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| Massachusetts to Investigate Economics of Outpatient Facilities
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The battle between hospitals and ASCs continues in Massachusetts, where recent legislation established a 16-member task force to investigate the economic impact of outpatient surgery facilities and diagnostic imaging centers on the state's healthcare industry. The task force will perform a cost-benefit analysis and examine the effects of such facilities on hospital-based services and on patients' access to health services.
Hospital officials welcome the study, says Paul Wingle, spokesman for the Massachusetts Hospital Association. Mr. Wingle says he hopes the study will provide a forum to openly discuss the fairness of current state regulations. He says hospitals wanting to add services or new technology are subject to an extensive state examination, and must justify the need for the service in the market they serve and how the facility proposes to meet the projected demand.
Ambulatory surgery centers and outpatient imaging centers are not subject to the same detailed needs analysis, says Mr. Wingle. "We hope to work on a level regulatory playing field," he adds.
Linda Rahm, president of the Massachusetts Association of Ambulatory Surgery Centers, believes the study will reveal that "ASCs are a progressive and innovative way to deal with the state's healthcare costs."
The task force will meet no later than Oct. 1 and file a report, with legislative recommendations, no later than July 1, 2007, according to the state legislation.
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| Cuffed Endo Tubes Could Prevent Flash Fires
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Fires in the oropharynx caused by electrocautery during adenotonsillectomies could be prevented by cuffed endotracheal tubes, according to a case study published in a recent issue of the Journal of Clinical Anesthesiology. In the two cases they describe, researchers say they believe that "the leak around the uncuffed endotracheal tubes raised the oxygen concentration in the oropharynx" during A&Ts in pediatric patients, completing the fire triangle: ignition source, fuel and oxygen.
"Although there are at least 20 to 30 surgical patient fires each year in the US, few are reported," note the authors, clinicians at the Children's Hospital of Michigan in Detroit. They say their paper is the first to report on electrocautery-induced fire after the ignition of tonsillar tissue during adenotonsillectomy.
In both cases, the uncuffed endotracheal tubes developed leaks, leading to the burning of tonsillar tissue. In the first case, the leak was not detected before the fire; in the second, the leak was detected, leading the surgeon to discover charred tissue on the electrocautery device. Neither patient was injured, and both procedures continued uneventfully after the endotracheal tubes were replaced (in the first case with a cuffed tube, and with another uncuffed tube in the second).
"As suggested by these two cases, we recommend that every attempt should be made to minimize an ETT leak for oropharyngeal surgeries where electrocautery is to be used," write the researchers. "The leak of oxidizer can be controlled easily by inflating the cuff of the ETT. Cuffed endotracheal tubes provide many advantages, and their use should strongly be considered during adenotonsillectomy in children when electrocautery is to be used."
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| FDA Approves Antiemetic Therapy for PONV
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The U.S. Food and Drug Administration has approved Merck's Emend (aprepitant) for the prevention of post-operative nausea and vomiting, one of the most common side effects associated with anesthesia and surgical procedures. The recommended dose of Emend for PONV is a single 40mg dose administered orally within three hours before the induction of anesthesia.
The drug, already cleared to prevent chemotherapy-related nausea and vomiting, belongs to a class of medications called substance P/neurokinin 1 (NK-1) receptor antagonists and works by blocking nausea and vomiting signals to the brain, says Merck. Most current therapies target signals to the gut. About one-third of patients experience nausea and vomiting after surgery, according to the American Society of Anesthesiologists.
Meanwhile, Endo Pharmaceuticals has launched Synera (lidocaine 70mg and tetracaine 70mg), a topical peel-and-stick anesthetic patch. Synera is the first self-contained topical patch for prevention of pain associated with superficial venous access and superficial dermatological procedures in patients three years of age and older, says Endo. The recommended application time for the Synera patch is 20 to 30 minutes.
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| News and Notes
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The U.S. Food and Drug Administration has approved Merck's Emend (aprepitant) for the prevention of post-operative nausea and vomiting, one of the most common side effects associated with anesthesia and surgical procedures. The recommended dose of Emend for PONV is a single 40mg dose administered orally within three hours before the induction of anesthesia.
The drug, already cleared to prevent chemotherapy-related nausea and vomiting, belongs to a class of medications called substance P/neurokinin 1 (NK-1) receptor antagonists and works by blocking nausea and vomiting signals to the brain, says Merck. Most current therapies target signals to the gut. About one-third of patients experience nausea and vomiting after surgery, according to the American Society of Anesthesiologists.
Meanwhile, Endo Pharmaceuticals has launched Synera (lidocaine 70mg and tetracaine 70mg), a topical peel-and-stick anesthetic patch. Synera is the first self-contained topical patch for prevention of pain associated with superficial venous access and superficial dermatological procedures in patients three years of age and older, says Endo. The recommended application time for the Synera patch is 20 to 30 minutes.
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