Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2008
Randomized Controlled Trial Comparative StudyThe ECLIPSE trials: comparative studies of clevidipine to nitroglycerin, sodium nitroprusside, and nicardipine for acute hypertension treatment in cardiac surgery patients.
Acute hypertension during cardiac surgery can be difficult to manage and may adversely affect patient outcomes. Clevidipine is a novel, rapidly acting dihydropyridine L-type calcium channel blocker with an ultrashort half-life that decreases arterial blood pressure (BP). The Evaluation of CLevidipine In the Perioperative Treatment of Hypertension Assessing Safety Events trial (ECLIPSE) was performed to compare the safety and efficacy of clevidipine (CLV) with nitroglycerin (NTG), sodium nitroprusside (SNP), and nicardipine (NIC) in the treatment of perioperative acute hypertension in patients undergoing cardiac surgery. ⋯ CLV is a safe and effective treatment for acute hypertension in patients undergoing cardiac surgery.
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Anesthesia and analgesia · Oct 2008
ReviewAnemia and cerebral outcomes: many questions, fewer answers.
A number of clinical studies have associated acute anemia with cerebral injury in perioperative patients. Evidence of such injury has been observed near the currently accepted transfusion threshold (hemoglobin [Hb] concentration, 7-8 g/dL), and well above the threshold for cerebral tissue hypoxia (Hb 3-4 g/dL). However, hypoxic and nonhypoxic mechanisms of anemia-induced cerebral injury have not been clearly elucidated. ⋯ Potential mechanisms of cerebral protection include NOS/NO-dependent optimization of cerebral oxygen delivery and cytoprotective mechanisms including HIF-1alpha, erythropoietin, and vascular endothelial growth factor. The overall balance of these activated cellular mechanisms may dictate whether or not their up-regulation leads to cytoprotection or cellular injury during anemia. A clearer understanding of these mechanisms may help us target therapies that will minimize anemia-induced cerebral injury in perioperative patients.
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Anesthesia and analgesia · Oct 2008
Randomized Controlled TrialThe effect of intranasal administration of remifentanil on intubating conditions and airway response after sevoflurane induction of anesthesia in children.
Intubation without the use of muscle relaxants in children is frequently done before IV access is secured. In this randomized controlled trial, we compared intubating conditions and airway response to intubation (coughing and/or movement) after sevoflurane induction in children at 2 and 3 min after the administration of intranasal remifentanil (4 mcg/kg) or saline. ⋯ Nasal administration of remifentanil produces good-to-excellent intubating conditions in 2-3 min after sevoflurane induction of anesthesia.
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Anesthesia and analgesia · Oct 2008
The risk of severe postoperative pain: modification and validation of a clinical prediction rule.
Recently, a prediction rule was developed to preoperatively predict the risk of severe pain in the first postoperative hour in surgical inpatients. We aimed to modify the rule to enhance its use in both surgical inpatients and outpatients (ambulatory patients). Subsequently, we prospectively tested the modified rule in patients who underwent surgery later in time and in another hospital (external validation). ⋯ A previously developed prediction rule to predict severe postoperative pain was modified to allow use in both inpatients and outpatients. By validating the rule in patients who underwent surgery several years later in another hospital, it was shown that the rule could be generalized in time and place. We demonstrated that, instead of deriving new prediction rules for new populations, a simple adjustment may be enough to recalibrate prediction rules for new populations. This is in line with the perception that external validation and updating of prediction rules is a continuing and multistage process.
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Anesthesia and analgesia · Oct 2008
The effect of injectate conductivity on the electric field with the nerve stimulator needle: a computer simulation.
Electrical neural stimulation is commonly used to localize neural structures and place local anesthetic for regional anesthesia. The sharp tip of the stimulating needle gives rise to an electric field which is highly localized. The electrostatic effect of the injected solution on the field distribution and strength has not previously been modeled. ⋯ The electric field magnitude in the vicinity of the needle tip decayed more slowly with distance than predicted by Coulomb's law. This was independent of the presence of injectate. The near instantaneous abolition of muscle twitch with injection of small volumes of local anesthetic is consistent with an electrostatic effect, rather than a pharmacological or mechanical one. The change in field strength depended upon the volume of the injectate and its conductivity relative to that of the surrounding tissue. In this simulation, even tiny volumes of injectate lead to significant changes in field and therefore threshold current, which may have clinical implications.