Anesthesia and analgesia
-
Anesthesia and analgesia · Jun 2008
Randomized Controlled TrialTransdermal oxygen does not improve sternal wound oxygenation in patients recovering from cardiac surgery.
Sternal wound dehiscence and infection complicate 1% of cardiac surgeries. Tissue oxygen tension (PsqO(2)) is the primary determinant of surgical wound infection risk and is often critically low in surgical incisions. We tested the hypothesis that local transdermal delivery of oxygen improves oxygenation in sternotomy wounds after cardiac surgery. Our secondary hypothesis was that supplemental inspired oxygen improves sternal wound PsqO(2). ⋯ Additional inspired oxygen improved Pao(2) and sternal wound PsqO(2) after bypass and may, consequently, reduce infection risk. However, oxygen insufflated locally into an occlusive dressing did not improve wound PsqO(2) and, therefore, does not appear to be useful clinically in cardiac surgery patients to reduce sternal wound infections.
-
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.
-
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.
-
Anesthesia and analgesia · Jun 2008
Randomized Controlled Trial Comparative StudyA prospective, randomized comparison of the effects of inhaled sevoflurane anesthesia and propofol/remifentanil intravenous anesthesia on salivary excretion during laryngeal microsurgery.
One of the goals of anesthesia for laryngeal microsurgery is to provide a clear surgical view, and therefore anesthetics that produce less saliva are desirable. Sevoflurane inhalation anesthesia and total IV anesthesia with propofol/remifentanil are widely used for anesthesia during laryngeal microsurgery; however, few rigorous comparisons of the effects of sevoflurane and propofol/remifentanil on salivation have been performed. ⋯ Salivary excretion under propofol/remifentanil anesthesia is greater than under sevoflurane anesthesia during laryngeal surgery.
-
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.