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
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
Randomized Controlled TrialDouble-lumen tube placement using a retractable carinal hook: a preliminary report.
Proper placement of a double-lumen tube (DLT) is vital for its optimal functioning. We modified the standard blind method of left-sided DLT placement using a retractable carinal hook. The aim of this study was to determine whether this modified method could improve the success rate of correct initial tube positioning compared with the conventional method. ⋯ The use of a retractable carinal hook increased the success rate and shortens the time for correct DLT positioning. Further, larger studies are required to confirm its safety and reliability.
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Anesthesia and analgesia · Aug 2009
Randomized Controlled TrialFacial nerve electromyographic monitoring to predict movement in patients titrated to a standard anesthetic depth.
Facial nerve (FN) monitoring has been accepted as a standard of care in craniofacial, middle ear, and skull-based surgeries as a means of reducing iatrogenic injury, localizing the FN, and predicting postoperative neurologic function. Past studies have also shown that FN electromyographic monitoring (FNEMG) may have some clinical utility as a monitor of anesthetic depth and predicting patient movement. In this study, we evaluated Bispectral Index (BIS) and FNEMG using two different anesthetic techniques to determine whether these monitors can be used to predict movement in patients undergoing skull-based surgical procedures. ⋯ This study shows that FNEMG may be an effective monitor for predicting patient movement when undergoing craniofacial and skull-based surgeries. BIS monitoring, however, was not an adequate monitor to predict movement in this patient population. The DES group had more hemodynamic variability and FNEMG activity, whereas TIVA proved to be a more effective anesthetic in preventing patient movement when clinically titrated to produce stable operation conditions. FNEMG was a useful clinical tool to help predict and prevent movement in these patients.
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Anesthesia and analgesia · Aug 2009
Randomized Controlled TrialNeostigmine decreases bupivacaine use by patient-controlled epidural analgesia during labor: a randomized controlled study.
Intrathecal neostigmine not only produces analgesia but also severe nausea. In contrast, epidural neostigmine enhances opioid and local anesthetic analgesia without causing nausea. Previous studies examined only single epidural neostigmine bolus administration and did not assess the efficacy of continuous epidural infusion or several aspects of maternal and fetal safety. We therefore tested the hypothesis that epidural neostigmine in combination with bupivacaine by continuous infusion during labor would reduce the amount of bupivacaine required. ⋯ These data show that adding epidural neostigmine 4 microg/mL reduces the hourly bupivacaine requirement by 19%-25% with patient-controlled epidural analgesia during labor. Administered as a bolus and by continuous infusion at the studied doses, epidural neostigmine does not cause nausea and does not induce uterine contractions or FHR abnormalities, but mild sedation can occur.