Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2007
Randomized Controlled Trial Comparative StudyParasacral sciatic nerve block: does the elicited motor response predict the success rate?
In this prospective, randomized, double-blind study, we compared the tibial and the peroneal evoked motor response with regard to efficacy of sciatic nerve block using the parasacral approach. ⋯ Eliciting a tibial motor response predicts a higher success rate than eliciting a peroneal motor response with parasacral sciatic nerve block.
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Anesthesia and analgesia · Jul 2007
Randomized Controlled Trial Comparative StudyRemifentanil halves the EC50 of propofol for successful insertion of the laryngeal mask airway and laryngeal tube in pediatric patients.
Propofol and remifentanil are the drugs of choice for insertion of the supraglottic airway without muscle relaxants for short duration surgery. In this study, we compared propofol concentrations required for insertion of laryngeal mask way (LMA) or laryngeal tube (LT) with and without remifentanil. ⋯ Remifentanil 7.5 ng/mL reduced the propofol concentration required for airway insertion by half, and improved conditions for insertion. Propofol concentrations for insertion of the LMA and LT were similar.
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Anesthesia and analgesia · Jul 2007
Comparative StudyRapid recovery from sevoflurane and desflurane with hypercapnia and hyperventilation.
Hypercapnia with hyperventilation shortens the time between turning off the vaporizer (1 MAC) and when patients open their eyes after isoflurane anesthesia by 62%. ⋯ Concurrent hyperventilation to rapidly remove the anesthetic from the lungs and rebreathing to induce hypercapnia can significantly shorten recovery times and produce the same proportionate decrease for anesthetics that differ in solubility.
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Anesthesia and analgesia · Jul 2007
Comparative StudyA simple method for deciding when patients should be ready on the day of surgery without procedure-specific data.
Deciding when patients should arrive for same-day-admission or ambulatory surgery is a problem at many hospitals and surgery centers. Although staff can often start cases earlier than scheduled, the potential start times are not known when each case is scheduled. Patient availability must therefore be balanced against patient waiting times and fasting times. Knowing the earliest time that a case might begin, given its scheduled start time, provides a rational basis for telling patients when to report for surgery and when to refrain from eating or drinking before their procedure. ⋯ We have developed a simple method for determining when patients should be ready on the day of surgery based on the start times of historical cases performed by the same surgical suite/surgical service/day of the week combination as the case of interest.
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Anesthesia and analgesia · Jul 2007
Comparative StudyThe reliability of pulse contour-derived cardiac output during hemorrhage and after vasopressor administration.
Reliable measurement of cardiac output (CO) is important in the critically ill. Pulse contour-derived CO (PCCO) has been evaluated during stable hemodynamics, but is sensitive to changes in vascular tone and has not been validated under conditions of changing hemodynamics. Furthermore, PCCO requires calibration for the individual vascular impedance by transpulmonary thermodilution CO (TPCO), and the required frequency of recalibration to maintain accurate measurements, especially during changing conditions, has not been confirmed. We compared PCCO measurements of CO with TPCO and continuous and bolus pulmonary artery CO (CCO and BCO, respectively) during conditions of uncontrolled hemorrhage and resuscitation with norepinephrine. ⋯ PCCO needs frequent recalibration during hemorrhage and after vasopressor administration.