Anesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Continuous infusion of ropivacaine for pain relief after iliac crest bone grafting for shoulder surgery.
The aim of the study was to compare the efficacy of either ropivacaine or placebo through an iliac crest (IC) catheter after Bankart repair with IC bone grafting. ⋯ Continuous application of 0.2% ropivacaine through an IC catheter after Bankart repair with IC bone grafting is an effective method for pain relief for the first 48 h, with few adverse effects and high patient satisfaction. The benefit of this technique is still present after 3 months.
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Comparative Study
Impact of anesthesia management characteristics on severe morbidity and mortality.
Quantitative estimates of how anesthesia management impacts perioperative morbidity and mortality are limited. The authors performed a study to identify risk factors related to anesthesia management for 24-h postoperative severe morbidity and mortality. ⋯ Mortality after surgery is substantial and an association was established between perioperative coma and death and anesthesia management factors like intraoperative presence of anesthesia personnel, administration of drugs intraoperatively and postoperatively, and characteristics of delivered intraoperative and postoperative anesthetic care.
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Comparative Study
Hemodynamic changes after protamine administration: association with mortality after coronary artery bypass surgery.
Protamine sulfate is standard therapy to reverse heparin anticoagulation. Hemodynamic responses to protamine are common, ranging from minor perturbations to cardiovascular collapse. Although severe fatal reactions occur, the relation of less extreme responses with postoperative mortality is unknown. Therefore, the authors tested the hypothesis that hemodynamic "protamine reactions" (systemic hypotension and pulmonary hypertension) are associated with mortality after cardiac surgery. ⋯ Hemodynamic perturbations after protamine administration are independently related to in-hospital mortality after primary coronary artery bypass surgery; the relation is present even in the lowest observed range of values for both systemic hypotension and pulmonary hypertension. Although randomized trials are necessary to address causality, this evidence suggests that strategies that avoid or attenuate these reactions may improve patient care.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intraoperative remifentanil infusion does not increase postoperative opioid consumption compared with 70% nitrous oxide.
Remifentanil is commonly used to replace nitrous oxide in general anesthesia to avoid the side effects of the latter. However, there are reports that intraoperative remifentanil infusion can lead to acute opioid tolerance. In this study, the authors tried to determine the dose of remifentanil comparable in efficacy to 70% nitrous oxide and to evaluate its effect on postoperative pain and morphine consumption after colorectal surgery using isoflurane anesthesia. ⋯ The substitution of 70% nitrous oxide with remifentanil at a mean infusion rate of 0.17 mug . kg . minute for colorectal surgery did not affect postoperative opioid consumption.
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Comparative Study
Effect of carbon dioxide pneumoperitoneum on development of atelectasis during anesthesia, examined by spiral computed tomography.
Anesthesia per se results in atelectasis development in the dependent regions of the lungs. The effect of pneumoperitoneum on atelectasis formation is not known. The aim of the current study was to measure by spiral computed tomography the effect of carbon dioxide pneumoperitoneum for laparoscopic surgery on the development of atelectasis, overall lung volume, and regional tissue volumes of gas and tissue. ⋯ Pneumoperitoneum at an intraabdominal pressure level of 11-13 mmHg increased the volume of atelectasis. Because lung tissue volume increased in the lung, there may have been an opening of previously closed vessels, which could explain previously seen increase in arterial oxygenation after induction of pneumoperitoneum.