Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2009
Randomized Controlled Trial Comparative StudyDesflurane versus sevoflurane for maintenance of outpatient anesthesia: the effect on early versus late recovery and perioperative coughing.
There is controversy regarding the relative perioperative benefits of desflurane versus sevoflurane when used for maintenance of anesthesia in the ambulatory setting. Although studies have consistently demonstrated a faster emergence with desflurane (versus sevoflurane), the impact of this difference on the later recovery end points has not been definitively established. Furthermore, the effect of desflurane (versus sevoflurane) on the incidence of coughing is also controversial. ⋯ Use of desflurane for maintenance of anesthesia was associated with a faster emergence and a higher incidence of coughing. Despite the faster initial recovery with desflurane, no significant differences were found between the two volatile anesthetics in the later recovery period. Both volatile anesthetics should be available for ambulatory anesthesia.
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Anesthesia and analgesia · Aug 2009
Evaluating the requirements of electroencephalograph instruction for anesthesiology residents.
During a 1-mo neurosurgical intensive care unit rotation, anesthesiology residents interpret electroencephalograms (EEGs) performed throughout the institution, including intraoperative EEGs. The curriculum goal is to increase familiarity with EEG use and interpretation with 20 EEG interpretations with a clinical neurophysiologist during this rotation. We aimed to determine whether the EEG curriculum goals could be achieved with fewer EEG interpretations. ⋯ This innovative, collaborative approach using the expertise of the clinical neurophysiologist met the curriculum goals after 10 supervised EEG interpretations, as measured by the study assessment tool.
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Anesthesia and analgesia · Aug 2009
Randomized Controlled Trial Comparative StudyA comparison of a single or triple injection technique for ultrasound-guided infraclavicular block: a prospective randomized controlled study.
Good success rates have been reported with ultrasound-guided infraclavicular block using one or multiple injections of local anesthetic. We hypothesized that a separate injection of local anesthetics on each cord enhances the onset of complete sensory block. We designed this prospective randomized study to compare the rate of complete sensory block using one or three injections of local anesthetic. ⋯ The success rate and the onset of complete sensory block after ultrasound-guided infraclavicular block are not enhanced by a triple injection of local anesthetic compared with a single injection posterior to the axillary artery.
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Anesthesia and analgesia · Aug 2009
Review Meta AnalysisThe efficacy of an intraoperative cell saver during cardiac surgery: a meta-analysis of randomized trials.
Cell salvage may be used during cardiac surgery to avoid allogeneic blood transfusion. It has also been claimed to improve patient outcomes by removing debris from shed blood, which may increase the risk of stroke or neurocognitive dysfunction. In this study, we sought to determine the overall safety and efficacy of cell salvage in cardiac surgery by performing a systematic review and meta-analysis of published randomized controlled trials. ⋯ Current evidence suggests that the use of a cell saver reduces exposure to allogeneic blood products or red blood cell transfusion for patients undergoing cardiac surgery. Subanalyses suggest that a cell saver may be beneficial only when it is used for shed blood and/or residual blood or during the entire operative period. Processing cardiotomy suction blood with a cell saver only during cardiopulmonary bypass has no significant effect on blood conservation and increases fresh frozen plasma transfusion.