Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2011
Randomized Controlled Trial Comparative StudyA comparison of sartorius versus quadriceps stimulation for femoral nerve block: a prospective randomized double-blind controlled trial.
Femoral nerve block is widely used for regional anesthesia and analgesia in many lower limb operations. Peripheral nerve stimulation of the femoral nerve may elicit 1 of 2 responses: contraction of the sartorius muscle through stimulation of its muscular branch or contraction of the quadriceps muscle through stimulation of its respective muscular branches. Historically, a quadriceps response has been preferred. We hypothesized that the success of femoral nerve block using a sartorius muscle evoked motor response is equivalent to that using quadriceps muscle twitch response. This prospective randomized double-blind controlled trial compared sartorius or quadriceps muscle evoked motor response as the end point for stimulation for femoral nerve block. ⋯ Our study demonstrated that using sartorius or quadriceps evoked muscle twitch as an end point of stimulation was associated with an equivalent degree of femoral nerve block.
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Anesthesia and analgesia · Mar 2011
Review Comparative StudyA systematic review of third-generation hydroxyethyl starch (HES 130/0.4) in resuscitation: safety not adequately addressed.
Hydroxyethyl starches (HES) are widely used for intravascular volume therapy in surgical, emergency, and intensive care patients. There are safety concerns with regard to coagulopathy, renal failure, pruritus, tissue storage, and mortality. Third-generation HES 130/0.4 is considered to have an improved risk profile. A common rationale for the use of HES is the belief that 3 to 4 times more crystalloid than colloid volume is needed to achieve similar hemodynamic end points. Our goal was to assess whether published studies on HES 130/0.4 resuscitation are sufficiently well designed to draw conclusions about the safety of this compound. In addition, we wanted to assess crystalloid-to-colloid fluid ratios in studies with goal-directed fluid regimen. ⋯ In summary, the extent of fluid load reduction that can be achieved by HES 130/0.4 is overestimated. Use of older HES solutions may be associated with serious side effects, and clinicians should be aware that there is no convincing evidence that third-generation HES 130/0.4 is safe in surgical, emergency, or intensive care patients despite publication of numerous clinical studies.
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In this focused review, we discuss an algorithm specifically for the unanticipated difficult intubation in obstetrics. This generic algorithm emphasizes a standardized and prespecified sequence of interventions to provide safe, efficient, and effective airway management for the emergency obstetric surgical patient. Individual institutions and anesthesia providers are encouraged to use this framework to select specific pieces of equipment for each step, and to create regular opportunities for all obstetric anesthesia providers to become facile with each airway device and to integrate the algorithm under simulated conditions.
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Anesthesia and analgesia · Mar 2011
Randomized Controlled Trial Comparative StudyA comparison of the classic and a modified laryngeal mask airway (OPLAC™) in adult patients.
A modified disposable laryngeal mask airway (LMA) (Oro-Pharyngo-Laryngeal Airway Cap, OPLAC™) was developed in our department. In this study, we compared the performance of the LMA Classic™ with that of the OPLAC. ⋯ Both devices have comparable airflow resistance and are easy to insert. The OPLAC requires less insertion time, has less variation on insertion time, fits better into the laryngopharynx, is less likely to cause gastric insufflations, and has a higher sealing pressure.
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Anesthesia and analgesia · Mar 2011
Randomized Controlled Trial Comparative StudyForced-air and a novel patient-warming system (vitalHEAT vH2) comparably maintain normothermia during open abdominal surgery.
The vitalHEAT vH(2) (Dynatherm Medical, Inc., Fremont, California) system transfers heat through a single extremity using a combination of conductive heat (circulating warm water within soft fluid pads) with mild vacuum, which improves both vasodilation and contact between the heating element and the skin surface. We tested the hypothesis that core temperatures were not >0.5°C lower in patients warmed with the vitalHEAT system than with forced air. ⋯ The 2 systems thus apparently transfer comparable amounts of heat. Both appear suitable for maintaining normothermia even during large and long operations.