Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2010
Randomized Controlled Trial Comparative StudyFemoral vein cannulation performed by residents: a comparison between ultrasound-guided and landmark technique in infants and children undergoing cardiac surgery.
Percutaneous cannulation of the femoral vein, in the pediatric age group, can be technically challenging, especially when performed by residents in training. We examined whether the use of real-time ultrasound guidance is superior to a landmark technique for femoral vein catheterization in children undergoing heart surgery. ⋯ Ultrasound-guided cannulation of the femoral vein, in pediatric patients, when performed by senior anesthesia residents, is superior to the landmark technique in terms of speed and number of needle passes, with remarkable improvement in first attempt success.
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Anesthesia and analgesia · Sep 2010
ReviewReview article: the surgical approach to the management of increased intracranial pressure after traumatic brain injury.
Increased intracranial pressure occurring after severe traumatic brain injury is a common and potentially devastating phenomenon. It has been clearly demonstrated that increased intracranial pressure that is refractory to initial medical measures is a poor prognostic sign. Current optimal management is based on a sequential, target-driven approach combining both medical and surgical treatment strategies. ⋯ In this review, we highlight the ongoing debate about the use of decompressive craniectomy to control intracranial pressure after traumatic brain injury; included is a summary of review of the most recent literature on the effect of decompressive craniectomy on increased intracranial pressure after traumatic brain injury and associated long-term outcome. The RESCUEicp and DECRA studies are discussed in detail. It is hoped that these 2 randomized controlled trials, which are evaluating the short- and longer-term outcomes of decompressive craniectomy, will provide conclusive evidence regarding the role of decompressive craniectomy in managing increased intracranial pressure after trauma.
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Anesthesia and analgesia · Sep 2010
Randomized Controlled TrialPresenting research risks and benefits to parents: does format matter?
Several studies suggest that many parents and research participants have poor understanding of the elements of consent, particularly the risks and benefits. However, some data suggest that the format and framing of research risks and benefits may be an important determinant of subject understanding. We examined the effect of tabular and graphical presentation of risks and benefits on parents' understanding of a research study. ⋯ Many parents and patients have difficulty in assimilating and interpreting risk/benefit information for both research and treatment. This is due, in part, to the manner in which risks and benefits are communicated and to the literacy and numeracy abilities of the individual. The results of this study suggest a simple and practical method for enhancing understanding of risk/benefit statistics for parents with varying numeracy and literacy skills.
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Anesthesia and analgesia · Sep 2010
Review Meta AnalysisRecompression and adjunctive therapy for decompression illness: a systematic review of randomized controlled trials.
Decompression illness (DCI) is caused by bubble formation in the blood or tissues after a reduction in ambient pressure. Clinically, DCI may range from a trivial illness to paralysis, loss of consciousness, cardiovascular collapse, and death. Recompression is the universally accepted standard for the treatment of DCI. When recompression is delayed, a number of strategies have been suggested to improve the outcome. We examined the effectiveness and safety of both recompression and adjunctive therapies in the treatment of DCI. ⋯ Recompression therapy is the standard for treatment of DCI, but there is no RCT evidence. The addition of a nonsteroidal antiinflammatory drug (tenoxicam) or the use of heliox may reduce the number of recompressions required, but neither improves the odds of recovery. The application of either of these strategies may be justified. The modest number of patients studied demands a cautious interpretation. Benefits may be largely economic, and an economic analysis should be undertaken. There is a case for large randomized trials of high methodological rigor to define any benefit from the use of different breathing gases and pressure profiles during recompression.
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Anesthesia and analgesia · Sep 2010
Comparative StudyA prospective clinical registry of ultrasound-guided regional anesthesia for ambulatory shoulder surgery.
There is a lack of clinical registries to document efficacy and safety of ultrasound-guided regional anesthesia. Interscalene blocks are effective for shoulder arthroscopy, and ultrasound guidance may reduce risk. Furthermore, ultrasound-guided supraclavicular block is a novel approach for shoulder anesthesia that may have less risk for neurological symptoms than interscalene block. ⋯ Ultrasound-guided interscalene and supraclavicular blocks are effective and safe for shoulder arthroscopy. Temporary and permanent PONS is uncommon.