Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2015
Randomized Controlled TrialDexmedetomidine Improves Intubating Conditions Without Muscle Relaxants in Children After Induction With Propofol and Remifentanil.
Anesthesia induction using propofol (3 mg/kg) and remifentanil (2 μg/kg) without the use of muscle relaxants has been associated with a lower incidence of successful intubation. Dexmedetomidine has been found to effectively decrease the requirements for propofol and remifentanil and to attenuate the hemodynamic response to intubation. Therefore, in this study, we examined intubating conditions and hemodynamic changes in children after induction with dexmedetomidine (1 μg/kg) combined with propofol (3 mg/kg) and remifentanil (2 μg/kg). ⋯ A single dose of dexmedetomidine (1 μg/kg) improved intubation conditions in children after induction with propofol (3 mg/kg) and remifentanil (2 μg/kg) without muscle relaxants. Dexmedetomidine did not affect the hemodynamic response to intubation.
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Anesthesia and analgesia · Sep 2015
Comparative Study Observational StudyA Prospective Observational Comparison Between Arm and Wrist Blood Pressure During Scheduled Cesarean Delivery.
Shivering is common during cesarean delivery (CD) under neuraxial anesthesia and may disrupt the measurement of noninvasive blood pressure (BP). BP measured at the wrist may be less affected by shivering. There have been no studies comparing trends in BP measured on the upper arm and wrist. We hypothesized that wrist systolic blood pressure (sBP) would accurately trend with upper arm sBP measurements (agree within a limit of ±10%) in parturients undergoing elective CD under spinal anesthesia or combined spinal-epidural anesthesia. ⋯ The wrist measurement overestimated the reading relative to the upper arm measurement for multiple measurements over time. However, when the time series for each subject was examined for percentage change from baseline, the 2 methods mirrored each other in most cases. Nevertheless, our hypothesis was rejected as the limits of agreement were higher than ±10%. This finding suggests that wrist BP may not be an accurate method of detecting hypotension or hypertension during spinal or combined spinal-epidural anesthesia for CD.
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Anesthesia and analgesia · Sep 2015
Observational StudyBedside Gastric Ultrasonography in Term Pregnant Women Before Elective Cesarean Delivery: A Prospective Cohort Study.
Bedside gastric ultrasound can reliably assess gastric contents in the perioperative period. We aimed to describe the qualitative and quantitative ultrasound assessment of the gastric antrum in fasted pregnant women at term. ⋯ All women but one presented with antral CSA compatible with residual gastric fluid. The qualitative 3-point grading system may be used to assess individual risk of perioperative gastric content aspiration. Our results suggest that an antral CSA of 10.3 cm in the right lateral decubitus position more accurately describes the upper limit of normal findings in the fasted pregnant patient at term.
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Anesthesia and analgesia · Sep 2015
Initial Preference for Labor Without Neuraxial Analgesia and Actual Use: Results from a National Survey in France.
The rate of neuraxial analgesia during labor in France is one of the highest among high-income countries: 77% of vaginal deliveries in 2010. In this context, the question of how women's preferences for delivering without neuraxial analgesia relate to actual use is of interest. Our objective was to study the factors associated with women's initial preference for labor without neuraxial analgesia and those associated with its use in women who initially preferred not to have it. ⋯ Our results suggest that parity, the management of labor, and availability of anesthesiologists play a major role in the intrapartum decision to use neuraxial analgesia for women who initially preferred not to have it. Further research is necessary in the clinical circumstances leading to this decision and the role of women's demands and medical staff attitudes throughout labor.
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Anesthesia and analgesia · Sep 2015
The Effect of Hypothyroidism on a Composite of Mortality, Cardiovascular and Wound Complications After Noncardiac Surgery: A Retrospective Cohort Analysis.
We tested the hypothesis that hypothyroidism, as defined by thyroid-stimulating hormone (TSH) concentration, is associated with a severity-weighted composite of mortality and major cardiovascular and infectious complications after noncardiac surgery. ⋯ Hypothyroidism was not associated with worse postoperative mortality, wound, or cardiovascular outcomes in noncardiac patients. Thus, postponing surgery to initiate thyroid replacement therapy in patients with hypothyroidism seems unnecessary.