Economic analysis of the use of video laryngoscopy versus direct laryngoscopy in the surgical setting.

Aim: Compared with direct laryngoscopy (DL), video laryngoscopy (VL) offers clinical benefits in routine and difficult airways. The health economic benefit of VL versus DL for routine tracheal intubation remains unknown. Materials & methods: This analysis compared VL and DL health economic outcomes, including total inpatient costs, length of hospital stay (LOS), postoperative intensive care unit (ICU) admission and incidence of procedurally associated complications. Results: Patients with VL had decreased inpatient cost (US$1144-5891 across eight major diagnostic categories [MDC]); >1-day LOS reduction in five MDC; reduced odds for postoperative ICU admission (0.04-0.68) and reduced odds of respiratory complications in three MDC (0.43-0.90). Conclusion: Video laryngoscopy may lower total costs, reduce LOS and decrease the likelihood of postoperative ICU admission.

Lay abstract In this study, we compared the difference in hospital cost, length of hospital stay, post-surgery complications and post-surgery intensive care unit (ICU) admission between two groups of patients. Both groups of patients were admitted to the hospital for a surgical procedure and underwent general anesthesia for at least 1 h. Before administering anesthesia for surgery, an anesthesiologist inserts a tube into the patient's airway to ventilate the patient. The anesthesiologist might use different types of laryngoscope to assist with the insertion of the tube. The choice of the laryngoscope type is based on several factors such as the availability of the device, doctor's experience, preference and patient's medical and physical conditions. This study focuses on two different types of laryngoscopes: the video laryngoscope and the direct laryngoscope. Patients who received video laryngoscope or direct laryngoscope were divided into separate groups. We made sure that these two groups of patients were comparable in terms of similar age, gender and disease conditions, stayed in similar types of hospitals and had similar procedures. Compared with the direct laryngoscope group, the video laryngoscope group had lower hospital costs (reduced by US$1144­5891), at least 1-day shorter length of hospital stay, reduced rates of ICU admission and fewer complications. This study indicates that video laryngoscopy offers benefits over direct laryngoscopy for elective surgical procedures.

Effects of milrinone versus epinephrine on left ventricular relaxation after cardiopulmonary bypass following myocardial revascularization: assessment by color m-mode and tissue Doppler.

OBJECTIVE: The purpose of this study was to evaluate the left ventricular lusitropic effects of epinephrine versus milrinone after cardiopulmonary bypass. DESIGN: Prospective randomized study. SETTING: Single institution, university teaching hospital. PARTICIPANTS: Adult patients undergoing coronary artery bypass grafting under cardiopulmonary bypass. INTERVENTIONS: After separation from cardiopulmonary bypass, patients were randomized to receive intravenous epinephrine by continuous infusion (0.03 microg/kg/min) or milrinone (50 microg/kg followed by 0.5 microg/kg/min). Transesophageal echocardiographic evaluation of left ventricular diastolic function, with emphasis on relaxation, was performed before and after bypass and after the administration of either epinephrine or milrinone. MEASUREMENTS AND MAIN RESULTS: Measurements included pulse-wave Doppler analysis of mitral inflow and pulmonary vein and left ventricular outflow tract velocities. Left ventricular inflow velocity of propagation measured with color M-mode and tissue Doppler assessment of early mitral annulus velocity were used to evaluate left ventricular relaxation. Values of velocity of propagation and mitral annulus velocity improved significantly after bypass, suggesting improved relaxation. The administration of either epinephrine or milrinone did not result in further improvement in left ventricular relaxation. CONCLUSIONS: After cardiopulmonary bypass, left ventricular relaxation was significantly improved. Neither epinephrine nor milrinone exhibited favorable lusitropic effects after bypass.