Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2011
Randomized Controlled Trial Comparative Study Clinical TrialA randomized comparison of the use of an optical compared with a rigid laryngoscope on the success rate of novices performing tracheal intubation.
Proficiency in tracheal intubation is a difficult skill to acquire, especially when using a rigid laryngoscope. We compared success in tracheal intubation by novices using an optical laryngoscope with that achieved with a rigid laryngoscope. ⋯ Intubation time was shorter using the optical laryngoscope (35 seconds; 95% confidence interval, 27-44 seconds) compared with the rigid laryngoscope (75 seconds; 95% confidence interval, 59-90 seconds) in successfully intubated patients (P < 0.001). Our study demonstrated greater successful tracheal intubation and reduced intubation time during the first two attempted intubations by novices using an optical compared with a rigid laryngoscope.
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Anesthesia and analgesia · Mar 2011
Case ReportsChallenging lung isolation secondary to aberrant tracheobronchial anatomy.
Aberrant tracheobronchial anatomy is reported at an incidence of approximately 10% and most frequently involves the segmental and subsegmental bronchi. The most relevant abnormality to the practice of anesthesiology is the presence of a tracheal bronchus. Although typically an asymptomatic finding during bronchoscopy, a tracheal bronchus has important implications for airway management and lung isolation. ⋯ We describe a patient with a tracheal bronchus, coexisting with a left-shifted carina and apically retracted left mainstem bronchus, presenting for right extrapleural pneumonectomy. Attempts to place a left-sided double-lumen endotracheal tube were unsuccessful. We discuss our solution, review the literature, and present potential solutions for lung isolation in patients with a tracheal bronchus.
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Anesthesia and analgesia · Mar 2011
Randomized Controlled Trial Comparative Study Clinical TrialThe efficacy and safety of fentanyl buccal tablet compared with immediate-release oxycodone for the management of breakthrough pain in opioid-tolerant patients with chronic pain.
Current clinical guidelines have identified the need for studies comparing the effect of different short-acting or rapid-onset opioids for the treatment of breakthrough pain (BTP). In this study we evaluated the efficacy and safety of treatment with fentanyl buccal tablet (FBT) in comparison with immediate-release oxycodone in alleviating BTP in opioid-tolerant patients with chronic pain. ⋯ FBT resulted in more rapid onset of analgesia and was generally well tolerated in comparison with oxycodone for the treatment of BTP in opioid-tolerant patients.
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Anesthesia and analgesia · Mar 2011
Randomized Controlled Trial Multicenter Study Comparative StudyClosed-loop coadministration of propofol and remifentanil guided by bispectral index: a randomized multicenter study.
We have developed a proportional-integral-derivative controller allowing the closed-loop coadministration of propofol and remifentanil, guided by a Bispectral Index (BIS) monitor, during induction and maintenance of general anesthesia. The controller was compared with manual target-controlled infusion. ⋯ The controller allows the automated delivery of propofol and remifentanil and maintains BIS values in predetermined boundaries during general anesthesia better than manual administration.