Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2005
The relationship between salivary biomarkers and state-trait anxiety inventory score under mental arithmetic stress: a pilot study.
Measurement of stress hormones is a common objective method for assessment of mental stress. However, the stress of blood sampling alone may also increase stress hormone levels. ⋯ The STAI-s was significantly correlated to salivary alpha-amylase (r = 0.589; P < 0.01) but not to salivary chromogranin-A or cortisol. Therefore, salivary alpha-amylase is a useful indicator of psychosocial stress.
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Anesthesia and analgesia · Dec 2005
Meta Analysis Comparative StudyA comparison of regional versus general anesthesia for ambulatory anesthesia: a meta-analysis of randomized controlled trials.
Both regional anesthesia and general anesthesia have been proposed to provide optimal ambulatory anesthesia. We searched MEDLINE and other databases for randomized controlled trials comparing regional anesthesia and general anesthesia in ambulatory surgery patients for meta-analysis. Only major conduction blocks were considered to be regional anesthesia. ⋯ This meta-analysis indicates potential advantages for regional anesthesia, such as decreased postanesthesia care unit use, nausea, and postoperative pain. Although these factors have been proposed to reduce ambulatory surgery unit stay, neither central neuraxial block nor peripheral nerve block were associated with reduced ambulatory surgery unit time. Other factors, such as unsuitable discharge criteria and limitations of meta-analysis, may explain this discrepancy.
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Anesthesia and analgesia · Dec 2005
Randomized Controlled Trial Comparative StudyThe comparative effects of remifentanil or magnesium sulfate versus placebo on attenuating the hemodynamic responses after electroconvulsive therapy.
In this prospective, randomized, double-blind, placebo-controlled, crossover study we compared the effects of remifentanil or magnesium sulfate (MgSO4) versus placebo in attenuating the sympathetic response to electroconvulsive therapy. Twenty adults underwent a total of 115 anesthetics for therapeutic electroconvulsive therapy. Patients were randomly allocated twice into each of the three test groups: placebo control, MgSO4 30 mg/kg, or remifentanil 1.0 microg/kg. ⋯ Mean seizure duration time was 33 (+/- 14) s, with no difference among the groups. In conclusion, remifentanil 1.0 microg/kg and MgSO4 30 mg/kg attenuated the systolic arterial blood pressure response to electroconvulsive therapy without reducing the duration of seizure activity. Because MgSO4 has less effect on HR, it might offer advantages over remifentanil in patients at risk for post-electroconvulsive therapy bradycardia.
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Anesthesia and analgesia · Dec 2005
Randomized Controlled TrialCardiac output measurement using the transesophageal Doppler method is less accurate than the thermodilution method when changing PaCO2.
Cardiac output (CO) determination using transesophageal Doppler is based on the measurement of descending aortic blood flow. Because cerebral blood flow is dependent on PaCO2, an increase in PaCO2 would result in an increase of CO because of the increase in cerebral blood flow and vice versa. We enrolled 30 patients undergoing off-pump coronary artery graft surgery in the study. ⋯ On the other hand, there were no significant differences in CO by transesophageal Doppler: 3.85 +/- 0.76 L/min at PaCO2 of 40 mmHg and 3.77 +/- 0.74 at 30 mmHg. Bland-Altman analysis yielded bias and precision of -0.32 and 0.49 L/min at PaCO2 of 40 mmHg, and -0.01 and 0.34 L/min at 30 mmHg. These results indicate that both methods of CO measurement are in agreement at 30 mmHg of PaCO2, but the thermodilution method provides higher values at 40 mmHg of PaCO2.
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Anesthesia and analgesia · Dec 2005
Randomized Controlled TrialThe influence of a muscle relaxant bolus on bispectral and datex-ohmeda entropy values during propofol-remifentanil induced loss of consciousness.
Studies investigating the influence of muscle relaxants on the bispectral index have yielded contradictory results. In our prospective, randomized, double-blind experiments, patients received a fixed target concentration of remifentanil along with a target-controlled infusion of propofol, titrated until loss of consciousness. Two minutes after loss of consciousness, the study group received a bolus injection of atracurium, whereas the control group received a placebo. ⋯ Atracurium administration induced a decrease in bispectral index (P < 0.0001), spectral edge frequency (P < 0.01), electromyographic activity (P < 0.0001), state entropy (P < 0.0001), and response entropy (P < 0.0001) values. Decreases in bispectral index (P < 0.05), electromyographic activity (P < 0.0001), and response entropy (P < 0.01) were larger after atracurium than placebo injection. In lightly anesthetized patients, myorelaxant administration decreases bispectral index and response entropy, but not state entropy values.