Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2014
Randomized Controlled Trial Multicenter Study Comparative StudyA Safety and Efficacy Evaluation of Hemoglobin-Based Oxygen Carrier HBOC-201 in a Randomized, Multicenter Red Blood Cell-Controlled Trial in Noncardiac Surgery Patients.
Small study of data collected more than 15 years ago suggests hemoglobin-based oxygen carrier HBOC-201 may reduce transfusion requirements in a non-cardiac surgery cohort. Although no significant difference in adverse events or mortality, a trend to higher incidence of both among the HBOC-201 group requires a much larger trial to be conducted before any conclusion regarding safety of such a novel therapy can be made.
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Anesthesia and analgesia · Oct 2014
Meta AnalysisWhat Epidural Opioid Results in the Best Analgesia Outcomes and Fewest Side Effects After Surgery?: A Meta-Analysis of Randomized Controlled Trials.
Epidural opioids are widely used for central neuraxial blockade and postoperative analgesia. However, differences in analgesic efficacy and side effect rates among individual opioids remain controversial. ⋯ Analgesic outcome, in terms of VAS pain score, was similar between the epidural opioids studied. These similarities in analgesia may reflect the common practices of concurrently using epidural local anesthetics with the opioids and titrating infusion rates according to a patient's pain status. With respect to side effects, the incidence of PONV and possibly pruritus was higher with morphine compared with fentanyl, despite there being similar total opioid consumption between those groups.
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Anesthesia and analgesia · Oct 2014
Comparative StudyOutcomes After Radical Prostatectomy for Cancer: A Comparison Between General Anesthesia and Epidural Anesthesia with Fentanyl Analgesia: A Matched Cohort Study.
Regional anesthesia and analgesia confers no oncological-outcome benefit compared with general anesthesia for radical prostatectomy.
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Anesthesia and analgesia · Oct 2014
Multicenter StudyThe Safety of Modern Anesthesia for Children with Long QT Syndrome.
Patients with long QT syndrome (LQTS) may experience a clinical spectrum of symptoms, ranging from asymptomatic, through presyncope, syncope, and aborted cardiac arrest, to sudden cardiac death. Arrhythmias in LQTS are often precipitated by autonomic changes. This patient population is believed to be at high risk for perioperative arrhythmia, specifically torsades de pointes (TdP), although this perception is largely based on limited literature that predates current anesthetic drugs and standards of perioperative monitoring. We present the largest multicenter review to date of anesthetic management in children with LQTS. ⋯ With optimized perioperative management, modern anesthesia for incidental surgery in patients with LQTS is safer than anecdotal case report literature might suggest. Our series suggests that the risk of perioperative TdP is concentrated in neonates and infants requiring urgent interventions after failed first-line management of LQTS.
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Anesthesia and analgesia · Oct 2014
Randomized Controlled Trial Multicenter StudyPredictors of Arterial Blood Pressure Control During Deliberate Hypotension with Sodium Nitroprusside in Children.
Sodium nitroprusside (SNP) is used to decrease arterial blood pressure (BP) during certain surgical procedures. There are limited data regarding efficacy of BP control with SNP. There are no data on patient and clinician factors that affect BP control. We evaluated the dose-response relationship of SNP in infants and children undergoing major surgery and performed a quantitative assessment of BP control. ⋯ SNP was effective in reducing BP. However, BP was within the target range less than half of the time. No clinician or patient factors were predictive of BP control, although 2 inverse relationships were identified. These relationships require additional study and may be best coupled with exposure-response modeling to propose improved dosing strategies when using SNP for controlled hypotension in the pediatric population.