Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2012
Randomized Controlled TrialDetection of dehydration by using volume kinetics.
Patients admitted to surgery may be dehydrated, which is difficult to diagnose except when it is severe (>5% Gl116 of the body weight). We hypothesized that modest dehydration can be detected by kinetic analysis of the blood hemoglobin concentration after a bolus infusion of crystalloid fluid. ⋯ Dehydration amounting to 2% of the body weight could be detected from the elimination clearance and the half-life of an infusion of 5 mL/kg Ringer's solution.
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Anesthesia and analgesia · Oct 2012
Randomized Controlled TrialIntravenous sodium bicarbonate verifies intravenous position of catheters in ventilated children.
Vascular access in children carries a significant risk of accidental extravasation of IV fluids and medications with the potential for tissue injury. In this prospective controlled study we assessed the diagnostic utility of using IV diluted sodium bicarbonate to confirm placement of IV catheters in ventilated children. Diluted sodium bicarbonate was created using undiluted standard 8.4% (1 mEq/mL) sodium bicarbonate mixed in a 1:3 and 1:5 ratio with sterile water to achieve a final diluted concentration of 2.1% (0. 25 mEq/mL) and 1.05% (0.125 mEq/mL) sodium bicarbonate, respectively. ⋯ The injection of 2.1% sodium bicarbonate in mechanically ventilated ASA I-II children identified intravascular placement and patency of an IV catheter by an increase in the exhaled CO(2) concentration. The injections did not have any clinically significant effects on blood pH, bicarbonate, or sodium concentration.
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Anesthesia and analgesia · Oct 2012
ReviewFresh whole blood use for hemorrhagic shock: preserving benefit while avoiding complications.
Transfusion support of patients with hemorrhagic shock has changed over time with the development of storage and processing methods. Transfusion medicine developed during World War I with the use of whole blood, and now in the developed world, component therapy predominates. In contrast, there is still clinical use of fresh whole blood (FWB) in the developing world, in a minority of children's hospitals, and in combat settings. ⋯ It is important to recognize that current processing and storage methods for components have also not been adequately explored to determine whether they affect clinical outcomes. In this article, we review potential benefits and risks of FWB use for patients with hemorrhagic shock from any cause, and how current and future processing and storage methods may affect efficacy and safety of FWB in this population. We intend this review to stimulate hypothesis generation and clinical investigation in determining when FWB may be indicated and how to optimally process and store FWB to maximize its risk-benefit ratio.
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Obese parturients present obstetric anesthesia providers with multiple challenges, including increased incidence of maternal coexisting disease, labor complications, and potential for difficult initiation and failure of neuraxial labor analgesia. This focused review discusses these challenges, and suggests potential methods to increase labor analgesia success in this population.
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Anesthesia and analgesia · Oct 2012
Randomized Controlled TrialLateral injection using a Whitacre needle with patients in the lateral decubitus position maintained for a prolonged time period produces symmetric sensory block.
The directional flow of injection through a Whitacre needle can be used to modify the level of sensory blockade. We hypothesized that injection of hyperbaric local anesthetic through a Whitacre needle with the bevel oriented laterally can produce a more symmetric sensory block. ⋯ Injection of 10 mg of 0.5% hyperbaric bupivacaine with the bevel of the Whitacre needle oriented laterally produces more symmetric sensory levels of blockade between the dependent and nondependent sides.