Anesthesia and analgesia
-
Anesthesia and analgesia · Dec 2009
Improvement in psychosocial outcomes in chronic pain patients receiving intrathecal morphine infusions.
When conventional multimodal analgesic therapy is unsuccessful, more aggressive analgesic treatments are required for patients with intractable chronic pain. Despite extensive clinical experience with implanted morphine pumps, there is still controversy regarding the psychosocial effects of this invasive analgesic therapy. In this prospective study, we evaluated the impact of intrathecal (IT) morphine infusions on pain perception and psychosocial functionality. A secondary objective of this pilot study was to assess the effect of IT morphine infusion on the patient's level of functional activity. ⋯ IT infusion of morphine using an implantable pump was helpful in improving psychosocial function in patients with intractable pain that had failed to respond to standard multimodal analgesic therapy.
-
Anesthesia and analgesia · Dec 2009
The efficacy and safety of continuous intravenous administration of remifentanil for birth pain relief: an open study of 205 parturients.
In an observational study, we prospectively evaluated the efficacy and safety of remifentanil in 205 parturients. Remifentanil was administered as a continuous infusion. ⋯ The mean (+/-sd) visual analog score before the start of the infusion was 9.4 +/- 1.2 cm and decreased to 5.1 +/- 0.4 cm after 5 min and 3.6 +/- 1.5 cm after 30 min. The maternal side effects were minimal and no fetal or neonatal side effects were noted.
-
Anesthesia and analgesia · Dec 2009
Need for emergency surgical airway reduced by a comprehensive difficult airway program.
Inability to intubate and ventilate patients with respiratory failure is associated with significant morbidity and mortality. A patient is considered to have a difficult airway if an anesthesiologist or other health care provider experienced in airway management is unable to ventilate the patient's lungs using bag-mask ventilation and/or is unable to intubate the trachea using direct laryngoscopy. ⋯ A comprehensive difficult airway program was associated with a reduction in the number of emergency surgical airway procedures performed for the inability of an anesthesiologist to intubate and ventilate, a reduction that was sustained over an 11-yr period. This decrease occurred despite an increase in the number of patients reported to have a difficult airway and an overall increase in the total number of patients receiving anesthesia per year.
-
Anesthesia and analgesia · Dec 2009
Comparative StudyA visual stethoscope to detect the position of the tracheal tube.
Advancing a tracheal tube into the bronchus produces unilateral breath sounds. We created a Visual Stethoscope that allows real-time fast Fourier transformation of the sound signal and 3-dimensional (frequency-amplitude-time) color rendering of the results on a personal computer with simultaneous processing of 2 individual sound signals. The aim of this study was to evaluate whether the Visual Stethoscope can detect bronchial intubation in comparison with auscultation. ⋯ During advancement of the tracheal tube, alterations of the shape of the visualized breath sounds using the Visual Stethoscope appeared before the changes of the breath sounds were detected by auscultation. Bilateral breath sounds disappeared when the tip of the tracheal tube was advanced beyond the carina in both groups.
-
Anesthesia and analgesia · Dec 2009
Clinical TrialStroke volume variation during acute normovolemic hemodilution.
The intravascular volume of surgical patients should be optimized to avoid complications associated with both overhydration and underresuscitation. In patients undergoing intraoperative acute normovolemic hemodilution, we investigated whether stroke volume variation (SVV) derived from an arterial pressure-based cardiac output (CO) monitor system (FloTrac/Vigileo, Edwards Lifesciences, Irvine, CA) tracked the changes associated with blood removal and replacement. We further evaluated the correlations between SVV and 3-dimensional (3D) transesophageal echocardiographic (TEE) left ventricular (LV) volume measurements. ⋯ The SVV derived from the FloTrac/Vigileo system changes significantly as blood is removed and replaced during hemodilution. These changes correlate with 3D TEE measurements of LV volume. The utility of SVV in guiding optimization of intravascular volume merits further study.