Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2006
The effect of electroencephalogram-targeted high- and low-dose propofol infusion on histopathological damage after traumatic brain injury in the rat.
Propofol is commonly used to sedate patients after traumatic brain injury. However, the dose-dependent neuroprotective effects of propofol after head trauma are unknown. We compared histopathological damage after 6 h of electroencephalogram-targeted high- and low-dose propofol infusion in rats subjected to controlled cortical impact (CCI). ⋯ Despite different levels of cortical neuronal function, there were no relevant differences in the short-term histopathological damage. These results challenge the view that the neuroprotective effect of propofol relates to the suppression of cerebral metabolic demand.
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Anesthesia and analgesia · Dec 2006
Case ReportsThe effect of too much intravenous lidocaine on bispectral index.
Systemic local anesthetics have beneficial perioperative properties and have an anesthetic-sparing effect. To assess depth of anesthesia during lidocaine infusion, it would be important to know the effect of systemic local anesthetics on bispectral index (BIS). ⋯ We report an inadvertent overdose of i.v. lidocaine in a patient monitored with BIS. BIS decreased to 0 for approximately 15 min, indicating that lidocaine and sevoflurane interact to decrease BIS.
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Anesthesia and analgesia · Dec 2006
Randomized Controlled Trial Comparative StudyThe posterior approach to the sciatic nerve in the popliteal fossa: a comparison of single- versus double-injection technique.
We compared single-injection and double-injection of the sciatic nerve with nerve stimulation in the posterior popliteal approach using mepivacaine 1% in a prospective, randomized and single-blind study to evaluate effectiveness, delay of onset, and complications in patients undergoing foot and ankle surgery. In the single-injection group (Group S, n = 30), 25 mL of mepivacaine 1% was administered after eliciting foot inversion or plantar flexion. In the double-injection group (Group D, n = 30), 12.5 mL of the solution was injected after eversion or dorsiflexion and 12.5 mL after plantar flexion of the foot. ⋯ Complete analgesia of the deep peroneal nerve was achieved in 80% and 97% in Group S and D, respectively; P < 0.05. There were more paresthesias during block procedure in Group D (17% vs 40%) (P < 0.05). We conclude that double-nerve stimulation of the sciatic nerve gives similar complete onset times and overall success rate to single-nerve stimulation and more paresthesias during block performance.
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Anesthesia and analgesia · Dec 2006
Outpatient management of continuous peripheral nerve catheters placed using ultrasound guidance: an experience in 620 patients.
Continuous peripheral nerve block (CPNB) is an optimal choice for analgesia after orthopedic procedures, but is not commonly used in outpatients because of concern regarding the possibility of catheter-related complications. In addition, it may be difficult to provide adequate patient access to physicians in this setting. We present 620 outpatients who were treated with CPNB using an established protocol. ⋯ In this large series of outpatients treated with CPNB, there were surprisingly few interventions requiring an anesthesiologist. Likewise, patients were able to manage and remove their catheters at home without additional follow-up. This suggests that with adequate instruction and telephone access to health care providers, patients are comfortable with managing and removing CPNB catheters at home.
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Anesthesia and analgesia · Dec 2006
Acoustic monitoring of double-lumen ventilated lungs for the detection of selective unilateral lung ventilation.
One-lung intubation (OLI) is among the most common complications of endotracheal intubation. None of the monitoring tools now available has proved effective for its early detection. In this study we investigated the efficacy of acoustic analysis for the detection of OLI. ⋯ Each respiration was classified into one of the three categories: bilateral ventilation, selective right-lung ventilation, or selective left-lung ventilation, on the basis of the ratio between the energy signals of each lung. OLI was accurately identified in 10 of the 11 patients during right OLI and in all 11 patients during left OLI. This study suggests that acoustic monitoring is effective for the detection of selective lung ventilation and may be useful for early diagnosis of OLI.