Anesthesia and analgesia
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Although obstetric patients are generally healthy, population risk is increasing because of increases in maternal age, obesity, and rates of multifetal pregnancies, and complications may occur in the immediate postoperative period. In this study, we sought to identify the current level of recovery care for obstetric patients in North American academic institutions after either general or major neuraxial anesthesia for cesarean delivery. ⋯ Guidelines put forth by the American Society of Anesthesiologists Task Force on Postanesthetic Care and the American Society of PeriAnesthesia Nurses apply to all postoperative patients regardless of their recovery locations. Results from this survey suggest that the level of care provided for postanesthesia recovery from cesarean delivery in North American academic institutions may not meet these guidelines.
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Anesthesia and analgesia · Jun 2009
The efficacy of the Storz Miller 1 video laryngoscope in a simulated infant difficult intubation.
Several studies have shown video laryngoscopy to be a useful technique in the management of patients in whom glottic exposure by direct laryngoscopy is difficult. We conducted this study as a preliminary investigation comparing the Storz DCI Miller 1 video laryngoscope (VL, Karl Storz GmbH, Tuttlingen, Germany) and direct laryngoscopy with a Miller 1 laryngoscope (DL) in an infant manikin model simulating difficult direct laryngoscopy. We hypothesized that compared with DL, VL would provide a better glottic view but would be associated with a longer time to intubation because of the different skill set required when using video intubation. ⋯ The Storz Miller 1 VL blade improved glottic exposure in a simulated difficult laryngoscopy compared with direct laryngoscopy with a standard Miller 1 blade without increasing the time to intubation.
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A 56-yr-old woman with chronic hepatitis B and decompensated hepatic cirrhosis was treated with liver transplantation. At the beginning of the neohepatic phase, her arterial blood pressure remained at 60/40 mm Hg for approximately 40 min and did not respond to vasoconstrictive drugs. ⋯ This patient was diagnosed with vasoplegic syndrome and was treated with i.v. infusion of methylene blue (0.5 mg/kg) and norepinephrine. This report has potential significance to treatment in patients who undergo orthotopic liver transplantation.
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Anesthesia and analgesia · Jun 2009
Randomized Controlled TrialEpidural ropivacaine concentrations for intraoperative analgesia during major upper abdominal surgery: a prospective, randomized, double-blinded, placebo-controlled study.
The postoperative beneficial effects of thoracic epidural analgesia (TEA) within various clinical pathways are well documented. However, intraoperative data are lacking on the effect of different epidurally administered concentrations of local anesthetics on inhaled anesthetic, fluid and vasopressor requirement, and hemodynamic changes. We performed this study among patients undergoing major upper abdominal surgery under combined TEA and general anesthesia. ⋯ Epidural administration of 0.5% ropivacaine leads to a more pronounced sparing effect on desflurane concentration for an adequate anesthetic depth when compared with a 0.2% concentration of ropivacaine at comparable levels of vasopressor support and i.v. fluid requirement.
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Anesthesia and analgesia · Jun 2009
Randomized Controlled TrialLidocaine patch for postoperative analgesia after radical retropubic prostatectomy.
In a prospective, double-blind, placebo-controlled study, patients undergoing radical retropubic prostatectomy under general anesthesia were randomly assigned to receive a lidocaine patch or placebo applied on each side of the wound at the end of surgery. Data were collected for 24 h after surgery. ⋯ Demographics and postoperative morphine consumption were not different between the groups. However, the lidocaine patch group reported significantly less pain on coughing (19%-33% reduction) over all time periods (treatment vs placebo P < 0.0001, time x treatment P = 0.3056) and at rest (17%-32% reduction) for up to 6 h (treatment vs placebo P = 0.0003, time x treatment P = 0.0130).