Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2006
Randomized Controlled Trial Comparative StudyPostoperative analgesia after major spine surgery: patient-controlled epidural analgesia versus patient-controlled intravenous analgesia.
Spinal fusion surgery causes severe postoperative pain, hampering reconvalescense. We investigated the efficacy of patient-controlled epidural analgesia (PCEA) in a prospective, double-blind, randomized, controlled comparison with patient-controlled IV analgesia (PCIA). ⋯ We conclude that PCEA with ropivacaine and sufentanil, using intraoperatively placed epidural catheters, provides superior analgesia and higher patient satisfaction when compared with PCIA after spinal fusion surgery.
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Anesthesia and analgesia · Aug 2006
Randomized Controlled Trial Comparative StudyBispectral-index-guided versus clinically guided remifentanil/propofol analgesia/sedation for interventional radiological procedures: an observer-blinded randomized study.
Patients undergoing potentially painful interventional radiological procedures generally require a combination of analgesia and sedation. This sedation/analgesia should allow the patient to communicate while also remaining calm. Bispectral index (BIS) monitoring could be useful in achieving this. ⋯ In conclusion, a BIS-guided regimen was more effective than a SAS-guided regimen. The use of BIS resulted in fewer remifentanil and propofol doses. The targeted BIS range of 80-85 provided a sufficient functional level of sedation.
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Anesthesia and analgesia · Mar 2006
Comparative StudyIncreased fibrinolysis and platelet activation in elderly patients undergoing coronary bypass surgery.
Reexploration for hemorrhage after cardiac surgery is associated with increased morbidity and mortality. Elderly cardiac surgical patients have an increased risk of excessive bleeding and reexploration. In the present study we investigated the perioperative hemostatic function in elderly patients compared with younger patients undergoing coronary artery bypass grafting. ⋯ Blood samples for the analysis of platelet counts, international normalized ratio, activated partial thromboplastin time, fibrinogen, d-dimer, antithrombin, prothrombin fragment 1 + 2, thrombin-antithrombin complex, plasmin inhibitor, neutrophil-activating peptide 2, and platelet-monocyte complexes were drawn preoperatively, 30 min, and 3 h postoperatively and approximately 20 h postoperatively. Elderly patients had an increased activation of the hemostatic system. In particular, elderly patients showed a more pronounced increase in fibrinolysis and platelet activation postoperatively compared with younger patients.
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Anesthesia and analgesia · Dec 2006
Randomized Controlled TrialThe effects of melatonin premedication on propofol and thiopental induction dose-response curves: a prospective, randomized, double-blind study.
The effect of melatonin on the intraoperative requirements for i.v.anesthetics has not been documented. We studied the effect of melatonin premedication on the propofol and thiopental dose-response curves for abolition of responses to verbal commands and eyelash stimulation. ⋯ Melatonin premedication significantly decreased the doses of both propofol and thiopental required to induce anesthesia.
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Anesthesia and analgesia · Jan 2006
Comparative StudyPredicting which child-parent pair will benefit from parental presence during induction of anesthesia: a decision-making approach.
Using a multiply matched, concurrent cohort analysis, with 568 subjects matched from data obtained by our laboratory over the past 7 yr, we examined whether parental presence during induction of anesthesia (PPIA) reduces children's anxiety depending on the interaction between child and parent's baseline anxiety. Children's and parents' baseline anxiety was assessed preoperatively; children's anxiety was again assessed during induction of anesthesia. ⋯ We found no effect of PPIA on children's anxiety during induction of anesthesia when calm parents accompanied calm children into the operating room (P = 0.15) or when overly anxious parents accompanied anxious children (P = 0.49). We conclude that the presence of a calm parent does benefit an anxious child during induction of anesthesia and the presence of an overly anxious parent has no benefit.