Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2011
What rules of thumb do clinicians use to decide whether to antagonize nondepolarizing neuromuscular blocking drugs?
In anesthesia practice, inadequate antagonism of neuromuscular blocking drugs (NMBD) may lead to frequent prevalence of residual neuromuscular block that is associated with morbidity and death. In this study we analyzed the clinical decision on antagonizing NMBD to generate hypotheses about barriers to the introduction of experts' recommendations into clinical practice. ⋯ In our institution, the clinical decision to antagonize NMBD is mainly based on the pharmacological forecast and a qualitative judgment of the adequacy of the breathing pattern. Clinicians judge themselves as better skilled at avoiding residual block than they do their colleagues, making them overconfident in their capacity to estimate the duration of action of intermediate-acting NMBD. Awareness of these systematic errors related to clinical intuition may facilitate the adoption of experts' recommendations into clinical practice.
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Anesthesia and analgesia · Nov 2011
Randomized Controlled Trial Comparative StudyA randomized comparison between the Pentax AWS video laryngoscope and the Macintosh laryngoscope in morbidly obese patients.
The Pentax AWS is a novel video laryngoscope designed to facilitate tracheal intubation by providing indirect visualization of the laryngeal inlet. We sought to compare the intubation success rate and time to intubation for the Pentax AWS and the classic Macintosh laryngoscope. Specifically, we tested the hypothesis that intubation with the Pentax AWS would be easier and faster than with a standard Macintosh #4 blade in obese patients. ⋯ The time required for tracheal intubation using the Pentax AWS was longer than for the Macintosh laryngoscope and #4 blade. The AWS should not routinely be substituted for a conventional Macintosh #4 blade in morbidly obese patients.
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Anesthesia and analgesia · Nov 2011
Randomized Controlled Trial Comparative StudyA randomized comparison of intraoperative PerfecTemp and forced-air warming during open abdominal surgery.
The PerfecTemp is an underbody resistive warming system that combines servocontrolled underbody warming with viscoelastic foam pressure relief. Clinical efficacy of the system has yet to be formally evaluated. We therefore tested the hypothesis that intraoperative distal esophageal (core) temperatures with the PerfecTemp (underbody resistive) warming system are noninferior to upper-body forced-air warming in patients undergoing major open abdominal surgery under general anesthesia. ⋯ Mean intraoperative time-weighted average core temperatures were no different, and significantly noninferior, with underbody resistive heating in comparison with upper-body forced-air warming. Underbody resistive heating may be an alternative to forced-air warming.
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Anesthesia and analgesia · Nov 2011
ReviewSpecial article: Future directions in malignant hyperthermia research and patient care.
Malignant hyperthermia (MH) is a complex pharmacogenetic disorder of muscle metabolism. To more closely examine the complexities of MH and other related muscle disorders, the Malignant Hyperthermia Association of the United States (MHAUS) recently sponsored a scientific conference at which an interdisciplinary group of experts gathered to share new information and ideas. In this Special Article, we highlight key concepts and theories presented at the conference along with exciting new trends and challenges in MH research and patient care.
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Anesthesia and analgesia · Nov 2011
Screening of the ryanodine 1 gene for malignant hyperthermia causative mutations by high resolution melt curve analysis.
A diagnosis of malignant hyperthermia (MH) can be determined by performing an in vitro (muscle) contracture test (IVCT) or by identifying a known MH causative mutation in the ryanodine receptor 1 gene (RYR1). Genetic diagnosis has an advantage over IVCT because it is less invasive. Direct sequencing of the very large RYR1 coding region (15.117 bases) is a laborious and expensive task. In this study, we applied the High Resolution Melting (HRM) curve analysis as a tool to screen the entire coding region of the gene. ⋯ HRM curve analysis is a sensitive and cost-effective tool for the identification of nucleotide sequence variants in complex genes such as the RYR1 gene.