Journal of clinical anesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Effectiveness of remifentanil versus traditional fentanyl-based anesthetic in high-risk outpatient surgery.
To determine if remifentanil would offer a superior hemodynamic and recovery profile compared to the current standard of care, which implements a fentanyl-based technique. ⋯ Remifentanil, a new short-acting opioid, offers excellent hemodynamic control for brief, intense outpatient procedures performed in high-risk patients; however, its use was not associated with any improvement in recovery profiles.
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Continuous interscalene brachial plexus blockade can provide anesthesia and analgesia in the shoulder region. Difficulty accessing the interscalene space and premature displacement of interscalene catheters may preclude their use in certain situations. We present two case reports in which a catheter was advanced from the axilla along the brachial plexus sheath to the interscalene space to provide continuous cervicobrachial plexus analgesia. ⋯ In the second case report, a catheter was inserted in a similar fashion from the axillary to the interscalene space to provide 14 days of continuous analgesia in the management of complex regional pain syndrome. We have found that this technique allows us to secure the catheter more easily than with the traditional interscalene approach and thus prevents premature dislodgment. This approach may be a suitable alternative when either an interscalene or an infraclavicular catheter may not be inserted.
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Randomized Controlled Trial Comparative Study Clinical Trial
The influence of preemptive spinal anesthesia on postoperative pain.
To examine the influence of spinal anesthesia on postoperative pain and postoperative opioid requirements. ⋯ Preoperative neural blockade may reduce postoperative analgesic requirements.
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To evaluate the efficacy of tropisetron, a selective 5-HT(3) receptor antagonist, in preventing nausea and vomiting in high-risk inpatients undergoing various surgical procedures. ⋯ Prophylactic tropisetron can reduce the incidence of PONV in selected high-risk inpatients undergoing various types of surgical procedures.
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Case Reports Clinical Trial
Noninvasive ventilation using bilevel positive airway pressure to treat impending respiratory failure in the postanesthesia care unit.
The author presents the use of noninvasive positive pressure ventilation using bilevel positive airway pressure (BiPAP) to treat respiratory insufficiency and hypoxemia in three patients in the postanesthesia care unit. BiPAP improved respiratory function with a decreased respiratory rate, decreased PaCO2, and improved oxygenation in the three patients. The applications of these techniques and equipment required are reviewed.