Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2006
Randomized Controlled Trial Comparative StudyA comparison of epidural analgesia with combined continuous femoral-sciatic nerve blocks after total knee replacement.
Epidural analgesia remains the "gold standard" of pain relief after total knee replacement. However, peripheral nerve block is gaining popularity because the incidence of side effects may be reduced. Our study tests this postulate. ⋯ Pain on mobilization was well controlled in both groups and there were no differences in the length of hospital stay. Rehabilitation indices were similar. The results demonstrate a reduced incidence of side effects in the femoral/sciatic nerve block group than in the epidural group on the first postoperative day.
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Anesthesia and analgesia · Apr 2006
Randomized Controlled Trial Comparative StudyNitrous oxide and anesthetic requirement for loss of response to command during propofol anesthesia.
The blood concentration associated with loss of response (LOR) to command in 50% of subjects (CP50(LOR)) is an important measure of anesthetic potency. We therefore determined the CP50(LOR) in 40 healthy surgical patients, aged 18-60 yr old, receiving propofol alone or propofol with 67% nitrous oxide (N2O). Patients were randomized to receive 100% oxygen or 67% N2O in oxygen via facemask. ⋯ At testing for response to command, both the measured and target propofol concentrations were significantly larger and BIS values significantly smaller in the propofol-alone group compared with the propofol-N2O group. The CP50(LOR) of propofol in the propofol-alone group was 4.58 mug/mL (95% confidence interval [CI], 1.14-15.36) and 2.67 microg/mL (95% CI, 2.28-3.17) in the propofol-N2O group. The BIS value when 50% of patients responded to command was 60 (95% CI, 55-65) in the propofol-alone group and 75 (95% CI, 73-83) in the propofol-N2O group.
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Anesthesia and analgesia · Apr 2006
Randomized Controlled Trial Comparative StudyPrevention of emergence agitation after sevoflurane anesthesia for pediatric cerebral magnetic resonance imaging by small doses of ketamine or nalbuphine administered just before discontinuing anesthesia.
Magnetic resonance imaging (MRI) requires long-lasting immobilization that frequently can only be provided by general anesthesia in pediatric patients. Sevoflurane provides adequate anesthesia but many patients experience emergence agitation. Small doses of ketamine and nalbuphine provide moderate sedation but their benefits have subsided at the time of emergence. ⋯ All patients met discharge criteria at 30 min but significantly more children were awake and quiet in the K-group and still more in the N-group. In conclusion, small doses of ketamine or nalbuphine administered at the end of an MRI procedure under sevoflurane anesthesia reduce emergence agitation without delaying discharge. Nalbuphine provided better results than ketamine.
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Anesthesia and analgesia · Apr 2006
Randomized Controlled Trial Comparative StudyThe effect of single-injection femoral nerve block versus continuous femoral nerve block after total knee arthroplasty on hospital length of stay and long-term functional recovery within an established clinical pathway.
Total knee arthroplasty (TKA) may result in severe pain, and single-injection femoral nerve blocks (SFNB) have been demonstrated to have a limited duration of analgesia. Continuous femoral nerve blocks (CFNB) can prolong the analgesic duration of SFNB. We prospectively randomized 36 patients undergoing TKA to CFNB versus SFNB and evaluated the effect on hospital length of stay (LOS) as the primary outcome within a standardized clinical pathway. ⋯ Mean oxycodone consumption was significantly lower among patients who received CFNB versus SFNB: 15 mg versus 40 mg (P = or < 0.0001) on the first day after surgery; 20 mg versus 43 mg (P = 0.0004) on the second day after surgery. There was no difference in hospital LOS (3.8 vs 3.9 days) or long-term functional recovery (117 degrees versus 113 degrees knee flexion at 12 wk) between the two groups. The lack of effect provided by increased duration of analgesia (from CFNB) after TKA may now have minimal impact on hospital LOS and long-term functional recovery in the contemporary healthcare environment within the United States.
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Anesthesia and analgesia · Apr 2006
Randomized Controlled Trial Comparative StudyThe effect of sevoflurane on cerebral autoregulation in young children as assessed by the transient hyperemic response.
The transient hyperemic response (THR) test is a simple, noninvasive technique to evaluate cerebral autoregulation using transcranial Doppler. It has not yet been used in studies involving children. In this study we evaluated this response in children undergoing general anesthesia using sevoflurane. ⋯ A THRR of more than 1.09 has previously been accepted as the lower limit of a positive response. The results in this study suggest that THR is affected by sevoflurane in a dose-dependent fashion but is maintained at up to 1.5 MAC. This suggests cerebral autoregulation is preserved in children anesthetized with up to 1.5 MAC sevoflurane.