Anesthesiology
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Editorial Comment
Genetic testing for malignant hyperthermia in North America.
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Randomized Controlled Trial Comparative Study Clinical Trial
Infraclavicular perineural local anesthetic infusion: a comparison of three dosing regimens for postoperative analgesia.
In this randomized, double-blind study, the authors investigated the efficacy of continuous and patient-controlled ropivacaine infusions via an infraclavicular perineural catheter in ambulatory patients undergoing moderately painful orthopedic surgery at or distal to the elbow. ⋯ After moderately painful orthopedic surgery at or distal to the elbow, 0.2% ropivacaine delivered as a continuous infusion combined with patient-controlled bolus doses via an infraclavicular perineural catheter optimizes analgesia while minimizing oral analgesic use compared with basal- or bolus-only dosing regimens.
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Multicenter Study Clinical Trial
Ophthalmic regional anesthesia: medial canthus episcleral (sub-tenon) single injection block.
The purpose of this study was to evaluate the efficacy and safety of episcleral single-injection anesthesia in a large number of patients. ⋯ This is the first survey of a large experience in episcleral single-injection anesthesia, a form of anesthesia that does not preclude sharp-needle complications and does require training. Only one complication occurred among 2,031 patients; however, a larger number of patients is needed to definitively evaluate the safety of episcleral single-injection anesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Paravertebral analgesia with levobupivacaine increases postoperative flap tissue oxygen tension after immediate latissimus dorsi breast reconstruction compared with intravenous opioid analgesia.
Directly measured tissue oxygen tension (Pto2) reflects the adequacy of local tissue oxygenation and influences surgical wound healing. Epidural analgesia increases Pto2 compared with intravenous morphine analgesia after abdominal surgery. The authors tested the hypothesis that paravertebral regional anesthesia and analgesia would increase Pto2 compared with intravenous opioid-based anesthesia and analgesia. ⋯ The postoperative latissimus dorsi flap Pto2 was higher for 20 h after breast reconstruction with paravertebral analgesia compared with intravenous morphine analgesia.
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Randomized Controlled Trial Clinical Trial
Laryngeal mask airway insertion by anesthetists and nonanesthetists wearing unconventional protective gear: a prospective, randomized, crossover study in humans.
Mass casualty situations impose special difficulties in airway management, even for experienced caregivers. The laryngeal mask airway is part of the difficult airway algorithm. The authors evaluated the success rate and the time to secure airways by mask by anesthetists, surgeons, and novices when wearing either surgical attire or full antichemical protective gear that included butyl rubber gloves and a filtering antigas mask. ⋯ Anesthesia residents insert laryngeal mask airways at a similar speed when wearing surgical attire or limiting antichemical protective gear and two to three times faster than surgical residents or novices wearing either outfit. Novices initially perform at the level of surgical residents, but their learning curve was quick under both conditions.