Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2009
Randomized Controlled Trial Comparative StudyThe safety of modern hydroxyethyl starch in living donor liver transplantation: a comparison with human albumin.
Intravascular volume replacement therapy is an important issue in the perioperative management of liver transplantation. There is paucity of data on the safety of hydroxyethyl starch (HES) in patients undergoing liver transplantation. We evaluated the safety of a new HES 130/0.4 in the perioperative management of liver transplantation, with a special emphasis on renal function. ⋯ The use of HES 130/0.4 as an alternative to human albumin resulted in equivalent renal outcome after liver transplantation.
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Anesthesia and analgesia · Sep 2009
Randomized Controlled TrialShould dosing of rocuronium in obese patients be based on ideal or corrected body weight?
Pharmacokinetic studies in obese patients suggest that dosing of rocuronium should be based on ideal body weight (IBW). This may, however, result in a prolonged onset time or compromised conditions for tracheal intubation. In this study, we compared onset time, conditions for tracheal intubation, and duration of action in obese patients when the intubation dose of rocuronium was based on three different weight corrections. ⋯ In obese patients undergoing gastric banding or gastric bypass, rocuronium dosed according to IBW provided a shorter duration of action without a significantly prolonged onset time or compromised conditions for tracheal intubation.
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Approximately 25% of initial arteriovenous fistula (AVF) placements will fail as a result of thrombosis or failure to develop adequate vessel size and blood flow. Fistula maturation is impacted by patient characteristics and surgical technique, but both increased vein diameter and high fistula blood flow rates are the most important predictors of successful AVFs. Anesthetic techniques used in vascular access surgery (monitored anesthesia care, regional blocks, and general anesthesia) may affect these characteristics and fistula failure. ⋯ Use of regional blocks may improve the success of vascular access procedures by producing significant vasodilatation, greater fistula blood flow, sympathectomy-like effects, and decreased maturation time. However, a large-scale, prospective, clinical trial comparing the different anesthetic techniques is still needed to verify these findings.
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Anesthesia and analgesia · Sep 2009
Randomized Controlled TrialA Macintosh laryngoscope blade for videolaryngoscopy reduces stylet use in patients with normal airways.
Although most tracheal intubations with direct laryngoscopy are not performed with a styletted endotracheal tube, it is recommended that a stylet can be used with indirect videolaryngoscopy. Recently, there were several reports of complications associated with styletted endotracheal tubes and videolaryngoscopy. In this study, we compared three videolaryngoscopes (VLSs) in patients undergoing tracheal intubation for elective surgery: the GlideScope Ranger (GlideScope, Bothell, WA), the V-MAC Storz Berci DCI (Karl Storz, Tuttlingen, Germany), and the McGrath (McGrath series 5, Aircraft medical, Edinburgh, UK) and tested whether it is feasible to intubate the trachea of patients with indirect videolaryngoscopy without using a stylet. ⋯ The trachea of a large proportion of patients with normal airways can be intubated successfully with certain VLS blades without using a stylet, although the three studied VLSs clearly differ in outcome. The Storz VLS displaces soft tissues in the fashion of a classic Macintosh scope, affording room for tracheal tube insertion and limiting the need for stylet use compared with the other two scopes. Although VLSs offer several advantages, including better visualization of the glottic entrance and intubation conditions, a good laryngeal view does not guarantee easy or successful tracheal tube insertion. We recommend that the geometry of VLSs, including blade design, should be studied in more detail.