Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2010
Randomized Controlled Trial Multicenter StudyMonitored anesthesia care with dexmedetomidine: a prospective, randomized, double-blind, multicenter trial.
Dexmedetomidine (DEX) is increasingly being used as a sedative for monitored anesthesia care (MAC) because of its analgesic properties, "cooperative sedation," and lack of respiratory depression. In this randomized, multicenter, double-blind, Phase III Food and Drug Administration study, we evaluated the safety and efficacy of two doses of DEX for sedation of patients undergoing a broad range of surgical or diagnostic procedures requiring MAC. ⋯ DEX is an effective baseline sedative for patients undergoing MAC for a broad range of surgical procedures providing better patient satisfaction, less opioid requirements, and less respiratory depression than placebo rescued with midazolam and fentanyl.
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Anesthesia and analgesia · Dec 2009
Randomized Controlled Trial Multicenter Study Comparative StudyThe Flex-It stylet is less effective than a malleable stylet for orotracheal intubation using the GlideScope.
The GlideScope videolaryngoscope (Verathon Medical, Bothell, WA) usually provides excellent glottic visualization, but directing an endotracheal tube through the vocal cords can be challenging. The goal of the study was to compare the dedicated Flex-It stylet (FIS, Parker Medical, Highlands Ranch, CO) with a malleable stylet, as assessed by time to intubation (TTI). ⋯ In a group of experienced operators using the GlideScope, the FIS was less effective for orotracheal intubation than a malleable endotracheal tube stylet.
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Anesthesia and analgesia · Dec 2009
Multicenter Study Clinical TrialGlucose as a marker of fluid absorption in bipolar transurethral surgery.
Historically, a reduced serum sodium concentration has been used to diagnose absorption of electrolyte-free irrigating fluid during transurethral resection of the prostate (TURP). In bipolar TURP, the irrigating solution contains electrolytes, thus invalidating the serum sodium method. In this study, we investigated whether glucose can be used to diagnose the absorption of irrigating fluid during TURP procedures. ⋯ In bipolar TURP, the addition of glucose to a concentration of 1% in the electrolyte-containing irrigation fluid can be used as a tracer of absorption that is comparable with measuring serum sodium after monopolar TURP.
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Anesthesia and analgesia · Nov 2009
Multicenter StudyThe incidence of intraoperative awareness in children: childhood awareness and recall evaluation.
There is a considerable discrepancy between the reported incidences of awareness under anesthesia in children (0.2%-2.7%). In this prospective, observational, cohort study we evaluated 1) the incidence of awareness during general anesthesia in children across three settings, 2) factors contributing to awareness, and 3) short-term psychological effects of awareness. ⋯ Although 0.8% of children experienced possible/probable awareness in this study, none experienced short-term psychological distress.
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Anesthesia and analgesia · Oct 2009
Multicenter StudyModeling procedure and surgical times for current procedural terminology-anesthesia-surgeon combinations and evaluation in terms of case-duration prediction and operating room efficiency: a multicenter study.
Gains in operating room (OR) scheduling may be obtained by using accurate statistical models to predict surgical and procedure times. The 3 main contributions of this article are the following: (i) the validation of Strum's results on the statistical distribution of case durations, including surgeon effects, using OR databases of 2 European hospitals, (ii) the use of expert prior expectations to predict durations of rarely observed cases, and (iii) the application of the proposed methods to predict case durations, with an analysis of the resulting increase in OR efficiency. ⋯ OR case scheduling can be improved by using the 3-parameter lognormal model with surgeon effects and by using surgeons' prior guesses for rarely observed CPTs. Using the 3-parameter lognormal model for case-duration prediction and scheduling significantly reduces both the prediction error and OR inefficiency.