Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2009
Auditory event-related potentials, bispectral index, and entropy for the discrimination of different levels of sedation in intensive care unit patients.
Sedation protocols, including the use of sedation scales and regular sedation stops, help to reduce the length of mechanical ventilation and intensive care unit stay. Because clinical assessment of depth of sedation is labor-intensive, performed only intermittently, and interferes with sedation and sleep, processed electrophysiological signals from the brain have gained interest as surrogates. We hypothesized that auditory event-related potentials (ERPs), Bispectral Index (BIS), and Entropy can discriminate among clinically relevant sedation levels. ⋯ Neither ERPs nor BIS or Entropy can replace clinical sedation assessment with standard scoring systems. Discrimination among very deep, deep to moderate, and no sedation after general anesthesia can be provided by ERPs and processed electroencephalograms, with similar P(K)s. The high inter- and intraindividual variability of Entropy and BIS precludes defining a target range of values to predict the sedation level in critically ill patients using these parameters. The variability of ERPs is unknown.
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Anesthesia and analgesia · Sep 2009
Case ReportsUltrasound-guided ankle block in stone man disease, fibrodysplasia ossificans progressiva.
In this case report, we describe the successful use of ultrasound-guided regional anesthesia in progressive fibrodysplasia ossificans (stone man disease), a condition commonly regarded as a contraindication for regional anesthesia. A patient with advanced fibrodysplasia ossificans progressiva presented with osteomyelitis of a foot and was scheduled for resection of the infected bones and soft tissue. Ultrasound imaging allowed us to identify the obscured anatomic landmarks for ankle block anesthesia and to restrict the injection of local anesthetics to the epifascial tissue and subcutaneous compartment. With this ankle block, the patient uneventfully underwent surgery without need for additional sedative or analgesic drugs.
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Anesthesia and analgesia · Sep 2009
The success of emergency endotracheal intubation in trauma patients: a 10-year experience at a major adult trauma referral center.
Emergency airway management is a required skill for many anesthesiologists. We studied 10 yr of experience at a Level 1 trauma center to determine the outcomes of tracheal intubation attempts within the first 24 h of admission. ⋯ In the hands of experienced anesthesiologists, rapid sequence intubation followed by direct laryngoscopy is a remarkably effective approach to emergency airway management. An algorithm designed around this approach can achieve very high levels of success.
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Anesthesia and analgesia · Sep 2009
Numbers of simultaneous turnovers calculated from anesthesia or operating room information management system data.
More personnel are needed to turn over operating rooms (ORs) promptly when there are more simultaneous turnovers. Anesthesia and/or OR information management system data can be analyzed statistically to quantify simultaneous turnovers to evaluate whether to add an additional turnover team. ⋯ The number of simultaneous turnovers can be calculated for each 1 min over 1 yr. The reduction in the daily minutes of simultaneous turnovers exceeding the number of teams achieved by the addition of a turnover team can be averaged over the year's 13 4-wk periods to provide insight as to the value (or not) of adding an additional team.
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Anesthesia and analgesia · Sep 2009
Comparative StudyA comparison of dexmedetomidine with propofol for magnetic resonance imaging sleep studies in children.
Magnetic resonance imaging (MRI) sleep studies can be used to guide management of children with obstructive sleep apnea (OSA) refractory to conservative therapy. Because children with OSA are sensitive to the respiratory-depressant effects of sedatives and anesthetics, provision of anesthesia for imaging studies in this patient population can be challenging. Dexmedetomidine has been shown to have pharmacological properties simulating natural sleep with minimal respiratory depression. We hypothesized that, compared with propofol, dexmedetomidine would have less effect on upper airway tone and airway collapsibility, provide more favorable conditions during dynamic MRI airway imaging in children with OSA, have fewer scan interruptions, and require less aggressive airway interventions. ⋯ Dexmedetomidine provided an acceptable level of anesthesia for MRI sleep studies in children with OSA, producing a high yield of interpretable studies of the patient's native airway. The need for artificial airway support during the MRI sleep study was significantly less with dexmedetomidine than with propofol. Dexmedetomidine may be the preferred drug for anesthesia during MRI sleep studies in children with a history of severe OSA and may offer benefits to children with sleep-disordered breathing requiring anesthesia or anesthesia for other diagnostic imaging studies.