Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2010
Comparative StudyAn evaluation of remifentanil-sevoflurane response surface models in patients emerging from anesthesia: model improvement using effect-site sevoflurane concentrations.
We previously reported models that characterized the synergistic interaction between remifentanil and sevoflurane in blunting responses to verbal and painful stimuli. This preliminary study evaluated the ability of these models to predict a return of responsiveness during emergence from anesthesia and a response to tibial pressure when patients required analgesics in the recovery room. We hypothesized that model predictions would be consistent with observed responses. We also hypothesized that under non-steady-state conditions, accounting for the lag time between sevoflurane effect-site concentration (Ce) and end-tidal (ET) concentration would improve predictions. ⋯ Results confirmed, in part, our study hypothesis; accounting for the lag time between Ce and ET sevoflurane concentrations improved model predictions of responsiveness but had no effect on predicting a response to a noxious stimulus in the recovery room. These models may be useful in predicting events of clinical interest but large-scale evaluations with numerous patients are needed to better characterize model performance.
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Anesthesia and analgesia · Aug 2010
Randomized Controlled Trial Comparative StudyAirway scope and Macintosh laryngoscope for tracheal intubation in patients lying on the ground.
Direct laryngoscopy of a patient lying on the ground is difficult because the intubator's head is far above the head of the patient, making alignment of the intubator's visual axis with the patient's tracheal axis difficult. The Airway Scope is a laryngoscope designed to facilitate tracheal intubation without requiring alignment of the oral, pharyngeal, and tracheal axes. We thus tested the hypothesis that intubation with the Airway Scope is faster than with the Macintosh laryngoscope in subjects lying on the ground. ⋯ Both the Airway Scope and the Macintosh laryngoscope offer high success rates in adequately prepared paralyzed patients lying supine at ground level in the hands of a skilled practitioner. However, the Airway Scope facilitated faster tracheal intubation.
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Anesthesia and analgesia · Aug 2010
Randomized Controlled TrialIsocapnic hyperpnoea shortens postanesthetic care unit stay after isoflurane anesthesia.
We conducted a prospective controlled clinical trial of the effect of isocapnic hyperpnoea (IH) on the times-to-recovery milestones in the operating room (OR) and postanesthetic care unit (PACU) after 1.5 to 3 hours of isoflurane anesthesia. ⋯ IH accelerates recovery after 1.5 to 3 hours of isoflurane anesthesia and shortens OR and PACU stay.
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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
Comparative StudyAn assessment of clinical interchangeability of TEG and RoTEM thromboelastographic variables in cardiac surgical patients.
Bedside thromboelastography is increasingly used, but an assessment of the clinical interchangeability of the 2 major systems, TEG (Hemoscope) and RoTEM (Pentapharm), has not been performed. ⋯ The TEG and RoTEM measurements demonstrated a close correlation for the MA, but the alpha did not for the R and K variables. The kaoTEG had the best agreement with the exTEM measurement. Therefore TEG and RoTEM measurements are not completely interchangeable, and the clinical interpretation of thromboelastograhic data should be used with caution.