Anesthesia and analgesia
-
Anesthesia and analgesia · Mar 2008
Clinical TrialThe effect of lung expansion and positive end-expiratory pressure on respiratory mechanics in anesthetized children.
Imaging studies have shown that general anesthesia in children results in atelectasis. Lung recruitment total lung capacity (TLC) maneuvers plus positive end-expiratory pressure (PEEP) are effective in preventing atelectasis. However, physiological changes in children during general anesthesia have not been elucidated. ⋯ The observed steady decreases in E(st) with increasing V(T) (up to 16 mL/kg with PEEP) indicate marked reductions in end-expiratory relaxation volume (functional residual capacity) even with PEEP. Similarity in results with ZEEP and PEEP suggests that TLC-maneuvers and O2-N2 ventilation prevented airway closure throughout the study.
-
Anesthesia and analgesia · Mar 2008
Randomized Controlled Trial Comparative StudyDoes patient-controlled continuous interscalene block improve early functional rehabilitation after open shoulder surgery?
Early mobilization after shoulder surgery plays a vital role in successful functional rehabilitation. However, postoperative pain often reduces, or even prevents, effective physiotherapy. We investigated the effect of analgesia via patient-controlled interscalene technique on early functional rehabilitation after open shoulder surgery. ⋯ Compared with opioid-based PCA, PCISB improved analgesia, but not function, during early rehabilitation of the shoulder joint.
-
Anesthesia and analgesia · Mar 2008
Clinical TrialThe effect of thoracic epidural bupivacaine and an intravenous adrenaline infusion on gastric tube blood flow during esophagectomy.
Gastric tube necrosis is a major cause of anastomotic leak after esophagectomy. A correlation has been shown between reduced flux at the anastomotic end of the gastric tube and anastomotic leaks. ⋯ The administration of a thoracic epidural bolus may decrease flux at the anastomotic end of the gastric tube.
-
Anesthesia and analgesia · Mar 2008
Clinical TrialDecision support increases guideline adherence for prescribing postoperative nausea and vomiting prophylaxis.
Guidelines for postoperative nausea and vomiting (PONV) prevention are implemented widely but their effectiveness may be limited by poor adherence. We hypothesized that the use of an electronic decision support (DS) system would significantly improve guideline adherence. ⋯ Electronic DS increases guidelines adherence for the prescription of PONV prophylaxis in high-risk PONV patients.
-
Anesthesia and analgesia · Mar 2008
Comparative StudyMolecular actions of propofol on human 5-HT3A receptors: enhancement as well as inhibition by closely related phenol derivatives.
5-Hydroxytryptamine type 3 (5-HT3) receptors are excitatory ligand-gated ion channels which are involved in postoperative nausea and vomiting. They are depressed by the anesthetic propofol, which, in contrast, enhances the activity of inhibitory ligand-gated ion channels such as gamma-aminobutyric acid type A receptors and glycine receptors. To investigate the molecular mechanisms responsible for these contrasting actions, we examined the kinetics of the action of propofol and its lesser hydrophobic derivatives 2-isopropylphenol and phenol on human 5-HT3A receptors. ⋯ At least two separate inhibitory actions on 5-HT3A receptors could be identified for propofol, whereas the enhancing action seen for the two related smaller phenol derivatives could no longer be detected. 5-HT-dependent and 5-HT-independent interactions could be distinguished for all three drugs. Propofol was less potent than expected from its hydrophobic properties. Underlying mechanisms appear to involve the phenolic hydroxyl group, hydrophobic interactions, and steric restrictions.