Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2013
Randomized Controlled TrialPostoperative residual neuromuscular blockade is associated with impaired clinical recovery.
In this investigation, we sought to determine the association between objective evidence of residual neuromuscular blockade (train-of-four [TOF] ratio <0.9) and the type, incidence, and severity of subjective symptoms of muscle weakness in the postanesthesia care unit (PACU). ⋯ The incidence and severity of symptoms of muscle weakness were increased in the PACU in patients with a TOF <0.9.
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Anesthesia and analgesia · Jul 2013
Thromboelastometric maximum clot firmness in platelet-free plasma is influenced by the assay used.
Viscoelastic tests such as functional fibrinogen polymerization assays (FFPAs) in thrombelastography (TEG(®)) or thromboelastometry (ROTEM(®)) measure the elasticity of extrinsically activated clotting under conditions of platelet inhibition. There are no reports on whether components of the FFPAs have any effects on fibrin polymerization, aside from the effects of platelet inhibition. ⋯ We speculate that FIBTEM and FIBTEM PLUS may contain stabilizing agents that enhance fibrin polymerization whereas FFTEG might contain less tissue factor than the ROTEM assays.
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Anesthesia and analgesia · Jul 2013
The accuracy, precision and reliability of measuring ventilatory rate and detecting ventilatory pause by rainbow acoustic monitoring and capnometry.
Current methods for monitoring ventilatory rate have limitations including poor accuracy and precision and low patient tolerance. In this study, we evaluated a new acoustic ventilatory rate monitoring technology for accuracy, precision, reliability, and the ability to detect pauses in ventilation, relative to capnometry and a reference method in postsurgical patients. ⋯ In this study of a population of postsurgical patients, the acoustic monitor and capnometer both reliably monitored ventilatory rate. The acoustic monitor was statistically more accurate and more precise than the capnometer, but differences in performance were modest. It is not known whether the observed differences are clinically significant. The acoustic monitor was more sensitive to detecting pauses in ventilation. Acoustic monitoring may provide an effective and convenient means of monitoring ventilatory rate in postsurgical patients.
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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.
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Anesthesia and analgesia · Jul 2013
ReviewReview article: is ultrasound guidance advantageous for interventional pain management? A systematic review of chronic pain outcomes.
Modern ultrasound (US) is an attractive alternative to anatomical landmark-, nerve stimulation-, and fluoroscopic-guided techniques for interventional procedures performed to treat chronic pain syndromes. ⋯ There are presently insufficient data to support improved efficacy with procedures performed with US guidance for relieving both short- and long-term chronic pain.