The Mobility Scale for Acute Stroke predicts discharge destination after acute hospitalization.

OBJECTIVE: To evaluate the predictive validity of the Mobility Scale for Acute Stroke (MSAS) in determining discharge destination (home or not home) after an acute stroke. DESIGN: Cohort study. SUBJECTS: Two-hundred and twenty-three patients with acute ischemic or intraparenchymal hemorrhagic, unilateral stroke METHODS: The MSAS was administered as part of the initial physical therapy examination. The Receiver Operating Characteristic determined the optimal MSAS cutoff score associated with discharge home. A multiple logistic regression equation with discharge destination as the criterion variable (home or not home) was conducted with age, length of stay and optimal MSAS cutoff score as covariates. RESULTS: Subjects were discharged home 35.9% (n = 80) and not home 64.1% (n = 143) of the time. Mean age was 68.5 years (standard deviation 1.8). The ROC determined 26 to be the optimal cutoff score for the MSAS. Results of the multiple logistic regression equation indicated that controlling for age and length of stay, only the MSAS cutoff score of 26 reliably predicted discharge to home with an adjusted odds ratio of 57.79 with a 95% confidence interval of 20.09-166.21. CONCLUSION: The MSAS may be useful for predicting discharge destination from the acute hospital after stroke.

Anestesia subaracnoidea hipobárica a dosis bajas para cirugía anorrectal en posición de navaja: comparación entre levobupivacaína-fentanilo y lidocaína-fentanilo / Low-dose hypobaric spinal anesthesia for anorectal surgery in jackknife position: levobupivacaine-fentanyl compared to lidocaine-fentanyl

INTRODUCCIÓN: El objetivo de este estudio fue comparar el porcentaje de pacientes que evitaban su paso (bypass) por la unidad de recuperación postanestésica (URPA) después de una anestesia subaracnoidea selectiva con lidocaína- fentanilo respecto a otra de levobupivacaína-fentanilo, en cirugía anorrectal realizada en pacientes en posición de navaja. MATERIAL YMÉTODOS: Estudio aleatorizado, prospectivo y doble ciego. Se compararon dos grupos de 30 pacientes, ASA I-II. El grupo Lido recibió 18 mg de lidocaína 0,6% más 10 μg fentanilo y el grupo Levo 3 mg de levobupivacaína 0,1% más 10 μg fentanilo. Se monitorizaron las siguientes variables intraoperatorias: tiempo de inicio de la cirugía, nivel máximo de bloqueo sensitivo, necesidad de suplementación analgésica, aparición de eventos hemodinámicos. El nivel sensitivo se registró a los 5, 10 y 15 minutos y al final de la cirugía. Tras la cirugía se registró el grado de bloqueo motor, el nivel de propiocepción, el test de Romberg y si el paciente podía puentear la Unidad de recuperación postanestésica. Los tiempos de deambulación y de alta a domicilio, las complicaciones y la satisfacción postoperatoria también fueron registradas. RESULTADOS: No se observó diferencias significativas entre los grupos en cuanto a variables intraoperatorias. El 100% de los pacientes del estudio fue directamente a la unidad de adaptación al medio sin pasar por la URPA. Los tiempos para la deambulación, el alta a domicilio, así como las complicaciones y la satisfacción global postoperatoria fueron similares en ambos grupos. CONCLUSIONES: Ambas soluciones intratecales producen anestesia selectiva efectiva proporcionando un porcentaje de bypass de la URPA similar en cirugía anorrectal en posición de navaja(AU)

OBJECTIVE: To compare the percentage of patients who were able to bypass the postoperative intensive care recovery unit after selective spinal anesthesia with lidocaine-fentanyl versus levobupivacaine-fentanyl for anorectal surgery in jackknife position. MATERIAL AND METHODS: Randomized double-blind clinical trial comparing 2 groups of 30 patients classified ASA 1-2. One group received 18 mg of 0.6% lidocaine plus 10 μg of fentanyl while the other group received 3 mg of 0.1% levobupivacaine plus 10 μg of fentanyl. Intraoperative variables were time of start of surgery, maximum extension of sensory blockade, requirement for rescue analgesics, and hemodynamic events. The level of sensory blockade was recorded at 5, 10, and 15 minutes after the start of surgery and at the end of the procedure. The degrees of postoperative motor blockade and proprioception were recorded, as were the results of the Romberg test and whether or not the patient was able to bypass the postoperative recovery unit. Also noted were times of start of ambulation and discharge, complications, and postoperative satisfaction. RESULTS: Intraoperative variables did not differ significantly between groups, and all patients in both groups bypassed the postoperative recovery unit. Times until walking and discharge home, complications, and overall satisfaction after surgery were similar in the 2 groups. CONCLUSIONS: Both spinal anesthetic solutions provide effective, selective anesthesia and are associated with similar rates of recovery care unit bypass after anorectal surgery in jackknife position(AU)