Anesthesia and analgesia
-
Anesthesia and analgesia · Mar 2007
The out-of-hospital esophageal and endobronchial intubations performed by emergency physicians.
Rapid establishment of a patent airway in ill or injured patients is a priority for prehospital rescue personnel. Out-of-hospital tracheal intubation can be challenging. Unrecognized esophageal intubation is a clinical disaster. ⋯ The incidence of unrecognized esophageal intubation is frequent and is associated with a high mortality rate. Esophageal intubation can be detected with end-tidal carbon dioxide monitoring and an esophageal detection device. Out-of-hospital care providers should receive continuing training in airway management, and should be provided additional confirmatory adjuncts to aid in the determination of tracheal tube placement.
-
Some drugs used for sedation and anesthesia produce histopathologic central nervous system changes in juvenile animal models. These observations have raised concerns regarding the use of these drugs in pediatric patients. We summarized the findings in developing animals and describe the steps that the Food and Drug Administration (FDA) and others are taking to assess potential risks in pediatric patients. The FDA views this communication as opening a dialog with the anesthesia community to address this issue. ⋯ Animal studies suggest that neurodegeneration, with possible cognitive sequelae, is a potential long-term risk of anesthetics in neonatal and young pediatric patients. The existing nonclinical data implicate not only NMDA-receptor antagonists, but also drugs that potentiate gamma-aminobutyric acid signal transduction, as potentially neurotoxic to the developing brain. The potential for the combination of drugs that have activity at both receptor systems or that can induce more or less neurotoxicity is not clear; however, recent nonclinical data suggest that some combinations may be more neurotoxic than the individual components. The lack of information to date precludes the ability to designate any one anesthetic agent or regimen as safer than any other. Ongoing studies in juvenile animals should provide additional information regarding the risks. The FDA anticipates working with the anesthesia community and pharmaceutical industry to develop strategies for further assessing the safety of anesthetics in neonates and young children, and for providing data to guide clinicians in making the most informed decisions possible when choosing anesthetic regimens for their pediatric patients.
-
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.
-
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.
-
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.