Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2015
Randomized Controlled Trial Comparative StudyA Comparative Evaluation of Nebulized Dexmedetomidine, Nebulized Ketamine, and Their Combination as Premedication for Outpatient Pediatric Dental Surgery.
Nebulized ketamine with dexmedetomidine is suitable and effective for pediatric premedication before outpatient dental surgery.
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Anesthesia and analgesia · Jul 2015
Difficult Airway Response Team: A Novel Quality Improvement Program for Managing Hospital-Wide Airway Emergencies.
Difficult airway cases can quickly become emergencies, increasing the risk of life-threatening complications or death. Emergency airway management outside the operating room is particularly challenging. ⋯ DART is a comprehensive program for improving difficult airway management. Future studies will examine the comparative effectiveness of the DART program and evaluate how DART has impacted patient outcomes, operational efficiency, and costs of care.
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The Fontan operation places the systemic and pulmonary circulations in series, driven by a single ventricular chamber. It has become the treatment strategy of choice for palliating single-ventricle congenital heart disease. This anatomy engenders profound changes in physiology, affecting the cardiovascular and respiratory systems with direct implications for anesthetic and intensive care. The physical basis of these changes and their sequelae are reviewed.
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Anesthesia and analgesia · Jul 2015
Randomized Controlled TrialSedation-Analgesia with Propofol and Remifentanil: Concentrations Required to Avoid Gag Reflex in Upper Gastrointestinal Endoscopy.
The purpose of this study was to identify optimal target propofol and remifentanil concentrations to avoid a gag reflex in response to insertion of an upper gastrointestinal endoscope. ⋯ We identified a set of propofol and remifentanil TCIs that blocked the gag response to endoscope insertion in patients undergoing endoscopy. Propofol bolus doses and remifentanil infusion rates designed to achieve similar effect-site concentrations can be used to prevent gag response when TCI is not available.
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Anesthesia and analgesia · Jul 2015
Comparative StudyThe Influence of Acute Pulmonary Hypertension on Cardiac Output Measurements: Calibrated Pulse Contour Analysis, Transpulmonary and Pulmonary Artery Thermodilution Against a Modified Fick Method in an Animal Model.
In critically ill patients with significant pulmonary hypertension (PH), close perioperative cardiovascular monitoring is mandatory, considering the increased morbidity and mortality in this patient group. Although the pulmonary artery catheter is still the standard for the diagnosis of PH, its use to monitor cardiac output (CO) in patients with PH is decreasing as a result of increased morbidity and possible influence of tricuspid regurgitation on the measurements. However, continuous CO measurement methods have never been evaluated under PH regarding their agreement and trending ability. In this study, we evaluated the influence of acute PH and different CO states on transpulmonary thermodilution (TPTD) and calibrated pulse contour analysis (PiCCO; both assessed with PiCCO plus™), intermittent pulmonary artery thermodilution (PATD), and continuous thermodilution (CCO) compared with a modified Fick method (FICK) in an animal model. ⋯ TPTD compared with FICK was able to track all changes induced during the study period, including those by PH. It yielded better agreement than PATD both compared with FICK. PiCCO and CCO were not mapping all changes correctly, and when used clinically in unstable patients, regular controls with intermittent techniques are required. Acute pharmacologically induced PH did influence the difference between FICK and PiCCO.