Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2015
Randomized Controlled TrialDexmedetomidine as a Rapid Bolus for Treatment and Prophylactic Prevention of Emergence Agitation in Anesthetized Children.
Administration of dexmedetomidine (DEX) in the pediatric population for its sedative, analgesic, and anxiolytic properties has been widely reported, despite there being no label indication approved by the U.S. Food and Drug Administration for pediatric patients. Infusions of DEX, rather than bolus administration, are recommended to attenuate the hemodynamic response caused by the α2-adrenoreceptor agonist. In this prospective, double-blind, randomized study, we examined the effect of rapid IV bolus injection of DEX on emergence agitation and the hemodynamic response in a large sample of children undergoing tonsillectomy with or without adenoidectomy, with or without myringotomy, and/or tympanostomy tube insertion. ⋯ Rapid IV bolus administration of DEX in children improved their recovery profile by reducing the incidence of EA. A statistically significant change in hemodynamics was observed, but no patients required any intervention for hemodynamic changes. Furthermore, DEX reduced the incidence of postoperative opioid administration, and a trend of fewer adverse events was observed in group DEX.
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Anesthesia and analgesia · Nov 2015
Randomized Controlled TrialNitrous Oxide for the Treatment of Chronic Low Back Pain.
Neuropathic back pain is mediated, at least partially, by N-methyl-D-aspartate (NMDA) receptors. Nitrous oxide (N2O) is an NMDA receptor antagonist. We therefore tested the primary hypothesis that patients receiving N2O have lower pain scores after epidural steroid injection than patients not receiving N2O. ⋯ N2O administration did not improve pain or psychological or physical aspects of health-related quality of life. N2O does not appear to be an effective treatment for chronic neuropathic back pain.
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Anesthesia and analgesia · Nov 2015
Randomized Controlled TrialThe Effect of Low-Dose Dexmedetomidine as an Adjuvant to Levobupivacaine in Patients Undergoing Vitreoretinal Surgery Under Sub-Tenon's Block Anesthesia.
This study evaluated the motor and sensory block durations and the postoperative analgesic effects of adding dexmedetomidine to levobupivacaine for sub-Tenon's block anesthesia in patients undergoing vitreoretinal surgery. Motor and sensory block durations were considered as a primary end point. ⋯ For patients undergoing vitreoretinal surgery, adding 20 μg of dexmedetomidine to levobupivacaine for sub-Tenon's block anesthesia in vitreoretinal surgery extended the motor and sensory block durations and provided more effective postoperative analgesia with improvement in the sleep quality in the first postoperative night compared with levobupivacaine alone.
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Anesthesia and analgesia · Nov 2015
Multicenter Study Observational StudyIntraoperative Lung-Protective Ventilation Trends and Practice Patterns: A Report from the Multicenter Perioperative Outcomes Group.
The use of an intraoperative lung-protective ventilation strategy through tidal volume (TV) size reduction and positive end-expiratory pressure (PEEP) has been increasingly investigated. In this article, we describe the current intraoperative lung-protective ventilation practice patterns and trends. ⋯ Although decreasing, a significant percentage of patients are ventilated with TV > 10 mL/kg PBW, especially if they are female, obese, or of short stature. The use of PEEP ≥ 5 cm H2O has increased significantly. Creating awareness of contemporary practice patterns and demonstrating the efficacy of lung-protective ventilation are still needed to optimize intraoperative ventilation.