Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2010
Randomized Controlled Trial Comparative StudyThe impact of Trendelenburg position and positive end-expiratory pressure on the internal jugular cross-sectional area.
Increasing the cross-sectional area (CSA) of the right internal jugular vein facilitates cannulation and decreases complications. Maneuvers such as the Trendelenburg tilt position and ventilation with a positive end-expiratory pressure (PEEP) may increase the CSA of the right internal jugular vein. We determined the changes in the CSA in response to different maneuvers. ⋯ In a comparison of the effectiveness of applying different PEEP levels and/or the Trendelenburg tilt position on the CSA of the right internal jugular vein, the Trendelenburg tilt position was most effective.
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Anesthesia and analgesia · Aug 2010
Effect of the perioperative blood transfusion and blood conservation in cardiac surgery clinical practice guidelines of the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists upon clinical practices.
The 2007 Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists Clinical Practice Guideline for Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery was recently promulgated and has received much attention. Using a survey of cardiac anesthesiologists and perfusionists' clinical practice, we aimed to assess the current practices of perfusion, anesthesia, and surgery, as recommended by the Guidelines, and to also determine the role the Guidelines had in changing these practices. ⋯ Wide variation in clinical practices of cardiac surgery was reported. Little change in clinical practices was attributed to the Society of Thoracic Surgeons/Society of Cardiovascular Anesthesiologists Guidelines.
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Anesthesia and analgesia · Aug 2010
ReviewFocused review: ropivacaine versus bupivacaine for epidural labor analgesia.
Neuraxial analgesia is frequently administered to women in labor. For many years, bupivacaine has been used because of its long duration of action, lack of excessive motor block, and minimal fetal and neonatal effects. However, bupivacaine is one of the most cardiotoxic local anesthetics in current use and motor block is still a problem. ⋯ Ropivacaine, an amide local anesthetic produced in the pure levorotatory form addresses some of the concerns related to bupivacaine. In this article, we present the literature comparing ropivacaine and bupivacaine to determine whether there is an advantage to using one of these local anesthetics for labor analgesia. We found that there is no advantage to the routine use of ropivacaine for labor analgesia.
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Anesthesia and analgesia · Aug 2010
Analysis of operating room allocations to optimize scheduling of specialty rotations for anesthesia trainees.
Because specialty workloads and corresponding operating room (OR) allocations vary among days of the week, anesthesia residents and student nurse anesthetists are sometimes assigned to cases off rotation (e.g., scheduled for cardiac surgery but assigned to urology for the day). We describe a method to create hybrid rotations of two specialties (e.g., cardiac and vascular surgery), thereby reducing the numbers of days that trainees are "pulled" from their scheduled rotations. ⋯ We developed a methodology to determine rotations consisting of combinations of specialties to be paired for purposes of trainee scheduling to reduce the incidence of daily assignments off rotation. Practically, with this method, anesthesia residents and student nurse anesthetists can be assigned cases within their scheduled rotations as often as possible.
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Anesthesia and analgesia · Aug 2010
An ultrasonographic assessment of nerve stimulation-guided median nerve block at the elbow: a local anesthetic spread, nerve size, and clinical efficacy study.
Nerve stimulation is an effective technique for peripheral nerve blockade. However, the local anesthetic (LA) distribution pattern obtained with this blind approach is unknown and may explain its clinical effects. ⋯ Nerve stimulation does not prevent intraneural injection. In the absence of intraneural injection, the presence of circumferential LA spread image seemed predictive of successful sensory block in almost 75% of the cases within the 30-minute evaluation period.