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
Comparative StudyA comparison of ondansetron with promethazine for treating postoperative nausea and vomiting in patients who received prophylaxis with ondansetron: a retrospective database analysis.
There are little data on the efficacy of antiemetics for treating postoperative nausea and vomiting (PONV) in patients who received prior PONV prophylaxis. ⋯ Promethazine was significantly more effective than ondansetron for treating PONV after failed ondansetron prophylaxis. Promethazine 6.25 mg was as effective as higher doses.
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In healthy patients, the narrowest diameter of the subglottic upper airway is the width of the air-column at the level of the cricoid cartilage. This diameter governs the selection of the endotracheal tube size, as excessive tube diameter may damage the tracheal mucosa leading to postextubation stridor or subglottic stenosis. Unfortunately, selecting endotracheal tube size based on height, weight, or age does not reliably lead to the proper tube. The knowledge of airway diameter, especially using a bedside noninvasive tool, could therefore be helpful in anesthesia and intensive care. ⋯ In young healthy adults, ultrasonography appeared to be a reliable tool to assess the diameter of the subglottic upper airway.
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Anesthesia and analgesia · Mar 2007
Randomized Controlled TrialIntrathecal anesthesia for elderly patients undergoing short transurethral procedures: a dose-finding study.
One hundred elderly men (> or =65 yr) undergoing transurethral procedures (<45 min) received bupivacaine 7.5 mg, or bupivacaine 5 mg + fentanyl 20 mug, or bupivacaine 4 mg + fentanyl 20 mug, or bupivacaine 3 mg + fentanyl 20 mug, intrathecally. Intraoperative "rescue" fentanyl requirements were higher (P < 0.03) in group bupivacaine 3 mg + fentanyl. Times (min) to ambulation eligibility were decreased in a dose-dependant manner (157 +/- 50 vs 147 +/- 37 vs 128 +/- 40 vs 116 +/- 29, respectively). Of the techniques studied, intrathecal bupivacaine 4 mg + fentanyl 20 mug provided adequate analgesia and was associated with hemodynamic stability and a favorable recovery profile.
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Anesthesia and analgesia · Mar 2007
Randomized Controlled TrialProphylactic [corrected] granisetron does not prevent postdelivery nausea and vomiting during elective cesarean delivery under spinal anesthesia.
Intraoperative nausea and vomiting (IONV) during cesarean delivery (CD) under regional anesthesia has multiple etiologies, and the role of prophylactic antiemetics for prevention of IONV remains controversial. In this trial we sought to determine the efficacy of granisetron for prevention of IONV during elective CD under spinal anesthesia with strict control of the causative factors. ⋯ Despite strict control of the causative factors, IONV still affects 18% of patients undergoing elective CD, and prophylactic granisetron 1 mg is ineffective under the studied circumstances.