Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2013
Review Meta Analysis Comparative StudyIntermittent epidural bolus compared with continuous epidural infusions for labor analgesia: a systematic review and meta-analysis.
Intermittent epidural bolus when compared with continuous epidural infusion for labour analgesia results in slightly reduced local anaesthetic use and a small improvement in maternal satisfaction. Caesarean section and instrumental delivery rates were not significantly statistically different.
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Anesthesia and analgesia · Jun 2013
The hemodynamic management of 5177 neurosurgical and orthopedic patients who underwent surgery in the sitting or "beach chair" position without incidence of adverse neurologic events.
A small number of highly publicized case reports describe ischemic brain or spinal cord injury after surgery in the sitting ("beach chair") position. The incidence of such catastrophic outcomes remains unknown, as does the relationship between arterial blood pressure management and injury, because few hemodynamic details were included with those 4 cases. To add quantitative data to the discussion of anesthesia in the sitting position, we examined the detailed hemodynamics of a large number of patients managed at our institution who sustained no similar catastrophic outcomes. ⋯ This study provides a descriptive summary of intraoperative blood pressure changes, measured either invasively or noninvasively, and referenced to either head or heart level, but never lower than heart level, in patients under general anesthesia in the sitting position who sustained no catastrophic outcomes.
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Anesthesia and analgesia · Nov 2013
ReviewThe Use of Cognitive Aids During Emergencies in Anesthesia: A Review of the Literature.
Cognitive aids are prompts designed to help users complete a task or series of tasks. They may take the form of posters, flowcharts, checklists, or even mnemonics. It has been suggested that the use of cognitive aids improves performance and patient outcomes during anesthetic emergencies; however, a systematic assessment of the evidence is lacking. ⋯ Cognitive aids should continue to be developed from established clinical guidelines where guidelines exist. They would also benefit from more extensive simulation-based usability testing before use. Further evidence is required to explore the effects of cognitive aids in anesthetic emergencies, how they affect team function, and their design considerations.
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Anesthesia and analgesia · May 2013
Review Meta AnalysisPreventive analgesia by local anesthetics: the reduction of postoperative pain by peripheral nerve blocks and intravenous drugs.
Barreveld et al. show that LA administered either IV or via block; before, during or after surgery, significantly reduces postoperative pain and opioid consumption.
Specifically in:
- Total knee arthroplasty (femoral, sciatic and lumbar plexus b., single-shot or continuous)
- Total hip arthroplasty (continuous lumbar plexus; intra-articular LA)
- Knee arthroscopy (single-shot lumbar plexus; IA LA; single-shot femoral nerve ± sciatic).
- Arthroscopic shoulder surgery - interscalene b., single-shot or continuous. IA is not beneficial.
- Hand & forearm surgery - axillary b. offers analgesic benefits only on day of surgery.
- TAP block is beneficial for laparoscopic, open appendectomy, abdominal surgery, cesarean section, and TAH.
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Anesthesia and analgesia · May 2013
Randomized Controlled Trial Multicenter StudyNitrous oxide and serious morbidity and mortality in the POISE trial.
Nitrous oxide exposure was not associated with 30-day MI, stroke, death or hypotension in an observational analysis of POISE subjects.
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