Anesthesia and analgesia
-
Anesthesia and analgesia · Jan 2008
Clinical TrialCompliance and dead space fraction indicate an optimal level of positive end-expiratory pressure after recruitment in anesthetized patients.
"Optimal" positive end-expiratory pressure (PEEP) can be defined as the PEEP that prevents recollapse after a recruitment maneuver, avoids over-distension, and, consequently, leads to optimal lung mechanics at minimal dead space ventilation. In this study, we analyzed the effects of PEEP and recruitment on functional residual capacity (FRC), compliance, arterial oxygen partial pressure (Pao2) and dead space fraction, and we determined the most suitable variables indicating optimal PEEP. ⋯ All variables showed the positive effects of PEEP in conjunction with a recruitment maneuver. Optimal PEEP was 10 cm H2O because at this pressure level the highest compliance value in conjunction with the lowest dead space fraction indicated a maximum amount of effectively expanded alveoli. FRC and Pao2 were insensitive to alveolar over-distension.
-
Anesthesia and analgesia · Jan 2008
Randomized Controlled TrialThe effect of detailed, video-assisted anesthesia risk education on patient anxiety and the duration of the preanesthetic interview: a randomized controlled trial.
Video-assisted patient education during the preanesthetic clinic visit is a new intervention to increase knowledge transfer to the patient regarding anesthesia procedure and risks. However, little is known about whether video-based patient education influences patient anxiety and the duration of the preanesthetic visit. ⋯ Our study suggests that the use of a video for detailed anesthesia risk education does not change patient anxiety, but leads to a better understanding of the procedure and risks of anesthesia. When the video is shown before the preanesthetic interview, the interview is longer.
-
Anesthesia and analgesia · Jan 2008
Randomized Controlled Trial Comparative StudyCan remifentanil replace nitrous oxide during anesthesia for ambulatory orthopedic surgery with desflurane and fentanyl?
The administration of nitrous oxide (N2O) may be associated with side effects and toxicities. Remifentanil shares characteristics with N2O, including MAC-reducing and antinociceptive effects and a rapid decrease in clinical effect when discontinued. We compared the outcome after ambulatory orthopedic surgery with desflurane and fentanyl supplemented with clinically equivalent doses of either N2O or remifentanil. ⋯ This study demonstrates that a remifentanil infusion of 0.085 microg x kg(-1) x min(-1) may be substituted for 66% N2O during desflurane/fentanyl anesthesia without any clinically significant change in outcome.
-
Anesthesia and analgesia · Jan 2008
Randomized Controlled TrialPreoperative gabapentin: the effect on ropivacaine subarachnoid block and hemodynamics.
Gabapentin is an adjuvant analgesic and may enhance the spread of subarachnoid block. We investigated the effects of pretreatment with gabapentin on subarachnoid block characteristics and hemodynamics. ⋯ Pretreatment with gabapentin had no effect on the spread of sensory block or the regression of motor block but was associated with lower systolic arterial blood pressure values in patients undergoing subarachnoid anesthesia with ropivacaine.
-
Anesthesia and analgesia · Jan 2008
Comparative StudyAn assessment of dynamic autoregulation from spontaneous fluctuations of cerebral blood flow velocity: a comparison of two models, index of autoregulation and mean flow index.
Various methods of assessment of cerebral autoregulation, using spontaneous slow fluctuations of blood flow velocity (FV), arterial blood pressure, and cerebral perfusion pressure, have been used in clinical practice. We studied the association between the dynamic index of autoregulation (ARI) and time correlation index (mean flow index, Mx) in a group of patients after head injury. ⋯ ARI and Mx agree relatively well in head-injured patients. Autoregulation affects outcome after head injury.