Anesthesiology
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Randomized Controlled Trial Clinical Trial
Molar potency is predictive of the speed of onset of neuromuscular block for agents of intermediate, short, and ultrashort duration.
The times to peak effect of rocuronium, vecuronium, cisatracurium, mivacurium, and succinylcholine were evaluated to confirm that the correlation between potency and onset time observed for long-acting relaxants also held for drugs of intermediate and short duration. ⋯ The inverse correlation between the molar potency and speed of onset previously described for agents of long duration also applies to nondepolarizing agents of intermediate and short duration. The onset time of succinylcholine also appears to be compatible with this relation.
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Systemic air or gas embolism has been increasingly recognized as a complication of serious chest trauma and often presents with catastrophic circulatory and cerebral events. The classic findings are hemoptysis, sudden cardiac or cerebral dysfunction after initiation of PPV, air in retinal vessels, and air in arterial aspirations. The clinician must be wary of more subtle presentations. ⋯ HBOT is useful in managing cerebral air embolism and should be incorporated as soon as possible. Clinicians involved in trauma care must be familiar with SAE. By adopting a problem-based solution through innovative airway and ventilation management, anesthesiologists may significantly alter and improve the morbidity and mortality rate of SAE resulting from chest trauma.
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Intrathecally administered clonidine increases release of spinal acetylcholine, which may be related to its analgesic action in neuropathic pain. The current study determined the role of spinal muscarinic and nicotinic receptors in the antiallodynic effect of intrathecally administered clonidine in spinal nerve-ligated rats. ⋯ These results demonstrate that the analgesic effect of intrathecally administered clonidine on neuropathic pain is mediated by spinal muscarinic and nicotinic receptors. Therefore, this study provides functional evidence that spinally released acetylcholine plays a role in the antiallodynic effect of intrathecally administered clonidine in neuropathic pain.
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Randomized Controlled Trial Comparative Study Clinical Trial
Pulmonary airway resistance with the endotracheal tube versus laryngeal mask airway in paralyzed anesthetized adult patients.
The hypothesis that airway resistance is less with the laryngeal mask airway than with the endotracheal tube was tested. ⋯ The laryngeal mask airway triggers less bronchoconstriction than does the endotracheal tube in paralyzed anesthetized adult patients. This may have implications for maintaining intraoperative pulmonary function and reducing the risk for atelectasis and pulmonary infection.
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Randomized Controlled Trial Comparative Study Clinical Trial
Antiemetic prophylaxis does not improve outcomes after outpatient surgery when compared to symptomatic treatment.
Although prophylactic administration of antiemetics reduces the incidence of postoperative nausea, vomiting, or both (PONV), there is little evidence to suggest this improves patient outcomes. The authors hypothesized that early symptomatic treatment of PONV will result in outcomes, including time to discharge, unanticipated admission, patient satisfaction, and time to return to normal daily activities, that are similar to those achieved with routine prophylaxis. ⋯ Although PONV is unpleasant, the data indicate little difference in outcomes when routine prophylactic medications are administered versus simply treating PONV should symptoms occur.