Anesthesia and analgesia
-
Anesthesia and analgesia · Nov 2009
Randomized Controlled Trial Comparative StudyA comparison of three videolaryngoscopes: the Macintosh laryngoscope blade reduces, but does not replace, routine stylet use for intubation in morbidly obese patients.
Many manufacturers are producing videolaryngoscopes (VLSs) with differing specifications, user interfaces, and geometry. It is clinically relevant to know the relative performance of the blades. Visualization of the glottis and intubation are often problematic in (extremely) obese patients, and the new video technology may offer better functionality and performance. Although many tracheal intubations with direct laryngoscopy are performed with an unstyletted endotracheal tube, it is recommended to use a stylet for intubation using videolaryngoscopy. In this study, we compared 3 VLSs in morbidly obese patients undergoing intubation for elective surgery and tested whether it is feasible to intubate the tracheas of morbidly obese patients without using a stylet. ⋯ In this study, the VLS with the Macintosh blade (Storz VLS) had a better overall satisfaction score, intubation time, number of intubation attempts, and necessity of extra adjuncts, compared with the 2 other tested devices.
-
Anesthesia and analgesia · Nov 2009
Randomized Controlled Trial Comparative StudyThe effects of ultrasound guidance and neurostimulation on the minimum effective anesthetic volume of mepivacaine 1.5% required to block the sciatic nerve using the subgluteal approach.
We tested the hypothesis that ultrasound (US) guidance may reduce the minimum effective anesthetic volume (MEAV(50)) of 1.5% mepivacaine required to block the sciatic nerve with a subgluteal approach compared with neurostimulation (NS). ⋯ US provided a 37% reduction in the MEAV(50) of 1.5% mepivacaine required to block the sciatic nerve compared with NS.
-
Anesthesia and analgesia · Nov 2009
Comparative StudyInotropic support during experimental endotoxemic shock: part II. A comparison of levosimendan with dobutamine.
We compared the association of levosimendan or dobutamine with norepinephrine for the maintenance of systemic and hepatosplanchnic perfusion during early endotoxemic shock. ⋯ In volume-resuscitated endotoxemic pigs, the association of either levosimendan or dobutamine with norepinephrine preserved systemic blood flow, oxygen delivery, and VO(2). However, only dobutamine-norepinephrine maintained portal blood flow, which was associated with preservation of splanchnic and hepatic oxygen homeostasis and stable lactate concentrations.
-
Anesthesia and analgesia · Nov 2009
Behavioral analysis of children's response to induction of anesthesia.
It is documented that children experience distress at anesthesia induction, but little is known about the prevalence of specific behaviors exhibited by children. ⋯ Children undergoing anesthesia display a range of distress and nondistress behaviors. A group of behaviors was identified that, when displayed on the walk to the operating room, is associated with less distress at anesthesia induction. These data provide the first examination of potentially regulating behaviors of children, but more detailed sequential analysis is required to validate specific functions of these behaviors.
-
Anesthesia and analgesia · Nov 2009
Ultrasound-guided paravertebral block using an intercostal approach.
We describe an ultrasound-guided technique of continuous bilateral paravertebral block using an intercostal approach in 12 patients undergoing elective abdominal surgery. Postoperatively, each of the patient's paravertebral catheters was bolused with 10 mL lidocaine (15 mg/mL), and each of the patient's catheters was infused with 0.2% ropivacaine at 10 mL/h. ⋯ The median verbal pain score on postoperative day 1 was 5.5 (interquartile range, 3.5-6), and median dose of IV hydromorphone consumed during the first 24 h after surgery was 1.9 mg (interquartile range, 0.7-5.05). All catheters were removed within 72 h after surgery.