Journal of anesthesia
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Journal of anesthesia · Apr 2013
Randomized Controlled Trial Comparative StudyComparison of two spinal needle types to achieve a unilateral spinal block.
Unilateral spinal anesthesia is beneficial in patients undergoing unilateral leg surgery. The direction and the shape of the spinal needle are thought to influence the unilateral distribution of the local anesthetic in the intrathecal space. Therefore, to study the effects of different spinal needles we compared the effects of the Whitacre and Quincke spinal needles. ⋯ Unilateral spinal block for outpatient surgery can be achieved with both pencil-point (Whitacre) and Quincke needles using 6.0 mg of plain bupivacaine. Neither the spread of sensory and motor blocks nor the corresponding recovery times appeared to be different between the groups. Nor was there any difference in patient satisfaction.
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Journal of anesthesia · Apr 2013
ReviewAnesthesia for children with mitochondrial disorders: a national survey and review.
Mitochondrial diseases are a heterogeneous group of disorders. Patients with such diseases often need general anesthesia for diagnostic procedures and surgery; guidelines are lacking for the anesthetic care of these patients. ⋯ Although the response rate was low, the majority of the responders provide care to these children routinely, so it can be inferred that the results of this survey are the closest published results to the true trend.
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Journal of anesthesia · Apr 2013
Comparative StudyAnalysis of expert consultation referrals to the Korean Society of Anesthesiologists (KSA): a comparison of procedural sedation and general anesthesia.
Procedural sedation during diagnostic or therapeutic procedures is currently widely used by clinicians across a broad range of specialties. However, procedural sedation is a poorly controlled practice in many countries, often performed in potentially unsafe environments. ⋯ Our analysis of procedural sedation based on anesthesia-related adverse events compiled in the national database revealed a high severity of patient injury similar to that due to general anesthesia. Most procedural sedations were shown to be poorly controlled without adequate pre-procedural patient evaluation or intraoperative monitoring. Thus, it is essential to establish proper practical guidelines for procedural sedation and ensure strict adherence to these guidelines, especially during the NAAP.
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Journal of anesthesia · Apr 2013
Randomized Controlled Trial Comparative StudyDexmedetomidine versus remifentanil sedation during awake fiberoptic nasotracheal intubation: a double-blinded randomized controlled trial.
Awake fiberoptic nasotracheal intubation is usually performed in patients with an anticipated difficult airway. This study compares dexmedetomidine and remifentanil for conscious sedation during fiberoptic intubation. ⋯ Both dexmedetomidine and remifentanil were effective as sedatives in patients undergoing awake fiberoptic nasotracheal intubation. Compared with remifentanil, dexmedetomidine offered better endoscopy scores, lower recall of intubation, and greater patient satisfaction, with minor hemodynamic side effects.
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Sepsis is one of the leading causes of death in the critically ill. Early diagnosis is important to avoid delay in instituting appropriate treatment. ⋯ This article reviews the application of readily available biomarkers for diagnosis of sepsis, for predicting prognosis, and for antibiotic stewardship. 178 biomarkers are described in the literature--ranging from specimen cultures, which lack sensitivity and specificity for early diagnosis of sepsis, to biomarkers such as C-reactive protein, procalcitonin, and genetic biomarkers, which have their own limitations. Future research will mainly focus on use of more than one biomarker, but the main problem in sepsis biomarker research seems to be a lack of a recommended biomarker.