Journal of clinical anesthesia
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Randomized Controlled Trial Clinical Trial
The effect of repeated epidural sympathetic nerve block on "failed back surgery syndrome" associated chronic low back pain.
To assess the therapeutic benefits of repeated epidural local anesthetic administration on pain perception and straight leg raise (SLR) in patients suffering from chronic low back pain. ⋯ 46 patients completed the study. VAS for pain was marginally lower in Group B. However, statistical significance was not demonstrated. During the hospitalization period, the SLR in both study groups significantly (0.008) improved with time. However, no difference between the groups was demonstrated. In both groups, 1 week, 1 month, and 3 months after discharge, the SLR was comparable to prestudy recordings. In Group B, at 1 week, 1 month, and 3 months after discharge, patient-generated VAS for pain were significantly (p = 0.002) higher when compared to pain scores at the time of patient discharge.
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Clinical Trial Controlled Clinical Trial
The effect of a dissociative dose of ketamine on the bispectral index (BIS) during propofol hypnosis.
To compare the effect of a standardized stimulus during propofol-only hypnosis on the bispectral index (BIS) value with the effect of the injection of local anesthesia for surgery during ketamine plus propofol hypnosis (dissociative monitored anesthesia care). To determine whether ketamine increases the level of propofol hypnosis when used in dissociative doses. ⋯ This study demonstrated a positive BIS response to a standardized local anesthetic stimulus during propofol-only hypnosis and a zero response during ketamine plus propofol hypnosis (dissociative anesthesia). Ketamine administered in dissociative doses does not deepen the level of propofol hypnosis. Hypnosis alone does not imply general anesthesia. Patients move in response to inadequate local anesthesia. Because the ketamine analgesia is only transitory and the primary analgesia is not given intravenously, propofol-ketamine technique is not a total intravenous anesthetic technique (TIVA). Instead, propofol-ketamine technique may be classified as a form of monitored anesthesia care (MAC).
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We report a case of awake, fiberoptic tracheal intubation of a difficult airway (Ludwig's angina) using remifentanil as part of the sedation-analgesia regimen. Remifentanil's rapid onset-rapid offset pharmacokinetic profile enabled precise control of the level of opioid effect. In combination with other drugs, remifentanil may offer some clinical advantages compared to the other fentanyl congeners in providing the opioid component of conscious sedation-analgesia for awake tracheal intubation in patients with difficult airways.
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Randomized Controlled Trial Comparative Study Clinical Trial
The effects of preanesthetic oral clonidine on total requirement of propofol for general anesthesia.
To investigate the effects of preanesthetic oral clonidine on total propofol requirement for uniform minor surgery (breast conservative surgery: breast cancer removal with axillary lymph node dissection), and to compare the action of clonidine with that of preanesthetic oral diazepam, a commonly used benzodiazepine. ⋯ Preanesthetic oral clonidine (150 micrograms) but not diazepam (10 mg) reduced the total requirement of propofol while stabilizing hemodynamic parameters. In addition, 150 micrograms of oral clonidine attenuates the hemodynamic responses associated with tracheal intubation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Onset and recovery of neuromuscular blockade after two doses of rocuronium in children.
To determine if 450 micrograms/kg (1.5 times the ED95) of rocuronium would result in a comparable onset with a shorter duration of action when compared with 600 micrograms/kg (2 times the ED95). ⋯ The two doses of rocuronium did not differ statistically in onset or duration. Rocuronium at 600 micrograms/kg offers more reliability than 450 micrograms/kg in achieving adequate muscle relaxation, and the lower dose may result in a significantly large number of patients who may have inadequate intubating conditions.