Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2011
Hemodynamic perturbations during robot-assisted laparoscopic radical prostatectomy in 45° Trendelenburg position.
Robot-assisted laparoscopic radical prostatectomy has gained widespread use. However, circulatory effects in patients subjected to an extreme Trendelenburg position (45°) are not well characterized. ⋯ Pneumoperitoneum and 45° Trendelenburg position caused 2- to 3-fold increases in filling pressures, without effects on cardiac performance. Filling pressures were normalized immediately after surgery. Lung compliance was halved. Gas exchange was unaffected. No perioperative cardiovascular complications occurred.
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Anesthesia and analgesia · Nov 2011
Does sensory stimulation threshold affect lumbar facet radiofrequency denervation outcomes? A prospective clinical correlational study.
Radiofrequency facet denervation is one of the most frequently performed procedures for chronic low back pain. Although sensory stimulation is generally used as a surrogate measure to denote sufficient proximity of the electrode to the nerve, no study has examined whether stimulation threshold influences outcome. ⋯ There is no significant relationship between mean SST during lumbar facet radiofrequency denervation and treatment outcome, which may be due to differences in general sensory perception. Because stimulation threshold was optimized for each patient, these data cannot be interpreted to suggest that sensory testing should not be performed, or that high sensory stimulation thresholds obtained on the first attempt should be deemed acceptable.
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Anesthesia and analgesia · Nov 2011
Comparative StudySpontaneous breathing improves shunt fraction and oxygenation in comparison with controlled ventilation at a similar amount of lung collapse.
Spontaneous breathing (SB), when allowed during mechanical ventilation (MV), improves oxygenation in different models of acute lung injury. However, it is not known whether oxygenation is improved during mechanically unsupported SB. Therefore, we compared SB without any support with controlled MV at identical tidal volume (VT) and respiratory rate (RR) without positive end-expiratory pressure in a porcine lung collapse model. ⋯ SB without any support improves oxygenation and reduces shunt in comparison with MV at identical settings. This seems to be achieved without any major signs of recruitment of collapsed lung regions.
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Anesthesia and analgesia · Nov 2011
Pleth variability index to predict fluid responsiveness in colorectal surgery.
Goal-directed fluid therapy during major abdominal surgery may reduce postoperative morbidity. The Pleth Variability Index (PVI), derived from the pulse oximeter waveform, has been shown to be able to predict fluid responsiveness in a number of surgical circumstances. In the present study, we sought to determine whether PVI could predict fluid responsiveness in low-risk colorectal surgery patients who had fluid therapy guided by esophageal Doppler stroke volume measurements. ⋯ PVI measured at the finger may be able to predict fluid responsiveness during surgery in ventilated patients.
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Anesthesia and analgesia · Nov 2011
Technical communication: An initial evaluation of a novel anesthetic scavenging interface.
Waste anesthetic gas scavenging technology has not changed appreciably in the past 30 years. Open reservoir systems entrain high volumes of room air and dilute waste gases before emission into the atmosphere. This process requires a large vacuum pump, which is both costly to install and, although efficient, operates continuously and at near-full capacity. ⋯ Using the ventilator increased this flow by approximately 6 L/min because of the exhaust of ventilator drive gas into the scavenging circuit. Daytime workload of the central vacuum pump decreased from 92% to 12% (expressed as duty cycle). The new system produces energy savings and may increase vacuum pump lifespan.