Journal of clinical anesthesia
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Randomized Controlled Trial
Evaluation of the effect of ketamine on remifentanil-induced hyperalgesia: a double-blind, randomized study.
Opioids are associated with hyperalgesia that can reduce their analgesic effect. The aim of this study was to determine whether the addition of ketamine reduces remifentanil-induced hyperalgesia; improves its analgesic effect; and alters interleukin 6 (IL-6), IL-8, and IL-10 levels. ⋯ It was not possible to demonstrate that the addition of ketamine (5 μg/kg per minute) is effective in preventing or reducing remifentanil-induced postoperative hyperalgesia in laparoscopic cholecystectomy.
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In most instances, delayed emergence from anesthesia is attributed to residual anesthetic or analgesic medications. However, delayed emergence can be secondary to unusual causes and present diagnostic dilemmas. ⋯ In this review, we summarize and discuss less common and difficult to diagnose reasons for delayed emergence and present cases from our own experience or reference published case reports/case series. The goal is to draw attention to less common reasons for delayed emergence, identify patient populations that are potentially at risk and to help anesthesiologists identifying a possible cause why their patient is slow to wake up.
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Clinical Trial
Identification of location of nerve catheters using pumping maneuver and M-Mode-a novel technique.
Optimum positioning of the nerve catheter is crucial for a successful nerve block. We present a novel technique for confirmation of catheter position. ⋯ Pumping maneuver and M-Mode can be additional tools in the array of modalities applied to verify proper positioning of a nerve catheter.
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The initial developmental standards for Maintenance of Certification programs proposed by the American Board of Medical Specialties included the administration of patient and peer surveys by the diplomate every 5 years. The aim of this pilot study was to determine the feasibility of Maintenance of Certification in Anesthesiology Program (MOCA) patient and peer surveys in a selected group of American Board of Anesthesiology (ABA) diplomates. ⋯ These results suggest that threats to the validity of these surveys include distribution bias for peer surveys and response bias for patient surveys and that surveys often do not provide actionable information useful for practice improvement. Alternative approaches, such as including anesthesiologists within an integrated institutional evaluation system, could be explored to maximize the benefits of physician assessments provided by peers and patients.
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The study objective is to evaluate a scoring system to assess the quality of anesthesia used in ophthalmic surgery. ⋯ The quality of ophthalmic anesthesia is an important component of the surgical procedure and should be considered in any risk stratification. Suboptimal anesthesia is associated with an increased rate of surgical complications.