Anesthesia and analgesia
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Severe sepsis activates the hypothalamopituitary axis, increasing cortisol production. In some studies, hydrocortisone substitution based on an adrenocorticotropic hormone-stimulation test or baseline cortisol measurement has improved outcome. Because only the free fraction of cortisol is active, measurement of free cortisol may be more important than total cortisol in critically ill patients. We measured total and free cortisol in patients with severe sepsis and related the concentrations to outcome. ⋯ Clinically, calculation of free cortisol does not provide essential information for identification of patients who would benefit from corticoid treatment in severe sepsis and septic shock.
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Anesthesia and analgesia · Jun 2008
Randomized Controlled Trial Comparative StudyElectrical nerve stimulation or ultrasound guidance for lateral sagittal infraclavicular blocks: a randomized, controlled, observer-blinded, comparative study.
Ultrasound guidance is frequently used to perform infraclavicular brachial plexus blocks. In this study, we compared electrical nerve stimulation and ultrasound guidance for the lateral sagittal infraclavicular block. ⋯ We conclude that favorable results can be obtained when either nerve stimulation or ultrasound guidance is used for lateral sagittal infraclavicular block. Using ultrasound, local anesthetic injection cranioposterior to the artery appears feasible.
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Anesthesia and analgesia · Jun 2008
Randomized Controlled TrialPreoperative oral Passiflora incarnata reduces anxiety in ambulatory surgery patients: a double-blind, placebo-controlled study.
Many patients have preoperative anxiety; therefore, the development of a strong anxiolytic with minimal psychomotor impairment for premedication may be desirable. ⋯ In outpatient surgery, administration of oral Passiflora incarnata as a premedication reduces anxiety without inducing sedation.
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Anesthesia and analgesia · Jun 2008
Comparative StudyThe spinal antinociceptive effects of endomorphins in rats: behavioral and G protein functional studies.
Endomorphin-1 and endomorphin-2 are endogenous peptides that are highly selective for mu-opioid receptors. However, studies of their functional efficacy and selectivity are controversial. In this study, we systematically compared the effects of intrathecal (i.t.) administration of endomorphin-1 and -2 on nociception assays and G protein activation with those of [d-Ala(2),N-Me-Phe(4),Gly(5)-ol]-enkephalin (DAMGO), a highly effective peptidic mu-opioid receptor agonist. ⋯ Endomorphins are partial agonists for G protein activation at spinal and thalamic mu-opioid receptors. Both in vivo and in vitro measurements together suggest that DAMGO is more effective than endomorphins. Spinal endomorphins' antinociceptive efficacy may range between 53% and 84% depending on the intensity and modality of the nociceptive stimulus.
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Anesthesia and analgesia · Jun 2008
Comparative StudyAdvanced auditory displays and head-mounted displays: advantages and disadvantages for monitoring by the distracted anesthesiologist.
In a full-scale anesthesia simulator study we examined the relative effectiveness of advanced auditory displays for respiratory and blood pressure monitoring and of head-mounted displays (HMDs) as supplements to standard intraoperative monitoring. ⋯ Advanced auditory displays help the distracted anesthesiologist maintain peripheral awareness of a simulated patient's status, whereas a HMD does not significantly improve performance. Further studies should test these findings in other intraoperative contexts.