Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2004
Randomized Controlled Trial Clinical TrialReliability and validity of the perioperative opioid-related symptom distress scale.
A reduction in opioid use may reduce the incidence and severity of opioid-related side effects. However, no published studies have demonstrated this relationship. In a prospective, placebo-controlled, randomized trial of analgesia for laparoscopic cholecystectomy, we validated an opioid-related symptom distress scale (SDS) questionnaire and clinically meaningful events (CMEs). ⋯ CMEs for nausea, vomiting, and voiding showed a high specificity and lower sensitivity with directly assessed responses. The SDS questionnaire and CMEs are valid tools for assessing postoperative opioid-related symptoms after laparoscopic cholecystectomy. Symptoms defined as CMEs through the SDS may be more sensitive than those identified by direct assessment.
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Anesthesia and analgesia · Sep 2004
Randomized Controlled Trial Clinical TrialDoes benzydamine hydrochloride applied preemptively reduce sore throat due to laryngeal mask airway?
Sore throat is a common postoperative complaint. We investigated whether preemptive benzydamine hydrochloride (BH) treatment could prevent sore throat due to a laryngeal mask airway (LMA) cuff inflated with air. One-hundred ASA status I-II patients who underwent general anesthesia were randomly divided into two groups. ⋯ There were no significant differences between groups for cuff pressures, cuff volumes, analgesic doses, or operation times. However, sore throat symptoms were significantly less severe for the BH group during both resting and swallowing. In conclusion, preemptive topical BH may decrease the incidence of sore throat due to LMA use.
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Anesthesia and analgesia · Sep 2004
Randomized Controlled Trial Clinical TrialBupivacaine in microcapsules prolongs analgesia after subcutaneous infiltration in humans: a dose-finding study.
In this study, we examined the onset and duration of local analgesic effects of bupivacaine incorporated into biodegradable microcapsules (extended-duration local anesthetic; EDLA) administered as subcutaneous infiltrations in different doses in humans. In 18 volunteers, the skin on the medial calf was infiltrated with 10 mL of EDLA, and the opposite calf was infiltrated with 10 mL of aqueous bupivacaine (5.0 mg/mL) in a double-blinded, randomized manner. Three different concentrations of EDLA were tested (6.25, 12.5, and 25 mg/mL), with 6 subjects in each group. ⋯ In general, a dose-response gradient was seen in the EDLA group for 5 of 7 variables when the curves expressing effect over time for the different concentrations were evaluated. No serious side effects were observed for up to 6 mo after administration. In conclusion, bupivacaine incorporated in microcapsules provided analgesia for 96 h after subcutaneous infiltration.
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Anesthesia and analgesia · Sep 2004
The effect of different stages of neuromuscular block on the bispectral index and the bispectral index-XP under remifentanil/propofol anesthesia.
Facial electromyographic activity and neuromuscular block could influence bispectral index (BIS) depth of anesthesia monitoring. In this study we examined, in 30 patients undergoing general surgical procedures, the effect of different stages of neuromuscular block on BIS monitoring and compared the conventional A-2000 BIS trade mark (BIS(3.4)) with the new BIS-XP trade mark (BIS(XP)). At deep surgical anesthesia BIS(3.4) of approximately 40, under a propofol 3.61 microg/mL target-controlled infusion and a 0.15-0.3 microg. kg(-1). min(-1) remifentanil infusion, mivacurium 0.15 mg/kg was administered. ⋯ After that, BIS(3.4) and BIS(XP) did not significantly change during complete neuromuscular block or during various levels of neuromuscular recovery. At all phases, BIS(XP) was significantly lower than BIS(3.4). Our study indicated that the BIS(3.4)/BIS(XP) bias and the wide limits of agreement do not allow values given by the two monitors to be used interchangeably.
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Anesthesia and analgesia · Sep 2004
The effect of lengthening anesthesiology residency on subspecialty education.
In this study, we sought to determine the long-term effect of the additional year of anesthesia residency (postgraduate year [PGY]-4) instituted in 1989 by the American Board of Anesthesiology on the number of individuals who pursued 12-mo subspecialty anesthesia training. We tested the hypothesis that extending education by a year would decrease the number of anesthesia subspecialty trainees. Surveys were collected from approved anesthesia residency training programs in the United States from 1989 to 2001. ⋯ The largest declines occurred in critical care medicine and research. Our data do not indicate a decrease in the number of anesthesiology subspecialists. Factors other than the duration of training appear responsible for the selection of subspecialty education.