Journal of anesthesia
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Journal of anesthesia · Jan 2009
Randomized Controlled TrialAn individualized recruitment maneuver for mechanically ventilated patients after cardiac surgery.
The recruitment maneuver (RM) has been shown to improve oxygenation for post-cardiopulmonary bypass (CPB) patients; however, sustained inflation of the lung gives rise to hypotension. The primary goal of our study was to evaluate the safety and efficacy of our proposed RM, defined on the basis of dynamic lung compliance (Cdyn). ⋯ The present study indicates that the individualized RM resulted in minimum changes of hemodynamics and brought about improvement in oxygenation and lung compliance.
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Journal of anesthesia · Jan 2009
Randomized Controlled TrialLow dose of fentanyl reduces predicted effect-site concentration of propofol for flexible laryngeal mask airway insertion.
In contrast to reports on the classical laryngeal mask airway (classical LMA; CLMA), no report has calculated the 50% and 95% effect-site concentrations (EC(50) and EC(95), respectively) of propofol required for flexible LMA (FLMA) insertion. This study was designed to determine the EC(50) and EC(95) of propofol for FLMA insertion, using probit analysis, and to investigate whether supplemental 0.25 microg x kg(-1) fentanyl decreased these concentrations. ⋯ The propofol EC(50) for FLMA insertion was decreased by supplemental 0.25 microg x kg(-1) fentanyl without BIS, hemodynamic, or respiratory depression.
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Journal of anesthesia · Jan 2009
Randomized Controlled TrialPerineural morphine in patients with chronic ischemic lower extremity pain: efficacy and long-term results.
To compare the efficacy, safety, and impact on daily activity of peripherally administered morphine plus a local anesthetic with that of a local anesthetic alone in patients with chronic ischemic lower extremity pain. ⋯ A peripherally administered bupivacaine plus morphine combination provided better and longer analgesia for ischemic pain compared to bupivacaine alone for the short term, but not for the long term. On the other hand, our results show that continuous popliteal treatment is an effective, safe, and comfortable modality for long-term use in the home setting for patients with intractable chronic pain.
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Journal of anesthesia · Jan 2009
Randomized Controlled TrialInsertion length and resistance during advancing of epidural catheter.
The migration of an epidural catheter into the intravascular and subarachnoid spaces sometimes occurs. This study was designed to investigate where the resistance was felt during the advancing of the catheter into the epidural space and whether the length of catheter advanced in the epidural space affected the incidence of catheter migration. ⋯ At approximately 2.5 cm in the epidural space, advancing an epidural catheter causes resistance. Further advancing past this point may cause migration of the catheter into the vessels, or the coiling of the catheter.
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Journal of anesthesia · Jan 2009
ReviewEthical issues in anesthesia: the need for a more practical and contextual approach in teaching.
Teaching ethics to medical students is one of the current topics of major interest. Issues of ethics pertaining to anesthesia are unique. This article reviews these issues with respect to the preoperative, intraoperative, and postoperative periods. ⋯ In addition to separate modules in didactic and clinical formats, incorporating the ethical aspects into every clinical problem has many advantages. This approach will stimulate students to ponder over the ethical dimension of every clinical scenario, and the reinforcement of this approach during teaching in the clinical setting may help in inculcating these qualities in the students. Additionally, this approach contextualizes these issues to the local and regional perspective, instead of lecturing on the ethical codes developed elsewhere.