Journal of anesthesia
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Journal of anesthesia · Apr 2017
Randomized Controlled Trial Comparative StudyA randomized controlled trial comparing paravertebral block via the surgical field with thoracic epidural block using ropivacaine for post-thoracotomy pain relief.
We conducted a comparative study to evaluate analgesic efficacy between paravertebral block via the surgical field (PVB-sf), in which the catheter was inserted into the ventral side of the sympathetic trunk in the paravertebral space by a thoracic surgeon under thoracoscopic visualization, and epidural block (Epi) using ropivacaine for post-thoracotomy pain relief. ⋯ The Epi was superior to PVB-sf for the management of post-thoracotomy pain in this patient cohort. The number of dermatomes anaesthetized by Epi was greater than that anaesthetized by PVB-sf. No difference in complication rates was observed between the two groups.
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Journal of anesthesia · Apr 2017
Randomized Controlled Trial Comparative StudyOral 30% glucose provides sufficient sedation in newborns during MRI.
Newborns are often sedated during MRI but sedation itself creates adverse events and management is more challenging in this environment. Oral glucose/sucrose administration has been studied in newborns during painful procedures; however, its effectiveness in keeping newborns sleepy and motionlessness during painless procedures has not been demonstrated. The objective of this study was to describe effectiveness of oral 30% glucose administration by comparing with intravenous midazolam sedation for newborns during MRI. ⋯ Oral 30% glucose administration for newborns during MRI is as effective as standard sedation protocol with midazolam. Thereby, we recommend and support the integration of this safe and reliable technique into routine practice for newborns during MRI.
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Journal of anesthesia · Apr 2017
Randomized Controlled Trial Comparative StudyIntrathecal morphine versus intravenous opioid administration to impact postoperative analgesia in hepato-pancreatic surgery: a randomized controlled trial.
Inadequate analgesia following abdominal surgery may affect outcome. Data in patients undergoing liver surgery suggested that postoperative coagulopathy might delay epidural catheter removal. Thus, alternative analgesic techniques should be evaluated. ⋯ The findings suggest that a single dose of ITM before hepatic/pancreatic surgery may offer better postoperative pain control than i.v. opioid administration during surgery. This beneficial effect is maintained throughout the first three PODs and is not associated with a higher complication rate; neither did it influence recovery parameters. ITM provides an appropriate alternative to i.v. morphine during major abdominal surgery.
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Journal of anesthesia · Apr 2017
Randomized Controlled TrialHyperinsulinemic normoglycemia decreases glucose variability during cardiac surgery.
Increased glucose variability may be associated with worse outcomes in critically ill patients. Hyperinsulinemic normoglycemia provides intensive glucose control during surgery and may reduce glucose variability. Our objective was to compare glycemic variability between two methods of glucose control in cardiac surgical patients: hyperinsulinemic normoglycemia vs standard insulin infusion. We also assessed whether the effect differed between patients with and without diabetes mellitus. ⋯ Hyperinsulinemic normoglycemia decreases glucose variability for cardiac surgical patients with a stronger effect in nondiabetic patients.
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Journal of anesthesia · Apr 2017
Randomized Controlled TrialSwallowing action immediately before intravenous fentanyl at induction of anesthesia prevents fentanyl-induced coughing: a randomized controlled study.
Fentanyl is a strong µ-opioid analgesic which attenuates the stimulation of surgical invasion and tracheal intubation. However, intravenous fentanyl often induces coughing [fentanyl-induced coughing (FIC)] during induction of anesthesia. We found that the swallowing action, when requested at induction of anesthesia, attenuated FIC. In the current study, we investigated the relationship between the occurrence of FIC and the swallowing action. ⋯ The swallowing action immediately before intravenous fentanyl may be a simple and clinically feasible method for preventing FIC effectively. Clinical trial number: UMIN000012086 ( https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&recptno=Rn000014126&language=J ).