Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2007
Randomized Controlled Trial Comparative StudyA comparison of a basal infusion with automated mandatory boluses in parturient-controlled epidural analgesia during labor.
The use of parturient-controlled epidural analgesia (PCEA) with a basal infusion is commonly used in laboring women. We compared a novel approach of providing basal intermittent boluses concurrently with PCEA: PCEA plus automated mandatory boluses (PCEA+AMB) versus PCEA plus basal continuous infusion (PCEA+BCI). We hypothesized that epidural local anesthetic consumption would be lower if basal intermittent boluses were used instead of a basal infusion. ⋯ Our study showed that PCEA+AMB reduced analgesic consumption and could be useful as the mode of maintenance for epidural analgesia.
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Anesthesia and analgesia · Mar 2007
A survey of the use of ultrasound during central venous catheterization.
Complications during central venous catheterization (CVC) are not rare and can be serious. The use of ultrasound (US) during CVC has been recommended to improve patient safety. We performed a survey to evaluate the frequency of, and factors influencing, US use. ⋯ The use of US during CVC remains limited and is most strongly associated with the availability of equipment. Screening and rescue use of US are more common than real-time guidance. Our survey suggests that current use of US during CVC differs from existing evidence-based recommendations.
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Anesthesia and analgesia · Mar 2007
Hydroxyethyl starch, but not modified fluid gelatin, affects inflammatory response in a rat model of polymicrobial sepsis with capillary leakage.
Intravascular volume therapy is crucial in septic patients to improve tissue perfusion and maintain stable hemodynamics. Modified fluid gelatins (MFG) and medium weight hydroxyethyl starches (HES) are the most widely used synthetic colloids. Our aim in this study, performed in septic rats challenged by cecal ligation and puncture (CLP), was to investigate the effects of HES and MFG on pulmonary capillary leakage and to determine whether an antiinflammatory mechanism was involved. ⋯ HES may attenuate capillary leakage by modulating an inflammatory response, whereas an antiinflammatory mechanism was not involved in the effects of MFG on capillary leakage.
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Anesthesia and analgesia · Mar 2007
Randomized Controlled Trial Multicenter StudyReversal of rocuronium-induced neuromuscular block with the novel drug sugammadex is equally effective under maintenance anesthesia with propofol or sevoflurane.
In this study we investigated whether the novel reversal drug, sugammadex, is equally effective at reversing rocuronium-induced neuromuscular block (NMB) in patients under propofol or sevoflurane maintenance anesthesia. After receiving propofol for induction, patients were randomized to propofol (n = 21) or sevoflurane (n = 21). Rocuronium 0.6 mg/kg was administered for tracheal intubation. ⋯ There were no treatment-related serious adverse events and no discontinuations or deaths. No residual paralysis occurred. The safety profile of sugammadex was somewhat more favorable under propofol than under sevoflurane anesthesia.
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Anesthesia and analgesia · Mar 2007
ReviewEffect of postoperative analgesia on major postoperative complications: a systematic update of the evidence.
Few individual clinical trials have had sufficient subject numbers to definitively determine the effects of postoperative analgesia on major outcomes. ⋯ Overall, there is insufficient evidence to confirm or deny the ability of postoperative analgesic techniques to affect major postoperative mortality or morbidity. This is primarily due to typically insufficient subject numbers to detect differences in currently low incidences of postoperative complications.