Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2013
Review Meta AnalysisSafety of modern starches used during surgery.
Various hydroxyethyl starch (HES) preparations have been used for decades to augment blood volume. There has been concern recently regarding possible adverse outcomes when using HES in the intensive care setting, especially in patients with septic shock. ⋯ Consequently, we assessed the safety of tetrastarches when used during surgery, using a formal search, that yielded 59 primary full publications of studies that met a priori inclusion criteria and randomly allocated 4529 patients with 2139 patients treated with tetrastarch compared with 2390 patients treated with a comparator. There were no indications that the use of tetrastarches during surgery induces adverse renal effects as assessed by change or absolute concentrations of serum creatinine or need for renal replacement therapy (39 trials, 3389 patients), increased blood loss (38 trials, 3280 patients), allogeneic erythrocyte transfusion (20 trials, 2151 patients; odds ratio for HES transfusion 0.73 [95% confidence interval = 0.61-0.87], P = 0.0005), or increased mortality (odds ratio for HES mortality = 0.51 [0.24-1.05], P = 0.079).
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Anesthesia and analgesia · Jan 2013
Randomized Controlled TrialEfficacy of intrathecal baclofen on different pain qualities in complex regional pain syndrome.
Complex regional pain syndrome (CRPS) is characterized by severe debilitating chronic pain. Patients with CRPS may experience various pain sensations, which likely embody different pathophysiologic mechanisms. In this study, we evaluated the differential effects of central γ-aminobutyric acid (B) receptor stimulation on the different pain qualities in CRPS patients with dystonia. ⋯ γ-Aminobutyric acid (B) receptor stimulation by ITB exerts differential antinociceptive effects on specific pain qualities in CRPS patients with dystonia.