Anesthesiology
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Adverse drug events related to patient-controlled analgesia (PCA) place patients at risk. ⋯ At less than 1%, the incidence of PCA errors is relatively low. Most errors occur during PCA administration. Safety can be improved by addressing equipment, education, and process issues.
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Reversal of residual neuromuscular blockade by acetylcholinesterase inhibitors (e.g., neostigmine) improves respiratory function. However, neostigmine may also impair muscle strength. We hypothesized that neostigmine administered after recovery of the train-of-four (TOF) ratio impairs upper airway integrity and genioglossus muscle function. ⋯ Neostigmine/glycopyrrolate, when administered after recovery from neuromuscular block, increases upper airway collapsibility and impairs genioglossus muscle activation in response to negative pharyngeal pressure. Reversal with acetylcholinesterase inhibitors may be undesirable in the absence of neuromuscular blockade.
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Comparative Study
Positive end-expiratory pressure redistributes regional blood flow and ventilation differently in supine and prone humans.
Animal studies have demonstrated an interaction between posture and the effect of positive end-expiratory pressure (PEEP) on regional ventilation and lung blood flow. The aim of this study was to explore this interaction in humans. ⋯ During mechanical ventilation of healthy volunteers, the addition of PEEP, 10 cm H2O, causes redistribution of both lung blood flow and ventilation, and the effect is different between the supine and prone postures. Our results suggest that the addition of PEEP in prone might be less beneficial than in supine and that optimal use of the prone posture requires reevaluation of the applied PEEP.
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Pulmonary function is impaired during pneumoperitoneum mainly as a result of atelectasis formation. We studied the effects of 10 cm H2O of positive end-expiratory pressure (PEEP) and PEEP followed by a recruitment maneuver (PEEP+RM) on end-expiratory lung volume (EELV), oxygenation and respiratory mechanics in patients undergoing laparoscopic surgery. ⋯ RM combined with 10 cm H2O of PEEP improved EELV, respiratory mechanics, and oxygenation during pneumoperitoneum whereas PEEP alone did not.