Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2008
Online monitoring of pulse pressure variation to guide fluid therapy after cardiac surgery.
The arterial pulse pressure variation induced by mechanical ventilation (deltaPP) has been shown to be a predictor of fluid responsiveness. Until now, deltaPP has had to be calculated offline (from a computer recording or a paper printing of the arterial pressure curve), or to be derived from specific cardiac output monitors, limiting the widespread use of this parameter. Recently, a method has been developed for the automatic calculation and real-time monitoring of deltaPP using standard bedside monitors. Whether this method is to predict reliable predictor of fluid responsiveness remains to be determined. ⋯ Automatic real-time monitoring of deltaPP is possible using a standard bedside monitor and was found to be a reliable method to predict fluid responsiveness after cardiac surgery. Additional studies are needed to determine if this technique can be used to avoid the complications of fluid administration in high-risk patients.
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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
Randomized Controlled TrialThe effects of intravenous granisetron on the sensory and motor blockade produced by intrathecal bupivacaine.
We hypothesized that pretreatment with i.v. granisetron would affect the sensory and motor components of spinal blockade through 5-HT(3) receptor blockade. ⋯ We concluded that i.v. granisetron facilitated a faster recovery of sensory block after bupivacaine subarachnoid anesthesia.
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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
Intravascular injection in lumbar medial branch block: a prospective evaluation of 1433 injections.
The successful outcome and validity of lumbar medial branch block (MBB) are largely dependent on technique accuracy. Intravascular uptake of injectate causes a false-negative response to block and is associated with various possible complications. In the current study, we prospectively evaluated the incidence of, and the factors associated with, intravascular injection during block. In addition, we assessed the efficiencies of generally accepted safety measures, such as preinjection aspiration and intermittent fluoroscopy to avoid intravascular injections. ⋯ The aspiration test with or without spot radiography frequently missed the intravascular uptake of contrast during lumbar MBBs. We strongly advocate the use of real-time fluoroscopy during contrast injection to increase diagnostic and therapeutic value and to avoid possible complications.