Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2010
Randomized Controlled Trial Comparative StudyIpsilateral transversus abdominis plane block provides effective analgesia after appendectomy in children: a randomized controlled trial.
The transversus abdominis plane (TAP) block provides effective postoperative analgesia in adults undergoing major abdominal surgery. Its efficacy in children remains unclear, with no randomized clinical trials in this population. In this study, we evaluated its analgesic efficacy over the first 48 postoperative hours after appendectomy performed through an open abdominal incision, in a randomized, controlled, double-blind clinical trial. ⋯ Unilateral TAP block, as a component of a multimodal analgesic regimen, provided superior analgesia compared with placebo in the first 48 postoperative hours after appendectomy in children.
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Anesthesia and analgesia · Oct 2010
Randomized Controlled Trial Comparative StudyThe influence of time of day of administration on duration of opioid labor analgesia.
Medications administered into the epidural or intrathecal space for labor analgesia may demonstrate variable effects dependent on time of day, and this may affect clinical research trials investigating the pharmacology of specific drugs. In this retrospective study, we evaluated the effect of time of day of administration of intrathecal fentanyl and systemic hydromorphone labor analgesia from data collected as part of a randomized clinical trial examining the influence of analgesia method on labor outcome. ⋯ Time of day of administration did not seem to influence combined spinal-epidural or systemic labor analgesia duration under these study conditions.
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Anesthesia and analgesia · Oct 2010
Comparative StudyRobot-assisted airway support: a simulated case.
Recent advances in telemedicine and robotically assisted telesurgery may offer advanced surgical care for the geographically remote patient. Similar advances in tele-anesthesia will be necessary to optimize perioperative care for these patients. ⋯ Both oral and nasal approaches to fiberoptic intubation were successful, but presented unique opportunities and challenges inherent to the robot's design. Robotically assisted airway management is feasible using multipurpose surgical robotic systems.
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Anesthesia and analgesia · Oct 2010
Comparative StudyPitfalls in chronobiology: a suggested analysis using intrathecal bupivacaine analgesia as an example.
The duration of analgesia from epidural administration of local anesthetics to parturients has been shown to follow a rhythmic pattern according to the time of drug administration. We studied whether there was a similar pattern after intrathecal administration of bupivacaine in parturients. In the course of the analysis, we came to believe that some data points coincident with provider shift changes were influenced by nonbiological, health care system factors, thus incorrectly suggesting a periodic signal in duration of labor analgesia. We developed graphical and analytical tools to help assess the influence of individual points on the chronobiological analysis. ⋯ Chronobiology includes the influence of external daily rhythms in the environment (e.g., nursing shifts) as well as human biological rhythms. We were able to distinguish the influence of an external rhythm by combining several novel analyses: (1) graphical presentation superimposing the raw data, external rhythms (e.g., nursing and anesthesia provider shifts), and smoothing functions; (2) graphical display of the contribution of each data point to the statistical significance; and (3) bootstrap analysis to identify whether the statistical significance was highly dependent on a data subset. These approaches suggested that 2 data points were likely artifacts of the change in nursing and anesthesia shifts. When these points were removed, there was no suggestion of biological rhythm in the duration of intrathecal bupivacaine analgesia.
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Anesthesia and analgesia · Oct 2010
Comment Letter Case ReportsAnatomic snuffbox radial artery cannulation.