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
Randomized Controlled Trial Comparative StudyA comparison of 4 airway devices on cervical spine alignment in cadaver models of global ligamentous instability at c1-2.
The effects of advanced airway management on cervical spine alignment in patients with upper cervical spine instability are uncertain. ⋯ In cadavers with instability at C1-2, the Lightwand technique produced less motion than the Macintosh and intubating LMA.
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Anesthesia and analgesia · Jul 2013
Randomized Controlled TrialThe relationship of intravenous dextrose administration during emergence from anesthesia to postoperative nausea and vomiting: a randomized controlled trial.
Postoperative nausea and vomiting (PONV) may occur despite antiemetic prophylaxis and is associated with unanticipated hospital admission, financial impact, and patient dissatisfaction. Previous studies have shown variable impact of IV dextrose on PONV. We sought to determine the relationship of IV dextrose administered during emergence from anesthesia to PONV. ⋯ The administration of dextrose during emergence from anesthesia was not associated with a difference in the incidence of PONV exceeding 20% or in the severity of PONV in the first 2 hours after anesthesia. The relationship between PONV and the optimal dose and timing of IV dextrose administration remains unclear and may warrant further study.
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Anesthesia and analgesia · Jul 2013
Randomized Controlled TrialGuided paravertebral blocks with versus without clonidine for women undergoing breast surgery: a prospective double-blinded randomized study.
Paravertebral blocks (PVBs) have been introduced as an alternative to general anesthesia for breast cancer surgeries. The addition of clonidine as an adjuvant in PVBs may enhance quality and duration of analgesia and significantly reduce the consumption of analgesics after breast surgery. In this prospective randomized double-blind study, we assessed the significance of adding clonidine to the anesthetic mixture for women undergoing mastectomy. ⋯ The addition of clonidine enhanced the analgesic efficacy of PVB up to 3 days postoperatively for patients undergoing breast surgery.
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Anesthesia and analgesia · Jul 2013
The impact of video laryngoscopy use during urgent endotracheal intubation in the critically ill.
The video laryngoscope (VL) has been shown to improve laryngoscopic views and first-attempt success rates in elective operating room and simulated tracheal intubations compared with the direct laryngoscope (DL). However, there are limited data on the effectiveness of the VL compared with the DL in urgent endotracheal intubations (UEIs) in the critically ill. We assessed the effectiveness of using a VL as the primary intubating device during UEI in critically ill patients when performed by less experienced operators. ⋯ UEI using a VL as the primary device improved intubation success and decreased complications compared with a DL when PCCM fellows were the primary operators. These data suggest that the VL should be used as the primary device when urgent intubations are performed by less experienced operators.