Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2011
Comparative StudyThe utility of pre-residency standardized tests for anesthesiology resident selection: the place of United States Medical Licensing Examination scores.
The resident selection process could be improved if United States Medical Licensing Examination (USMLE) scores obtained during residency application were found to predict success on the American Board of Anesthesiology (ABA) written examination (part 1). In this study, we compared USMLE performance during medical school to anesthesiology residency standardized examination performance. ⋯ The USMLE is a significant predictor of residency ABA/ASA In-Training Examination and ABA written examination performance in anesthesiology. Our program has significantly increased its average written board examination performance while increasing the relative importance of USMLE in resident selection.
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Anesthesia and analgesia · Jan 2011
Randomized Controlled Trial Comparative StudyGabapentin improves postcesarean delivery pain management: a randomized, placebo-controlled trial.
Gabapentin is effective for preventing and treating acute and chronic postoperative pain; however, it has not been described for use in cesarean delivery. We hypothesized that preoperative gabapentin would reduce postcesarean delivery pain. ⋯ Preoperative gabapentin 600 mg in the setting of multimodal analgesia reduces postcesarean delivery pain and increases maternal satisfaction in comparison with placebo.
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Anesthesia and analgesia · Jan 2011
Comparative StudyDetermination of the precision error of the pulmonary artery thermodilution catheter using an in vitro continuous flow test rig.
Thermodilution cardiac output using a pulmonary artery catheter is the reference method against which all new methods of cardiac output measurement are judged. However, thermodilution lacks precision and has a quoted precision error of ± 20%. There is uncertainty about its true precision and this causes difficulty when validating new cardiac output technology. Our aim in this investigation was to determine the current precision error of thermodilution measurements. ⋯ In vitro testing of pulmonary artery catheters enabled us to measure both the random and systematic error components of thermodilution cardiac output measurement, and thus calculate the precision error. Using the Siemens monitor, we established a precision error of ± 15.3% for single and ± 13.0% for triplicate reading, which was similar to the previous estimate of ± 20%. However, this precision error was significantly worsened by using the Sirecust and Philips monitors. Clinicians should recognize that the precision error of thermodilution cardiac output is dependent on the selection of catheter and monitor model.
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Anesthesia and analgesia · Jan 2011
Randomized Controlled Trial Multicenter Study Comparative StudyThe duration of residual neuromuscular block after administration of neostigmine or sugammadex at two visible twitches during train-of-four monitoring.
Adequate recovery from neuromuscular block (NMB) is imperative for the patient to have full control of pharyngeal and respiratory muscles. The train-of-4 (TOF) ratio should return to at least 0.90 to exclude potentially clinically significant postoperative residual block. Fade cannot be detected reliably with a peripheral nerve stimulator (PNS) at a TOF ratio >0.4. The time gap between loss of visual fade by using a PNS until objective TOF ratio has returned to >0.90 can be considered "the potentially unsafe period of recovery." According to our hypothesis the duration of this period would be significantly shorter with sugammadex than with neostigmine. ⋯ There is a significant time gap between visual loss of fade and return of TOF ratio >0.90 after reversal of a rocuronium block by neostigmine. Sugammadex in comparison with neostigmine allows a safer reversal of a moderate NMB when relying on visual evaluation of the TOF response.