Journal of clinical anesthesia
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Randomized Controlled Trial Clinical Trial
Effects of alkalinization of lidocaine on the pain of skin infiltration and intravenous catheterization.
To test the hypothesis that alkalinization of lidocaine decreases the pain of skin infiltration in surgical patients. ⋯ Pain resulting from skin infiltration of lidocaine solutions can be diminished by adding NaHCO3. However, catheter size is more important than the presence or absence of NaHCO3 in determining the pain of i.v. catheterization.
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Recent pharmacologic and technologic advances in anesthesia and surgery allow outpatients with complex medical problems to undergo a wide variety of diagnostic and surgical procedures on an ambulatory basis. Increasingly, however, anesthesia practitioners, as well as pharmacy and therapeutic committees, are demanding proof that a new, more costly drug or medical device is superior to existing products in achieving its desired effect, is associated with fewer adverse effects, enhances efficiency, and reduces health care costs. The new field of pharmacoeconomics has emphasized the importance of cost-effectiveness analyses that consider both direct and indirect costs of newer drugs and therapeutic modalities. ⋯ Ambulatory anesthesia and surgery will continue to increase because of the potential cost savings for patients undergoing elective operations on an outpatient basis. However, the challenge we face will be to continue to provide high-quality anesthesia care at a reduced cost. A careful examination of commonly accepted (but unproven) clinical practice patterns will be necessary to meet this challenge.
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To evaluate the ability of arterial waveform contour analysis to measure cardiac output (CO) continuously in postoperative critically ill patients. ⋯ The PCCO method appears to be able to estimate changes in CO under the conditions tested, in which PCCO was recalibrated after each TDCO measurement. However, limitations of this method in the immediate postoperative period following aortic aneurysm surgery were identified.
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To describe a method of the authors' design for estimating gastric volume quantitatively using ultrasound and to evaluate the usefulness of this method in the clinical setting. ⋯ This method would be useful to estimate gastric contents quantitatively, and a CSA of 8.0 cm2 might be a valid indicator of an empty stomach.
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To determine whether nitrogen insufflation reduces the laser-induced combustibility of polyvinyl chloride (PVC) endotracheal tube cuffs. ⋯ Nitrogen insufflation decreases CO2 laser-induced PVC endotracheal tube cuff combustibility. However, clinical applications of this technique should be undertaken with caution, as the administration of a hypoxic mixture may be possible.