Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2012
Review Meta AnalysisFluid resuscitation with 6% hydroxyethyl starch (130/0.4) in acutely ill patients: an updated systematic review and meta-analysis.
Recent research suggests that 6% hydroxyethyl starch (HES) 130/0.4 is one of the most frequently used resuscitation fluids worldwide. The retraction of studies evaluating its use necessitates a reevaluation of available evidence regarding its safety and efficacy. ⋯ Published studies are of poor quality and report too few events to reliably estimate the benefits or risks of administering 6% HES 130/0.4. This same conclusion is reached with or without the retracted studies. Given the widespread use of 6% HES 130/0.4, high-quality trials reporting a large number of events are urgently required.
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Anesthesia and analgesia · Jan 2012
Randomized Controlled Trial Comparative StudyTracheal intubation through the I-gel™ supraglottic airway versus the LMA Fastrach™: a randomized controlled trial.
The i-gel™ is a supraglottic airway device not requiring inflation of a cuff for lung ventilation. Its design allows for unobstructed passage of a tracheal tube and previous studies have demonstrated a favorable alignment with the glottic inlet. In this prospective randomized study, we compared the success rate of blind tracheal intubation using the i-gel and the laryngeal mask airway (LMA) Fastrach™. ⋯ On first attempts, successful blind tracheal intubation was obtained at comparable rates using the i-gel and the LMA Fastrach. However, when the first attempt was unsuccessful, subsequent attempts through the i-gel did not significantly increase tracheal intubation success rate. The LMA Fastrach yielded a higher overall intubation success rate.
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Anesthesia and analgesia · Jan 2012
ReviewReview article: closed-loop systems in anesthesia: is there a potential for closed-loop fluid management and hemodynamic optimization?
Closed-loop (automated) controllers are encountered in all aspects of modern life in applications ranging from air-conditioning to spaceflight. Although these systems are virtually ubiquitous, they are infrequently used in anesthesiology because of the complexity of physiologic systems and the difficulty in obtaining reliable and valid feedback data from the patient. Despite these challenges, closed-loop systems are being increasingly studied and improved for medical use. ⋯ First, the further description and development of dynamic predictors of fluid responsiveness provides a strong parameter for use as a control variable to guide fluid administration. Second, rapid advances in noninvasive monitoring of cardiac output and other hemodynamic variables make goal-directed therapy applicable for a wide range of patients in a variety of clinical care settings. In this article, we review the history of closed-loop controllers in clinical care, discuss the current understanding and limitations of the dynamic predictors of fluid responsiveness, and examine how these variables might be incorporated into a closed-loop fluid administration system.
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Anesthesia and analgesia · Jan 2012
Randomized Controlled Trial Comparative StudyBrief reports: a comparison of an injection cephalad or caudad to the division of the sciatic nerve for ultrasound-guided popliteal block: a prospective randomized study.
The optimal site for local anesthetic injection during ultrasound-guided sciatic popliteal block remains controversial. ⋯ The caudad technique provided better surgical anesthesia.