Anesthesia and analgesia
-
Anesthesia and analgesia · Jan 2009
Randomized Controlled TrialTramadol as an adjuvant to lidocaine for axillary brachial plexus block.
In this prospective randomized study, we evaluated the effect of tramadol as an adjuvant to axillary block. ⋯ The benefit of block prolongation associated with the addition of 200 mg tramadol to lidocaine during axillary block is limited by the slow onset of the block.
-
Anesthesia and analgesia · Jan 2009
Randomized Controlled Trial Comparative StudyA randomized trial of breakthrough pain during combined spinal-epidural versus epidural labor analgesia in parous women.
There is controversy regarding the benefits and risks of combined spinal-epidural compared with epidural analgesia (CSE, EPID) for labor analgesia. We hypothesized that CSE would result in fewer patient requests for top-up doses compared to EPID. ⋯ We did not find a difference in the need for top-up doses in parous patients; however, CSE provided better analgesia in the first 30 min compared to EPID.
-
Anesthesia and analgesia · Jan 2009
Randomized Controlled Trial Multicenter StudyThe effects of local anesthetic concentration and dose on continuous infraclavicular nerve blocks: a multicenter, randomized, observer-masked, controlled study.
It remains unclear whether local anesthetic concentration or total drug dose is the primary determinant of continuous peripheral nerve block effects. The only previous investigation, involving continuous popliteal-sciatic nerve blocks, specifically addressing this issue reported that insensate limbs were far more common with higher volumes of relatively dilute ropivacaine compared with lower volumes of relatively concentrated ropivacaine. However, it remains unknown if this relationship is specific to the sciatic nerve in the popliteal fossa or whether it varies depending on anatomic location. We therefore tested the null hypothesis that providing ropivacaine at different concentrations and rates, but at an equal total basal dose, produces comparable effects when used in a continuous infraclavicular brachial plexus block. ⋯ For continuous infraclavicular nerve blocks, local anesthetic concentration and volume influence perineural infusion effects in addition to the total mass of local anesthetic administered. Insensate limbs were far more common with smaller volumes of relatively concentrated ropivacaine. This is the opposite of the relationship previously reported for continuous popliteal-sciatic nerve blocks. The interaction between local anesthetic concentration and volume is thus complex and varies among catheter locations.
-
Anesthesia and analgesia · Jan 2009
Randomized Controlled Trial Comparative StudyPerformance of certified registered nurse anesthetists and anesthesiologists in a simulation-based skills assessment.
Anesthesiologists and certified registered nurse anesthetists (CRNAs) must acquire the skills to recognize and manage a variety of acute intraoperative emergencies. A simulation-based assessment provides a useful and efficient means to evaluate these skills. In this study, we evaluated and compared the performance of board-certified anesthesiologists and CRNAs managing a set of simulated intraoperative emergencies. ⋯ Although anesthesiologists, on average, achieved a modestly higher overall score, there was marked and similar variability in both groups. This wide range suggests that certification in either discipline may not yield uniform acumen in management of simulated intraoperative emergencies. In both groups, there were practitioners who failed to diagnose and treat simulated emergencies. If this is reflective of clinical practice, it represents a patient safety concern. Simulation-based assessment provides a tool to determine the ability of practitioners to respond appropriately to clinical emergencies. If all practitioners could effectively manage these critical events, the standard of patient care and ultimately patient safety could be improved.
-
Anesthesia and analgesia · Jan 2009
Meta AnalysisCardiovascular safety of the cyclooxygenase-2 selective inhibitors parecoxib and valdecoxib in the postoperative setting: an analysis of integrated data.
Studies of parecoxib, the inactive prodrug of the cyclooxygenase-2 selective inhibitor valdecoxib, and valdecoxib for postoperative pain relief in patients undergoing coronary artery bypass graft surgery revealed an increased risk of cardiovascular (CV) adverse events compared with placebo. We conducted this study to address whether parecoxib and valdecoxib increased CV risk in noncardiac surgery patients. ⋯ In the largest analysis of the CV risk of cyclooxygenase selective inhibitors or nonsteroidal antiinflammatory drugs for perioperative pain management, parecoxib and valdecoxib were not found to increase the risk of CV adverse events after noncardiac surgery.