Anesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
The effects of isoflurane and desflurane on intracranial pressure, cerebral perfusion pressure, and cerebral arteriovenous oxygen content difference in normocapnic patients with supratentorial brain tumors.
Desflurane is a volatile anesthetic agent with low solubility whose use in neurosurgery has been debated because of its effect on intracranial pressure and cerebral blood flow. The purpose of this study was to determine the variations on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) as well as on cerebral arteriovenous oxygen content difference (AVDo(2)) in normocapnic patients scheduled to undergo removal of supratentorial brain tumors with no evidence of mass effect during anesthesia with isoflurane or desflurane. ⋯ The results of this study indicate that there are no variations on ICP in normocapnic patients undergoing removal of supratentorial brain tumors without midline shift, as they were anesthetized with isoflurane or desflurane. CPP and cerebral AVDo(2) decreased with both agents.
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Comparative Study
Peri-MAC depression of a nociceptive withdrawal reflex is accompanied by reduced dorsal horn activity with halothane but not isoflurane.
Anesthetics act in the spinal cord to suppress movement evoked by a noxious stimulus, although the exact site is unknown. ⋯ Halothane reduces noxious-evoked movement at least partly via depression of dorsal horn neurons, whereas isoflurane suppresses movement by an action at more ventral sites in the spinal cord.
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In cardiac patients, pulmonary capillary wedge pressure (PCWP) is estimated using color M-mode Doppler study of left ventricular filling and Doppler tissue imaging. The goal of this study was to assess whether echocardiography accurately estimates PCWP in critically ill patients. ⋯ In patients with postoperative circulatory shock and acute lung injury, transesophageal echocardiography estimates noninvasively PCWP. However, echocardiographic estimation of PCWP may not be accurate enough for adjusting therapy.
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According to previous studies, the addition of ketamine to morphine for intravenous patient-controlled analgesia (PCA) may be beneficial. The authors developed and applied a new model to optimize the combination of morphine, ketamine, and a lockout interval for PCA after lumbar spine and hip surgery. ⋯ Using a novel method to analyze drug combinations, the study supports combinations of morphine with ketamine in a ratio of 1:1 and a lockout interval of 8 min for postoperative PCA following spine and hip surgery.
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Randomized Controlled Trial Clinical Trial
Does the suggested lightwand bent length fit every patient? The relation between bent length and patient's thyroid prominence-to-mandibular angle distance.
To date, no study has explored the effect of bent length on lightwand intubation. For successful intubation in daily practice, the authors found that bent length should be approximated to the patient's thyroid prominence-to-mandibular angle distance (TMD), but some patients have a TMD much shorter than the suggested bent length range. The purposes of this study were to understand TMD distribution in adults and to test the influence of bent length on lightwand intubation. ⋯ The suggested range was suitable for patients in group B (TMD > 5.5 cm). However, in group A (=5.5 cm), the large discrepancy between the upper limit of the suggested range and this TMD caused difficulty in lightwand intubation. A 6.5-cm bent length is more suitable than an 8.5-cm bent length in these patients.