Anesthesia and analgesia
-
Anesthesia and analgesia · Dec 2012
Randomized Controlled Trial Comparative StudyThe postoperative analgesic efficacy of preperitoneal continuous wound infusion compared to epidural continuous infusion with local anesthetics after colorectal cancer surgery: a randomized controlled multicenter study.
Open colorectal cancer (CRC) surgery induces severe and prolonged postoperative pain. The optimal method of postoperative analgesia in CRC surgery has not been established. We evaluated the efficacy of preperitoneal continuous wound infusion (CWI) of ropivacaine for postoperative analgesia after open CRC surgery in a multicenter randomized controlled trial. ⋯ Preperitoneal CWI analgesia with ropivacaine 0.2% continuous infusion at 10 mL/h during 48 hours after open CRC surgery provided effective postoperative pain relief not inferior to CEI analgesia.
-
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.
-
Anesthesia and analgesia · Dec 2012
ReviewReview article: cerebral near-infrared spectroscopy in adults: a work in progress.
Near-infrared spectroscopy (NIRS) has potential as a noninvasive brain monitor across a spectrum of disorders. In the last decade, there has been a rapid expansion of clinical experience using NIRS to monitor cerebral oxygenation, and there is some evidence that NIRS-guided brain protection protocols might lead to a reduction in perioperative neurologic complications after cardiac surgery. ⋯ Although increasingly sophisticated apparatuses, including broadband and time-resolved spectroscopy systems, provide insights into the potential of NIRS to measure regional cerebral oxygenation, hemodynamics, and metabolism in real-time, these innovations have yet to translate into effective monitor-guided brain protection treatment strategies. NIRS has many potential advantages over other neuromonitoring techniques, but further investigation and technological advances are necessary before it can be introduced more widely into clinical practice.
-
Anesthesia and analgesia · Dec 2012
Biography Historical ArticleSpecial Article: Ronald D. Miller: tribute to a past editor-in-chief.
For anesthesiologists around the world who have practiced or trained in the past 4 decades, the name Ronald Miller, MD, has been synonymous with a commitment to excellence that has been evident in all aspects of his remarkable career as a distinguished clinician-scientist, editor, writer, and educator. Dr. Miller's contributions as Editor-in-Chief of Anesthesia & Analgesia (1991-2006) have stimulated this salutation of his career and of his influence on transforming the Journal.
-
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.