Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2013
Randomized Controlled Trial Comparative StudyA comparative evaluation of local application of the combination of eutectic mixture of local anesthetics and capsaicin for attenuation of venipuncture pain.
Topical capsaicin and eutectic mixture of local anesthetics (EMLA) have been found to be equally effective in minimizing the pain of venipuncture. After the injection of capsaicin, both tertiary amine local anesthetics and their quaternary ammonium derivatives can elicit a prolonged and predominantly sensory/nociceptor selective block. We hypothesized that the combined application of capsaicin and ELMA will be more effective than their individual effect, and lower concentrations of individual drugs in this mixture may also be associated with reduced side effects. ⋯ We observed that the combination of capsaicin and EMLA in a low concentration is as effective in managing venous cannulation as when applied as an individual drug alone. Larger studies with varying concentration of capsaicin and EMLA are recommended to more fully evaluate the potential advantages.
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Anesthesia and analgesia · Mar 2013
Randomized Controlled TrialDetection of tidal recruitment/overdistension in lung-healthy mechanically ventilated patients under general anesthesia.
The volume-dependent single compartment model (VDSCM) has been applied for identification of overdistension in mechanically ventilated patients with acute lung injury. In this observational study we evaluated the use of the VDSCM to identify tidal recruitment/overdistension induced by tidal volume (Vt) and positive end-expiratory pressure (PEEP) in lung-healthy anesthetized subjects. ⋯ The distension index %E(2), derived from the VDSCM considering flow-dependencies, seems able to identify tidal recruitment/overdistension induced by Vt and PEEP independent of flow waveform in healthy lung-anesthetized patients.
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Anesthesia and analgesia · Mar 2013
Randomized Controlled Trial Comparative StudyA randomized controlled comparison of epidural analgesia and combined spinal-epidural analgesia in a private practice setting: pain scores during first and second stages of labor and at delivery.
There has been no prospective evaluation of combined spinal-epidural (CSE) analgesia in a private practice setting and few studies have focused on pain relief during the second stage of labor and at delivery. In this randomized controlled trial, we compared verbal pain scores during the first and second stages of labor and at delivery in women receiving CSE or traditional epidural analgesia at a busy private maternity hospital. ⋯ Compared with traditional epidural labor analgesia, CSE analgesia provided better first-stage analgesia despite fewer epidural top-up injections by an anesthesiologist.
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Anesthesia and analgesia · Mar 2013
Randomized Controlled Trial Multicenter Study Comparative StudyThe impact of bispectral index versus end-tidal anesthetic concentration-guided anesthesia on time to tracheal extubation in fast-track cardiac surgery.
Bispectral Index (BIS)-guided anesthesia administration has been reported to reduce the time to tracheal extubation. However, no trials have compared the ability of BIS guidance to promote earlier tracheal extubation relative to guidance by end-tidal anesthetic concentration (ETAC). We hypothesized that BIS-guided anesthesia would result in earlier tracheal extubation compared with ETAC-guided anesthesia in fast-track cardiac surgery patients. ⋯ Compared with management based on ETAC, anesthetic management based on BIS guidance does not strongly increase the probability of earlier tracheal extubation in patients undergoing fast-track cardiac surgery. The decision to extubate the trachea is more influenced by patient characteristics and perioperative course than the assignment to BIS or ETAC monitoring.
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Anesthesia and analgesia · Mar 2013
Randomized Controlled Trial Comparative StudyCuff inflation-supplemented laryngoscope-guided nasal intubation: a comparison of three endotracheal tubes.
Softer endotracheal (ET) tubes are more difficult to navigate in the oropharynx than the stiffer polyvinyl chloride (PVC) tubes during nasotracheal intubation (NTI). Cuff inflation has been used to guide PVC tubes into the laryngeal inlet during blind NTI, but it has not been tested when performing NTI under direct laryngoscopic guidance. We assessed the role of cuff inflation in improving oropharyngeal navigation of 3 ET tubes of varying stiffness during direct laryngoscope-guided NTI. Simultaneously, we also assessed and compared the nasotracheal navigability and incidence of nasal injury with these ET tubes during cuff inflation-supplemented, laryngoscope-guided NTI. ⋯ The cuff inflation technique consistently improved the oropharyngeal insertion of the 3 ET tubes of varying stiffness during direct laryngoscope-guided NTI. Supplemented with the cuff inflation technique, the SWR ET tube seems to be better than the PVC and WR ET tubes in terms of complete nasotracheal navigability and less perioperative nasal injury.