Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2011
Randomized Controlled Trial Comparative StudyDoes the baricity of bupivacaine influence intrathecal spread in the prolonged sitting position before elective cesarean delivery? A prospective randomized controlled study.
Difficulties in inserting an epidural catheter while performing combined spinal-epidural anesthesia for cesarean delivery may lead to undue delays between the spinal injection of the local anesthetic mixture and the adoption of the supine position with lateral tilt. We hypothesized that this delay may affect the intrathecal distribution of local anesthetic of different baricities such that hypobaric local anesthetic would lead to a higher sensory block level. ⋯ We demonstrated that when parturients undergoing cesarean delivery were maintained in the sitting position for 5 minutes after spinal injection of the local anesthetic, hypobaric bupivacaine resulted in sensory block levels that were higher compared with isobaric and hyperbaric bupivacaine, respectively, during the study period.
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Anesthesia and analgesia · Oct 2011
Review Meta AnalysisA comparison between remifentanil and meperidine for labor analgesia: a systematic review.
Remifentanil is an ultrashort-acting opioid with favorable pharmacokinetic properties that make it suitable as a labor analgesic. Although it crosses the placenta freely, it is eliminated quickly in the neonate by rapid metabolism and redistribution. We aimed to determine whether remifentanil compared with meperidine is effective in reducing pain scores in laboring parturients. Other effects on the mother, the labor process, and the neonate were also examined. ⋯ Compared with meperidine, remifentanil is superior in reducing mean VAS scores for labor pain after 1 hour.
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Anesthesia and analgesia · Oct 2011
Randomized Controlled Trial Multicenter Study Comparative StudyThe impact of anesthesia on glycine absorption in operative hysteroscopy: a randomized controlled trial.
Operative hysteroscopy requires the use of a distension medium and its absorption can lead to serious consequences from intravascular volume overload and water intoxication. We compared the impact of 2 types of anesthesia (general anesthesia and local anesthesia with sedation) on the absorption of glycine solution in operative hysteroscopy. ⋯ Compared with general anesthesia, local anesthesia with sedation is associated with less glycine absorption and should be considered the preferred method of anesthesia for operative hysteroscopy.
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Anesthesia and analgesia · Oct 2011
Randomized Controlled Trial Comparative StudyPropofol in a modified cyclodextrin formulation: first human study of dose-response with emphasis on injection pain.
A new lipid-free preparation of propofol has been developed containing the drug, sulfobutylether ß-cyclodextrin and water. The primary objective of this study was to compare the effects of propofol in the lipid formulation with those of the new cyclodextrin formulation, particularly with regard to pain on injection. We hypothesized that the propofol in cyclodextrin would be associated with less pain on injection than propofol in lipid. ⋯ The propofol in cyclodextrin formulation failed to reduce the pain on injection associated with propofol.
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Anesthesia and analgesia · Oct 2011
Point-of-care electronic prompts: an effective means of increasing compliance, demonstrating quality, and improving outcome.
Incentives based on quality indicators such as the Surgical Care Improvement Project core measures (SCIP 1) encourage implementation of evidence-based guidelines consistently into clinical practice. Information systems with point-of-care electronic prompts (POCEPs) can facilitate adoption of processes and benchmark performance. We evaluated the effectiveness of POCEPs on rates of antibiotic administration within 60 minutes of surgical incision and effect on outcome in a prospective observational trial. ⋯ POCEPs increased compliance with SCIP indicators by >30% and were associated with a 0.4% absolute risk reduction in the incidence of SSI. POCEPs may be useful to modulate provider behavior and demonstrate intraoperative quality and value.