Anesthesiology
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Randomized Controlled Trial Clinical Trial
Ambulatory surgery patients may be discharged before voiding after short-acting spinal and epidural anesthesia.
Voiding before discharge is usually required after outpatient epidural or spinal anesthesia because of concern about bladder overdistention and dysfunction. Shorter duration spinal and epidural anesthesia may allow return of bladder function before overdistention occurs in low-risk patients (those younger than age 70, not having hernia, rectal, or urologic surgery, and without a history of voiding difficulty), and predischarge voiding may not be necessary. ⋯ Delay of discharge after outpatient spinal or epidural anesthesia with short-duration drugs for low-risk procedures is not necessary, and may result in prolonged discharge times.
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Letter Randomized Controlled Trial Clinical Trial
Manual occlusion of the internal jugular vein during subclavian vein catheterization: a maneuver to prevent misplacement of catheter into internal jugular vein.
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Randomized Controlled Trial Clinical Trial
A neuroanatomical construct for the amnesic effects of propofol.
This study was designed to identify neuroanatomical locations of propofol's effects on episodic memory by producing minimal and maximal memory impairment during conscious sedation. Drug-related changes in regional cerebral blood flow (rCBF) were located in comparison with rCBF increases during a simple word memory task. ⋯ As amnesia becomes maximal, rCBF reductions induced by propofol occur in brain regions identified with working memory processes. In contrast, medial temporal lobe structures were resistant to the global CBF decrease associated with propofol sedation. The authors postulate that the episodic memory effect of propofol is produced by interference with distributed cortical processes necessary for normal memory function rather than specific effects on medial temporal lobe structures.
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Randomized Controlled Trial Clinical Trial
Pharmacokinetics of tranexamic acid during cardiopulmonary bypass.
Tranexamic acid (TA) reduces blood loss and blood transfusion during heart surgery with cardiopulmonary bypass (CPB). TA dosing has been empiric because only limited pharmacokinetic studies have been reported, and CPB effects have not been characterized. We hypothesized that many of the published TA dosing techniques would prove, with pharmacokinetic modeling and simulation, to yield unstable TA concentrations. ⋯ Tranexamic acid pharmacokinetics are influenced by CPB. Our TA pharmacokinetic model does not provide support for the wide range of TA dosing techniques that have been reported. Variation in TA efficacy from study to study and confusion about the optimal duration of TA treatment may be the result of dosing techniques that do not maintain stable, therapeutic TA concentrations.
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Randomized Controlled Trial Clinical Trial
Randomized prospective comparison of forced air warming using hospital blankets versus commercial blankets in surgical patients.
The purpose of this study was to evaluate the efficacy of an experimental approach to forced air warming using hospital blankets or a Bair Hugger warming unit (Augustine Medical Inc., Eden Prairie, MN) to create a tent of warm air. ⋯ Standard hospital blankets heated to 38 degrees C forced air were equally as effective as commercial blankets heated with forced air at 43 degrees C. However, based on concerns expressed by the manufacturer, this experimental technique should not be used until further safety evaluation has been undertaken.