Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2008
The dynamic relationship between end-tidal sevoflurane concentrations, bispectral index, and cerebral state index in children.
To guide anesthetic administration with electroencephalogram monitors in children, an adequate characterization of the anesthetic effect measured by these monitors in this population is needed. We sought to quantify and compare the dynamic profile of sevoflurane's effect measured with the cerebral state index (CSI) and the bispectral index (BIS) in children. ⋯ In children, the t(1/2) k(e0) of sevoflurane and the pharmacodynamics of sevoflurane were quantified and the results were entirely dependent on the monitor used to measure its hypnotic effect. Within the anesthetic depth range studied, the rate of change of sevoflurane's effect was slower with the CSI. To adequately guide sevoflurane administration with these monitors in children, these differences should be considered.
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Anesthesia and analgesia · Nov 2008
Resistive polymer versus forced-air warming: comparable heat transfer and core rewarming rates in volunteers.
Mild perioperative hypothermia increases the risk of several severe complications. Perioperative patient warming to preserve normothermia has thus become routine, with forced-air warming being used most often. In previous studies, various resistive warming systems have shown mixed results in comparison with forced-air. Recently, a polymer-based resistive patient warming system has been developed. We compared the efficacy of a standard forced-air warming system with the resistive polymer system in volunteers. ⋯ Heating efficacy and core rewarming rates were similar with full-body forced-air and full-body resistive polymer heating in healthy volunteers.
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Anesthesia and analgesia · Nov 2008
Dexmedetomidine: a novel drug for the treatment of atrial and junctional tachyarrhythmias during the perioperative period for congenital cardiac surgery: a preliminary study.
Atrial and junctional tachyarrhythmias occur frequently during the perioperative period for congenital cardiac surgery and can be a cause of increased morbidity and mortality. These rhythm disturbances that may be well tolerated in a normal heart can cause significant hemodynamic instability in patients with congenital heart defects, particularly during the postcardiopulmonary bypass period. Management of these arrhythmias presents more of a challenge, since currently available antiarrhythmic drugs can be ineffective and poorly tolerated. In this study, we examined the possible effect of dexmedetomidine, a primarily sedative drug, on atrial and junctional tachyarrhythmias. Though some animal data have shown that it can prevent certain types of ventricular tachycardia, its therapeutic role during these types of arrhythmias has not been studied. ⋯ This preliminary, observational report suggests that dexmedetomidine may have a potential therapeutic role in the acute phase of perioperative atrial and junctional tachyarrhythmias for either HR control or conversion to NSR.
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Anesthesia and analgesia · Nov 2008
Low-dose systemic bupivacaine prevents the development of allodynia after thoracotomy in rats.
Chronic pain after thoracotomy has been recently reproduced in a rat model that allows investigation of the effect of drugs that might reduce the incidence of allodynia after thoracotomy. Previous studies suggest that intrathecal or systemic morphine, clonidine, neostigmine, and gabapentin reduce the incidence of allodynia in the rat postthoracotomy pain model. Our purpose was to test whether intercostal and systemic injection of bupivacaine prevented the development of allodynia in an animal model of chronic intercostal neuropathic pain. ⋯ Previous studies suggest that allodynia after rib retraction can be prevented by opioids, alpha2-adrenergic agonists, neostigmine, and gabapentin. The current results suggest that bupivacaine is effective in preventing mechanical allodynia, whether given by intercostal injection before or after surgery, or systemically before surgery.
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Anesthesia and analgesia · Nov 2008
Emergency airway management with fiberoptic intubation in the prone position with a fixed flexed neck.
We describe emergency airway management with fiberoptic intubation in a patient in the prone position with her neck flexed by a head pin holder during a neurosurgical procedure. Laryngeal mask airway is suggested in emergency difficult airway algorithms; however, this was not feasible in this patient because of her edematous upper airway and limited mouth opening resulting from extreme neck flexion by a head pin holder. The case illustrates the role of fiberoptic intubation in emergency airway management in this critical situation. Maneuvers to facilitate fiberoptic technique are also described.