Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2008
Randomized Controlled Trial Multicenter Study Comparative StudyDoes hyperventilation improve operating condition during supratentorial craniotomy? A multicenter randomized crossover trial.
Hyperventilation has been an integral, but poorly validated part of neuroanesthetic practice. We conducted a two-period, crossover, randomized trial to evaluate surgeon-assessed brain bulk and measured intracranial pressure (ICP) in patients undergoing craniotomy for removal of supratentorial brain tumors during moderate hypocapnia or normocapnia. ⋯ In patients with supratentorial brain tumors, intraoperative hyperventilation improves surgeon-assessed brain bulk which was associated with a decrease in ICP.
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Anesthesia and analgesia · Feb 2008
Multicenter Study Comparative Study Clinical TrialIntrathecal ziconotide for severe chronic pain: safety and tolerability results of an open-label, long-term trial.
Ziconotide is a non-opioid drug indicated for management of severe chronic pain in patients for whom intrathecal (IT) therapy is warranted and who are intolerant of or refractory to other treatments. ⋯ We conclude that long-term IT ziconotide is an option for patients with severe, refractory chronic pain.
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Anesthesia and analgesia · Jan 2008
Randomized Controlled Trial Multicenter StudyDisposition and clinical outcome after intraperitoneal meperidine and ropivacaine administration during laparoscopic surgery.
Limited evidence supports the efficacy of intraperitoneal (IP) meperidine or local anesthetic for postoperative analgesia. Our study aims were to investigate analgesic efficacy and to quantify the plasma concentrations of meperidine and ropivacaine after IP administration. The null hypothesis was that there was no significant difference among groups for dynamic pain in the first 24 h after major abdominal laparoscopic surgery. ⋯ Compared with systemic opioid, IP meperidine and ropivacaine, alone or in combination, did not produce better pain relief or opioid dose-sparing after laparoscopic surgery.
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Anesthesia and analgesia · Jan 2008
Randomized Controlled Trial Multicenter Study Clinical TrialDoes spectral entropy reflect the response to intubation or incision during propofol-remifentanil anesthesia?
Spectral entropy is an electroencephalogram-based monitoring technique with a frequency band enlarged to include the electromyogram spectrum, which is intended to help to assess analgesia. Although its correlation with hypnosis has been shown, its performance during a noxious stimulation and the influence of neuromuscular blockade have not been described. ⋯ Entropy predicted a motor response to noxious stimulations but not a hemodynamic response, which limits its usefulness for assessing the analgesic component of anesthesia in paralyzed patients. High values (RE >55) before the stimulation should be avoided in order to decrease the risk of motor response, but lower values might not prevent this response when the opioid concentration is insufficient, despite an adequate hypnosis.
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Anesthesia and analgesia · Jan 2008
Multicenter Study Comparative StudyA comparison of the clinical utility of pain assessment tools for children with cognitive impairment.
Difficulty assessing pain has been cited as one of the primary reasons for infrequent and inadequate assessment and analgesia for children with cognitive impairment (CI). Several behavioral observational pain tools have been shown to have good psychometric properties for pain assessment in this population; however, routine clinical use may depend largely on their pragmatic qualities. We designed this study to evaluate pragmatic attributes or clinical utility properties of three recently developed pain assessment tools for children with CI. ⋯ We found that clinicians rated the complexity, compatibility, relative advantage, and overall clinical utility higher for the r-FLACC and NAPI compared with the NCCPC-PV, suggesting that these tools may be more readily adopted into clinical practice.