Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2017
Observational StudyTranscutaneous Carbon Dioxide Measurements in Women Receiving Intrathecal Morphine for Cesarean Delivery: A Prospective Observational Study.
Hypercapnia events are common in women receiving 150 mcg intrathecal morphine for cesarean delivery, although clinical significance is uncertain.
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Anesthesia and analgesia · Mar 2017
Observational StudyDynamic Ultrasound-Guided Short-Axis Needle Tip Navigation Technique for Facilitating Cannulation of Peripheral Veins in Obese Patients.
This preliminary observational study evaluated a specific ultrasound technique for venous access. Ultrasound was utilized for navigating a needle and catheter within the vessel lumen after venopuncture. ⋯ Veins in 95 patients were cannulated successfully on the first attempt. This ultrasound-guided protocol facilitates navigation of both the catheter and needle within a vessel, increasing the first-attempt success rate of peripheral venous cannulation in adult obese patients.
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Anesthesia and analgesia · Mar 2017
Observational StudyA Pilot Assessment of 3 Point-of-Care Strategies for Diagnosis of Perioperative Lung Pathology.
Lung ultrasonography is superior to clinical examination and chest X-ray (CXR) in diagnosis of acute respiratory pathology in the emergency and critical care setting and after cardiothoracic surgery in intensive care. Lung ultrasound may be useful before cardiothoracic surgery and after discharge from intensive care, but the proportion of significant respiratory pathology in this setting is unknown and may be too low to justify its routine use. The aim of this study was to determine the proportion of clinically significant respiratory pathology detectable with CXR, clinical examination, and lung ultrasound in patients on the ward before and after cardiothoracic surgery. ⋯ Clinically important respiratory pathology is detectable by lung ultrasound in a substantial number of noncritically ill, pre or postoperative cardiothoracic surgery participants with high estimate of interobserver agreement beyond that expected by chance, and we showed clinically significant diagnoses may be missed by the contemporary practice of clinical examination and CXR.
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Anesthesia and analgesia · Mar 2017
Randomized Controlled Trial Comparative StudyEffect of a High-Rate Versus a Low-Rate Oxytocin Infusion for Maintaining Uterine Contractility During Elective Cesarean Delivery: A Prospective Randomized Clinical Trial.
Oxytocin is routinely used as prophylaxis against uterine atony. During elective cesarean delivery (CD), an oxytocin bolus is used to initiate adequate uterine tone, followed by an oxytocin infusion to maintain uterine contractility. However, it is unclear whether oxytocin maintenance infusion rate influences total estimated blood loss (EBL). ⋯ Among women undergoing elective CD receiving an oxytocin maintenance infusion, EBL and uterine tone did not differ between women receiving 2.5 U/h oxytocin and those receiving 15 U/h oxytocin. Our findings suggest that efficacy can be obtained with a low oxytocin maintenance infusion rate; however, dose-finding studies are needed to determine the infusion rate that optimizes drug efficacy while minimizing side effects.