Anesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of the LMA-classic with the new disposable soft seal laryngeal mask in spontaneously breathing adult patients.
The laryngeal mask airway LMA-Classic has been used widely in clinical practice. A new disposable supraglottic airway device, the Soft Seal LM, has been introduced recently. In a randomized study, the authors compared the LMA-Classic and the disposable Soft Seal LM in terms of their clinical performance, cuff pressures during nitrous oxide anesthesia, position of the laryngeal mask in situ by fiberoptic evaluation, and morbidity in a wide range of routine general surgery procedures. ⋯ In spontaneously breathing adult patients requiring a size 4 laryngeal mask airway, the new disposable Soft Seal LM device is an acceptable alternative to the reusable LMA-Classic trade mark, resulting in a good laryngeal seal and offering similar clinical performance. Cuff pressures increase substantially when the LMA-Classic is used but not when using the Soft Seal LM. There was less trauma to patients using the Soft Seal LM, as assessed by the incidence of sore throat in the early postoperative period.
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Randomized Controlled Trial Comparative Study Clinical Trial
Efficacy, safety, and pharmacokinetics of levobupivacaine with and without fentanyl after continuous epidural infusion in children: a multicenter trial.
Levobupivacaine, the levo-enantiomer of bupivacaine, is as potent as bupivacaine but less toxic. Therefore, the authors investigated the efficacy, safety, and pharmacokinetics of perioperative epidural levobupivacaine with and without fentanyl in children. ⋯ We conclude that 0.0625% levobupivacaine without fentanyl is an effective perioperative epidural solution in children when infused at a rate of 0.3 ml. kg-1. h-1. The plasma concentrations of 0.125% and 0.0625% levobupivacaine and fentanyl (1 mug/ml) at the end of a 24-h infusion are low.
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Experimental studies suggest that surgical injury may up- or down-regulate nociceptive function. Therefore, the aim of this clinical study was to evaluate the effect of elective arthroscopically assisted knee surgery on nociceptive responses to a heat injury. ⋯ Arthroscopic knee surgery did not modify nociceptive responses to a contralaterally applied experimental burn injury.
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Ethical conduct in human research in anesthesia includes approval by an institutional review board (IRB) or ethics committee and informed consent. Evidence of these is sometimes lacking in journal publications. ⋯ This study suggests that rates of IRB approval and informed consent vary among publications in anesthesia journals. Clearer guidelines (and author adherence) for all types of publication are needed, both as a protection for research subjects and to maintain public trust in the process.
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In critical illness, the gut is susceptible to hypoperfusion and hypoxia. Positive-pressure ventilation can affect systemic hemodynamics and regional blood flow distribution, with potentially deleterious effects on the intestinal circulation. The authors hypothesized that spontaneous breathing (SB) with airway pressure release ventilation (APRV) provides better systemic and intestinal blood flow than APRV without SB. ⋯ Maintaining SB during APRV was associated with better systemic and intestinal blood flows. Improvements were more pronounced in the mucosal-submucosal layer.