Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2011
Early childhood exposure to anesthesia and risk of developmental and behavioral disorders in a sibling birth cohort.
In vitro and in vivo studies of anesthetics have demonstrated serious neurotoxic effects on the developing brain. However, the clinical relevance of these findings to children undergoing anesthesia remains unclear. Using data from a sibling birth cohort, we assessed the association between exposure to anesthesia in the setting of surgery in patients younger than 3 years and the risk of developmental and behavioral disorders. ⋯ The risk of being subsequently diagnosed with developmental and behavioral disorders in children who were enrolled in a state Medicaid program and who had surgery when they were younger than 3 years was 60% greater than that of a similar group of siblings who did not undergo surgery. More tightly matched pairwise analyses indicate that the extent to which the excess risk is causally attributable to anesthesia or mediated by unmeasured factors remains to be determined.
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Anesthesia and analgesia · Nov 2011
Randomized Controlled Trial Comparative StudyA randomized crossover study to determine the effect of a 30° head-up versus a supine position on the functional residual capacity of term parturients.
Airway management continues to pose challenges to the obstetric anesthesiologist. Functional residual capacity (FRC), which acts as an oxygen reservoir, is reduced from the second trimester onwards and is exacerbated in the supine position. Mechanisms to increase FRC may delay the onset of hypoxemia during periods of apnea. Values for changes in FRC in term parturients in semierect positions are unknown. We hypothesized that the FRC of healthy term parturients would increase significantly in the 30° head-up position in comparison with the supine position. ⋯ We have demonstrated that the FRC of healthy term parturients increases significantly in the 30° head-up position in comparison with supine.
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Anesthesia and analgesia · Nov 2011
Comparative StudyA prospective survey of patient-controlled epidural analgesia with bupivacaine and clonidine after total hip replacement: a pre- and postchange comparison with bupivacaine and hydromorphone in 1,000 patients.
Patient-controlled epidural analgesia (PCEA) with bupivacaine and hydromorphone provides high quality analgesia after orthopedic surgery but is associated with a frequent incidence of opioid-related side effects (15%-30%). Epidural clonidine has a different side effect profile, but there are no large surveys documenting its use. We performed this prospective survey to evaluate analgesia and the side effect profile in total hip replacement patients before and after a systematic change from PCEA with bupivacaine/hydromorphone to bupivacaine/clonidine. ⋯ The systematic changeover from epidural hydromorphone to clonidine produced mixed results without obvious superiority. The VPS at rest was reduced only on postoperative day 0; pruritus was reduced, but hypotension was increased. On the basis of medical staff preference, we discontinued the systematic change and returned to our previous standard solution of bupivacaine and hydromorphone for PCEA after total hip replacement.
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Anesthesia and analgesia · Nov 2011
Allergic reactions during anesthesia at a large United States referral center.
The types of agents implicated to trigger intraoperative anaphylactic reactions vary among reports, and there are no recent series from the United States. In this retrospective study, we examined perioperative anaphylactic reactions that occurred at a major tertiary referral academic center. ⋯ Antibiotics were the most common likely causative agent associated with IgE-mediated anaphylactic reactions; however, for 52.6% of reactions, a causative agent could not be determined, suggesting a non-IgE-mediated anaphylactic reaction. The undiagnosed allergic reactions place patients at risk of a subsequent reexposure to the same allergen, or lead to unnecessary avoidance of needed medications.
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Anesthesia and analgesia · Nov 2011
Comparative StudySpontaneous breathing improves shunt fraction and oxygenation in comparison with controlled ventilation at a similar amount of lung collapse.
Spontaneous breathing (SB), when allowed during mechanical ventilation (MV), improves oxygenation in different models of acute lung injury. However, it is not known whether oxygenation is improved during mechanically unsupported SB. Therefore, we compared SB without any support with controlled MV at identical tidal volume (VT) and respiratory rate (RR) without positive end-expiratory pressure in a porcine lung collapse model. ⋯ SB without any support improves oxygenation and reduces shunt in comparison with MV at identical settings. This seems to be achieved without any major signs of recruitment of collapsed lung regions.