Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2013
Randomized Controlled TrialThe effectiveness of a perioperative smoking cessation program: a randomized clinical trial.
Cigarette smoking by surgical patients is associated with increased complications, particularly perioperative respiratory problems and poor wound healing. In this study, we sought to determine whether a pragmatic perioperative smoking cessation intervention designed for a busy preadmission clinic would be successful in reducing smoking rates and intraoperative and immediate postoperative complications. ⋯ One of the objections to widespread use of smoking cessation interventions in the preadmission clinic is that it is too labor-intensive. The results of this study show that a smoking cessation intervention, designed to minimize additional use of physician or nursing time, results in decreased smoking rates on the day of surgery and promotes abstinence 30 days postoperatively.
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Anesthesia and analgesia · Sep 2013
ReviewSpecial article: the endothelial glycocalyx: emerging concepts in pulmonary edema and acute lung injury.
The endothelial glycocalyx is a dynamic layer of macromolecules at the luminal surface of vascular endothelium that is involved in fluid homeostasis and regulation. Its role in vascular permeability and edema formation is emerging but is still not well understood. In this special article, we highlight key concepts of endothelial dysfunction with regards to the glycocalyx and provide new insights into the glycocalyx as a mediator of processes central to the development of pulmonary edema and lung injury.
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Anesthesia and analgesia · Sep 2013
Randomized Controlled TrialThe efficacy of 2 doses of epidural morphine for postcesarean delivery analgesia: a randomized noninferiority trial.
A single dose of epidural morphine is effective in reducing pain after cesarean delivery but is associated with adverse effects. In this study, we sought to establish whether half the traditional dose of epidural morphine, when administered as part of a multimodal analgesia regimen after cesarean delivery, was associated with noninferior analgesia and fewer adverse effects. ⋯ When used as part of a multimodal analgesia regimen, 1.5 mg epidural morphine provided noninferior postcesarean analgesia and caused fewer adverse effects compared with 3 mg epidural morphine.
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Anesthesia and analgesia · Sep 2013
The relationship between neuraxial anesthesia and advanced ovarian cancer-related outcomes in the chilean population.
Mixed evidence has been published relating the use of regional anesthesia during oncologic surgery to a decrease in time to cancer recurrence and improvement in overall survival. We investigated whether the use of epidural anesthesia, in addition to general analgesia during and/or after surgical removal of advanced ovarian cancer, has an impact on time to recurrence and overall survival. ⋯ After PS matching and weighting, we found no benefit in overall survival or time to recurrence in patients with advanced stages (International Federation of Gynecologists and Obstetricians IIIC and IV) of ovarian cancer after the use of EA during and after tumor debulking surgery.
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Anesthesia and analgesia · Sep 2013
Stored platelet functionality is not decreased after warming with a fluid warmer.
Warming of IV-administered fluids and blood products is routinely performed in the operating room to help maintain normothermia. Current guidelines recommend against the warming of platelets (PLTs), although there is no evidence for this prohibition in the literature. Our goal in this pilot study was to determine whether the warming of stored PLTs had any effect on their function. ⋯ Although small in size, the results of this study do not support the prohibition against mechanical PLT warming. Studies of PLT activation after warming are also warranted.