Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2008
Randomized Controlled TrialPostoperative pain and analgesic requirements after anesthesia with sevoflurane, desflurane or propofol.
General anesthetics may have nociceptive actions that affect postoperative pain. In studies evaluating postoperative pain, the effect of general anesthetics on analgesic requirements has not been considered except for one recent study suggesting that propofol anesthesia provides better analgesia after surgery than isoflurane. ⋯ Morphine consumption and pain 24 h postoperatively did not differ among the sevoflurane, desflurane, and propofol groups.
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Anesthesia and analgesia · Nov 2008
Randomized Controlled TrialImproved neuromuscular blockade using a novel neuromuscular blockade advisory system: a randomized, controlled, clinical trial.
Conventional incremental bolus administration of neuromuscular blocking (NMB) drugs is associated with limitations in intraoperative control, potential delays in recovery, and residual blockade in the postanesthetic period. To overcome such limitations, we developed a novel adaptive control computer program, the Neuromuscular Blockade Advisory System (NMBAS). The NMBAS advises the anesthesiologist on the timing and dose of NMB drugs based on a sixth-order Laguerre model and the history of the patient's electromyographic responses. Here, we tested the hypothesis that the use of the NMBAS improves NMB compared to standard care. ⋯ Compared to standard practice, NMBAS-guided care was associated with improved NMB quality and higher TOF ratios at the end of surgery, potentially reducing the risk of residual NMB and improving perioperative patient safety.
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Anesthesia and analgesia · Nov 2008
A thromboelastometric evaluation of the effects of hypothermia on the coagulation system.
Hypothermia may be accidental or therapeutic. Therapeutic hypothermia is increasingly used as treatment for various conditions, e.g., neuroprotection after cardiac arrest. Hypothermia leads to an impairment of the coagulation system, but the degree of impairment has been difficult to determine. Most studies have been performed on plasma instead of whole blood. We therefore evaluated whole blood investigating the effects of hypothermia on the coagulation system over a wide range of temperatures (25-40 degrees C). ⋯ Evaluation using a whole blood analysis shows that hypothermia progressively impairs the coagulation system.
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Anesthesia and analgesia · Nov 2008
Randomized Controlled TrialGabapentin attenuates late but not early postoperative pain after thyroidectomy with superficial cervical plexus block.
Preoperative oral gabapentin has been shown to reduce postoperative pain. However, the effects of gabapentin as an adjunct to regional anesthesia is unclear and its effects on chronic pain remains unknown. In patients undergoing thyroidectomy, we investigated the effects on early and late (at 6 mo) postoperative pain of preoperative oral gabapentin as an adjunct to superficial cervical plexus block (SCPB). ⋯ Oral preoperative administration of gabapentin did not modify immediate pain management in thyroidectomy patients receiving SCPB, but prevented delayed neuropathic pain at 6 mo.
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Anesthesia and analgesia · Nov 2008
Case ReportsThe anesthetic management for cesarean delivery in a patient with Shone's syndrome.
Shone's syndrome is a rare congenital cardiac condition that consists of up to four obstructive left-sided cardiac lesions. We report a 17-yr-old nullipara with Shone's syndrome who presented for cesarean delivery. ⋯ Epidural anesthesia was attempted, but the patient developed severe hypotension associated with fetal bradycardia necessitating immediate cesarean delivery under general anesthesia. The peripartum anesthetic and management considerations for these patients are discussed.