Analgesia for pediatric thoracostomy tube removal.

Eutectic mixture of local anesthetics (EMLA; Astra Pharmaceuticals, Wayne, PA) has been shown to reduce the pain of blood draws in children. We investigated the use of EMLA versus IV morphine for providing analgesia during chest tube removal (CTR) in children. One hundred twenty pediatric cardiothoracic surgery patients were enrolled. Patients were randomly assigned to receive either morphine (0.1 mg/kg up to 10 mg IV 30 min before CTR) or EMLA cream (5 g per chest tube cutaneously 3 h before CTR). A single, trained observer rated the patient's pain before, during, and after CTR using a 10-cm visual analog scale. The sites were evaluated for adverse effect. Methylhemoglobin levels were monitored in infants. Before CTR, the pain scores of the children who received morphine were rated lower than those who received EMLA (P < 0.01). During CTR, there was no difference in the pain score between the morphine or EMLA group. The change from baseline pain score in the morphine group was significantly larger than in the EMLA group (P < 0.01). We conclude that EMLA is safe and useful for blunting the pain of CTR.

Topical lidocaine-prilocaine cream (EMLA) for thoracostomy tube removal.

UNLABELLED: We prospectively studied topical lidocaine-prilocaine cream (EMLA) versus IV morphine in a double-blinded, randomized fashion for pain relief during thoracostomy tube (chest tube; CT) removal. Adult patients who had undergone thoracotomy or median sternotomy were randomized to receive either EMLA cream over CT sites transdermally for 3 h or IV morphine 0.5 h before CT removal. Pain behavior was observed and rated before, during, and after CT removal. Pain behavior increased less in the topical EMLA group (mean +/- SE, 4.4+/-0.39) compared with the IV morphine group (6.0+/-0.38; P < 0.01). No signs of infection were noted at the CT sites 24 or 48 h after CT removal. We conclude that EMLA cream is more effective than IV morphine in preventing the pain associated with CT removal. IMPLICATIONS: Postoperatively applying a topical anesthetic cream onto chest tube sites of chest surgery patients 3 h before chest tube removal is more effective than IV morphine in blunting pain response.

Cost containment in anesthesiology: a survey of department activities.

STUDY OBJECTIVE: To survey cost containment activities in anesthesiology and to determine to what extent departments use cost policies and guidelines. DESIGN: Mail survey. SETTING: Academic and large nonacademic anesthesiology departments. MEASUREMENTS AND MAIN RESULTS: 147 responding departments answered 20 questions. 38% of surveys were returned. 90 responders identified themselves as academic departments and 57 responders as nonacademic. 73% of departments reported pressure from hospital administrators to reduce anesthesia costs. The most common cost-saving activity, used by 90% of departments, is improving operating room (OR) utilization. 53% of all departments have policies or guidelines to contain drug costs, while 48% of departments have these to contain other product costs. Departments reporting themselves as academic generally reported greater use of cost policies. CONCLUSIONS: Anesthesiology departments are experiencing pressure to reduce costs and the majority have cost policies and guidelines concerning utilization of ORs and anesthetic drugs. Academic anesthesiology departments may be experiencing more cost-containment pressure than nonacademic departments.

Managing pharmaceutical sales activities in an academic anesthesiology department.

To contain costs, departments of anesthesiology must control the use of new, expensive drugs. Conflicts with pharmaceutical companies can arise when they promote drug sales. Pharmaceutical company sales represent anesthesiology department expenses. Anesthesiologists hold diverse opinions on this clash of interests, on the proper roles of pharmaceutical sales representatives in anesthesiology departments, and on the ethics of accepting industry gifts. Our department has managed pharmaceutical sales activities by encouraging discussion of the ethics and legal limits of industry gifts, by banning sales representatives from bringing food into the department, and by adopting The American Medical Association Guidelines on Gifts.

HLA may be involved in resistance and susceptibility to affective disorders.

The role of HLA in susceptibility to affective disorders was assessed by sib pair linkage analysis and by association studies. Unipolar Disorder (UD) and Bipolar Disorder (BD) were studied separately. Both the sib pair data and the antigen frequency distribution suggested an HLA-linked susceptibility to UD. For BD however, the HLA haplotype sharing distribution in sib pairs was random, but the antigen frequencies suggested at least one positive association and one negative association with HLA. The lack of evidence for linkage to HLA from sib pairs may have been due to the genetic heterogeneity of BD.