Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2009
Review Meta AnalysisEpidural space identification: a meta-analysis of complications after air versus liquid as the medium for loss of resistance.
The best method for identifying the epidural space for neuraxial blocks is controversial. We conducted this meta-analysis to test the hypothesis that loss of resistance with liquid reduces complications with epidural placement. ⋯ Larger studies that overcome limitations of heterogeneity across studies and a relatively infrequent occurrence of complications are required to determine the optimal medium for loss of resistance during epidural block.
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Anesthesia and analgesia · Dec 2009
A new index derived from the cerebrovascular pressure transmission and correlated with consciousness recovery in severely head-injured intensive care patients.
In patients with serious head trauma, a moderate (20-25 mm Hg) mean level of intracranial pressure (ICP) may fail to distinguish patients with a real deteriorated intracranial status from those who are stable or improving. Because of these limitations, we analyzed the ICP curve in search of other relevant information regarding cerebrovascular pressure transmission. We looked for parameters with physiological meaning extracted from spectral analysis of cerebrovascular pressure transmission and correlated with consciousness recovery in patients with severe head injuries. ⋯ Gr/Gc, which characterizes the cerebrovascular transmission, better discriminates bad evolution than high values of ICP or low values of cerebral perfusion pressure in patients with severe head trauma. A reduction in Gr/Gc ratio might be an early alarm signaling worsening intracranial hemodynamic conditions.
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Anesthesia and analgesia · Dec 2009
Randomized Controlled Trial Comparative Study Retracted PublicationCardiopulmonary bypass priming using a high dose of a balanced hydroxyethyl starch versus an albumin-based priming strategy.
The optimal priming solution for cardiopulmonary bypass (CPB) is unclear. In this study, we evaluated the influence of high-volume priming with a modern balanced hydroxyethyl starch (HES) preparation on coagulation, inflammation, and organ function compared with an albumin-based CPB priming regimen. ⋯ High-volume priming of the CPB circuit with a modern balanced HES solution resulted in reduced inflammation, less endothelial damage, and fewer alterations in renal tubular integrity compared with an albumin-based priming. Coagulation including platelet function was better preserved with high-dose balanced HES CPB priming compared with albumin-based CPB priming.
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Anesthesia and analgesia · Dec 2009
Clinical TrialUltrasound-assisted and evoked motor response stimulation of the deep peroneal nerve.
We performed an observational volunteer study to document an ultrasound-guided evoked motor response blockade of the deep peroneal nerve. ⋯ Visualization of the deep peroneal nerve with ultrasound followed by elicitation of an evoked motor response, or paresthesia, predicts successful blockade of the deep peroneal nerve.
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Mask ventilation is the most fundamental skill in airway management. In this review, we summarize the current knowledge about difficult mask ventilation (DMV) situations. Various definitions for DMV have been used in the literature. ⋯ These signs should, therefore, be recognized and documented during the preoperative evaluation. DMV can be even more challenging in infants and children, because they develop hypoxemia much faster than adults. Finally, difficult tracheal intubation is more frequent in patients who experience DMV, and thus, clinicians should be familiar with the corrective measures and management options when faced with a challenging, difficult, or impossible mask ventilation situation.