Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2008
Comparative StudyMinimizing stomach inflation versus optimizing chest compressions.
In a bench model, we evaluated a bag-valve device (Smart Bag MO) with limited maximum inspiratory gas flow developed to reduce the risk of stomach inflation in an unprotected airway. During simulated cardiopulmonary resuscitation with uninterrupted chest compressions, ventilation with the "disabled" Smart Bag MO or an adult self-inflating bag-valve device provided only adequate tidal volumes if inspiratory time was 0.5 s. Ventilation with the "enabled" Smart Bag MO, even in ventilation windows of 0.5 s, provided inadequate tidal volumes during simulated cardiopulmonary resuscitation and would result in hypoventilation in a patient.
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Anesthesia and analgesia · Feb 2008
Comparative StudyDoes sciatic parasacral injection spread to the obturator nerve? An anatomic study.
The ability of parasacral sciatic nerve block to provide consistent obturator nerve and perineal blockade remains undetermined. In this anatomic work, we assessed the spread of a colored latex mimicking a parasacral injection, and observed the spread to the obturator nerve and sacral nerve roots. ⋯ We conclude from this anatomical study that successful parasacral injection consistently spreads to the pelvic portion of the obturator nerve and to the sacral roots. Therefore, parasacral block should theoretically provide obturator and perineal blockade, and eliminate the need for systematic separate obturator nerve block. These results must be confirmed by further clinical studies.
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Anesthesia and analgesia · Feb 2008
Randomized Controlled Trial Comparative StudyA randomized, controlled, double-blind trial of patient-controlled sedation with propofol/remifentanil versus midazolam/fentanyl for colonoscopy.
Patient-controlled sedation (PCS) with propofol has been advocated as a method for dealing with the narrow therapeutic window for moderate sedation, but previous studies have methodologic limitations. We hypothesized that, by using remifentanil in conjunction with propofol and using PCS in both arms of the study, we could demonstrate marked improvements in facility use compared with fentanyl plus midazolam. ⋯ PCS with propofol/remifentanil yields superior facility throughput compared with midazolam/fentanyl when used in an appropriate care setting.
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Anesthesia and analgesia · Feb 2008
Comparative Study Clinical TrialThe limited efficacy of tramadol in postoperative patients: a study of ED80 using the continual reassessment method.
The aim of this study was to reevaluate the efficacy of tramadol for postoperative analgesia and to determine its ED80 (the clinical dose for which 80% of the patients had their pain adequately relieved) using the Continual Reassessment Method. Because the preliminary results of the first 24 patients were contradictory to the literature, we performed a second trial to verify and validate our data. ⋯ Tramadol used as a sole drug cannot be considered the drug of choice after moderately painful surgery. The doses needed to relieve pain in 80% of patients are much larger than the usual dose of 100 mg. The Continual Reassessment Method allowed us to determine the ED80 of tramadol with a limited number of patients.
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Anesthesia and analgesia · Feb 2008
Multicenter Study Comparative Study Clinical TrialIntrathecal ziconotide for severe chronic pain: safety and tolerability results of an open-label, long-term trial.
Ziconotide is a non-opioid drug indicated for management of severe chronic pain in patients for whom intrathecal (IT) therapy is warranted and who are intolerant of or refractory to other treatments. ⋯ We conclude that long-term IT ziconotide is an option for patients with severe, refractory chronic pain.