Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2010
Positive intravascular test dose criteria in children during total intravenous anesthesia with propofol and remifentanil are different than during inhaled anesthesia.
The use of local anesthetic test doses is standard practice when performing regional anesthesia. When an intravascular test dose is administered during inhaled anesthesia, the heart rate does not increase in about 25% of children; altered T-wave amplitude is a better indicator. No studies have examined the criteria for a positive result during total i.v. anesthesia (TIVA) in children. ⋯ A positive test dose during TIVA is best detected by increased arterial blood pressure. Twenty-seven percent of intravascular injections were missed using heart rate criteria. T-wave amplitude is not a reliable indicator of intravascular injection during TIVA. This is in marked distinction to what is seen during inhaled anesthesia.
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Anesthesia and analgesia · Jan 2010
Clinical TrialThe use of the Behavioral Pain Scale to assess pain in conscious sedated patients.
Assessing pain in mechanically ventilated critically ill patients is a great challenge. There is a need for an adequate pain measurement tool for use in conscious sedated patients because of their questionable communicative abilities. In this study, we evaluated the use of the Behavioral Pain Scale (BPS) in conscious sedated patients in comparison with its use in deeply sedated patients, for whom the BPS was developed. Additionally, in conscious sedated patients, the combination of the BPS and the patient-rated Verbal Rating Scale (VRS-4) was evaluated. ⋯ The BPS is a valid tool for measuring pain in conscious sedated patients during painful procedures. Thus, for noncommunicative and mechanically ventilated patients, it may be regarded as a bridge between the observational scale used by nurses and the VRS-4 used by patients who are able to self-report pain.
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Anesthesia and analgesia · Jan 2010
Pressures available for transtracheal jet ventilation from anesthesia machines and wall-mounted oxygen flowmeters.
Oxygen supplies capable of supporting transtracheal jet ventilators can be lifesaving. There is not much information about which oxygen sources (readily available inside and outside operating rooms) have sufficient driving pressure for transtracheal jet ventilation. ⋯ Oxygen sources other than dedicated jet ventilator connectors to high-pressure pipeline oxygen may supply adequate working pressure, but each type of oxygen source needs testing to ensure that it supplies adequate working pressure.
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Anesthesia and analgesia · Jan 2010
The first scintigraphic detection of tumor necrosis factor-alpha in patients with complex regional pain syndrome type 1.
Tumor necrosis factor (TNF)-alpha has been identified as a pathogenic factor in many immunologically based diseases and complex regional pain syndrome (CRPS). In this case series, we used radiolabeled technetium anti-TNF-alpha antibody to scintigraphically image TNF-alpha in 3 patients with type 1 CRPS. ⋯ No uptake was seen in clinically unaffected hands and late-stage CRPS. Our findings support the growing evidence for neuroimmune disturbance in patients with CRPS and may have important further implications for specific anticytokine treatment in patients with CRPS.
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Anesthesia and analgesia · Jan 2010
Transient changes in brain tissue oxygen in response to modifications of cerebral perfusion pressure: an observational study.
The relative merits of the mechanisms for the maintenance of brain tissue oxygenation (PbtO(2)) have been much debated. There is a wealth of studies regarding various factors that may determine the absolute value and changes in PbtO(2). However, only a few of them analyzed fast (few minutes) and transient behavior of PbtO(2) in response to variations (waves) of intracranial pressure (ICP) and cerebral perfusion pressure (CPP). ⋯ PbtO(2) is more than a number; it is rather a waveform following rapid changes in ICP and ABP. We show that PbtO(2) generally tracks the direction of CPP irrespective of the state of cerebral autoregulation.