Anesthesia and analgesia
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Anesthesia and analgesia · May 2009
Randomized Controlled Trial Comparative StudyA comparison of cervical spine motion during orotracheal intubation with the trachlight(r) or the flexible fiberoptic bronchoscope.
Tracheal intubation of an unstable cervical spine (c-spine) patient with the flexible fiberoptic bronchoscope (FOB) is thought to minimize c-spine movement but may be technically difficult in certain patients. Intubation using a luminous stylet, such as the Trachlight(R) (TL), also produces minimal motion of the c-spine and may be an interesting alternative technique for patients with an unstable c-spine. In this study, we compared the cervical motion caused by the TL and the FOB during intubation. ⋯ In patients under general anesthesia with neuromuscular blockade and manual in-line stabilization, we found no difference in the segmental c-spine motion produced during endotracheal intubation using the FOB and the TL.
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Anesthesia and analgesia · May 2009
Randomized Controlled Trial Comparative StudySurface anatomy as a guide to vertebral level for thoracic epidural placement.
Precise placement of thoracic epidural catheters is required to optimize postoperative analgesia and minimize adverse effects. Previous research demonstrated that anesthesiologists are inaccurate when using surface anatomy to locate vertebral levels. In this study, we compared the accuracy of two different landmarks to identify the seventh thoracic (T7) spinous process. ⋯ For patients with a BMI <25, the T7 spinous process can be reliably identified to within one interspace in 78% of patients using the C7 (vertebra prominens) surface landmark. Neither the vertebra prominens nor the tip of scapula is a reliable landmark to identify T7 in patients with a BMI >or=25.
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Anesthesia and analgesia · May 2009
Randomized Controlled Trial Comparative StudyA prospective randomized comparison of ultrasound and neurostimulation as needle end points for interscalene catheter placement.
In this prospective, randomized study, we tested the hypothesis that interscalene catheters placed for shoulder surgery using an ultrasound needle end point provide postoperative analgesia similar in quality to those placed using a neurostimulation needle end point. Secondary end points included needle time under the skin, procedure-related pain, and the incidence of early neurological complications. ⋯ Interscalene catheters placed for shoulder surgery using an ultrasound needle end point provide postoperative analgesia that is of similar quality to that obtained when using a neurostimulation needle end point. The ultrasound end point was associated with a reduction in needle under the skin time and procedure-related pain.
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Anesthesia and analgesia · May 2009
Randomized Controlled TrialMixed-effects modeling of the influence of midazolam on propofol pharmacokinetics.
The combined administration of anesthetics has been associated with pharmacokinetic interactions that induce concentration changes of up to 30%. Midazolam is often used as a preoperative sedative in advance of a propofol-based anesthetic. In this study, we identified the influence of midazolam on the pharmacokinetics of propofol. ⋯ Midazolam reduces the metabolic and rapid and slow distribution clearances of propofol. In addition, a reduction in mean arterial blood pressure is associated with propofol pharmacokinetic alterations that increase the blood propofol concentration.
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Anesthesia and analgesia · May 2009
Randomized Controlled Trial Multicenter Study Comparative StudyA randomized, double-blind, multicenter trial comparing transdermal scopolamine plus ondansetron to ondansetron alone for the prevention of postoperative nausea and vomiting in the outpatient setting.
Postoperative nausea and vomiting (PONV) are common complications after ambulatory surgery. We sought to determine whether the use of transdermal scopolamine (TDS) in combination with IV ondansetron (OND) is more effective than one alone for reducing PONV in outpatient settings. ⋯ TDS + OND reduces PONV compared with OND alone. This is achieved with a reduction in adverse events.