Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2010
Monitoring with head-mounted displays in general anesthesia: a clinical evaluation in the operating room.
Patient monitors in the operating room are often positioned where it is difficult for the anesthesiologist to see them when performing procedures. Head-mounted displays (HMDs) can help anesthesiologists by superimposing a display of the patient's vital signs over the anesthesiologist's field of view. Simulator studies indicate that by using an HMD, anesthesiologists can spend more time looking at the patient and less at the monitors. We performed a clinical evaluation testing whether this finding would apply in practice. ⋯ An HMD of patient vital signs reduces anesthesiologists' surveillance of the anesthesia workstation and allows them to spend more time monitoring their patient and surgical field during normal anesthesia. More research is needed to determine whether the behavioral changes can lead to improved anesthesiologist performance in the operating room.
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Isovaline, a nonproteinogenic alpha-amino acid rarely found in the biosphere, is structurally similar to the inhibitory neurotransmitters glycine and gamma-aminobutyric acid. Because glycine(A) and gamma-aminobutyric acid receptor agonists are antiallodynic, we hypothesized that isovaline produces antinociception in mice. ⋯ Isovaline reduced responses in mouse pain models without producing acute toxicity, possibly by enhancing receptor modulation of nociceptive information.
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Anesthesia and analgesia · Apr 2010
Use of state discharge abstract data to identify hospitals performing similar types of operative procedures.
A hospital or anesthesia or surgical group that is making decisions to expand its practice benefits from knowledge of the types of surgical procedures performed at other hospitals. ⋯ The similarity index is a robust and valid method for quantitatively comparing the numbers and types of inpatient surgical procedures performed at different hospitals. The similarity index, when combined with CCS categories, is useful for identifying opportunities that enable surgeons and anesthesiologists to better meet the needs of their communities.
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Anesthesia and analgesia · Apr 2010
Randomized Controlled TrialPerioperative pregabalin improves pain and functional outcomes 3 months after lumbar discectomy.
Patient outcome after lumbar discectomy for radicular low back pain is variable and the benefit is inconsistent. Many patients continue to experience pain 3 months after surgery. Pregabalin, a membrane stabilizer, may decrease perioperative central sensitization and subsequent persistent pain. ⋯ Perioperative pregabalin administration is associated with less pain intensity and improved functional outcomes 3 months after lumbar discectomy.
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Anesthesia and analgesia · Apr 2010
Clinical TrialHigh-dose bupivacaine remotely loaded into multivesicular liposomes demonstrates slow drug release without systemic toxic plasma concentrations after subcutaneous administration in humans.
Depot formulations prolong the analgesic effect of local anesthetics and reduce peak plasma drug concentration. This allows for safer administration of larger doses of local anesthetics, which further prolongs the duration of analgesic effect. We previously reported the development of large multivesicular vesicles (LMVVs) remotely loaded with bupivacaine (LMVV liposomal bupivacaine) and demonstrated a >5-fold prolongation of analgesic effect in animals and humans. In this study, we present pharmacokinetic data of LMVV liposomal bupivacaine in humans. ⋯ Peak plasma bupivacaine concentrations were not different in the 2 groups, despite a 4-fold increase in total bupivacaine dose administered in the novel liposomal preparation. The delayed elimination and prolonged redistribution of liposomal bupivacaine to plasma is compatible with the depot-related slow-release effect leading to the prolonged pharmacodynamic effect previously reported.