Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2009
Case ReportsUltrasound and neurostimulation-guided axillary brachial plexus block for resection of a hemodialysis fistula aneurysm.
An ASA III patient presenting with a voluminous hemodialysis fistula aneurysm at the elbow was scheduled for its resection. Axillary brachial plexus block was performed under ultrasound and neurostimulation guidance. Despite unexpected nerve positions in relation to pathological vascular anatomy, this combined approach resulted in an adequate block with a low volume of local anesthetic, without obvious vascular puncture or intraneural injection.
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Anesthesia and analgesia · Jun 2009
Comparative StudySame-patient reproducibility of state entropy: a comparison of simultaneous bilateral measurements during general anesthesia.
State Entropy (SE) is an index of anesthetic depth similar to Bispectral Index (BIS). Both indices use a single-channel electroencephalogram, recorded from a unilaterally applied electrode on the forehead, as their input. Intrapatient reproducibility of BIS was questioned in a recent study in which simultaneous measurements from two electrodes applied to the same patient showed conflicting anesthetic depths. Our purpose was to determine whether SE results are similarly reproducible, even though their computation uses a different algorithm than BIS. In this study, we investigated the reproducibility of SE measurements simultaneously obtained from bilaterally applied electrodes in the same patient. ⋯ SE showed a clinically significant degree of disagreement when probes were applied on both sides of the forehead in the same patient. Bland-Altman statistics showed better same-patient reproducibility in SE than did a similar study on BIS. Nevertheless, 4% of the simultaneously measured pairs of SE suggested different anesthetic depths and differed by more than 10 points. Caution is advised when using SE as a clinical index of anesthetic depth.
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Anesthesia and analgesia · Jun 2009
Randomized Controlled Trial Comparative StudyDoes ultrasound guidance improve the success rate of infraclavicular brachial plexus block when compared with nerve stimulation in children with radial club hands?
The classical response to nerve stimulation may be altered in cases of radial club hand. Ultrasound guidance may prove to be a useful tool in such situations. In this study, we compared the success rate of ultrasound-guided infraclavicular brachial plexus block with nerve stimulation for children undergoing radial club hand repair. ⋯ Ultrasound-guided infraclavicular brachial plexus block improves the success rate in patients with radial club hands when compared with nerve stimulation in patients undergoing radial club hand correction.
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Anesthesia and analgesia · Jun 2009
Automatic algorithm for monitoring systolic pressure variation and difference in pulse pressure.
Difference in pulse pressure (dPP) reliably predicts fluid responsiveness in patients. We have developed a respiratory variation (RV) monitoring device (RV monitor), which continuously records both airway pressure and arterial blood pressure (ABP). We compared the RV monitor measurements with manual dPP measurements. ⋯ Measurements of the automated device are comparable with measurements obtained by human observers, who use a computer-assisted method. The importance of the PAW signal is questionable.
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Anesthesia and analgesia · Jun 2009
Endocrine response after severe subarachnoid hemorrhage related to sodium and blood volume regulation.
Hyponatremia is often associated with, and worsens, the prognosis of severe aneurysmal subarachnoid hemorrhage (SAH). Several possible endocrine perturbations of variable severity and variable sodium and water intake have been described in SAH. However, a comprehensive study of the different hormonal systems involved in sodium and water homeostasis and circulating blood volume modifications is still needed. Our aim was to assess water and sodium regulation after severe SAH by investigating blood volume and several hormonal regulatory systems in the context of hyponatremia prevention by controlled sodium intake. ⋯ After severe SAH, in the context of multiple clinical interventions, increased natriuresis and low blood volume are consistent with cerebral salt wasting syndrome, probably related to the sequence of severe SAH, highly increased sympathetic tone, hyperreninemic hypoaldosteronism syndrome, and increased natriuretic peptides release.