Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2005
Randomized Controlled Trial Clinical TrialAn anatomic landmark to simplify subclavian vein cannulation: the "deltoid tuberosity".
The subclavian vein is frequently used to obtain central venous access. Several landmarks exist to determine the puncture site and angle, but they may require patient manipulation and anatomic measurements. We studied the feasibility of using the deltoid tuberosity, located on the lateral aspect of the clavicle, as an anatomic landmark. ⋯ In phase 3, there was no significant difference in skin-vein distance between the left (4.9 +/- 0.5 cm) and right (4.7 +/- 0.6 cm) sides. In phase 4, subclavian vein cannulation could be performed in all patients; moreover, subclavian vein cannulation was significantly (P < 0.01) faster in the deltoid tuberosity group versus the standard approach group (23 +/- 16 versus 34 +/- 14 s). We conclude that the clavicle's tuberosity may reflect an alternative anatomic landmark to simplify subclavian vein cannulation by minimizing patient manipulation and anatomic measurements.
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Anesthesia and analgesia · Mar 2005
Randomized Controlled Trial Clinical TrialBacteriostatic saline containing benzyl alcohol decreases the pain associated with the injection of propofol.
Bacteriostatic saline is a physiological saline solution containing the bacteriostatic agent benzyl alcohol as a 0.9% solution. It is used mostly for diluting and dissolving drugs for IV injection and as a flush for intravascular catheters. It also has local anesthetic properties. ⋯ Fifteen of 39 patients (38%) in the benzyl alcohol group complained of pain on injection compared to 33 of 39 (84%) in the placebo group and 22 of 42 (52%) in the lidocaine group. Differences were significant between the benzyl alcohol and placebo groups (P < 0.01) and the lidocaine and placebo groups (P < 0.01). Preinjection with bacteriostatic saline decreases the incidence of pain associated with IV administration of propofol and is comparable to that of mixing lidocaine with propofol.
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Anesthesia and analgesia · Mar 2005
Randomized Controlled Trial Clinical TrialAirway reflexes return more rapidly after desflurane anesthesia than after sevoflurane anesthesia.
Patients given a more soluble inhaled anesthetic usually take longer to awaken from anesthesia than do patients given a less soluble anesthetic. In the present study, we tested whether such a delay in awakening was also associated with a delay in restoration of protective airway reflexes. Patients were randomly assigned to receive desflurane (n = 31) or sevoflurane (n = 33) via a laryngeal mask airway. ⋯ At 2 min after responding to command, all patients given desflurane were able to swallow without coughing or drooling, whereas 55% of patients given sevoflurane coughed and/or drooled (P < 0.001). At 6 min after responding to command, 18% of patients given sevoflurane still could not swallow without coughing or drooling (P < 0.05). We conclude that desflurane allows an earlier return of protective airway reflexes.
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Anesthesia and analgesia · Mar 2005
Comparative StudyA retrospective comparison of costs for regional and general anesthesia techniques.
In this retrospective study, we compared the costs for three different regional anesthesia techniques with the costs of general anesthesia (GA). A total of 1587 anesthesia cases which were performed for orthopedic and trauma patients over a 1-yr period in a tertiary level, university hospital setting were analyzed. The anesthesia technique-related costs were determined calculating case-specific costs for personnel, supplies, and drugs. ⋯ We concluded that cost comparisons of anesthesia techniques largely depend on the surgical duration of the cases studied. Even in a teaching hospital setting, spinal anesthesia has economic advantages over GA. Especially for short cases, brachial plexus block is more expensive in this setting.