Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2008
Randomized Controlled Trial Comparative StudyA prospective comparison of continuous wound infiltration with ropivacaine versus single-injection paravertebral block after modified radical mastectomy.
The efficacy of continuous wound infiltration with local anesthetic has not been compared with that of thoracic paravertebral block (PVB) after breast surgery. In this study, we evaluated the analgesic efficacy and morphine consumption of the two techniques after mastectomy. ⋯ Continuous wound infiltration of local anesthetics is an effective alternative to paravertebral analgesia after mastectomy with axillary dissection.
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Anesthesia and analgesia · Mar 2008
Randomized Controlled Trial Comparative StudyCervical spine motion during tracheal intubation with manual in-line stabilization: direct laryngoscopy versus GlideScope videolaryngoscopy.
The optimal tracheal intubation technique for patients with potential cervical (C) spine injury remains controversial. Using continuous cinefluoroscopy, we conducted a prospective study comparing C-spine movement during intubation using direct laryngoscopy (DL) or GlideScope videolaryngoscopy (GVL), with uninterrupted manual in-line stabilization of the head by an assistant. ⋯ During intubation under general anesthesia with neuromuscular blockade and manual in-line stabilization, the use of GVL produced better glottic visualization, but did not significantly decrease movement of the nonpathologic C-spine when compared with DL.
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Anesthesia and analgesia · Mar 2008
Randomized Controlled TrialAn evaluation of a full-access underbody forced-air warming system during near-normothermic, on-pump cardiac surgery.
A new underbody forced-air warming system is available for use during cardiac surgery. We tested the hypothesis combining underbody forced-air warming with standard thermal management would maintain intraoperative core temperature and reduce core temperature after-drop (largest decrease in core temperature in the 60 min after bypass) in patients undergoing near-normothermic cardiopulmonary bypass (CPB). ⋯ Adding an underbody forced-air warming system to the near-normothermic thermal management protocol significantly increased pre-bypass temperature; however, it had no further clinically important effect on core temperature.
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Anesthesia and analgesia · Mar 2008
Randomized Controlled Trial Comparative StudyThe effective concentration 50 (EC50) for propofol with 70% xenon versus 70% nitrous oxide.
Xenon anesthesia has many favorable properties, such as pain modulation and organ protection. However, due to its MAC of 70%, it cannot be used as a sole anesthetic. We estimated the amount of propofol required to supplement xenon to produce adequate anesthesia in 50% and 95% of patients in comparison with nitrous oxide. ⋯ Xenon seems to be clinically more potent than nitrous oxide, but still requires minimal supplement of a hypnotic anesthetic to suppress noxious stimulation during and after skin incision.
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Anesthesia and analgesia · Mar 2008
Randomized Controlled Trial Comparative StudyPerioperative versus postoperative celecoxib on patient outcomes after major plastic surgery procedures.
Controversy continues to surround the use of cyclooxygenase (COX)-2 inhibitors in the perioperative period. We designed this randomized, double-blind, placebo-controlled study to examine the hypothesis that administration of celecoxib preoperatively or postoperatively and for 3 days after major plastic surgery would improve pain control and clinically important patient outcomes. Another objective of the study was to determine whether perioperative administration of celecoxib offered any advantages over postoperative administration alone. ⋯ Celecoxib (400 mg p.o.) administered on the day of surgery and for 3 days postoperatively is effective in improving postoperative pain management, as well as the speed and quality of recovery after major plastic surgery. However, perioperative administration offers no advantages over simply giving the drug after surgery.