General anesthesia versus sedation for implantation of a biventricular pacing device for cardiac resynchronization therapy.

OBJECTIVE: Heart failure carries significant risk for major noncardiac surgery. Whether this risk is transferable to minor surgery is less well-documented. Thus, the aim of this study was to assess the outcome of a contemporary cohort of heart failure patients undergoing cardiac resynchronization therapy (CRT) device insertion under general anesthesia or sedation. DESIGN: Retrospective observational study. SETTING: Tertiary cardiac specialist hospital. PARTICIPANTS: Heart failure patients. INTERVENTIONS: CRT insertion under general anesthesia or sedation. MEASUREMENTS AND MAIN RESULTS: Anesthesia, heart failure, and outcome data were collected on a consecutive series of patients having CRT device insertion between 2002 and 2010. A total of 242 patients were managed by the anesthesia department during the study period. After exclusion criteria were applied, data for 183 patients were analyzed. Immediate perioperative (<24 hours) mortality was zero; 30-day mortality of 138 patients was 2.2%. One patient (0.5%) required unplanned intensive care admission. A comparison was made between the sedation (n = 76) group and the general anesthesia (GA) group (n = 107). When compared with the sedation group, the GA group had more intraoperative hypotension (26.2% versus 4.0%, p<0.00001). There was no difference between the GA and sedation groups with regard to 30-day mortality (1.4% versus 3.1%, p = 0.57), unplanned intensive care admission (0% versus 1.3%, p = 0.42), and length of stay in days (3 versus 3, p = 0.82). CONCLUSION: The authors found that patients with heart failure undergoing CRT insertion with concurrent general anesthesia or sedation had minimal immediate perioperative risk and that there was no difference in postoperative outcome between general anesthesia and sedation.

Promoting Best Practices for Medical Science Liaisons Position Statement from the APPA, IFAPP, MAPS and MSLS.

This position paper is intended to provide recommendations that will help lay the foundation for best practices for medical science liaisons (MSLs) and their activities. Its objective is to outline the roles and responsibilities expected of an MSL and provide clarity on the juxtaposition of MSLs and Sales representatives (SRs) when it comes to scientific exchange versus promotional messaging. It is of utmost importance that industry integrity and ethical standards are assured during external stakeholder engagement as well as medical and scientific communications. This guidance, delivered through the lens of APPA, IFAPP, MAPS and the MSLS executive committees, has been prepared primarily as a supportive resource to assist the Medical Affairs teams in the industry to develop their own set of standard operating procedures (SOPs), codes of conduct and policies within the framework of relevant industry regulations. We acknowledge that whilst there are guidelines already available that provide excellent directive to the MSL function, this paper is a review and distillation of these existing recommendations combined with the perspectives of four peak professional bodies to offer a practically focused resource to help MSLs interact, collaborate and exchange scientific information appropriately with external experts when out in the field.

Allergic rhinoconjunctivitis in the Australian population: burden of disease and attitudes to intranasal corticosteroid treatment.

BACKGROUND: Allergic rhinoconjunctivitis (AR/C) is a global health problem causing significant morbidity and has a major impact on quality of life (QOL) and health expenditure. Despite the widespread prevalence, the overall health impact of AR/C may be underappreciated. The results of a survey designed to capture the burden of allergic rhinitis within the Asia-Pacific region have been published recently. Of particular note when evaluating treatment in this region was the fact that despite the value of intranasal corticosteroid (INCS) use, only a small percentage of patients used them. Whether this same trend is present within the population of Australian sufferers is unknown. This study examines the burden of AR/C and explores use of, and attitudes, to INCS sprays in the Australian population. METHODS: Three hundred three completed interviews from adults and children who had physician-diagnosed AR/C and who were symptomatic or had received treatment in the previous 12 months were analyzed for QOL measures and attitudes to INCS use. RESULTS: Most patients surveyed had received their diagnosis from a general practitioner (GP), and in most cases, a GP provided the majority of ongoing medical care. Only 8% of respondents had consulted a relevant specialist. Diagnostic tests had not been performed in 55% of respondents. The major symptoms causing most distress were nasal congestion and ocular symptoms. The burden of AR/C was considerable; 42% described significant work or school interference because of symptoms, one-third reporting moderate-to-extreme interference with sleep. Despite the significant impact on QOL reported by this sample, 17% had never used INCS and 27% had not used them in the previous 12 months. Respondents' knowledge about INCSs was poor. CONCLUSION: AR/C is a common disease associated with significant morbidity and impairment of QOL. Improvement in diagnosis, management, and patient education is needed.

An animal model of "syringe feel" during peripheral nerve block.

BACKGROUND: The perception of high resistance during injection of a local anesthetic during regional anesthesia may indicate intraneural injection. Anesthetists' ability to detect high resistance by "syringe feel" has been questioned in the past. The aim of our study was to investigate the anesthetist's ability to detect abnormal resistance to injection using an animal model. METHODS: We created a model using nerve, muscle, bone, and tendon tissue dissected from a sheep. Regional anesthesia needles of 21-gauge and 100 mm were placed into each of these tissues under direct vision, and 40 anesthetists were then asked to inject normal saline from a 20-mL syringe. They were unable to see the needle position. Once injected into all 4 tissues, they were asked to state which tissue they thought each was. RESULTS: Of the 40 anesthetists, 12 (30%) correctly identified the nerve. This was no better than chance (25%) and shows that the tested anesthetists were unable to correctly identify beyond chance what tissues they were injecting into. When those who did not practice regional anesthesia regularly (n = 7) were excluded, similar results were obtained. Ten (30%) of the 33 self-identified experienced regional anesthetists correctly identified the nerve. A score that measured the number of correctly identified tissues (score 1) was used to compare anesthetists on grade and level of experience. This showed that the more experienced anesthetists did better than the less experienced ones. CONCLUSION: Under the conditions of this study model, anesthetists were unable to correctly identify intraneural injection by syringe feel during simulated regional anesthesia.