Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2009
Randomized Controlled Trial Comparative StudyIntraoperative ventilatory strategies for prevention of pulmonary atelectasis in obese patients undergoing laparoscopic bariatric surgery.
Atelectasis occurs regularly after induction of general anesthesia, persists postoperatively, and may contribute to significant postoperative morbidity and additional health care costs. Laparoscopic surgery has been reported to be associated with an increased incidence of postoperative atelectasis. It has been shown that during general anesthesia, obese patients have a greater risk of atelectasis than nonobese patients. Preventing atelectasis is important for all patients but is especially important when caring for obese patients. ⋯ Intraoperative alveolar recruitment with a VCM followed by PEEP 10 cm H(2)O is effective at preventing lung atelectasis and is associated with better oxygenation, shorter PACU stay, and fewer pulmonary complications in the postoperative period in obese patients undergoing laparoscopic bariatric surgery.
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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.
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Anesthesia and analgesia · Nov 2009
Multicenter StudyThe incidence of intraoperative awareness in children: childhood awareness and recall evaluation.
There is a considerable discrepancy between the reported incidences of awareness under anesthesia in children (0.2%-2.7%). In this prospective, observational, cohort study we evaluated 1) the incidence of awareness during general anesthesia in children across three settings, 2) factors contributing to awareness, and 3) short-term psychological effects of awareness. ⋯ Although 0.8% of children experienced possible/probable awareness in this study, none experienced short-term psychological distress.
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Anesthesia and analgesia · Nov 2009
Randomized Controlled Trial Comparative StudyA randomized comparison of low doses of hyperbaric bupivacaine in combined spinal-epidural anesthesia for cesarean delivery.
The aim of our study was to investigate the block characteristics of intrathecal hyperbaric bupivacaine 7, 8, or 9 mg administered during combined spinal-epidural anesthesia for cesarean delivery and to elucidate the dose that produces adequate sensory blockade for surgery while minimizing the incidence of hypotension, high neuroblockade, and the need for intraoperative epidural supplementation. ⋯ The lowest dose of hyperbaric bupivacaine (7 mg) provided equally rapid onset and effective anesthesia for cesarean delivery while reducing the incidence of hypotension compared with 8 and 9 mg. However, because of its shorter duration of anesthesia, it may be feasible only when the block can be reinforced using a functional epidural catheter.
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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.