Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2002
Case ReportsTreatment of persistent tachycardia with dexmedetomidine during off-pump cardiac surgery.
After unsuccessful treatment of intraoperative tachycardia with esmolol during off-pump revascularization, heart rate was successfully reduced with a bolus and infusion of dexmedetomidine.
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Anesthesia and analgesia · Aug 2002
The construction of learning curves for basic skills in anesthetic procedures: an application for the cumulative sum method.
This study aimed at constructing learning curves for basic procedural skills in anesthesiology using the cumulative sum method. We recorded 1234 peripheral venous cannulations, 895 orotracheal intubations, 688 spinals, and 344 epidurals performed by residents during the first 10 mo of training. Learning curves for each procedure were constructed by using the cusum method. The number of procedures performed until attainment of acceptable failure rates was calculated. All residents mastered peripheral venous cannulation after 79 +/- 47 procedures. Four of 7 residents attained acceptable failure rates at orotracheal intubation after 43 +/- 33 proce- dures. Seven of 11 residents attained acceptable failure rates at spinal anesthesia after 36 +/- 20 procedures. At epidural anesthesia, 5 of 11 residents attained acceptable failure rates after 21 +/- 11 procedures. The cusum method is a useful tool for objectively measuring performance during the learning phase of basic procedures. The wide interindividual variability in the number of procedures required to be performed before attaining acceptable failure rates suggests that performance should be followed on an individual basis. ⋯ Learning curves for peripheral venous cannulation, tracheal intubation, and spinal and epidural anesthesia were constructed using the cumulative sum (cusum) method. There was a wide variability in the number of procedures performed until attainment of acceptable failure rates. The cusum method may improve our means of evaluating residents' technical skills.
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Anesthesia and analgesia · Aug 2002
The mechanisms of intracranial pressure modulation by epidural blood and other injectates in a postdural puncture rat model.
The epidural blood patch is considered effective in treating postdural puncture headache. We have developed a postdural puncture model in rats for quantitative evaluation of the magnitude and duration of changes in cerebrospinal fluid (CSF) pressure in the cisterna magna in response to the administration of epidural blood or other moieties. This model was used to compare the efficacy of various methods of epidural injection for restoring and maintaining CSF pressure for up to 240 min. After lumbar dural puncture, CSF pressure declined 3.6 +/- 0.2 mm Hg. Epidural saline (100 microL) injected at the puncture site initially increased pressure by 7.2 +/- 0.7 mm Hg, but it rapidly (7.8 +/- 0.6 min) returned to postdural puncture baseline. A similar initial increase of CSF pressure was observed with equal volumes of all other epidural injectates, but the duration of pressure increase varied greatly. Hetastarch and dextran 40 produced results similar to saline. Only whole blood or fibrin glue consistently increased CSF pressure for the entire 240-min observation period. Whole blood mixed with anticoagulant or injected 20-mm cephalad to the puncture site did not sustain pressure. After laminectomy, direct application of blood or adhesive to the dural defect caused no pressure increase. Continuous infusion of saline after bolus could maintain pressure increase for 180 min, but within 60 min of stopping infusion, pressure returned to baseline. These results confirm the efficacy of the epidural administration of blood or fibrin glue to correct CSF hypotension after dural puncture and also provide insight into the mechanisms of intracranial pressure modulation. Sealing the dural defect does not effectively correct CSF pressure unless an epidural tamponade effect is also maintained. ⋯ A rat model was developed to evaluate different drugs that may be injected epidurally to treat postdural puncture headache. Epidural injection of blood or fibrin glue was the most effective method of maintaining increased cerebrospinal fluid pressure after dural puncture. Sealing the dural defect does not effectively correct cerebrospinal fluid pressure unless an epidural tamponade effect is maintained.