Anesthesia and analgesia
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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.
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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 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.
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Anesthesia and analgesia · Jun 2008
Does patient position influence Doppler signal quality from the USCOM ultrasonic cardiac output monitor?
The USCOM1A continuous wave cardiac output monitor (USCOM Pty Ltd., Sydney, NSW, Australia) is a novel Doppler-based device used to measure cardiac output noninvasively. The proper alignment of the transducer, and hence the ultrasound beam to the aortic or pulmonary outflow tracts, is essential to acquire accurate measurements and often much time is spent on transducer and/or patient positioning. In this prospective, observational, crossover study, we investigated the effect of patient positioning on the acquisition of cardiac output measurement with USCOM1A. ⋯ Our results suggested the sitting position is the least suitable and least reliable position in which to perform cardiac output measurements using USCOM1A compared with the supine, Trendelenburg (20 degrees), left lateral tilt (20 degrees), and right lateral tilt (20 degrees) positions.
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Anesthesia and analgesia · Jun 2008
Comparative Study Clinical TrialBispectral index values during sevoflurane-nitrous oxide general anesthesia in women undergoing cesarean delivery: a comparison between women with and without prior labor.
An end-tidal concentration of 1% sevoflurane (1% ET(SEVO)) in 50% nitrous oxide (N(2)O) during elective cesarean delivery has been associated with bispectral index (BIS) values >60, which are associated with an increased risk of awareness. We hypothesized that BIS values during sevoflurane-N(2)O general anesthesia for cesarean delivery would be lower in women with prior labor compared with women without prior labor. ⋯ Prior labor was associated with lower intraoperative BIS values during sevoflurane/N(2)O general anesthesia and reduced postoperative analgesic consumption in women undergoing cesarean delivery compared with women without prior labor.