Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2005
Randomized Controlled Trial Comparative Study Clinical TrialEpidural anesthesia for coronary artery bypass surgery compared with general anesthesia alone does not reduce biochemical markers of myocardial damage.
High thoracic epidural anesthesia/analgesia (HTEA) for coronary artery bypass grafting (CABG) surgery may have myocardial protective effects. In this prospective randomized controlled study, we investigated the effect of HTEA for elective CABG surgery on the release of troponin I, time to tracheal extubation, and analgesia. One-hundred-twenty patients were randomized to a general anesthesia (GA) group or a GA plus HTEA group. ⋯ Analgesia was improved in the HTEA group compared with the GA group. Mean arterial blood pressure poststernotomy and systemic vascular resistance in the intensive care unit were lower in the HTEA group. We conclude that HTEA for CABG surgery had no effect on troponin release but improved postoperative analgesia and was associated with a reduced time to extubation.
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Anesthesia and analgesia · Apr 2005
Assessing fluid-responsiveness by a standardized ventilatory maneuver: the respiratory systolic variation test.
Respiratory-induced changes in arterial blood pressure predict fluid responsiveness. However, the accuracy of these variables is affected by the preset tidal volume and by the early inspiratory increase in arterial blood pressure. ⋯ In 14 ventilated patients, after major vascular surgery, the slope of the RSVT decreased significantly after intravascular fluid administration and correlated with the end-diastolic area and with changes in cardiac output better than filling pressures. This preliminary study suggests that a standardized ventilatory maneuver may be useful in guiding fluid therapy in ventilated patients.
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Anesthesia and analgesia · Apr 2005
A magnetic resonance imaging analysis of the infraclavicular region: can brachial plexus depth be estimated before needle insertion?
In this study we examined the anatomy of the infraclavicular region to assess the possibility of estimating brachial plexus depth before performing an infraclavicular block, by using readily identifiable landmarks such as the coracoid process (CP) and the clavicle (CL). Four parasagittal planes across the infraclavicular region were analyzed in 21 individual series of magnetic resonance imaging studies. Measurements included distance to the plexus from the skin of the anterior chest wall, position of the plexus relative to the CL, and clavicular width. ⋯ Furthermore, not only is it uncommon to find the lung in this same parasagittal plane, but when it does appear, it is well behind the plexus. Estimating plexus depth, or "depth gauging," in the infraclavicular region is achievable and is a potentially useful strategy. Further study is required to confirm this finding in the clinical environment.
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Anesthesia and analgesia · Apr 2005
Clinical TrialThe effect of nitroglycerin on microvascular perfusion and oxygenation during gastric tube reconstruction.
Esophagectomy followed by gastric tube reconstruction is the surgical treatment of choice for patients with esophageal cancer. Complications of the cervical anastomosis are associated with impaired microvascular blood flow (MBF) and ischemia in the gastric fundus. The aim of the present study was to differentiate whether the decrease in MBF is a result of arterial insufficiency or of venous congestion. ⋯ After application of nitroglycerin, MBF doubled. We conclude that MBF decreases during gastric tube reconstruction but that muHbSo(2) and muHbcon do not. This decrease might be the result of venous congestion, which can partly be counteracted by application of nitroglycerin.
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Anesthesia and analgesia · Apr 2005
Clinical TrialHyperglycemia in patients administered dexamethasone for craniotomy.
Hyperglycemia should be avoided during neurosurgery in order to decrease the risk of neurological injury. Dexamethasone has been associated with increased blood glucose during surgery. In this prospective, nonrandomized study, we documented the blood glucose concentration changes for 12 h in 34 nondiabetic patients undergoing craniotomy and compared patients who received intraoperative dexamethasone (10 mg IV on induction and 4 mg IV 6 h later), with or without preoperative dexamethasone, with patients who did not receive dexamethasone. ⋯ Patients not taking dexamethasone before surgery, but who were given it intra- and postoperatively, had the largest peak blood glucose concentrations (11.0 +/- 2.0 mmol/L, mean +/- sd; P < 0.01) compared with patients who received no dexamethasone (7.8 +/- 2.1 mmol/L) or those who had been taking dexamethasone before surgery and continued it during surgery (8.5 +/- 1.2 mmol/L). The peak blood glucose concentrations in this group occurred 9 +/- 2 h after the induction of anesthesia. We recommend that the blood glucose concentration be monitored for at least 12 h in nondiabetic patients having neurosurgery who are newly administered dexamethasone.