Journal of clinical anesthesia
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The operating room (OR) is a busy environment with multiple opportunities for distraction. A well-trained anesthesiologist or certified registered nurse anesthetist (CRNA) should remain focused on providing excellent patient care despite these potential distractions. The purpose of this narrative review is to present the multiple types of OR distractions and evaluate each for their level of distraction and their likely impact on patient safety. ⋯ The impact of OR distractions on patient outcomes deserves more vigorous investigation. We must provide anesthesia trainees with the skills to remain vigilant despite numerous and varied OR distractions while also attempting to reduce such OR distractions to improve patient safety. Further research is needed to inform the institution of policies to lessen unnecessary OR distractions.
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Randomized Controlled Trial
Dose dependent reduction in median effective concentration (EC50) of ropivacaine with adjuvant dexmedetomidine in labor epidural analgesia: An up-down sequential allocation study.
Adjuvant dexmedetomidine can be used to reduce the required concentration of ropivacaine for labor epidural analgesia. However, the potency of dexmedetomidine has not been fully studied. The purpose of this study was to determine the median effective concentration (EC50) of ropivacaine with adjuvant dexmedetomidine. ⋯ In this study, the lowest concentration of dexmedetomidine in ropivacaine with the greatest clinical effect was 0.4 μg/ml, which is important because there may be no additional analgesic benefit of dexmedetomidine greater than 0.4 μg/ml.
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This scoping review investigates the optimal combination of motor-sparing analgesic interventions for patients undergoing total knee replacement (TKR). ⋯ The optimal analgesic strategy for TKR may include a combination of different analgesic modalities (periarticular infiltration, femoral triangle blocks, obturator nerve block). Future trials are required to investigate the incremental benefits provided by local anesthetic infiltration between the popliteal artery and the capsule of the knee (IPACK), popliteal plexus block and genicular nerve block.
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Whether dexmedetomidine effectively attenuates the increase in intraocular pressure (IOP) remains inconclusive. We aim to evaluate the effects of dexmedetomidine on IOP in adult patients undergoing surgery which requires general anesthesia and endotracheal intubation. ⋯ Dexmedetomidine effectively attenuates the increase in IOP levels, and should be considered especially for at-risk patients.