Anesthesia and analgesia
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Anesthesia and analgesia · May 2013
Case ReportsCase report: Three-dimensional high-resolution ultrasound-guided nerve blocks: a new panoramic vision of local anesthetic spread and perineural catheter tip location.
We report in 3 patients that high-frequency ultrasound 3-dimensional imaging enabled us to analyze anatomic variations, evaluate local anesthetic spread, and optimize a perineural catheter location by withdrawing it until its tip was appropriately positioned. This innovative technology may provide answers to different problems facing the operator performing ultrasound-guided nerve blocks. It may enhance predictability and safety aspects of peripheral nerve blocks.
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Anesthesia and analgesia · May 2013
The impact of postoperative nausea and vomiting prophylaxis with dexamethasone on postoperative wound complications in patients undergoing laparotomy for endometrial cancer.
Dexamethasone is widely used for postoperative nausea and vomiting (PONV) prophylaxis. However, there are limited data on the risk of wound complications associated with single-dose dexamethasone use for this purpose. We performed this retrospective study to determine whether intraoperative dexamethasone for PONV prevention increases the risk or severity of postoperative wound complications. ⋯ Intraoperative dexamethasone for PONV prophylaxis does not seem to increase the rate or severity of postoperative wound complications in women undergoing laparotomy for endometrial cancer. BMI and smoking were significant predictors of wound complications in this patient population.
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Anesthesia and analgesia · May 2013
The impact of hypothermia on emergence from isoflurane anesthesia in orexin neuron-ablated mice.
Orexin neurons regulate the sleep/wake cycle and are proposed to influence general anesthesia. In animal experiments, orexin neurons have been shown to drive emergence from general anesthesia. In human studies, however, the role of orexin neurons remains controversial, owing at least, in part, to the fact that orexin neurons are multifunctional. Orexin neurons regulate not only the sleep/wake cycle, but also body temperature. We hypothesized that orexin neurons do not directly regulate emergence from anesthesia, but instead affect emergence indirectly through thermoregulation because anesthesia-induced hypothermia can greatly influence emergence time. To test our hypothesis, we used simultaneous measurement of body temperature and locomotor activity. ⋯ The effect of orexin deficiency to impair thermoregulation during general anesthesia is of sufficient magnitude that body temperature must be appropriately controlled when studying the role of orexin neurons in emergence from anesthesia.
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Anesthesia and analgesia · May 2013
Review Comparative StudyEstimating surgical case durations and making comparisons among facilities: identifying facilities with lower anesthesia professional fees.
Consumer-driven health care relies on transparency in cost estimates for surgery, including anesthesia professional fees. Using systematic narrative review, we show that providing anesthesia costs requires that each facility (anesthesia group) estimate statistics, reasonably the mean and the 90% upper prediction limit of case durations by procedure. The prediction limits need to be calculated, for many procedures, using Bayesian methods based on the log-normal distribution. ⋯ Such comparisons of durations among facilities should be performed with correction for the effects of the multiple comparisons. Our review also has direct implications to the potentially more important issue of how to study the association between anesthetic durations and patient morbidity and mortality. When pooling duration data among facilities, both the large heterogeneity in the means and coefficients of variation of durations among facilities need to be considered (e.g., using "multilevel" or "hierarchical" models).