Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2006
Case ReportsInfusion pump delivers over-dosage of propofol as a result of missing syringe support.
We describe the malfunction of a common drug infusion pump. The syringe saddle was missing and allowed the syringe barrel to contact the pump case, which decreased the outward displacement of the syringe clamp. Then, the infusion pump falsely detected a smaller syringe size and consequently delivered an increased infusion rate and overdose of propofol to the patient. More commonly, an incorrectly mounted syringe may increase the outward displacement of the syringe clamp so that the infusion pump falsely detects a larger syringe size, with resultant less than expected infusion rate.
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Anesthesia and analgesia · Apr 2006
Prediction of the effect of acute normovolemic hemodilution on the hematological constituents of sequestered autologous whole blood.
During acute normovolemic hemodilution (ANH), autologous whole blood is collected in a series of collection bags containing anticoagulant. The effect of hemodilution on the actual hematological constituents of this sequestered whole blood product has never been examined. We developed a mathematical model that predicts how whole blood bag constituents change during ANH to elucidate the theoretical basis for ANH efficacy. ⋯ The impact of ANH on autologous whole blood constituents may be accurately predicted using this model. Conversion of WB(ANH) into equivalent allogeneic blood products could provide a useful method of comparing outcome in various ANH studies. The exponential envelope may be used to assess the actual ANH technique performed by the anesthesiologist, which in turn may impact quality assurance standards.
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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 StudyDoes bilateral superficial cervical plexus block decrease analgesic requirement after thyroid surgery?
In this randomized, double-blind and controlled study we evaluated and compared the analgesic efficacy of bilateral superficial cervical plexus block and local anesthetic wound infiltration after thyroid surgery. Forty-five patients were assigned to 3 groups. After general anesthesia induction, bilateral superficial cervical plexus block with 0.25% bupivacaine 15 mL in each side was performed in Group I, and local anesthetic wound infiltration with 0.25% bupivacaine 20 mL was performed in Group II. ⋯ Intravenous patient-controlled analgesia was used to evaluate postoperative analgesic requirement. Neither visual analog scale scores nor total patient-controlled analgesia doses were different among groups. We concluded that bilateral superficial cervical plexus block or local anesthetic wound infiltration with 0.25% bupivacaine did not decrease analgesic requirement after thyroid surgery.