Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2006
Comparative StudyDuration of dialysis is a significant predictor of prolonged postoperative mechanical ventilation in dialysis-dependent patients undergoing cardiac surgery.
Prolonged mechanical ventilation is reported to correlate with increased risk of mortality after cardiac surgery. We designed the present study to determine the preoperative and intraoperative risk factors that could predict postoperative prolonged mechanical ventilation in dialysis-dependent patients undergoing cardiac surgery with cardiopulmonary bypass. Forty-four dialysis-dependent patients were divided into two groups; patients of group E were tracheally extubated within 24 h after admission to the intensive care unit postoperatively (n = 19) and patients of group L (n = 25) required more than 24 h of mechanical ventilation. ⋯ On admission to the intensive care unit, Pao2/Fio2 of group L was significantly lower than that of group E (294 +/- 135 versus 415 +/- 99 mm Hg) and the circulatory status of group L was worse than that of group E. The median (interquartile range) duration of intensive care unit stay in group E was 3 (3.00) days, which was significantly shorter than that of group L (5 [2.75] days). It is possible that longer surgery increases the likelihood of cardiac dysfunction and poor oxygenation in patients with a long history of dialysis.
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Anesthesia and analgesia · Jan 2006
Case ReportsPartial sensory and motor deficit of ipsilateral lower limb after continuous interscalene brachial plexus block.
We describe a partial sensory and motor block of the ipsilateral lower limb after interscalene infusion. After and injection of 20 mL of ropivacaine through the needle, the catheter was advanced 5 cm, and an infusion of ropivacaine 0.2% 5 mL/h commenced. ⋯ We conclude that the neurological symptoms were caused by an injection of local anesthetic via an interscalene catheter placed in proximity to the epidural space. To avoid this complication, we recommend advancing the catheter no more than 2-3 cm and performing frequent neurological evaluation of patients.
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Anesthesia and analgesia · Jan 2006
Comparative StudyAccreditation Council for Graduate Medical Education competencies and the American Board of Anesthesiology Clinical Competence Committee: a comparison.
We compared the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project to the long-standing requirement of the American Board of Anesthesiology for a Clinical Competence Committee Report. There are many similarities between these two systems of resident evaluation. ⋯ In addition, the Clinical Competence Committee Report is primarily a summative evaluation for the purpose of assigning credit for training. The ACGME Outcome Project may be used as a component of a summative evaluation, but the primary emphasis is on formative assessment.
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Anesthesia and analgesia · Jan 2006
Case ReportsFires in the operating room and intensive care unit: awareness is the key to prevention.
Recent recommendations from the Centers for Disease Control (CDC) to use alcohol-based substances for hand hygiene and skin antisepsis could introduce new fire hazards in the operating room (OR). This potential for an increase in the number of fires in the hospital setting with wide spread use of alcohol-based agents warrants heightened awareness of the risks and implementation of safety measures when using these agents. Here, we report a patient who, during a tracheostomy, sustained severe burns resulting from a fire in the OR. In this case, the use of an alcohol-based antiseptic was the major contributing factor to the surgical fire.
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Anesthesia and analgesia · Jan 2006
Randomized Controlled Trial Comparative StudyThe analgesic effect of tramadol after intravenous injection in healthy volunteers in relation to CYP2D6.
Tramadol analgesia results from a monoaminergic effect by tramadol itself and an opioid effect of its metabolite (+)-M1 formed by O-demethylation of tramadol by CYP2D6. In this study we sought to determine the impact of (+)-M1 on the analgesic effect of tramadol evaluated by experimental pain models. The effect of an IV injection of 100 mg tramadol on experimental pain was studied 15-90 min after dosing in volunteers, 10 extensive metabolizers with CYP2D6 and 10 poor metabolizers without CYP2D6 in 2 placebo-controlled trials. ⋯ In extensive metabolizers, tramadol reduced discomfort experienced during the cold pressor test (P = 0.002). In poor metabolizers, the pain tolerance thresholds to sural nerve stimulation were increased (P = 0.04). (+)-M1 could be detected in the serum samples from all extensive metabolizers except one, but (+)-M1 was below the limit of determination in all poor metabolizers. The opioid effect of (+)-M1 appears to contribute to the analgesic effect of tramadol, but the monoaminergic effect of tramadol itself seems to create an analgesic effect.