Effect of preemptive topical application of lidocaine or prilocaine-lidocaine on successful catheterization of ear veins in New Zealand White rabbits.

OBJECTIVE: To compare 5% lidocaine ointment applied for 10 minutes before intravenous (IV) catheterization to a eutectic mixture of local anesthetics (2.5% lidocaine and 2.5% prilocaine; EMLA) cream applied for 10 or 60 minutes prior and a water-based placebo for 60 minutes for successful marginal ear IV catheterization in rabbits. STUDY DESIGN: Randomized, blinded, complete crossover, controlled trial. ANIMALS: A total of 10 intact male, New Zealand White rabbits aged 4 months. METHODS: After application of one of the treatments on the marginal ear vein, an operator unaware of the treatment attempted IV catheter placement. Successful IV catheterization was considered as a catheter inserted at the first attempt, safely secured, with appropriate patency. Generalized linear mixed models were developed to identify relevant predictors of successful catheter placement. RESULTS: Ears that had EMLA cream applied 60 minutes before the catheterization attempt had more than 10 times the odds of successful catheter placement [odds ratio (OR)=10.75; 95% confidence interval (CI), 1.92-60.16; p < 0.008] compared with placebo. Both the application of EMLA cream or lidocaine ointment 10 minutes before the catheterization attempt resulted in approximately three times the odds of successful catheter placement compared with placebo, but were not statistically significant. CONCLUSIONS AND CLINICAL RELEVANCE: Application of EMLA cream on the marginal ear vein 60 minutes before catheterization increases the chance of successful IV catheter placement in conscious rabbits.

Patient-Reported Quality-of-Life Outcome Measures in the Thyroid Cancer Population.

Background: There is an escalating worldwide population of thyroid cancer (TC) survivors. In addition to conventional metrics of quality of care, quality-of-life (QoL) assessment in TC patients is imperative. TC survivors face unique impediments to health-related quality of life (HRQoL), including thyroid-specific symptoms and exposure to disease-related stressors-including fear of recurrence and financial toxicity-over a prolonged survival period. Survey instruments currently used to assess HRQoL in TC survivors may be insufficient to accurately capture the burden of disease in this population. We aimed to identify the HRQoL instruments in the literature, which have been applied in the TC survivor population, and to present the psychometric properties of the scales and indexes that have been used. We hypothesized that few instruments have shown evidence of validity in this population. Summary: Of the 927 articles identified by search criteria, only 28 studies using 15 HRQoL instruments met inclusion criteria. Of the 15 HRQoL instruments identified, 9 were psychometric health status instruments and 6 were preference-based indexes, but none had been validated in the TC survivor population. While the majority of reviewed studies demonstrated impaired psychological and emotional well-being in TC survivors, these findings were not uniformly demonstrated across studies, and the longevity of the impact of TC on HRQoL was variably reported. Conclusions: Discrepancies in the literature regarding the impact of TC survivorship on HRQoL emphasize the challenges of accurately assessing patient perspectives, reinforcing the importance of using well-constructed instruments to measure patient-reported outcomes in the target population. Care providers involved in the treatment of TC survivors should be aware of longitudinal effects on HRQoL, especially pertaining to chronic psychological debilitation. Further development and rigorous validation of TC-specific instruments will allow for better data gathering and understanding of the barriers to achieving high long-term HRQoL in TC survivors throughout their long postsurvival course.

Thromboprophylaxis and Orthopaedic Surgery: Options and Current Guidelines

Antithrombotic therapy remains crucial in the peri- and post-operative management of patients who undergo orthopaedic surgical procedures, particularly total joint arthroplasty (TJA) and hip fracture surgery (HFS). Optimal thromboprophylaxis is currently mandatory in most orthopaedic practices to avoid the dreaded complications of venous thromboembolism (VTE). The pathogenesis of VTE is multifactorial and includes the well-known Virchow's triad of hypercoagulability, venous stasis, and endothelial damage. With current advances in orthopaedic surgery, a multimodal approach to thromboprophylaxis, anaesthetic management, and post-operative convalescence have altered the risks of venous thromboembolism after TJA and HFS in the lower extremity. This article reviews the various VTE prophylactic options and current best practice guidelines for orthopaedic TJA and HFS.