Anesthesia and analgesia
-
Anesthesia and analgesia · Feb 2014
Meta AnalysisTransversus abdominis plane block to ameliorate postoperative pain outcomes after laparoscopic surgery: a meta-analysis of randomized controlled trials.
Meta-analysis of 10 RCTs totalling 633 subjects showed that while pain at rest following laparoscopic surgery was reduced by transverse abdominis plane block, early (0-4 h) pain was only moderately reduced (-2.4 cm) and late pain (24 hours) minimally reduced (-1.3 cm). Pain with movement was not significantly different between TAP blocks and controls.
summary -
Anesthesia and analgesia · Feb 2014
Meta AnalysisLow-dose hydrocortisone therapy attenuates septic shock in adult patients but does not reduce 28-day mortality: a meta-analysis of randomized controlled trials.
The role of low-dose hydrocortisone in attenuating septic shock and reducing short-term mortality in adult patients with septic shock is unclear. We conducted a meta-analysis of previous studies to determine whether hydrocortisone could ameliorate the effects of septic shock at 7 and 28 days and reduce 28-day morality. ⋯ Although low-dose hydrocortisone therapy ameliorates septic shock at 7 and 28 days, it does not reduce 28-day mortality.
-
Anesthesia and analgesia · Feb 2014
The impact of sleep apnea on postoperative utilization of resources and adverse outcomes.
Despite the concern that sleep apnea (SA) is associated with increased risk for postoperative complications, a paucity of information is available regarding the effect of this disorder on postoperative complications and resource utilization in the orthopedic population. With an increasing number of surgical patients suffering from SA, this information is important to physicians, patients, policymakers, and administrators alike. ⋯ The presence of SA is a major clinical and economic challenge in the postoperative period. More research is needed to identify SA patients at risk for complications and develop evidence-based practices to aid in the allocation of clinical and economic resources.
-
Anesthesia and analgesia · Feb 2014
Malignant Hyperthermia in Canada: Characteristics of Index Anesthetics in 129 Malignant Hyperthermia Susceptible Probands.
Between 1992 and 2011, 373 Canadian individuals with adverse anesthetic reaction were referred to the Malignant Hyperthermia Unit in Toronto, Ontario, Canada for malignant hyperthermia (MH) diagnostic testing. We analyzed the epidemiologic characteristics of the index adverse anesthetics for those probands who were confirmed to be MH susceptible. ⋯ This is the first Canadian study in 3 decades to report nationwide data on MH epidemiology. Features that differ from earlier reports include a 15.5% incidence of reactions triggered by succinylcholine alone and lower complication rates. In agreement with previously published studies, we confirmed in this independent dataset that increased complication rates were associated with an increased time interval between the first adverse clinical sign and dantrolene treatment. This underscores the need for early diagnosis and rapid dantrolene access and administration in anesthetizing locations using either succinylcholine or volatile anesthetic drugs.
-
Anesthesia and analgesia · Feb 2014
Observational StudyPlatelet Dysfunction as Measured by a Point-of-Care Monitor is an Independent Predictor of High Blood Loss in Cardiac Surgery.
Excessive bleeding carries a heavy burden of illness in cardiac surgery. Although platelet dysfunction is considered to be an important cause, it is not routinely measured. Our objective was to explore the relationship between platelet dysfunction and blood loss in cardiac surgery. ⋯ Platelet dysfunction, as measured by a point-of-care method during rewarming and postprotamine, is independently associated with high blood loss in cardiac surgery. Additional studies are needed to determine whether the incorporation of this assay into blood management algorithms might help rationalize blood transfusion therapy, potentially reducing blood loss and improving clinical outcomes.