Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2008
Comparative StudyThe relationship between bispectral index and propofol during target-controlled infusion anesthesia: a comparative study between children and young adults.
In this prospective study, we compared the relationship between propofol concentrations and bispectral index (BIS) in children versus young adults anesthetized with target-controlled infusion (TCI) of propofol. ⋯ The good relationship between propofol and BIS demonstrated in children as in adults suggested a slightly lower sensitivity to propofol in children. As the predictability of plasma propofol concentrations with the classical pharmacokinetic/pharmacodynamic models is limited in children, a cerebral pharmacodynamic feedback, such as BIS, may be useful in this population.
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Anesthesia and analgesia · Apr 2008
The importance of increased neck circumference to intubation difficulties in obese patients.
Using the intubation difficulty scale (IDS), we sought to confirm that obese patients are more difficult to intubate than lean patients. We assessed classical bedside tests and included neck circumference. ⋯ We found that problematic intubation was associated with thyromental distance, increasing neck circumference, BMI, and a Mallampati score of > or = 3. Neck circumference should be assessed preoperatively to predict difficult intubation.
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Anesthesia and analgesia · Apr 2008
Randomized Controlled TrialThe predictive performance of a pharmacokinetic model for manually adjusted infusion of liquid sevofluorane for use with the Anesthetic-Conserving Device (AnaConDa): a clinical study.
The Anesthetic-Conserving Device (AnaConDa) can be used to administer inhaled anesthetics using an intensive care unit (ICU) ventilator. We evaluated the predictive performance of a simple manually adjusted pump infusion scheme, for infusion of liquid sevoflurane to the AnaConDa. ⋯ There is an excellent 6-h predictive performance of a simplified pharmacokinetic model for manually adjusted infusion of liquid sevoflurane when using the AnaConDa to deliver sevoflurane to ICU patients.
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Anesthesia and analgesia · Apr 2008
Long-term forecasting of anesthesia workload in operating rooms from changes in a hospital's local population can be inaccurate.
Anesthesia department planning depends on forecasting future demand for perioperative services. Little is known about long-range forecasting of anesthesia workload. ⋯ Although growth of the elderly population is a simple justification for building more ORs, managers should be cautious in arguing for strategic changes in capacity at individual hospitals based on future changes in the national age-adjusted population. Local population can provide little value in forecasting future anesthesia workloads at individual hospitals. In addition, anesthesia groups and hospital administrators should not focus on quarterly changes in workload, because workload can vary widely, despite consistent patterns over decades. To facilitate long-range planning, anesthesia groups and hospitals should save their billing and OR time data, display it graphically over years, and supplement with corresponding forecasting methods (e.g., staff an additional OR when an upper prediction bound of workload per OR exceeds a threshold).
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Anesthesia and analgesia · Apr 2008
Case ReportsBilateral ultrasound-guided continuous ilioinguinal-iliohypogastric block for pain relief after cesarean delivery.
We present three cases in which continuous ilioinguinal-iliohypogastric nerve block with 0.2% ropivacaine, together with oral ibuprofen, was used to provide analgesia after cesarean delivery. The catheters were placed under ultrasound guidance in the plane between the internal oblique and transversus abdominis muscles on both sides of the abdomen. Numeric pain rating was used for the assessment of postoperative pain. Low pain scores, minimal use of supplemental opioid, and the absence of nausea and vomiting suggests that continuous ilioinguinal-iliohypogastric nerve blockade deserves further study as a possible component of multimodal analgesia after cesarean delivery.