Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2012
Randomized Controlled Trial Comparative StudyPhenylephrine infusion versus bolus regimens during cesarean delivery under spinal anesthesia: a double-blind randomized clinical trial to assess hemodynamic changes.
This small study (N=60) found no significant clinical difference between bolus phenylephrine and phenylephrine infusion when used to maintain maternal blood pressure during caesarean section conducted under spinal anaesthesia.
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Anesthesia and analgesia · Dec 2012
ReviewReview article: update in trauma anesthesiology: perioperative resuscitation management.
The management of trauma patients has matured significantly since a systematic approach to trauma care was introduced nearly a half century ago. The resuscitation continuum emphasizes the effect that initial therapy has on the outcome of the trauma patient. The initiation of this continuum begins with prompt field medical care and efficient transportation to designated trauma centers, where lifesaving procedures are immediately undertaken. ⋯ The concept of "early goal-directed therapy" used in sepsis may be applicable in trauma as well. An early, appropriately aggressive resuscitation with blood products, as well as adjunctive pharmacologic therapy, may attenuate the systemic inflammatory response of trauma. Future investigations will need to determine whether this approach offers a similar survival benefit.
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Anesthesia and analgesia · Dec 2012
Case ReportsCase report: neurological complications associated with epidural analgesia in children: a report of 4 cases of ambiguous etiologies.
The safety and utility of pediatric epidural analgesia is well established, but the risk of permanent neurological injury is unknown and largely must be extrapolated from adult literature. In this article we present a series of 4 cases of longterm or permanent neurologic complications associated with epidural analgesia. Possible mechanisms of injury and implications for practice are discussed.
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Anesthesia and analgesia · Dec 2012
Intraoperative hydroxyethyl starch 70/0.5 is not related to acute kidney injury in surgical patients: retrospective cohort study.
Although high-molecular-weight hydroxyethyl starch (HES) has been reported to cause acute kidney injury (AKI), it is not clear whether low-molecular-weight HES (6% HES 70/0.5) can be a risk for AKI or not. We hypothesized that intraoperative 6% HES 70/0.5 administration is not related to postoperative AKI. ⋯ In this uncontrolled retrospective chart review, intraoperative 6% HES 70/0.5 in a low dose was not related to postoperative AKI in patients with major intraoperative blood loss. Randomized controlled trials are warranted to further evaluate the safety and efficacy of low-molecular-weight HES.
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Anesthesia and analgesia · Dec 2012
Technical communication: anatomy and clinical implications of ultrasound-guided selective femoral nerve block.
In this study we evaluated the anatomic basis and clinical findings of ultrasound-guided femoral nerve block performed close to the distal apex of the femoral triangle. Cadaver studies were conducted in 9 thighs of fresh bodies within 24 hours postmortem. In all cases, during injection of 10 mL of blue dye, the skin proximal to the injection site was compressed to prevent the proximal flow. ⋯ The femoral nerve was successfully dyed in all cases of the cadaver study, whereas the muscular branch to the sartorius muscle and quadriceps muscle, with the exception of the vastus medialis muscle, evaded dyeing. All 20 patients with varus knee deformities reported analgesia; none of them experienced motor block. We conclude that local anesthetic injection at the site where the superficial femoral artery has passed beneath the medial border of the sartorius muscle (8 to 12 cm distal to the inguinal crease), combined with efforts taken to prevent proximal flow may anesthetize the sensation of the anterior-to medial aspect of the knee and motor branch of the vastus medialis muscle, without blocking the sartorius or quadriceps muscles.