Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2007
Comparative StudyComplications and adverse effects associated with continuous peripheral nerve blocks in orthopedic patients.
The increasing popularity of continuous peripheral nerve blocks (CPNBs) warrants further study of their adverse effects and complications. ⋯ Our results add to the evidence that major complications from CPNBs are rare. However, minor adverse effects associated with CPNBs may be more common.
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Anesthesia and analgesia · Jun 2007
Comparative StudyBispectral index monitoring does not improve anesthesia performance in patients with movement disorders undergoing deep brain stimulating electrode implantation.
Deep brain stimulation (DBS) has emerged as a promising therapy for movement disorders. During the implantation procedure for the electrodes, the patient emerges from anesthesia repeatedly to facilitate neurological testing. We investigated whether Bispectral Index (BIS) monitoring would be beneficial in patients receiving "sleep-awake-sleep" anesthesia with respect to time of arousal, consumption of propofol, and cardiopulmonary stability (i.e., heart rate, arterial blood pressure, and end-tidal carbon dioxide). ⋯ BIS monitoring does not improve anesthesia management for DBS electrode implantation in patients with movement disorders.
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Anesthesia and analgesia · Jun 2007
Comparative StudyThe effects of the local anesthetics lidocaine and procaine on glycine and gamma-aminobutyric acid receptors expressed in Xenopus oocytes.
The voltage-dependent sodium channel is the primary site of action for local anesthetics (LAs). Although systemically administered low-dose LAs have been shown to exert antihyperalgesic effects, the molecular targets responsible for these effects are not fully known and their functional effects on inhibitory neurotransmitter receptors associated with antinociception have not been sufficiently studied. ⋯ Lidocaine and procaine enhanced glycine receptor function at low concentrations and inhibited the functions of glycine and GABA(A) receptors at high concentrations. The mechanism of the LA-induced enhancement of glycine receptor function probably differs from that of general anesthetics. These findings may explain the pharmacological effects of LAs, such as antinociception and convulsion.
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Anesthesia and analgesia · Jun 2007
Comparative StudyAn observational study of anesthesia record completeness using an anesthesia information management system.
Studies of the accuracy and completeness of handwritten anesthesia records demonstrate deficiencies in documentation, suggesting that the quality of anesthesia records can be improved. ⋯ We found that electronic clinical anesthesia documentation was often incomplete. Dependence on free text remarks and the record keeping system's inability to automatically present entries in logical sequences consistent with workflow were associated with incomplete data entry. Our results suggest that the user interface for data entry, and the logic that an electronic system uses for preventing omissions and inconsistencies, merit further study and development in order to facilitate clinically useful documentation.
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Anesthesia and analgesia · Jun 2007
Case Reports Comparative StudyTen consecutive cases of complex regional pain syndrome of less than 12 months duration in active duty United States military personnel treated with spinal cord stimulation.
Complex regional pain syndrome describes a constellation of symptoms that may involve the sympathetic nervous system. Emerging consensus recommends early intervention with spinal cord stimulation to facilitate physical therapy. Isolated case reports suggest this may be an effective treatment. ⋯ Six received injuries directly as a result of service in Iraq or Afghanistan. These patients also had posttraumatic stress disorder, but it did not interfere with successful pain control. Additionally, 6 of 10 patients continued on active duty.