Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2006
Comparative StudyA clinical comparison of the Flexiblade and Macintosh laryngoscopes for laryngeal exposure in anesthetized adults.
The Flexiblade is a laryngoscope with a flexible blade. To evaluate the efficacy of the Flexiblade compared with the classic Macintosh laryngoscope, we performed a clinical study in 200 paralyzed patients undergoing elective surgery requiring general anesthesia and endotracheal intubation. Direct laryngoscopy was performed with a size 3 Macintosh laryngoscope and the Flexiblade, with and without activation of the lever. ⋯ Activating the Flexiblade lever never caused a deterioration of view. In only one case was the view better with the Macintosh blade than that with the activated Flexiblade. We conclude that the Flexiblade, after lever activation, is significantly better than the Macintosh laryngoscope for laryngeal visualization in paralyzed adults (P < 0.0001).
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Anesthesia and analgesia · Feb 2006
Cerebral autoregulation and CO2 reactivity in anterior and posterior cerebral circulation during sevoflurane anesthesia.
The purpose of the study was to compare cerebral autoregulation (CA) and CO2 reactivity (CO2R) between the anterior and posterior circulation under sevoflurane anesthesia. We studied 9 adult ASA physical status I patients (22-47 yr) scheduled for elective orthopedic surgery. Blood flow velocity in the middle cerebral artery (Vmca) and in the basilar artery (Vba) were measured using transcranial Doppler ultrasonography. ⋯ With regard to CO2R, Vmca increased with slope of 1.7 cm/s/mm Hg PaCO2, Vba increased with slope of 1.5 cm/s/mm Hg PaCO2; P = 0.83. Absolute Vmca was higher compared with Vba; P < 0.05. We conclude that in healthy individuals under 0.5 MAC of sevoflurane and small-dose remifentanil: 1) mean flow velocities of BA are less than those of MCA; 2) autoregulation and CO2R are preserved in the basilar artery and are similar to those of MCA.
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Anesthesia and analgesia · Feb 2006
Comparative StudyA comparison of observational and objective measures to differentiate depth of sedation in children from birth to 18 years of age.
Several observational and objective methods are available to assess sedation depth; however, data regarding their accuracy in differentiating deep sedation are limited. In this study we compared 3 sedation tools in children from birth to 18 yr of age and determined their relative value in detecting deep levels of sedation. Bispectral index monitoring (BIS), Modified Maintenance of Wakefulness Tests (MMWT), and the University of Michigan Sedation Scale (UMSS) were used to assess sedation. ⋯ There were significant decreases in BIS across UMSS scores except from scores 2-3. ROC curves suggested that BIS < or = 80 and MMWT < or = 14 min were most sensitive in delineating deep sedation. Our findings demonstrate the overall validity of these observational and objective measures of sedation depth in children <18 yr of age but show ongoing limitations distinguishing moderate from deep sedation.
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Anesthesia and analgesia · Feb 2006
An evaluation of the insertion and function of a new supraglottic airway device, the King LT, during spontaneous ventilation.
Trials of the King LT trade mark (LT, King Systems, Noblesville, IN) in controlled ventilation of the lungs have shown that it is an effective supraglottic airway device. We designed this study to evaluate the King LT regarding ease of insertion, position within the airway, and anatomic sealing properties during spontaneous ventilation in 50 ASA physical status I-III, Mallampati I-III, adult patients undergoing routine general anesthesia. Anesthesia was induced with up to 2 microg/kg fentanyl and 1.5-2 mg/kg propofol and maintained with 70% N2O/30%O2 and isoflurane. ⋯ Complications included laryngospasm (1) and coughing (3) on extubation. The incidence of sore throat at 1 h and 24 h postoperatively was 22% and 15%, respectively. The King LT trade mark is a simple and reliable supraglottic airway device for airway management during spontaneous ventilation.
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Anesthesia and analgesia · Feb 2006
The effect of fibrinogen substitution on reversal of dilutional coagulopathy: an in vitro model.
Colloids and crystalloids are usually administered as treatment for hypovolemia in severely injured patients. However, dilution of clotting factors and platelets together with impaired fibrinogen polymerization are associated with fluid therapy and may aggravate hemorrhage, thus worsening final outcome of these patients. We investigated, in an in vitro model, whether the addition of fibrinogen to diluted blood samples can reverse dilutional coagulopathy. ⋯ After 60% dilution, clotting times increased, whereas clot firmness and fibrin polymerization decreased significantly. After administration of fibrinogen, clotting times decreased and clot firmness, as well as fibrin polymerization, increased in all diluted blood samples. The effect of in vitro fibrinogen substitution on ROTEM variables was dependent on the fibrinogen dosage and the type of solution used to dilute the blood samples.