Journal of clinical anesthesia
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Meta Analysis Comparative Study
The effect of sevoflurane versus desflurane on the incidence of upper respiratory morbidity in patients undergoing general anesthesia with a Laryngeal Mask Airway: a meta-analysis of randomized controlled trials.
To compare the incidence of upper airway morbidity with sevoflurane versus desflurane in patients undergoing general anesthesia with a Laryngeal Mask Airway (LMA). ⋯ There is a lack of evidence that desflurane causes a greater incidence of upper airway adverse events than sevoflurane in patients undergoing general anesthesia with a LMA.
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Observational Study
Inadequate emergence after anesthesia: emergence delirium and hypoactive emergence in the Postanesthesia Care Unit.
To evaluate the frequency, determinants, and outcome of inadequate emergence after elective surgery in the Postanesthesia Care Unit (PACU). ⋯ Preventable determinants for emergence delirium were higher postoperative pain scores and longer fasting times. Hypoactive emergence was associated with longer postoperative PACU and hospital LOSs.
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Randomized Controlled Trial
Ultrasound-guided bilateral transversus abdominis plane blocks in conjunction with intrathecal morphine for postcesarean analgesia.
To determine whether transversus abdominis plane (TAP) blocks administered in conjunction with intrathecal morphine provided superior analgesia to intrathecal morphine alone. ⋯ Transversus abdominis plane blocks in conjunction with intrathecal morphine provided superior early postcesarean analgesia to intrathecal morphine alone. By 24 hours there was no difference in pain scores or analgesic consumption.
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Glycemic control has received intense scrutiny in the last decade as an important aspect of patient care. Earlier studies suggested that tight glycemic control (target level of 80 - 110 mg/dL) improved outcomes in intensive care unit (ICU) patients. Subsequent trials did not confirm the same benefit. ⋯ Tight glycemic control was associated with a high incidence of hypoglycemia, which may offset some of its potential benefits. Tight glycemic control in the perioperative and intensive care settings should not be totally abandoned either as a clinical practice or as a subject of future research. Beneficial effects of tight glycemic control may be demonstrated when the appropriate glycemic targets are matched to the appropriate population.
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Comparative Study
Comparison of stroke volume and fluid responsiveness measurements in commonly used technologies for goal-directed therapy.
To compare stroke volume (SV) and preload responsiveness measurements from different technologies with the esophageal Doppler monitor (EDM). ⋯ Stroke volume as measured by the FloTrac and LiDCOrapid systems does not correlate with the esphageal Doppler, has poor concordance, and a clinically unacceptable percentage error. The predictive value of the fluid responsiveness parameters is low, with only SVV measured by the LiDCOrapid having clinical utility.