Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2015
Comparative Study Clinical TrialMorphine Glucuronidation and Elimination in Intensive Care Patients: A Comparison with Healthy Volunteers.
Although morphine is used frequently to treat pain in the intensive care unit, its pharmacokinetics has not been adequately quantified in critically ill patients. We evaluated the glucuronidation and elimination clearance of morphine in intensive care patients compared with healthy volunteers based on the morphine and morphine-3-glucuronide (M3G) concentrations. ⋯ Under the assumptions in the model, M3G elimination was significantly decreased in intensive care patients when compared with healthy volunteers, which resulted in substantially increased M3G concentrations. Increased M3G levels were even more pronounced in patients with increased serum creatinine levels. Model-based simulations show that, because of the reduction in morphine clearance in intensive care patients with renal failure, a 33% reduction in the maintenance dose would result in morphine serum concentrations equal to those in healthy volunteers and intensive care patients with normal renal function, although M3G concentrations remain increased. Future pharmacodynamic investigations are needed to identify target concentrations in this population, after which final dosing recommendations can be made.
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Anesthesia and analgesia · Nov 2015
Observational StudyContinuous Spinal Analgesia for Labor and Delivery: An Observational Study with a 23-Gauge Spinal Catheter.
The aim of the study was to assess postdural puncture headache, pain relief, motor blockade, and success rate of conversion to cesarean delivery anesthesia of a 23-gauge spinal catheter (Wiley Spinal®) for labor analgesia. ⋯ The 23-gauge spinal catheter can be used for analgesia for labor. It can also be converted to surgical anesthesia for cesarean deliveries. Further studies are warranted to determine whether the spinal catheter will be a useful addition to the neuraxial techniques available for obstetric anesthesia care.
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Anesthesia and analgesia · Nov 2015
The Impact of Anesthetic Management on Surgical Site Infections in Patients Undergoing Total Knee or Total Hip Arthroplasty.
Surgical site infection (SSI) is one of the most challenging and costly complications associated with total joint arthroplasty. Our primary aim in this case-controlled trial was to compare the risk of SSI within a year of surgery for patients undergoing primary total knee arthroplasty (TKA) or total hip arthroplasty (THA) and revision TKA or THA under general anesthesia versus neuraxial anesthesia. Our secondary aim was to determine which patient, anesthetic, and surgical variables influence the risk of SSI. We hypothesized that patients who undergo neuraxial anesthesia may have a lesser risk of SSI compared with those who had a general anesthetic. ⋯ Recent studies using large databases have concluded that the use of neuraxial compared with general anesthesia is associated with a decreased incidence of SSI in patients undergoing total joint arthroplasty. In this retrospective, case-controlled study, we found no difference in the incidence of SSI in patients undergoing total joint arthroplasty under general versus neuraxial anesthesia. We also concluded that the use of peripheral nerve blocks does not influence the incidence of SSI. Increasing BMI and current smoking were found to significantly increase the incidence of SSI in patients undergoing lower extremity total joint arthroplasty.
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Anesthesia and analgesia · Nov 2015
Health Care Costs and the Perioperative Surgical Home: A Survey Study.
The perceptions of anesthesiologists of US health care finance reform are germane to informing the future of our specialty. For this reason, we sought to assess anesthesiologists' views of their own importance in cost-reduction strategies. In addition, respondents were asked a series of questions related to the Perioperative Surgical Home. ⋯ US anesthesiologists surveyed perceive other stakeholders, such as hospitals and insurance companies, as having a major responsibility in cost reduction. Furthermore, they are not enthusiastic about substantial financial reform such as cuts to Medicare payments.
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Anesthesia and analgesia · Nov 2015
Stridor in Neonates After Using the Microcuff® and Uncuffed Tracheal Tubes: A Retrospective Review.
We conducted a retrospective chart review to determine the frequency of stridor and contributing factors after the use of Microcuff® and uncuffed tracheal tubes (TTs) in neonates. ⋯ The use of the Microcuff TT is associated with increased odds of postextubation stridor in neonates compared with the use of uncuffed TT.