Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2011
Early childhood exposure to anesthesia and risk of developmental and behavioral disorders in a sibling birth cohort.
In vitro and in vivo studies of anesthetics have demonstrated serious neurotoxic effects on the developing brain. However, the clinical relevance of these findings to children undergoing anesthesia remains unclear. Using data from a sibling birth cohort, we assessed the association between exposure to anesthesia in the setting of surgery in patients younger than 3 years and the risk of developmental and behavioral disorders. ⋯ The risk of being subsequently diagnosed with developmental and behavioral disorders in children who were enrolled in a state Medicaid program and who had surgery when they were younger than 3 years was 60% greater than that of a similar group of siblings who did not undergo surgery. More tightly matched pairwise analyses indicate that the extent to which the excess risk is causally attributable to anesthesia or mediated by unmeasured factors remains to be determined.
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Anesthesia and analgesia · Nov 2011
Randomized Controlled TrialThe addition of lidocaine to bupivacaine does not shorten the duration of spinal anesthesia: a randomized, double-blinded study of patients undergoing knee arthroscopy.
The duration of spinal anesthesia with bupivacaine is often too long for day surgery. A recent study of patients presenting for transurethral surgery suggested that the addition of a small amount of lidocaine to intrathecal hyperbaric bupivacaine could shorten the duration of the sensory and motor blocks. In this prospective, randomized double-blind study we investigated these findings in patients undergoing unilateral knee arthroscopy. ⋯ We did not confirm, in patients undergoing knee arthroscopy, that the addition of a small dose of lidocaine to intrathecal hyperbaric bupivacaine could shorten the duration of sensory or motor blocks or time to readiness for discharge from the postanesthesia care unit.
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Anesthesia and analgesia · Nov 2011
Randomized Controlled Trial Comparative StudyA randomized crossover study to determine the effect of a 30° head-up versus a supine position on the functional residual capacity of term parturients.
Airway management continues to pose challenges to the obstetric anesthesiologist. Functional residual capacity (FRC), which acts as an oxygen reservoir, is reduced from the second trimester onwards and is exacerbated in the supine position. Mechanisms to increase FRC may delay the onset of hypoxemia during periods of apnea. Values for changes in FRC in term parturients in semierect positions are unknown. We hypothesized that the FRC of healthy term parturients would increase significantly in the 30° head-up position in comparison with the supine position. ⋯ We have demonstrated that the FRC of healthy term parturients increases significantly in the 30° head-up position in comparison with supine.
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Anesthesia and analgesia · Nov 2011
Editorial CommentImportant new model for studying anesthetic action.