps://jdc.jefferson.edu/patientsafetyposters/1085/thumbnail.jp

Implementation of Attending-Supervised IPASS Handoff in the Neuro-ICU

Background Duty hour restrictions, cross coverage, and the growing number of mid-level practitioners has led to an increased number of handoffs across medical specialties These handoffs are well-known points of communication breakdown which can lead to patient safety issues Factors contributing to an effective handoff include standardization of communication, appropriate training and supervision, ample time, a quiet environment, and a supportive culture We hypothesize that attending supervision of handoffs is feasible and can improve practitioner perception of transitions of carehttps://jdc.jefferson.edu/patientsafetyposters/1077/thumbnail.jp