Anesthesiology
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This historical landmark paper demonstrated the terribly-higher maternal mortality during cesarean section performed under general anesthesia vs regional anesthesia in the United States from 1979-1990.
This resulted in the oft-quoted statistic of being '...17 times more likely to die under a GA cesarean section than epidural or spinal.'
It is very important to note that this is a historical article and that the demonstrated very high mortality was greatly contributed to by a culture tolerating inexperienced anesthesia residents performing GA CS after-hours with limited senior support.
Hawkins followed up this study with another in 2011: Anesthesia-related maternal mortality in the United States: 1979-2002. This reassuringly showed a much improved GA CS maternal mortality from 1997-2002 (although still higher than regional CS).
The important take-home from this paper is that a GA cesarean section increases the risk of serious airway events, and if this is not managed by experienced and appropriately trained anaesthetists/anesthesiologists, will result in maternal deaths.
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It is not always possible to predict when tracheal intubation will be difficult or impossible. The authors wanted to determine whether indirect laryngoscopy could identify patients in whom intubation was difficult. ⋯ Although in 15% of patients indirect laryngoscopy could not be performed because of excessive gag reflex, indirect laryngoscopy can serve as an effective method to predict difficult intubation.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Perioperative sympatholysis. Beneficial effects of the alpha 2-adrenoceptor agonist mivazerol on hemodynamic stability and myocardial ischemia. McSPI--Europe Research Group.
Mivazerol hydrochloride is a new alpha 2-adrenoceptor agonist. In vitro and animal studies have demonstrated both sympatholytic and antiischemic properties. To evaluate the safety and efficacy of mivazerol in patients during perioperative stress, this multicenter phase II clinical trial studied hemodynamic stability and myocardial ischemia in patients with coronary artery disease undergoing noncardiac surgery. ⋯ Continuous, 72-h perioperative administration of mivazerol to high-risk patients appears to be relatively safe, producing no significant hypotension or adverse events but some evidence of bradycardia not associated with adverse clinical events. Mivazerol decreased the incidence of, and treatment for, tachycardia, hypertension, and myocardial ischemia, particularly during high stress periods. Therefore, these salutary effects of mivazerol indicate further study in large-scale trials that assess mivazerol's effects on adverse cardiac outcomes, including death and myocardial infarction.
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Randomized Controlled Trial Clinical Trial
Epidural clonidine used as the sole analgesic agent during and after abdominal surgery. A dose-response study.
Many studies have shown the beneficial effect of epidural clonidine in postoperative pain management. In these studies, the patients received local anesthetics, opioids, or both in combination with clonidine. Due to the interactive potentiation of those drugs, the importance of the intrinsic analgesic properties of the alpha 2-adrenoceptor agonist is difficult to establish. The authors investigated the analgesic potency of epidural clonidine when used as the sole analgesic agent during and after major abdominal surgery. ⋯ Epidural clonidine used as the sole analgesic agent provided dose-dependent control of the hemodynamic changes associated with surgical stimulation. It also produced dose-dependent postoperative analgesia without major side effects.
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Recent evidence suggests that the spinal cord is an important site of anesthesia that is necessary for surgical immobility, but the specific effect of anesthetics within the spinal cord is unclear. This study assessed the effect of isoflurane and nitrous oxide on spinal motoneuron excitability by monitoring the H-reflex and the F wave. ⋯ Both isoflurane alone and isoflurane plus nitrous oxide decrease H-reflex and F-wave amplitude and F-wave persistence. These effects suggest that isoflurane and nitrous oxide decrease motoneuronal excitability in the human spinal cord. This may play an important role in producing surgical immobility.