Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2011
Comparative StudyThe use of opioids and sedatives and time until death after withdrawing mechanical ventilation and vasoactive drugs in a dutch intensive care unit.
We studied the frequency of withdrawal of mechanical ventilation (MV) and/or vasoactive agents (VAs), the time until death, and dosages of opioids and sedatives in a Dutch academic intensive care unit (ICU), and compared these practices with international observations in this field. ⋯ Dutch patients who die in the ICU, or die after discharge from the ICU, die after MV and/or VAs are withdrawn. When treatments are withdrawn, death follows within 1 hour in most patients, which is a reflection of the severity of illnesses. At least 80% of patients receive opioids, and 67% receive sedatives until death. Fentanyl is the most used opioid, whereas midazolam is the most used sedative. Dosages of opioids and sedatives did not significantly exceed the ranges described as usual in the international literature.
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Anesthesia and analgesia · Mar 2011
Comparative StudyPredicting lumbar plexus depth in children and adolescents.
Lumbar plexus block provides effective analgesia for hip, thigh, and knee surgery. A simple measurement that accurately predicts lumbar plexus depth would be invaluable for clinicians performing this block in children, in whom plexus depth varies with age. ⋯ PSIS-ICL distance provides an accurate, patient-specific predictor for lumbar plexus depth in children over a wide range of age and body habitus. The strong linear relationship obviates the need for complex calculations. This measurement can be used as a guide for ultrasound location, to choose an appropriate needle length, and may reduce complications associated with this block.
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Anesthesia and analgesia · Mar 2011
Comparative StudyThe Veres adapter: clinical experience with a new device for jet ventilation via a laryngeal mask airway during flexible bronchoscopy.
A new device was developed to deliver high-frequency jet ventilation via a laryngeal mask airway (LMA). We investigated its use during flexible fiberoptic bronchoscopy in anesthetized patients. ⋯ We report the clinical use of the Veres adapter in conjunction with an LMA to achieve rapid surgical access and adequate ventilation during flexible bronchoscopy. As an alternative to the use of an endotracheal tube, the new system may better maintain the airway during interventional and diagnostic bronchoscopy because of the larger diameter conduit.
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Anesthesia and analgesia · Mar 2011
Comparative StudyPreoperative endoscopic airway examination (PEAE) provides superior airway information and may reduce the use of unnecessary awake intubation.
Development of a perioperative plan for management of patients with airway pathology is a challenge for the anesthesiologist. Lack of comprehensive information regarding the architecture of airway lesions often leads the clinician to consider techniques of awake intubation (AI) to avoid catastrophic outcomes in this population. In one uncontrolled trial, endoscopic visualization of the airway lesion was included in the preoperative anesthetic assessment for planning of airway management. We sought to determine whether visual inspection of airway pathology would change the anesthesiologist's approach to the management of these patients. ⋯ In 26% of the patients studied, PEAE affected the planned airway management. We believe that PEAE can be an essential component of the preoperative assessment of patients with airway pathology; airway visualization reduces the number of unnecessary AIs while providing superior information about the airway architecture. PEAE could be applied to other populations of patients at risk for airway control failure with the induction of anesthesia.