Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2010
Clinical TrialPrepuncture ultrasound imaging to predict transverse process and lumbar plexus depth for psoas compartment block and perineural catheter insertion: a prospective, observational study.
All widely used psoas compartment block/catheter techniques have a common limitation: external landmarks do not accurately predict lumbar plexus depth, leaving practitioners to "guess" at what depth to stop advancing the placement needle when neither transverse process nor lumbar plexus is intercepted. We assessed the accuracy of ultrasound in estimating transverse process depth before needle insertion and prediction of actual needle-to-plexus intercept depth for psoas compartment nerve blocks and perineural catheter insertion. ⋯ For psoas compartment blocks/catheters, prepuncture ultrasound imaging accurately predicts transverse process depth to within 1 cm, and if the lumbar plexus is estimated to be within 3 cm of the transverse process, ultrasound allows prediction of maximal lumbar plexus depth to within 1 cm.
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Anesthesia and analgesia · Jun 2010
Review Meta AnalysisShould in-line filters be used in peripheral intravenous catheters to prevent infusion-related phlebitis? A systematic review of randomized controlled trials.
In this systematic review, we assessed the effect of in-line filters on infusion-related phlebitis associated with peripheral IV catheters. The study was designed as a systematic review and meta-analysis of randomized controlled trials. We used MEDLINE and the Cochrane Controlled Trial Register up to August 10, 2009. ⋯ In-line filters in peripheral IV catheters cannot be recommended routinely, because evidence of their benefit is uncertain.
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Anesthesia and analgesia · Jun 2010
Randomized Controlled TrialPerioperative glucose and insulin administration while maintaining normoglycemia (GIN therapy) in patients undergoing major liver resection.
Although hyperglycemia is a well-recognized risk factor in the context of cardiac surgery, the relevance of perioperative glycemic control for patients undergoing major noncardiac operations has received little attention. We designed this study to assess the hyperglycemic response to liver resection, and to test the hypothesis that perioperative glucose and insulin administration while maintaining normoglycemia (GIN therapy) provides glycemic control superior to that achieved by the conventional use of insulin. ⋯ GIN therapy effectively provides normoglycemia in patients undergoing liver resection (clinicaltrials.gov, NCT00774098).
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Anesthesia and analgesia · Jun 2010
Electroencephalographic seizures after neonatal cardiac surgery with high-flow cardiopulmonary bypass.
Postoperative electroencephalographic (EEG) seizures are reported to occur in 14% to 20% of neonates after cardiac surgery with cardiopulmonary bypass (CPB). EEG seizures are associated with prolonged deep hypothermic circulatory arrest and with adverse long-term neurodevelopmental outcomes. We performed video/EEG monitoring before and for 72 hours after neonatal cardiac surgery, using a high-flow CPB protocol and cerebral oxygenation monitoring, to ascertain incidence, severity, and factors associated with EEG seizures. ⋯ EEG seizures are infrequent in neonates undergoing surgery with high-flow CPB. Cerebral desaturation did not affect EEG seizure occurrence; however, benzodiazepines may play a role in suppressing postoperative seizures caused by cerebral hypoxemia in this patient population. Using this anesthetic and surgical protocol, EEG seizures are a poor surrogate marker for acute neurological injury in this population.
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Anesthesia and analgesia · Jun 2010
Brief reports: nerve stimulator evoked motor response predicting a successful supraclavicular brachial plexus block.
We examined the success rate of supraclavicular brachial plexus block after the different evoked motor responses to nerve stimulation. ⋯ Simultaneous flexion of the third and fourth digits with or without other digits is associated with the highest success rate of supraclavicular brachial plexus block.