Anesthesia and analgesia
-
Anesthesia and analgesia · Apr 2010
Review Meta AnalysisCombining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain.
There has been a trend over recent years for combining a nonsteroidal antiinflammatory drug (NSAID) with paracetamol (acetaminophen) for pain management. However, therapeutic superiority of the combination of paracetamol and an NSAID over either drug alone remains controversial. We evaluated the efficacy of the combination of paracetamol and an NSAID versus either drug alone in various acute pain models. ⋯ Current evidence suggests that a combination of paracetamol and an NSAID may offer superior analgesia compared with either drug alone.
-
Anesthesia and analgesia · Apr 2010
An anesthetic management protocol to decrease respiratory complications after adenotonsillectomy in children with severe sleep apnea.
A high incidence of respiratory morbidity after adenotonsillectomy is reported in children with obstructive sleep apnea syndrome (OSAS). In an effort to decrease this morbidity, we implemented perioperative guidelines recommending an adjustment in the administration of opioids, dexamethasone, and atropine in children with OSAS who demonstrated recurrent episodes of profound hypoxemia during the perioperative sleep study. ⋯ A change in practice that included a dexamethasone administration and a reduction in opioid administration to children with profound recurrent hypoxia reduced the incidence of MMI(Respiratory) by >50%.
-
Anesthesia and analgesia · Apr 2010
In normal controls, both age and gender affect coagulability as measured by thrombelastography.
Our objective was to analyze the effects of age, gender, and the use of oral contraceptives (OCs) on coagulation using thrombelastography (TEG), a single test to analyze both plasma coagulation factors and cellular elements in whole blood. ⋯ Aging, female gender, use of OCs, and low-normal hematocrit levels have significant procoagulant effects. TEG measurements in native and recalcified citrated blood are not interchangeable, as indicated by differences between the 2 measurements ranging from 20% in maximal amplitude to 246% in clotting time. Furthermore, the limits of agreement strongly exceeded clinical acceptability to conclude interchangeability.
-
Anesthesia and analgesia · Apr 2010
Prospective trial of thoracic and spine surgeons' updating of their estimated case durations at the start of cases.
Surgeon estimates of case durations are important for operating room (OR) management decision making because many cases are rare combinations of procedures with few or no historical data. Thoracic and spine surgeons updated their scheduled OR times on the day of surgery just before the "time out" in the OR. ⋯ A systematic program of routinely and/or always asking for updated case duration predictions will not substantively improve OR management decision making. However, when a change in surgical approach, surgical procedure, or anesthetic procedure is identified (e.g., at the intraoperative briefing before case start), the updated estimate of case duration should be used, because such updates are not worse and often better than original estimates.