Anesthesiology
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Randomized Controlled Trial Multicenter Study Comparative Study
Comparison of the Potency of Different Propofol Formulations: A Randomized, Double-blind Trial Using Closed-loop Administration.
Different propofol formulations demonstrate different potencies when not mixed with lignocaine, but are similar when lignocaine is mixed.
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Randomized Controlled Trial
Impact of Risk Assessments on Prophylactic Antiemetic Prescription and the Incidence of Postoperative Nausea and Vomiting: A Cluster-randomized Trial.
Clinical prediction models have been shown to have moderate sensitivity and specificity, yet their use will depend on implementation in clinical practice. The authors hypothesized that implementation of a prediction model for postoperative nausea and vomiting (PONV) would lower the PONV incidence by stimulating anesthesiologists to administer more "risk-tailored" prophylaxis to patients. ⋯ Implementation of a PONV prediction model did not reduce the PONV incidence despite increased antiemetic prescription in high-risk patients by anesthesiologists. Before implementing prediction models into clinical practice, implementation studies that include patient outcomes as an endpoint are needed.
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Randomized Controlled Trial
Population Pharmacokinetic Modeling of Hydromorphone in Cardiac Surgery Patients during Postoperative Pain Therapy.
Hydromorphone is a µ-selective opioid agonist used in postoperative pain therapy. This study aimed to evaluate the pharmacokinetics of hydromorphone in cardiac surgery patients during postoperative analgesia with target-controlled infusion and patient-controlled analgesia. ⋯ The final pharmacokinetic model gave a robust representation of hydromorphone pharmacokinetics. Inclusion of age and body weight to the model demonstrated a significant influence of these covariates on hydromorphone pharmacokinetics. The application of this patient-derived population model in individualized pain therapy should improve the dosing of hydromorphone in patients undergoing cardiac surgery.
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Randomized Controlled Trial
Restrictive Deferred Hydration Combined with Preemptive Norepinephrine Infusion during Radical Cystectomy Reduces Postoperative Complications and Hospitalization Time: A Randomized Clinical Trial.
Anesthetics and neuraxial anesthesia commonly result in vasodilation/hypotension. Norepinephrine counteracts this effect and thus allows for decreased intraoperative hydration. The authors investigated whether this approach could result in reduced postoperative complication rate. ⋯ A restrictive-deferred hydration combined with preemptive norepinephrine infusion during radical cystectomy and urinary diversion significantly reduced the postoperative complication rate and hospitalization time.
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Randomized Controlled Trial
Moderate Hyperventilation during Intravenous Anesthesia Increases Net Cerebral Lactate Efflux.
Hyperventilation is known to decrease cerebral blood flow (CBF) and to impair cerebral metabolism, but the threshold in patients undergoing intravenous anesthesia is unknown. The authors hypothesized that reduced CBF associated with moderate hyperventilation might impair cerebral aerobic metabolism in patients undergoing intravenous anesthesia. ⋯ Moderate hyperventilation, when compared with moderate hypoventilation, in patients with cardiovascular disease undergoing intravenous anesthesia increased net cerebral lactate efflux and markedly reduced CBF and partial pressure of oxygen of the jugular venous bulb, suggesting partial impairment of cerebral aerobic metabolism at clinically relevant levels of hypocapnia.