Anesthesiology
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Randomized Controlled Trial Comparative Study
Comparison of continuous infusion versus automated bolus for postoperative patient-controlled analgesia with popliteal sciatic nerve catheters.
This investigation was designed to compare a new methodology of automated regular bolus with a continuous infusion of local anesthetic for continuous popliteal sciatic block; both regimens were combined with patient-controlled analgesia (PCA). ⋯ In continuous popliteal sciatic block, local anesthetic administered as an automated regular bolus in conjunction with PCA provided similar pain relief as a continuous infusion technique combined with PCA; however, the new dosing regimen reduced the need for additional PCA and the overall consumption of local anesthetic.
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Randomized Controlled Trial Comparative Study
Respiratory and sleep effects of remifentanil in volunteers with moderate obstructive sleep apnea.
There is concern that opioid-based analgesia will worsen sleep-related respiratory insufficiency in patients with obstructive sleep apnea (OSA), resulting in serious morbidity or mortality. However, there are no studies that directly address the merit of this concern. Consequently, the authors designed this study as the first prospective, double-blind, placebo-controlled investigation of opioid pharmacology in patients with documented OSA. ⋯ The decrease in obstructive apneas likely resulted from the marked decrease in rapid eye movement sleep caused by remifentanil. Despite fewer obstructions, OSA was worse during remifentanil infusion because of a marked increase in the number of central apneas. These data suggest that caution is warranted when administering opioids to subjects with moderate OSA, but that the primary risk may be central apnea, not obstructive apnea.
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Randomized Controlled Trial Comparative Study
Rigid laryngoscope-assisted insertion of transesophageal echocardiography probe reduces oropharyngeal mucosal injury in anesthetized patients.
Intraoperative transesophageal echocardiography has become a routine part of monitoring in patients with cardiac disease. However, insertion of a transesophageal echocardiography probe can be associated with oropharyngeal, esophageal, and gastric injuries. The purpose of this study was to determine whether insertion of a transesophageal echocardiography probe under direct laryngoscopic visualization can reduce the incidence of oropharyngeal mucosal injury. ⋯ Rigid laryngoscope-assisted insertion of the transesophageal echocardiography probe reduces the incidence of oropharyngeal mucosal injury, odynophagia, and the number of insertion attempts.