Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2000
Randomized Controlled Trial Comparative Study Clinical TrialHyaluronidase as an adjuvant in bupivacaine-lidocaine mixture for retrobulbar/peribulbar block.
Hyaluronidase 7.5 IU/mL added to the local anesthetic improves peribulbar block, but smaller concentrations have not been shown to be effective. In this prospective, double-blinded study, 714 consecutive ocular surgery patients were randomized into three groups: no hyaluronidase (n = 241), hyaluronidase 3.75 IU/mL (n = 244), and hyaluronidase 7.5 IU/mL (n = 229). Retrobulbar/peribulbar block was performed with two injections of a 1:1 mixture of bupivacaine 0.75% and lidocaine 2%, 6-8 mL. Patient data were collected on demographics, initial volume of local anesthetic, need for supplementary block, and akinesia of the anesthetized eye. When hyaluronidase was used (3.75 or 7.5 IU/mL), the initial block was sufficient and the anesthetized eye was akinetic significantly more often than in the group without hyaluronidase. The hyaluronidase groups (3.75 and 7.5 IU/mL) did not differ significantly in any respect. We conclude that the addition of hyaluronidase 3.75 or 7.5 IU/mL improved the success of the initial retrobulbar/peribulbar block and akinesia and reduced the need for supplementary block. ⋯ We conclude that the addition of hyaluronidase 3.75 or 7.5 IU/mL improved the success of the initial retrobulbar/peribulbar block and akinesia and reduced the need for supplementary block.
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Anesthesia and analgesia · Oct 2000
Meta AnalysisThe good, the bad, and the ugly: should we completely banish human albumin from our intensive care units?
Human albumin is still widely used in critically ill patients for volume replacement therapy or for correcting hypoproteinemia. Most meta-analyses on the value of albumin administration are over 15 yr old and raise more questions than they answer. With the help of a MEDLINE analysis, we examined more recent studies in humans using albumin. Most of these studies have recommended a very cautious use of albumin in critically ill patients.
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Anesthesia and analgesia · Oct 2000
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of spinal, epidural, and general anesthesia for outpatient knee arthroscopy.
We compared general, epidural, and spinal anesthesia for outpatient knee arthroscopy (excluding anterior cruciate ligament repairs). Forty-eight patients (ASA physical status I-III) were randomized to receive either propofol-nitrous oxide general anesthesia with a laryngeal mask airway with anesthetic depth titrated to a bispectral index level of 40-60, 15-20 mL of 3% 2-chloroprocaine epidural, or 75 mg of subarachnoid procaine with 20 microg fentanyl. All patients were premedicated with <0.035 mg/kg midazolam and <1 microg/kg fentanyl and received intraarticular bupivacaine and 15-30 mg of IV ketorolac during the procedure. Recovery times, operating room turnover times, and patient satisfaction were recorded by an observer using an objective scale for recovery assessment and a verbal rating scale for satisfaction. Statistical analysis was performed with analysis of variance and chi(2). Postanesthesia care unit discharge times for the general and epidural groups were similar (general = 104+/-31 min, epidural = 92+/-18 min), whereas the spinal group had a longer recovery time (146+/-52 min) (P = 0.0003). Patient satisfaction was equally good in all three groups (P = 0.34). Room turnover times did not differ among groups (P = 0.16). There were no anesthetic failures or serious adverse events in any group. Pruritus was more frequent in the spinal group (7 of 16 required treatment) than in the general or epidural groups (no pruritus) (P<0.001). We conclude that epidural anesthesia with 2-chloroprocaine provides comparable recovery and discharge times to general anesthesia provided with propofol and nitrous oxide. Spinal anesthesia with procaine and fentanyl is an effective alternative and is associated with a longer discharge time and increased side effects. ⋯ For outpatient knee arthroscopy, anesthesia can be provided adequately with regional or general anesthesia. Epidural and general anesthesia provide equal recovery times and patient satisfaction, whereas spinal anesthesia may prolong recovery and have increased side effects. The choice of anesthesia may depend primarily on the patient's interest in being alert or asleep during the procedure.
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Anesthesia and analgesia · Oct 2000
Randomized Controlled Trial Clinical TrialRandomized safety studies of intravenous perflubron emulsion. II. Effects on immune function in healthy volunteers.
Particle size distribution is a major determinant of particle clearance by the mononuclear phagocytic system and the potential for concomitant activation of resident macrophages. To test the safety of a second-generation perflubron-based emulsion (60% perfluorocarbon [PFC] wt/vol; Oxygent [Alliance Pharmaceutical Corp., San Diego, CA]) with a small mean particle size, two parallel, randomized, double-blinded, placebo-controlled studies were conducted in 48 healthy volunteers (n = 24 per study). The study described herein focuses on safety concerning immune function. ⋯ Perflubron emulsion was generally well tolerated, although there was a dose-dependent increase in minor flu-like symptoms in the perflubron treatment groups at 24 h after dosing. Increased serum levels of interleukin-6 were observed in those subjects exhibiting febrile responses. The clinical safety profile of perflubron emulsion supports its continued investigation as a temporary oxygen carrier in surgical patients to reduce exposure to allogeneic blood transfusion.
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Anesthesia and analgesia · Oct 2000
Comparative Study Clinical Trial Controlled Clinical TrialThe lack of benefit of tracheal extubation in the operating room after coronary artery bypass surgery.
Although early tracheal extubation in cardiac anesthesia is safe and cost beneficial, questions still remain regarding how early after cardiac surgery patients should be tracheally extubated (TE). Our objective was to determine the effects on resource use if patients scheduled for coronary artery bypass grafting have TE in the operating room (OR). We studied 100 consecutive patients undergoing elective coronary artery bypass grafting, requiring extracorporeal circulation, and those eligible for a fast-track pathway. ⋯ Three patients (6%) in the OR group had postoperative myocardial infarction, and one postoperative myocardial infarction (2%) occurred in the ICU group (P = 0.61). All four patients recovered satisfactorily. The incidences of other complications were similar between groups.