Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2008
Randomized Controlled TrialSingle-dose dexamethasone reduces dynamic pain after total hip arthroplasty.
Preoperative glucocorticoids reduce postoperative nausea but may also improve analgesia and decrease opioid consumption. ⋯ A single, preoperative i.v. dose of dexamethasone 40 mg has a prolonged suppressive effect on the inflammatory response and decreases dynamic pain 24 h after total hip arthroplasty.
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Anesthesia and analgesia · Apr 2008
Characterization of the coagulation deficit in porcine dilutional coagulopathy and substitution with a prothrombin complex concentrate.
In this study, we used a porcine model to investigate whether impaired coagulation and severe arterial or venous bleeding could be normalized by substitution with a prothrombin complex concentrate (PCC), Beriplex P/N, containing coagulation factors II, VII, IX, and X. ⋯ Dilutional coagulopathy produced a generalized decrease in coagulation factors and impaired platelet function. Substitution with PCC effectively normalized coagulation and significantly improved hemostasis after venous and arterial bleeding.
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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
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).