Letters & Emails


Better Postop Pain Control

RMV->)Better Postop Pain Control
Re: "Blocking Out Postop Pain" (January, page 28). This excellent article accurately describes new approaches to regional anesthesia/analgesia practice. I am doing the type of outpatient regional anesthesia described in the article (limited to orthopedic cases because our ASC is dedicated to orthopedic surgery). I was a guest at the Duke outpatient facility in September, and am familiar with what they do there. I have patterned my practice on similar procedures, with exceptional acceptance by the surgeons and patients. Hopefully, more anesthesiologists will utilize these techniques.

Charles A. Kottmeier, MD
Medical Director and Anesthesiologist
Orthopaedic Surgery Center of Clearwater
writeMail("[email protected]")
Preop Patient Assessment

Preop Patient Assessment
Re: "Preoperative Anesthesia Testing Gets Smarter" (December, page 48). What role does the supervising anesthesiologist play in this case-by-case screening of patients? In our ASC, we have a PAT nurse who performs phone assessment with the patient. Based on this interview and a preop testing requirements laundry list, the PAT nurse assures that the appropriate testing is ordered and performed. Once the testing results have been received, the anesthesiologist then reviews the chart. Does your anesthesiologist review every patient's chart before testing is ordered? If not, what are the logistics of your screening process? I am very interested in improving our PAT process.

Holly Nelson RN
Nurse Manager
Executive Woods ASC
writeMail("[email protected]")

Dr. Alan Marco replies:
At our facility, we use specifically trained nurses to do the bulk of the preoperative evaluations (history and basic exam). An attending anesthesiologist who covers the Preoperative Evaluation Center is available for consultation. We let the surgeons order whatever tests they feel are necessary for the surgery - especially if they are done at an outside facility.

Corrections and Clarifications
- "The Great Surgical Prepping Debate" (January 2003) should have stated "that a single 30-second application of ChloraPrep provides a strong residual property for reducing microorganisms on the skin surface for at least 48 hours," not five days. Also, to clarify, in a clinical trial with 85 subjects, ChloraPrep was compared in separate tests to both a 2% aqueous CHG solution and 70% isopropyl alcohol. In addition, some of the comments attributed to Cynthia Crosby, Medi-Flex's director of clinical education, were actually drawn from company literature rather than an interview with Ms. Crosby. Outpatient Surgery regrets any confusion.

- "Suck it up" (December 2002 Product News) implied that the Exmoor suction handpieces are easy to clean. These devices are only validated for single-use ear nose and throat surgery and should be disposed of after use.

- "Soak your scopes" (December 2002 Ideas that Work) from Linda M. Reecer, RN, BS, CNOR, CAPA, stated that she uses sterile 4x4 tubs to soak endoscopes. This is incorrect. Ms. Reecer's staff fills the tubs with water that they suction through the scopes immediately after the procedure.