Journal of clinical anesthesia
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Randomized Controlled Trial
Comparison of the ED50 of intrathecal hyperbaric ropivacaine co-administered with or without intrathecal dexmedetomidine for cesarean section: A prospective, double-blinded, randomized dose-response trial using up-down sequential allocation method.
Studies have showed that intrathecal dexmedetomidine as supplements to local anesthetics can improve the quality of the spinal anesthesia and reduce the local anesthetic requirement of spinal anesthesia for cesarean section. However, the magnitude of this effect has not been fully quantified. Therefore, we conducted the present study to investigate the ED50 of intrathecal hyperbaric ropivacaine with or without dexmedetomidine for cesarean section in healthy parturients. ED50 values obtained were compared to estimate the effect of intrathecal dexmedetomidine versus placebo on ropivacaine requirement. ⋯ Under the conditions of the present study, intrathecal dexmedetomidine (5 μg) reduced the ED50 of intrathecal hyperbaric ropivacaine by approximately 18% for cesarean section in healthy parturients under combined spinal-epidural anesthesia.
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There are few cognitive screening tools appropriate for fast-paced settings with limited staffing, and particularly in preoperative evaluation clinics. The Society for Perioperative Assessment and Quality Improvement (SPAQI) convened experts in neuropsychology, geriatric medicine, and anesthesiology to conduct a review of the literature and compile a comprehensive list of cognitive screening tools used within primary care and preoperative settings. This Recommendations Statement: 1. summarizes a review of the literature on existing cognitive screening tools used within preoperative settings; 2. discusses factors to consider when selecting cognitive screening tools in a preoperative environment; and 3. includes a work flow diagram to guide use of these screening measures. ⋯ Most had adequate sensitivity and specificity to detect cognitive impairment/dementia. While information on the psychometric properties of these tools is limited, the tools discussed are appropriate for lay examiners, are short in duration, and accessible for free or at a low cost. We describe factors that must be considered prior to instrument selection.
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Childhood and adolescent obesity increased in recent decades, and caregivers face an increasing number of obese pediatric surgical patients. Some clinical and pharmacogenetic data suggest that obese patients have altered pain sensitivity and analgesic requirements. ⋯ We found no clinically important increase in pain scores or opioid consumption in association with higher BMI in patients 8 to 18 years of age recovering from elective non-cardiac surgery.