Anesthesia and analgesia
-
Anesthesia and analgesia · Oct 2011
Randomized Controlled TrialNitrous oxide paradoxically modulates slow electroencephalogram oscillations: implications for anesthesia monitoring.
Anesthesia with nitrous oxide preserves awake features of the EEG leading to inappropriately higher BIS values.
pearl -
Anesthesia and analgesia · Oct 2011
Randomized Controlled Trial Comparative StudyLocal infiltration analgesia versus intrathecal morphine for postoperative pain management after total knee arthroplasty: a randomized controlled trial.
Local infiltration analgesia (LIA)--using a combination of local anesthetics, nonsteroidal anti-inflammatory drugs, and epinephrine, injected periarticularly during surgery-has become popular in postoperative pain management after total knee arthroplasty (TKA). We compared intrathecal morphine with LIA after TKA. ⋯ LIA technique provided better postoperative analgesia and earlier mobilization, resulting in shorter hospital stay, than did intrathecal morphine after TKA.
-
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.
-
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.
-
Anesthesia and analgesia · Oct 2011
ReviewContinuous peripheral nerve blocks: a review of the published evidence.
A continuous peripheral nerve block, also termed "perineural local anesthetic infusion," involves the percutaneous insertion of a catheter adjacent to a peripheral nerve, followed by local anesthetic administration via the catheter, providing anesthesia/analgesia for multiple days or even months. Continuous peripheral nerve blocks may be provided in the hospital setting, but the use of lightweight, portable pumps permits ambulatory infusion as well. This technique's most common application is providing analgesia after surgical procedures. ⋯ Nearly all benefits occur during the infusion itself, but several randomized controlled trials suggest that in some situations there are prolonged benefits after catheter removal as well. Easily rectified minor complications occur somewhat frequently, but major risks including clinically relevant infection and nerve injury are relatively rare. This article is an evidence-based review of the published literature involving continuous peripheral nerve blocks.