Articles: adult.
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Journal of anesthesia · Aug 2014
Randomized Controlled TrialEffects of adding epinephrine on the early systemic absorption kinetics of local anesthetics in abdominal truncal blocks.
We evaluated the pharmacokinetics of ropivacaine following rectus sheath block (RSB) and transversus abdominis plane (TAP) block with or without epinephrine. A total of 26 adult patients undergoing lower abdominal surgery with RSB (=RSB trial) and another 26 adult patients undergoing open prostatectomy with TAP block (=TAP trial) were enrolled. ⋯ The peak concentration was significantly lower and time to peak concentration was significantly longer in the TAP-E(+) group than in the TAP-E(-) group (P < 0.05 and <0.01, respectively), while there were no significant differences in these parameters between the RSB-E(+) and RSB-E(-) groups. These results indicate that epinephrine attenuates the early phase of local anesthetic absorption from the injected site in TAP blocks, but not RSB.
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Randomized Controlled Trial Multicenter Study
Antibiotic prophylaxis for ED patients with simple hand lacerations: a feasibility randomized controlled trial.
The benefit of antibiotic prophylaxis for simple hand lacerations (lacerations that do not involve special structures) has not been adequately studied. ⋯ The findings of this pilot study support the feasibility of a randomized, double-blind, controlled trial. The low rate of infection suggests the need of a large sample size for the trial.
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Randomized Controlled Trial Comparative Study
A prospective randomised comparison of two insertion methods for i-gel(™) placement in anaesthetised paralysed patients: standard vs rotational technique.
In this prospective randomised study, we compared two techniques for i-gel(™) insertion. One hundred and eighty-one anaesthetised, paralysed adult patients were randomly allocated into one of two groups. In the standard group (n = 91), the i-gel was inserted using the standard technique. ⋯ The mean (SD) insertion time was longer (26.9 (14.5) s vs. 22.4 (10.2) s; p = 0.016) and air leak pressure was lower (22.5 (10.4) cm H2O vs. 27.1 (9.4) cm H2O; p = 0.002) in the standard group. The incidence of bloodstaining was higher with the standard technique (8 (9%) vs. 1 (1%); p = 0.034). This study suggests that the rotational technique is superior to the standard technique for i-gel insertion.
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Anesthesia and analgesia · Jul 2014
Randomized Controlled TrialCapnography During Deep Sedation with Propofol by Nonanesthesiologists: A Randomized Controlled Trial.
Propofol, a short-acting hypnotic drug, is increasingly administered by a diverse group of specialists (e.g., cardiologists, gastroenterologists) during diagnostic and therapeutic procedures. Standard monitoring during sedation comprises continuous pulse oximetry with visual assessment of the patient's breathing pattern. Because undetected hypoventilation is a common pathway for complications, capnographic monitoring of exhaled carbon dioxide has been advocated. We examined whether the use of capnography reduces the incidence of hypoxemia during nonanesthesiologist-administered propofol sedation in patients who did not receive supplemental oxygen routinely. ⋯ We were unable to confirm an additive role for capnography in preventing hypoxemia during elective nonanesthesiologist-administered propofol (monotherapy) sedation in healthy women in whom supplemental oxygen is not routinely administered. Based on the confidence interval, the benefit of adding capnography is at most an absolute hypoxemia reduction of 7.5%, suggesting that adding it in this practice setting to the routine monitoring strategy does not necessarily improve patient safety in daily practice.
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Randomized Controlled Trial
Randomized trial of tourniquet vs blood pressure cuff for target vein dilation in ultrasound-guided peripheral intravenous access.
Ten percent of the time, peripheral intravenous access (PIV) is not obtained in 2 attempts in the emergency department. Typically, a tourniquet is used to dilate the target vein; but recent research showed that a blood pressure (BP) cuff improves dilation, which may translate to increased PIV success. ⋯ Tourniquet is superior to BP cuff for target vein dilation in ultrasound-guided PIV.