Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2004
Clinical TrialAn evaluation of a noninvasive cardiac output measurement using partial carbon dioxide rebreathing in children.
Cardiac output (CO) is an important hemodynamic measure that helps to guide the therapy of critically ill patients. Invasive CO assessment in infants and children is often avoided because of the inherent risks. A noninvasive CO monitor that uses partial rebreathing has been recently developed to determine CO via the Fick principle for carbon dioxide. ⋯ Cardiac index measurements demonstrated a decreased r value of 0.67 (P = 0.15) and a bias of -0.18 L . min(-1) . m(-2) and precision of +/-2.13 L . min(-1) . m(-2). Differences between partial rebreathing measurements and thermodilution measurements were largest in children with a body surface area of 0.6 m(2) body surface area and >300 mL tidal volume.
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Anesthesia and analgesia · Dec 2004
Randomized Controlled Trial Clinical TrialParamedian lumbar epidural catheter insertion with patients in the sitting position is equally successful in the flexed and unflexed spine.
Positioning for placement of an epidural catheter can be quite painful for patients with lower limb injuries. We randomly allocated 50 patients scheduled for surgery after lower limb injuries for placement of a lumbar epidural catheter in the sitting position with the back in the neutral unflexed position by either the midline or paramedian approach. If the approach failed after two attempts, patients were placed in a flexed-spine position, and the procedure was attempted again. ⋯ The incidences of resistance to catheter insertion (eight versus one), paresthesia (seven versus zero), and appearance of blood in the catheter (six versus zero) were significantly more frequent in the midline compared with the paramedian approach. The midline group also experienced more discomfort than the paramedian group. We conclude that, with the patient sitting with an unflexed spine, it is usually possible to insert an epidural catheter with the paramedian approach.
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Anesthesia and analgesia · Dec 2004
Randomized Controlled Trial Comparative Study Clinical TrialThe postoperative blood-sparing efficacy of oral versus intravenous tranexamic acid after total knee replacement.
To assess the blood-sparing efficacy of tranexamic acid (TA) administered orally or via a variable IV infusion, 80 healthy patients undergoing elective total knee replacement were studied according to a prospective, controlled, randomized, single-blinded study design. Patients were allocated to one of four treatment groups. In group TA-long, 30 min before deflation of the limb tourniquet, an IV bolus dose of TA 15 mg/kg was administered over 30 min. ⋯ In the control group, TA was not administered. At patient discharge, postoperative allogeneic blood administration was significantly more in group Control when compared with each of the three TA treatment groups. Because oral drug administration is simple and does not require specific infusion equipment, the authors suggest that oral TA is a superior blood-sparing strategy compared with IV drug administration.
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Anesthesia and analgesia · Dec 2004
Randomized Controlled Trial Clinical TrialThe use of high-fidelity human patient simulation and the introduction of new anesthesia delivery systems.
New anesthesia delivery systems are becoming increasingly complex. Although equipment is involved in a large proportion of intraoperative anesthesia problems (most also involving human error), the current methods of introducing new equipment into clinical practice have not been well studied. We designed a randomized, controlled, prospective study to investigate an alternative method of introducing new anesthesia equipment. ⋯ Performance was analyzed in terms of time to resolve the emergency, by using analysis of videos by an independent rater. Group 1 resolved both crises significantly faster. HPS allowed us to detect design features that were common sources of error.