Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2012
Ventilation of neck breathers undergoing a diagnostic procedure or surgery.
Receiving sedation while undergoing a diagnostic procedure or general anesthesia for surgery is challenging for neck breathers including laryngectomees. Unfortunately, most medical personnel including nurses, medical technicians, surgeons, and anesthesiologists caring for laryngectomees before, during, and after surgery are not familiar with their unique anatomy, how they speak, and how to manage their airways during and after the operation. Methods to improve the care are discussed. Educating medical personnel about these issues can improve the care of neck breathers.
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Anesthesia and analgesia · Jun 2012
Quantification of serum fentanyl concentrations from umbilical cord blood during ex utero intrapartum therapy.
Fetal IM injection of fentanyl is frequently performed during ex utero intrapartum therapy (EXIT procedure). We quantified the concentration of fentanyl in umbilical vein blood. Thirteen samples from 13 subjects were analyzed. ⋯ The dose of fentanyl was 60 μg (45-65 μg). The time between IM administration of fentanyl and collection of the sample was 37 minutes (5-86 minutes). Fentanyl was detected in all of the samples, with a median serum concentration of 14.0 ng/mL (4.3-64.0 ng/mL).
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Anesthesia and analgesia · Jun 2012
The pharmacokinetics of ketorolac after single postoperative intranasal administration in adolescent patients.
Ketorolac tromethamine (ketorolac) administration reduces postoperative opioid requirements. The pharmacokinetic characteristics of intranasal ketorolac tromethamine in children have not been characterized. Our objective of this study was to determine the pharmacokinetics of a single intranasal dose of ketorolac in adolescent patients. ⋯ Administration of ketorolac by the intranasal route resulted in a rapid increase in plasma concentration and may be a useful therapeutic alternative to IV injection in adolescents because plasma concentrations attained with the device are likely to be analgesic (investigational new drug no. 62,829).
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Anesthesia and analgesia · Jun 2012
Joint hypothesis testing and gatekeeping procedures for studies with multiple endpoints.
A claim of superiority of one intervention over another often depends naturally on results from several outcomes of interest. For such studies the common practice of making conclusions about individual outcomes in isolation can be problematic. For example, an intervention might be shown to improve one outcome (e.g., pain score) but worsen another (e.g., opioid consumption), making interpretation difficult. ⋯ We also advocate the more general "gatekeeping" procedures (both serial and parallel), in which primary and secondary hypotheses of interest are a priori organized into ordered sets, and testing does not proceed to the next set, i.e., through the "gate," unless the significance criteria for the previous sets are satisfied, thus protecting the overall type I error. We demonstrate methods using data from a randomized controlled trial assessing the effects of transdermal nicotine on pain and opioids after pelvic gynecological surgery. Joint hypothesis testing and gatekeeping procedures are shown to substantially improve the efficiency and interpretation of randomized and nonrandomized studies having multiple outcomes of interest.
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Anesthesia and analgesia · Jun 2012
Manipulation of hyperbaric lidocaine using a weak magnetic field: a pilot study.
High spinal block is a potentially fatal complication of spinal anesthesia, with an incidence of 0.6 per 1000. Current prevention strategies include decreasing the dose of local anesthetic drug and altering patient positioning such that the location of hyperbaric anesthetic drugs in the neuraxis can be manipulated by gravity. Incorporation of a ferrofluid into a local anesthetic solution, combined with application of an external magnetic field in an in vitro spine model, allowed control of position of a solution of ferrofluid, dye, and local anesthetic against gravity, suggesting an additional mechanism by which anesthesia providers may prevent high spinal block.