Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2006
Randomized Controlled Trial Comparative StudyA randomized comparison of programmed intermittent epidural bolus with continuous epidural infusion for labor analgesia.
Bolus injection through an epidural catheter may result in better distribution of anesthetic solution in the epidural space compared with continuous infusion of the same anesthetic solution. In this randomized, double-blind study we compared total bupivacaine consumption, need for supplemental epidural analgesia, quality of analgesia, and patient satisfaction in women who received programmed intermittent epidural boluses (PIEB) compared with continuous epidural infusion (CEI) for maintenance of labor analgesia. The primary outcome variable was bupivacaine consumption per hour of analgesia. ⋯ The median total bupivacaine dose per hour of analgesia was less in the PIEB (n = 63) (10.5 mg/h; 95% confidence interval, 9.5-11.8 mg/h) compared with the CEI group (n = 63) (12.3 mg/h; 95% confidence interval, 10.5-14.0 mg/h) (P < 0.01), fewer manual rescue boluses were required (rate difference 22%, 95% confidence interval of difference 5% to 38%), and satisfaction scores were higher. Labor pain, PCEA requests, and delivered PCEA doses did not differ. PIEB combined with PCEA provided similar analgesia, but with a smaller bupivacaine dose and better patient satisfaction compared with CEI with PCEA for maintenance of epidural labor analgesia.
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Anesthesia and analgesia · Mar 2006
Randomized Controlled Trial Comparative StudyContinuous epidural block versus continuous popliteal nerve block for postoperative pain relief after major podiatric surgery in children: a prospective, comparative randomized study.
Foot and ankle surgery in children is very painful postoperatively. Adverse effects from opioids and continuous epidural block (CEB) limit their use in children. Continuous popliteal nerve blocks (CPNB) have not been studied for this indication in children. ⋯ Eighty-six percent of the parents in the CEB groups and 100% in the CPNB groups were satisfied. We conclude that although both CEB and CPNB resulted in excellent postoperative analgesia in this study, CPNB was associated with less urinary retention and nausea and vomiting. Therefore, we recommend CPNB as the ideal form of postoperative analgesia after major podiatric surgery in 1- to 12-yr-old children.
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Anesthesia and analgesia · Mar 2006
Randomized Controlled Trial Comparative StudyRocuronium is not associated with more vocal cord injuries than succinylcholine after rapid-sequence induction: a randomized, prospective, controlled trial.
Postoperative hoarseness (PH), sore throat (ST), and vocal cord injuries (VCI) are common complications after general anesthesia. Excellent endotracheal intubating conditions are associated with less laryngeal morbidity than good or poor intubating conditions. Thus, we tested the hypothesis that a rapid-sequence induction (RSI) with succinylcholine would lead to less PH and VCI than with rocuronium. ⋯ Intubating conditions were significantly better in the succinylcholine group compared with the rocuronium group. The incidence and severity of ST and myalgia were not increased in the patients receiving succinylcholine. However, the rate of PH and VCI was similar to the rocuronium group.
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Anesthesia and analgesia · Mar 2006
Comparative StudyPredictive performance of three multivariate difficult tracheal intubation models: a double-blind, case-controlled study.
We performed a case-controlled, double-blind study to examine the performance of three multivariate clinical models (Wilson, Arné, and Naguib models) in the prediction of unanticipated difficult intubation. The study group consisted of 97 patients in whom an unanticipated difficult intubation had occurred. For each difficult intubation patient, a matched control patient was selected in whom tracheal intubation had been easily accomplished. ⋯ The corresponding area under the receiver operating characteristic curve was 0.87, 0.79, and 0.82, respectively. Our new model for prediction of difficult intubation was developed using logistic regression and includes thyromental distance, Mallampati score, interincisor gap, and height. This model is 82.5% sensitive and 85.6% specific with an area under the receiver operating characteristic curve of 0.90.
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Anesthesia and analgesia · Mar 2006
Randomized Controlled Trial Comparative StudyA comparison of dexmedetomidine versus conventional therapy for sedation and hemodynamic control during carotid endarterectomy performed under regional anesthesia.
The properties of dexmedetomidine (DEX) that result in titratable sedation and sympathetic modulation suggest that it would be suitable for use during carotid endarterectomy (CEA) performed under regional anesthesia. We performed a randomized, double-blind study in 56 patients having CEA under regional anesthesia and compared hemodynamic control using DEX versus a conventional sedation technique using midazolam and fentanyl standard (STD). Sedation was titrated to a Ramsay Sedation Score of 2-4 in both groups. ⋯ These were primarily for hypotension (DEX 7, 28% versus STD 3, 11%; P = 0.16). The number of patients requiring no additional pain relief in the postanesthesia care unit was significantly larger for patients in the DEX group (DEX 18, 72% versus STD 11, 38%; P = 0.027). DEX provides an acceptable alternative, without superiority to standard techniques for sedation during awake CEA.