Anesthesia and analgesia
-
Anesthesia and analgesia · Jun 2008
Review Meta AnalysisDoes supplemental oxygen reduce postoperative nausea and vomiting? A meta-analysis of randomized controlled trials.
Studies on the ability of supplemental oxygen to decrease the incidence of postoperative nausea and vomiting (PONV) are inconsistent, with initial studies suggesting benefit while subsequent trials demonstrate no decrease in PONV. ⋯ The positive results of two initial studies reducing the risk for PONV in patients given 80% Fio(2) were not confirmed by any of the subsequent trials. Considering all available evidence, 80% Fio(2) should no longer be considered an effective or reliable method to reduce overall PONV.
-
Anesthesia and analgesia · Jun 2008
Increased plasma serotonin in complex regional pain syndrome type 1.
In patients with complex regional pain syndrome type 1 (CRPS1), some improvement can be achieved by the administration of ketanserin, a 5-HT(2A) receptor antagonist. We measured plasma levels of serotonin (5-HT) during CRPS1 and correlated these levels with disease characteristics. ⋯ The markedly elevated levels of plasma 5-HT in CRPS1 patients suggest a role for 5-HT during the course of this disease. However, because of the lack of correlations with distinct disease characteristics, 5-HT is probably one of a number of mediators in CRPS1.
-
Anesthesia and analgesia · Jun 2008
Randomized Controlled TrialDexmedetomidine infusion during laparoscopic bariatric surgery: the effect on recovery outcome variables.
Dexmedetomidine (Dex), an alpha(2) agonist, has well-known anesthetic and analgesic-sparing effects. We designed this prospective, randomized, double-blind, and placebo-controlled dose-ranging study to evaluate the effect of Dex on both early and late recovery after laparoscopic bariatric surgery. ⋯ Adjunctive use of an intraoperative Dex infusion (0.2-0.8 microg x kg(-1) x h(-1)) decreased fentanyl use, antiemetic therapy, and the length of stay in the PACU. However, it failed to facilitate late recovery (e.g., bowel function) or improve the patients' overall quality of recovery. When used during bariatric surgery, a Dex infusion rate of 0.2 microg x kg(-1) x h(-1) is recommended to minimize the risk of adverse cardiovascular side effects.
-
Anesthesia and analgesia · Jun 2008
Multicenter StudyVascular endothelial growth factor in severe sepsis and septic shock.
Vascular endothelial growth factor (VEGF) levels have been shown to be elevated in severe sepsis. We investigated the value of VEGF in predicting organ dysfunction and hospital mortality in adult patients with severe sepsis. ⋯ VEGF concentrations are increased in patients with severe sepsis. Low concentrations are associated with hematological and renal dysfunction. VEGF concentrations were lower in nonsurvivors than in survivors, but did not adequately predict hospital mortality in patients with severe sepsis.
-
Anesthesia and analgesia · Jun 2008
ReviewAn assessment of the effects of general anesthetics on developing brain structure and neurocognitive function.
Neuronal cell death after general anesthesia has recently been documented in several immature animal models. Worldwide, volatile anesthetics are used in millions of young children every year during surgical procedures and imaging studies. The possibility of anesthesia-induced neurotoxicity during an uneventful anesthetic in neonates or infants has led to serious questions about the safety of pediatric anesthesia. However, the applicability of animal data to clinical anesthesia practice remains uncertain. In the present review, we assess the evidence for the effects of commonly used anesthetics on neuronal structure and neurocognitive function in newborn humans and animals. ⋯ The evidence for anesthesia-induced neurodegeneration in animal models is compelling. Although this phenomenon has not been prospectively studied in young children, anecdotal data point toward the possibility for neurological impairment after surgery and anesthesia early in life. Given the serious implications for public health, further investigations of this phenomenon are imperative, both in laboratory animals and in young children.