Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2009
Randomized Controlled Trial Comparative StudyA randomized comparison of a modified intertendinous and classic posterior approach to popliteal sciatic nerve block.
In this prospective randomized study, we compared a single-injection modified intertendinous (n = 55) with the classic posterior (n = 54) popliteal sciatic nerve block for patients undergoing ankle/foot surgery. ⋯ Potential advantages of the modified intertendinous approach include more rapid onset of anesthesia with an evoked motor response of inversion compared to a classic posterior popliteal sciatic nerve block.
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Anesthesia and analgesia · Jan 2009
Randomized Controlled Trial Comparative StudyA randomized trial of maximum cephalad sensory blockade with single-shot spinal compared with combined spinal-epidural techniques for cesarean delivery.
Previous studies have shown more extensive cephalad sensory blockade in women receiving combined spinal-epidural (CSE) anesthesia compared with single-shot spinal (SSS) anesthesia for elective cesarean delivery. It has been postulated that introduction of the epidural needle during CSE disturbs the negative pressure in the epidural space, resulting in relatively greater cerebrospinal fluid (CSF) pressure and increased spread of intrathecal local anesthetic. We tested the hypothesis that CSE results in more extensive cephalad sensory blockade than SSS anesthesia and that loss-of-resistance during initiation of CSE anesthesia increases CSF pressure compared with SSS. ⋯ The SSS and CSE techniques inserted in the lateral decubitus position resulted in similar extent of sensory blockade and CSF pressure. These findings suggest that altering the intrathecal dose is not necessary and that any difference in intrathecal pressure associated with initial placement of an epidural needle in the epidural space during CSE anesthesia is clinically inconsequential.
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Anesthesia and analgesia · Jan 2009
Randomized Controlled Trial Comparative StudyAirway scope and StyletScope for tracheal intubation in a simulated difficult airway.
Direct laryngoscopy is difficult when the cervical spine is immobilized. The Airway Scope and StyletScope are new laryngoscopes designed to facilitate intubation under these circumstances. Thus, in patients wearing a rigid cervical collar to simulate a difficult airway, we tested the hypothesis that the intubation success rates of the Airway Scope and StyletScope are similar, but that intubation with Airway Scope is faster. ⋯ Both the Airway Scope and StyletScope offer high success rates in a simulated difficult airway achieved by a rigid collar. However, the Airway Scope is faster and less likely to cause esophageal intubation.
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Anesthesia and analgesia · Jan 2009
Propofol and isoflurane enhancement of tonic gamma-aminobutyric acid type a current in cardiac vagal neurons in the nucleus ambiguus.
General anesthesia with propofol and isoflurane induces alterations of the cardiovascular system, including hypotension and changes in heart rate. The preganglionic cardiac vagal neurons (CVNs) are one of the major central components controlling heart rate and autonomic regulation. In this study, we examined whether propofol and isoflurane act on phasic or tonic gamma-aminobutyric acid type A (GABA(A)) receptor-mediated inhibition in CVNs. ⋯ The results demonstrate that the general anesthetics propofol and isoflurane enhance both phasic and tonic GABA(A) receptor-mediated inhibition of CVNs.
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Anesthesia and analgesia · Jan 2009
An evaluation of the epidural catheter position by epidural nerve stimulation in conjunction with continuous epidural analgesia in adult surgical patients.
The epidural stimulation test to confirm epidural catheter position has been described as being simple, fast, and reliable. We evaluated the feasibility of the epidural stimulation test and its potential in contributing to effective postoperative continuous epidural analgesia. ⋯ The epidural stimulation test was often associated with technical difficulties and interpretation problems. The role of the repeated use of the epidural stimulation test for quality assurance in patients undergoing postoperative continuous epidural analgesia remains undetermined.