Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2008
Randomized Controlled TrialIs the combination of morphine with ketamine better than morphine alone for postoperative intravenous patient-controlled analgesia?
The addition of ketamine to morphine for patient-controlled analgesia (PCA) is supported by previous basic and clinical research, but has been challenged by subsequent negative studies. Important limitations of previous studies are the low number of patients analyzed, the use of morphine-ketamine combinations that may not the optimal, and that not all the relevant outcomes have been analyzed. In this study, we compared the combination of morphine and ketamine with morphine alone for postoperative PCA in large patient groups. We used a morphine-ketamine combination identified by an optimization procedure in our previous study. ⋯ Small-dose ketamine combined with morphine for PCA provides no benefit to patients undergoing major orthopedic surgery and cannot be recommended for routine use.
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Anesthesia and analgesia · Jan 2008
Clinical TrialThe effects of dexmedetomidine on cardiac electrophysiology in children.
Dexmedetomidine (DEX) is an alpha2-adrenergic agonist that is approved by the Food and Drug Administration for short-term (<24 h) sedation in adults. It is not approved for use in children. Nevertheless, the use of DEX for sedation and anesthesia in infants and children appears to be increasing. There are some concerns regarding the hemodynamic effects of the drug, including bradycardia, hypertension, and hypotension. No data regarding the effects of DEX on the cardiac conduction system are available. We therefore aimed to characterize the effects of DEX on cardiac conduction in pediatric patients. ⋯ DEX significantly depressed sinus and atrioventricular nodal function in pediatric patients. Heart rate decreased and arterial blood pressure increased during administration of DEX. The use of DEX may not be desirable during electrophysiology study and may be associated with adverse effects in patients at risk for bradycardia or atrioventricular nodal block.
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Anesthesia and analgesia · Jan 2008
Clinical TrialContinuous infraclavicular brachial plexus block: a modified technique to better secure catheter position in infants and children.
The infraclavicular approach to the brachial plexus provides suitable anesthesia and also lends itself well to stabilizing and securing a catheter for a continuous infusion. We describe an approach for continuous infusions using an infraclavicular approach in children. ⋯ A modified technique for continuous infraclavicular brachial plexus block helps secure the catheter and provides effective intra- and postoperative pain relief in pediatric patients.
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Anesthesia and analgesia · Jan 2008
Case ReportsSubcutaneous cervical and facial emphysema with the use of the Bonfils fiberscope and high-flow oxygen insufflation.
We present a case in which use of the Bonfils retromolar intubation fiberscope resulted in cervical and facial subcutaneous emphysema. The patient was a 75-yr-old woman with Mallampati Grade I airway. The Bonfils retromolar intubation fiberscope was used for teaching purposes. ⋯ The patient was intubated conventionally and the emphysema resolved within 24 h. Subcutaneous emphysema after air insufflation is known from dental procedures with air entering through holes in the teeth. In our case, the oxygen insufflation was sufficient to create emphysema, probably through tiny mucosal lesions.
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Anesthesia and analgesia · Jan 2008
The prolonged analgesic effect of epidural ropivacaine in a rat model of neuropathic pain.
In clinical practice, the analgesic effects of epidurally administered local anesthetics on chronic pain sometimes outlast the duration of drug action expected from their pharmacokinetics. To investigate the underlying mechanisms of this prolonged effect, we examined the effects of ropivacaine, a local anesthetic, on pain-related behavior in a rat model of neuropathic pain. We also analyzed changes in the expression of nerve growth factor (NGF), which is involved in plasticity of the nociceptive circuit after nerve injury. ⋯ Repetitive administration of ropivacaine into the epidural space in CCI rats exerts an analgesic effect, possibly by inducing a plastic change in the nociceptive circuit.