Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2011
Randomized Controlled Trial Multicenter Study Comparative StudyA randomized, open-label study of the safety and tolerability of fospropofol for patients requiring intubation and mechanical ventilation in the intensive care unit.
Current drugs for induction and maintenance of sedation in mechanically ventilated patients in the intensive care unit have limitations. Fospropofol, a prodrug of propofol, has not been studied as a sedative in the ICU setting. ⋯ This pilot study suggests that fospropofol, administered in either an infusion/bolus or infusion-only regimen, is tolerable and effective for short-term induction and maintenance of sedation in mechanically ventilated intensive care unit patients.
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Anesthesia and analgesia · Sep 2011
Randomized Controlled Trial Comparative StudyThe temperature and humidity in a low-flow anesthesia workstation with and without a heat and moisture exchanger.
The Dräger Primus anesthesia workstation has a built-in hotplate to heat the patient's exhaled gas. The fresh gas flow is mixed with the heated exhaled gas as they pass through the soda lime canister. A heat and moisture exchanger (HME) may also be used to further heat and humidify the inhaled gas. In this study we measured the temperature and humidity of the inhaled gas coming from the Dräger Primus with or without a HME. ⋯ The Primus anesthesia workstation partially humidifies the inspired gas when a low fresh gas flow is used. Insertion of an HME increases the humidity in inhaled gas, bringing it close to physiological values.
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Anesthesia and analgesia · Sep 2011
Randomized Controlled TrialAn intraoperative small dose of ketamine prevents remifentanil-induced postanesthetic shivering.
Patients undergoing gynecological laparotomy were randomized to receive either 0.5 mg/kg ketamine at induction of anesthesia followed by an infusion of 0.3 mg/kg/h until the end of surgery (ketamine group, n = 32), or an equivalent volume of normal saline (control group, n = 32). Anesthesia was maintained with IV propofol, a fixed infusion rate of remifentanil (0.25 μg/kg/min), and epidural ropivacaine. ⋯ The incidence of PAS was less frequent in the ketamine group (n = 2, 6%) compared with the control group (n = 12, 38%, P = 0.005). We conclude that, during the early recovery phase, intraoperative ketamine reduces remifentanil-induced PAS.
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Anesthesia and analgesia · Sep 2011
Comparative StudyUltrasound assessment of the vertebral level of the intercristal line in pregnancy.
The intercristal line is known to most frequently cross the L4 spinous process or L4-5 interspace; however, it is speculated to be positioned higher during pregnancy because of the exaggerated lumbar lordosis. Clinical estimation of vertebral levels relying on the use of the intercristal line has been shown to often be inaccurate. We hypothesized that the vertebral level of the intercristal line determined by palpation would be higher than the level determined by ultrasound in pregnant women. ⋯ The anatomical position of the intercristal line was at L3 or higher in at least 6% of term pregnant patients using ultrasound. Clinical estimates were found to be ≥1 vertebral level higher than the anatomical position determined by ultrasound at least 40% of the time. This disparity may contribute to misidentification of lumbar interspaces and increased risk of neurologic injury during neuraxial anesthesia.
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Anesthesia and analgesia · Sep 2011
Ultrasound gel-nerve contact: an experimental animal histologic study.
Ultrasound (US) regional nerve block requires the use of gel applied over the skin. With subsequent needle insertion, some of the gel may adhere either on the shaft or within the needle lumen and may be carried to the perineural structures or intraneurally. We performed this experimental animal study to investigate the effects of US gel contact on the nerve histologic structure. ⋯ Histologic features after perineural exposure to US gel are rather nonspecific and likely of no clinical significance. However, further studies are needed to determine the effect of US gel injection on intraneural tissues.