Anesthesiology
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Comparative Study
Continuous Fick cardiac output compared to continuous pulmonary artery electromagnetic flow measurement in pigs.
A system for continuous Fick cardiac output measurement (CFCO) is described and compared to continuous electromagnetic pulmonary artery flow (EMCO) and intermittent thermodilution (TDCO) measurements. Oxygen consumption was determined from continuous respiratory gas exchange analysis and arterio-venous oxygen difference from fiberoptic oximetry. A computer calculated cardiac output and other variables every 20 s. ⋯ CFCO is recommended as a reliable standard of continuous cardiac output measurement. It is not a real time measurement; the technique has a time lag of approximately 20 s which is the result of the time constant of the VO2 measurement. Sources for error are discussed with suggestions for improving quality control.
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Comparative Study Clinical Trial
Epidural ketamine or morphine for postoperative analgesia.
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Comparative Study Clinical Trial Controlled Clinical Trial
Epidural hydromorphone: a double-blind comparison with intramuscular hydromorphone for postcesarean section analgesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Epidural anesthesia and analgesia in high-risk surgical patients.
The authors conducted a randomized controlled clinical trial to evaluate the effect of epidural anesthesia and postoperative analgesia (EAA) on postoperative morbidity in a group of high-risk surgical patients. A total of 53 patients were admitted to the study, 28 received EAA, and 25 received standard anesthetic and analgesic techniques without EAA. Surgical "risk" was evaluated preoperatively and found to be comparable in the two groups. ⋯ Urinary cortisol excretion, a marker of the stress response, was significantly diminished during the first 24 postoperative hours in the group receiving EAA (P = 0.025). Finally, hospital costs were significantly reduced for patients who received EAA (P = 0.02). The authors conclude that EAA exerted a significant beneficial effect on operative outcome in a group of high risk surgical patients.
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Anatomical study of the brachial plexus of 18 cadavers was undertaken to confirm the presence and significance of "septa" dividing the brachial plexus or axillary sheath. Dissection demonstrated that the sheath consists of multiple layers of thin connective tissue surrounding the various elements of the neurovascular bundle. ⋯ Single injections of methylene blue and Latex solutions into the axillary sheath resulted in immediate dye staining of median, radial, and ulnar nerves, despite the presence of septa. These data demonstrate that there are connections between compartments within the sheath and, therefore, do not support the need for multiple injections when performing an axillary block.