Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2011
Comparative StudyIntraoperative thromboelastometry is associated with reduced transfusion prevalence in pediatric cardiac surgery.
The majority of pediatric cardiac surgery patients receive blood transfusions. We hypothesized that the routine use of intraoperative thromboelastometry to guide transfusion decisions would reduce the overall proportion of patients receiving transfusions in pediatric cardiac surgery. ⋯ The results suggest that routine use of intraoperative thromboelastometry in pediatric cardiac surgery to guide transfusions is associated with a reduced proportion of patients receiving transfusions and an altered transfusion pattern.
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Anesthesia and analgesia · Jan 2011
Comparative StudyRemifentanil decreases sevoflurane requirements to block autonomic hyperreflexia during transurethral litholapaxy in patients with high complete spinal cord injury.
An inhaled anesthetic concentration required to block autonomic hyperreflexia (AHR) is high enough to cause severe hypotension in patients with high spinal cord injury (SCI). We determined the effects of remifentanil on the sevoflurane requirement to block AHR in SCI. ⋯ Target-controlled concentrations of 1 and 3 ng/mL remifentanil would reduce the requirement of sevoflurane combined with 50% nitrous oxide to block AHR by 16% and 29%, respectively, in SCI patients undergoing transurethral litholapaxy.
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Anesthesia and analgesia · Jan 2011
Comparative StudyTechnical communication: respiratory variation in pulse pressure and plethysmographic waveforms: intraoperative applicability in a North American academic center.
Dynamic variables are the best predictors of fluid responsiveness in patients under general anesthesia and mechanical ventilation; namely, respiratory variations in pulse pressure and in the plethysmographic waveform. However, these variables have potential limitations. ⋯ We extracted clinical data from all anesthesia procedures performed at our institution in 2009 and identified the number of cases that presented predetermined conditions of application. Among the 12,308 procedures, 39% met the criteria for the noninvasive monitoring of variations in the plethysmographic waveform of which 23% had arterial lines and met the criteria for the invasive monitoring of variations in pulse pressure.
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Anesthesia and analgesia · Jan 2011
Case ReportsCase report: computed tomography scan-guided Gasserian ganglion injection of dexamethasone and lidocaine for the treatment of recalcitrant pain associated with herpes simplex type 1 infection of the ophthalmic division of the trigeminal nerve.
We describe the case of a 17-year-old boy with dermatologic herpes simplex virus-1 outbreaks with incapacitating facial pain requiring multiple hospitalizations. He failed to respond to aggressive treatments including antiviral drugs, opioid analgesics, stellate ganglion, and supraorbital and supratrochlear nerve blocks. ⋯ The patient remained pain free during 6-month follow-up visits. This is the first reported use of Gasserian ganglion block for treatment of herpes simplex virus-1 infection of the trigeminal nerve.
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Anesthesia and analgesia · Jan 2011
Comparative StudyCurrent-distance relationships for peripheral nerve stimulation localization.
Successful peripheral nerve blocks require accurate placement of the injection needle tip before local anesthetic application. In this investigation, we experimentally reconstructed polarity-dependent (anode and cathode) stimulation maps using ex vivo and in vivo animal models. ⋯ Cathodic stimulation may produce conduction block at close tip-to-nerve distances. In contrast, anodic stimulation elicited output characteristics that were predictable and more suitable for nerve localization. We believe anodic stimulation is a viable option at near-nerve distances, despite the increased current requirements. This hypothesis is a paradigm shift in stimulation nerve localization, which conventionally has been cathode based. The hypothesis should be clinically validated.