Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2009
Ultrasound imaging of the lumbar spine in the transverse plane: the correlation between estimated and actual depth to the epidural space in obese parturients.
Prepuncture lumbar ultrasound scanning is a reliable tool to facilitate labor epidural needle placement in nonobese parturients. In this study, we assessed prepuncture lumbar ultrasound scanning as a tool for estimating the depth to the epidural space and determining the optimal insertion point in obese parturients. ⋯ We found a strong correlation between the ultrasound-estimated distance to the epidural space and the actual measured needle distance in obese parturients. We suggest that prepuncture lumbar ultrasound may be a useful guide to facilitate the placement of epidural needles in obese parturients.
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Anesthesia and analgesia · Jun 2009
Randomized Controlled TrialDoes infusion of colloid influence the occurrence of postoperative nausea and vomiting after elective surgery in women?
The impact of the type of fluid on postoperative nausea and vomiting (PONV) is not well defined. In this study we investigated the effects of colloids or crystalloids on PONV when given in addition to a background minimal crystalloid infusion in a female population of surgical patients. ⋯ In surgical procedures with minimal blood loss and minimal fluid shifts, the type of fluid replacement administered (colloid vs 0.9% normal saline) has minimal effect on the incidence of PONV.
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Anesthesia and analgesia · Jun 2009
ReviewPatient-controlled-analgesia analgesimetry and its problems.
In addition to providing pain relief, patient-controlled-analgesia (PCA) is also extensively used in clinical research for the assay of analgesic effectiveness of new drugs and methods of pain treatment. The main outcome measure of PCA analgesimetry is the difference in opioid requirements between the control (placebo) group and the new drug (or treatment) group. The following potential problems of PCA analgesimetry are analyzed: 1) weak correlation between pain intensity and opioid consumption, 2) interference of nonanalgesic effects of opioids, 3) role of acute tolerance to the analgesic effect of opioids, 4) problems of the patient's training, 5) interaction between main outcome measures, and 6) sample size and negative outcome problems. Knowledge of the pitfalls of PCA analgesimetry should decrease the risk of errors in its use.
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Anesthesia and analgesia · Jun 2009
ReviewNew therapeutic agents for diabetes mellitus: implications for anesthetic management.
Multiple hormones and transmitter systems contribute to glucose homeostasis and the control of metabolism. Recently, the gastrointestinal peptide hormones glucagon-like peptide 1 and amylin have been shown to significantly contribute to this complex physiology. These advances provide the foundation for new treatments for diabetes mellitus. ⋯ Rimonabant, the selective endocannabinoid receptor antagonist, had been used in European countries for the treatment of obesity; it has recently been withdrawn for this indication. This drug exhibited therapeutic benefits for metabolic variables and for type 2 diabetes mellitus. Anesthesia providers caring for patients with diabetes mellitus will need to understand the implications of these new therapies in perioperative settings, particularly with respect to side effects and interactions.
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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.