Sunday, July 6, 2014



Technology  escalating impact on perioperative  care : Clinical,compliance and medicolegal considerations

Brian J Cammarata and Brian J Thomas
APSF newsletter,Volume 29N1 1-24 June 2014–07–06

Vignette

A 57 year old female presents for a laparoscopic cholecystectomy
Following the uneventful induction of general anesthesia, the patient is prepped and surgery begins.
Intraoperatively, the patient becomes acutely hypotensive and tachycardic.
Despites intravenous fluids and phenylephrine, the hypotension persists.
The patient is ultimately resuscitated but slow to awaken postoperatively.
MRI of the head reveals an ischemic infarction.
She regains consciousness on postoperative day 1, but has persistent right sided weakness
The spouse and the surviving children bring suit against the anesthesiologist for failing to appropriately treat the hypotension resulting in a cerebro vascular accident.
During discovery, the circulating nurse and scrub technician testify that the anesthesiologists was on her cell phone and checking e-mail immediately prior to the event.
Plaintiff's attorney subpoenaed the cell phone and hospital computer records validating the allegation.

Comments - Cell phone and hospital computer records are discoverable and may be admissible evidence at trial.
In this case, the anesthesiologist's defensible care is compromised by the proven allegation of electronic distraction during the anesthetic


A Randomized Trial of Epidural Glucocorticoid Injections for Spinal Stenosis

 Janna L. Friedly, M.D et al.

 N Engl J Med 2014; 371:11-21July 3, 2014

 In a double-blind, multisite trial, they randomly assigned 400 patients who had lumbar central spinal stenosis and moderate-to-severe leg pain and disability to receive epidural injections of glucocorticoids plus lidocaine or lidocaine alone. The patients received one or two injections before the primary outcome evaluation, performed 6 weeks after randomization and the first injection. 

 At 6 weeks, there were no significant between-group differences in the RMDQ score (adjusted difference in the average treatment effect between the glucocorticoid–lidocaine group and the lidocaine-alone group).

In the treatment of lumbar spinal stenosis, epidural injection of glucocorticoids plus lidocaine offered minimal or no short-term benefit as compared with epidural injection of lidocaine alone.