Anesthesia and analgesia
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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
Randomized Controlled Trial Comparative StudyA comparison of heparin management strategies in infants undergoing cardiopulmonary bypass.
Recent investigations in adult patients have suggested that a heparin concentration-based anticoagulation protocol for heparin administration during cardiopulmonary bypass (CPB) significantly reduced hemostatic activation when compared with standard weight-based heparin doses. Reductions in hemostatic activation during CPB could be particularly beneficial in pediatric patients in whom CPB-related coagulation issues are complex and influenced by many variables. However, information regarding heparin levels during CPB and their correlation to hemostatic activation is lacking in children. In this investigation, we compared a patient-specific heparin concentration-based heparin management protocol with a standard weight-based protocol in infants <6-mo-of-age. The efficacy of these two protocols was assessed by comparisons of heparin concentration, levels of biochemical markers of hemostatic activation, and clinical outcome. ⋯ A heparin concentration-based heparin management protocol in infants <6-mo-old resulted in higher, more constant heparin concentrations during CPB than a standard weight-based protocol. Furthermore, higher heparin concentrations were associated with greater suppression of hemostatic activation, as measured by less generation of thrombin and less consumption of factor VIII. Our findings demonstrate that use of a patient-specific heparin concentration-based protocol for heparin administration during CPB in infants may attenuate hemostatic activation. However, further research is needed to determine if this protocol has clinically beneficial hemostatic effects.
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Anesthesia and analgesia · Feb 2008
Randomized Controlled Trial Multicenter Study Comparative StudyDoes hyperventilation improve operating condition during supratentorial craniotomy? A multicenter randomized crossover trial.
Hyperventilation has been an integral, but poorly validated part of neuroanesthetic practice. We conducted a two-period, crossover, randomized trial to evaluate surgeon-assessed brain bulk and measured intracranial pressure (ICP) in patients undergoing craniotomy for removal of supratentorial brain tumors during moderate hypocapnia or normocapnia. ⋯ In patients with supratentorial brain tumors, intraoperative hyperventilation improves surgeon-assessed brain bulk which was associated with a decrease in ICP.
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Anesthesia and analgesia · Feb 2008
Randomized Controlled Trial Comparative StudyManagement of lower limb complex regional pain syndrome type 1: an evaluation of percutaneous radiofrequency thermal lumbar sympathectomy versus phenol lumbar sympathetic neurolysis--a pilot study.
Complex regional pain syndrome type 1 can be difficult to treat. The purpose of this study was to compare the safety and efficacy of two therapeutic options: percutaneous radiofrequency thermal lumbar sympathectomy and lumbar sympathetic neurolysis. ⋯ Based on this pilot study, radiofrequency lumbar sympathectomy may be comparable to phenol lumbar sympathectomy. A larger trial is required to confirm these findings.
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Anesthesia and analgesia · Feb 2008
Randomized Controlled Trial Comparative StudyThe effect of motor activity on the onset and progression of brachial plexus block with bupivacaine: a randomized prospective study in patients undergoing arthroscopic shoulder surgery.
A decreased latency of onset of neural blockade has been noted when muscular exercise of the hand was performed after supraclavicular brachial plexus block using lidocaine. In this observational study, we examined the effect of repetitive muscle contraction of the hand on the speed of onset of interscalene brachial plexus block (ISB) using bupivacaine. ⋯ Our results imply that attempting to use a frequency-dependent conduction block with repetitive motor activity as a clinical adjuvant to brachial plexus block with bupivacaine is without merit.