Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2010
ReviewReview article: glucose measurement in the operating room: more complicated than it seems.
Abnormalities of blood glucose are common in patients undergoing surgery, and in recent years there has been considerable interest in tight control of glucose in the perioperative period. Implementation of any regime of close glycemic control requires more frequent measurement of blood glucose, a function for which small, inexpensive, and rapidly responding point-of-care devices might seem highly suitable. However, what is not well understood by many anesthesiologists and other staff caring for patients in the perioperative period is the lack of accuracy of home glucose meters that were designed for self-monitoring of blood glucose by patients. ⋯ Clinicians who are accustomed to the high level of accuracy of glucose measurement by a central laboratory device or by an automated blood gas analyzer may be unaware of the potential for harmful clinical errors that are caused by the inaccuracy exhibited by many self-monitoring of blood glucose devices, especially in the hypoglycemic range. Knowledge of the limitations of these meters is essential for the perioperative physician to minimize the possibility of a harmful measurement error. In this article, we will highlight these areas of interest and review the indications, technology, accuracy, and regulation of glucose measurement devices used in the perioperative setting.
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Anesthesia and analgesia · Apr 2010
Meta AnalysisCochrane corner: sugammadex, a selective reversal medication for preventing postoperative residual neuromuscular blockade.
Sugammadex is the first selective relaxant binding agent that has been studied for reversal of neuromuscular blockade induced by rocuronium and other steroidal non-depolarizing neuromuscular blocking agents (NMBAs). ⋯ Sugammadex was shown to be effective in reversing rocuronium-induced neuromuscular blockade. This review has found no evidence of a difference in the instance of unwanted effects between sugammadex, placebo or neostigmine. These results need to be confirmed by future trials on larger patient populations and with more focus on patient-related outcomes.
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Anesthesia and analgesia · Apr 2010
The influence of age on sample size calculation in acute pain trials using morphine consumption as an end point.
Many trials in acute postoperative pain use morphine consumption as an end point. Age has been shown to have a significant influence on morphine consumption but is rarely considered in end point analysis. ⋯ The model suggests that variations in age have a profound effect on sample size. Researchers may need to account for this to prevent both type 1 and type 2 error.
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Anesthesia and analgesia · Apr 2010
Randomized Controlled TrialBrief report: improved pain relief using intermittent bupivacaine injections at the donor site after breast reconstruction with deep inferior epigastric perforator flap.
Deep inferior epigastric perforator flap surgery usually results in postoperative pain from the donor site requiring opioids. ⋯ We conclude that intermittent delivery of bupivacaine at the abdominal donor site significantly reduces the postoperative pain and need for narcotic rescue medication.
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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.