Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2014
Randomized Controlled Trial Comparative StudyModified Short-Axis Out-of-Plane Ultrasound Versus Conventional Long-Axis In-Plane Ultrasound to Guide Radial Artery Cannulation: A Randomized Controlled Trial.
Currently, short-axis out-of-plane (SA-OOP) and long-axis in-plane (LA-IP) ultrasound techniques are used to guide radial artery cannulation. In this study, we compared the success rate of a modified SA-OOP technique with that of traditional LA-IP. ⋯ The modified SA-OOP technique may improve the success rate of cannula insertion into the radial artery on the first attempt.
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Anesthesia and analgesia · Jul 2014
Randomized Controlled TrialCapnography During Deep Sedation with Propofol by Nonanesthesiologists: A Randomized Controlled Trial.
Propofol, a short-acting hypnotic drug, is increasingly administered by a diverse group of specialists (e.g., cardiologists, gastroenterologists) during diagnostic and therapeutic procedures. Standard monitoring during sedation comprises continuous pulse oximetry with visual assessment of the patient's breathing pattern. Because undetected hypoventilation is a common pathway for complications, capnographic monitoring of exhaled carbon dioxide has been advocated. We examined whether the use of capnography reduces the incidence of hypoxemia during nonanesthesiologist-administered propofol sedation in patients who did not receive supplemental oxygen routinely. ⋯ We were unable to confirm an additive role for capnography in preventing hypoxemia during elective nonanesthesiologist-administered propofol (monotherapy) sedation in healthy women in whom supplemental oxygen is not routinely administered. Based on the confidence interval, the benefit of adding capnography is at most an absolute hypoxemia reduction of 7.5%, suggesting that adding it in this practice setting to the routine monitoring strategy does not necessarily improve patient safety in daily practice.
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Anesthesia and analgesia · Jul 2014
Randomized Controlled TrialInfra-Additive Effects of Nefopam and Meperidine on Shivering in Humans Nefopam and Meperidine Are Infra-Additive on the Shivering Threshold in Humans.
Induction of therapeutic hypothermia is often complicated by shivering. Nefopam, a nonsedative benzoxazocine analgesic, reduces the shivering threshold (triggering core temperature) with minimal side effects. Consequently, nefopam is an attractive drug for inducing therapeutic hypothermia. However, nefopam alone is insufficient and thus needs to be combined with another drug. Meperidine also reduces the shivering threshold. We therefore determined whether the combination of nefopam and meperidine is additive, infra-additive, or synergistic on the shivering threshold. ⋯ The combination of nefopam and meperidine should be avoided for induction of therapeutic hypothermia. Better options would be combinations of drugs that are at least additive or even synergistic.
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Anesthesia and analgesia · Jul 2014
Randomized Controlled TrialA Novel Blood-Sparing Agent in Cardiac Surgery? First In-Patient Experience with the Synthetic Serine Protease Inhibitor MDCO-2010: A Phase II, Randomized, Double-Blind, Placebo-Controlled Study in Patients Undergoing Coronary Artery Bypass Grafting with Cardiopulmonary Bypass.
Antifibrinolytics have been used for 2 decades to reduce bleeding in cardiac surgery. MDCO-2010 is a novel, synthetic, serine protease inhibitor. We describe the first experience with this drug in patients. ⋯ This first-in-patient study demonstrated dosage-proportional PK for MDCO-2010 and reduction of chest tube drainage and transfusions in patients undergoing primary coronary artery bypass grafting. Antifibrinolytic and anticoagulant effects were demonstrated using various markers of coagulation. MDCO-2010 was well tolerated and showed an acceptable initial safety profile. Larger multi-institutional studies are warranted to further investigate the safety and efficacy of this compound.