Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2013
Review Meta AnalysisThe facilitatory effects of intravenous dexmedetomidine on the duration of spinal anesthesia: a systematic review and meta-analysis.
Central mechanisms have been proposed to explain the prolongation of effect reported with the off-label use of dexmedetomidine as an adjuvant in local anesthetic admixtures. We evaluated whether IV dexmedetomidine can prolong the duration of sensory block associated with spinal anesthesia. ⋯ IV dexmedetomidine can prolong the duration of sensory block, motor block, and time to first analgesic request associated with spinal anesthesia.
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Anesthesia and analgesia · Jul 2013
The relationship between fibrinogen levels after cardiopulmonary bypass and large volume red cell transfusion in cardiac surgery: an observational study.
Coagulopathy leading to excessive blood loss and large volume red cell transfusion is a frequent complication of cardiac surgery with cardiopulmonary bypass (CPB) that may be caused by low perioperative fibrinogen levels. We explored the relationship between post-CPB fibrinogen levels and large volume red cell transfusion. ⋯ While this study was not equipped to detect the critical fibrinogen level in bleeding patients, its results suggest that current recommendations that fibrinogen replacement not be initiated in bleeding patients unless fibrinogen levels decrease below 0.8 to 1.0 g/L may be too conservative. Randomized trials are needed to determine whether maintaining higher fibrinogen levels in bleeding patients can reduce blood loss and transfusions and by that means improve clinical outcomes in cardiac surgery.
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Anesthesia and analgesia · Jul 2013
ReviewBrief report: a cost analysis of neuraxial anesthesia to facilitate external cephalic version for breech fetal presentation.
In this study, we sought to determine whether neuraxial anesthesia to facilitate external cephalic version (ECV) increased delivery costs for breech fetal presentation. ⋯ The total cost of delivery in women with breech presentation may be decreased (up to $720) or increased (up to $112) if ECV is attempted/performed with neuraxial anesthesia compared with ECV without neuraxial anesthesia. Increased ECV success with neuraxial anesthesia and the subsequent reduction in breech cesarean delivery rate offset the costs of providing anesthesia to facilitate ECV.
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Anesthesia and analgesia · Jul 2013
Editorial CommentBreaking down silos to protect the spinal cord.