Showing papers in "Anesthesia & Analgesia in 2002"
TL;DR: It is concluded that obesity alone is not predictive of tracheal intubation difficulties, and large neck circumference and high Mallampati score were the only predictors of potentialintubation problems.
Abstract: The tracheas of obese patients may be more difficult to intubate than those of normal-weight patients. We studied 100 morbidly obese patients (body mass index 40 kg/m 2 ) to identify which factors complicate direct laryngoscopy and tracheal intubation. Preoperative measurements (height, weight, neck circumference, width of mouth opening, sternomental distance, and thyromental distance) and Mallampati score were recorded. The view during direct laryngoscopy was graded, and the number of attempts at tracheal intubation was recorded. Neither absolute obesity nor body mass index was associated with intubation difficulties. Large neck circumference and high Mallampati score were the only predictors of potential intubation problems. Because in all but one patient the trachea was intubated successfully by direct laryngoscopy, the neck circumference that requires an intervention such as fiberoptic bronchoscopy to establish an airway remains unknown. We conclude that obesity alone is not predictive of tracheal intubation difficulties.
587 citations
TL;DR: At concentrations close to anesthetic 50% effective concentration, urethane had modest effects on all channels tested, suggesting the lack of a single predominant target for its action, which may account for its usefulness as a veterinary anesthetic.
Abstract: Urethane is widely used as an anesthetic for animal studies because of its minimal effects on cardiovascular and respiratory systems and maintenance of spinal reflexes. Despite its usefulness in animal research, there are no reports concerning its molecular actions. We designed this study to determi
479 citations
TL;DR: Perturbation of respiratory mechanics produced by general anesthesia and surgery is more pronounced in morbidly obese (MO) patients, and general anesthesia in MO patients generated much more atelectasis than in nonobese patients.
Abstract: Perturbation of respiratory mechanics produced by general anesthesia and surgery is more pronounced in morbidly obese (MO) patients. Because general anesthesia induces pulmonary atelectasis in nonobese patients, we hypothesized that atelectasis formation would be particularly significant in MO patie
475 citations
TL;DR: This systematic review does not support the traditional idea that ephedrine is the preferred choice for the management of maternal hypotension during spinal anesthesia for elective cesarean delivery in healthy, nonlaboring women.
Abstract: This quantitative systematic review compared the efficacy and safety of ephedrine with phenylephrine for the prevention and treatment of hypotension during spinal anesthesia for cesarean delivery. Seven randomized controlled trials (n 292) were identified after a systematic search of electronic databases (MEDLINE, EMBASE, The Cochrane Controlled Trials Registry), published articles, and contact with authors. Outcomes assessed were maternal hypotension, hypertension and bradycardia, and neonatal umbilical cord blood pH values and Apgar scores. For the management (prevention and treatment) of maternal hypotension, there was no difference between phenylephrine and ephedrine (relative risk [RR] of 1.00; 95% confidence interval [CI], 0.96 –1.06). Maternal bradycardia was more likely to occur with phenylephrine than with ephedrine (RR of 4.79; 95% CI, 1.47–15.60). Women given phenylephrine had neonates with higher umbilical arterial pH values than those given ephedrine (weighted mean difference of 0.03; 95% CI, 0.02– 0.04). There was no difference between the two vasopressors in the incidence of true fetal acidosis (umbilical arterial pH value of 7.2; RR of 0.78; 95% CI, 0.16 –3.92) or Apgar score of7 at 1 and 5 min. This systematic review does not support the traditional idea that ephedrine is the preferred choice for the management of maternal hypotension during spinal anesthesia for elective cesarean delivery in healthy, nonlaboring women. (Anesth Analg 2002;94:920 –6)
427 citations
TL;DR: This chapter discusses the development of Guidelines, further preoperative testing to Assess Coronary Risk, and management of Specific Preoperative Cardiovascular Condition.
Abstract: Table of ContentsI. IntroductionA. Development of GuidelinesB. General ApproachC. Preoperative Clinical EvaluationII. Further Preoperative Testing to Assess Coronary RiskA. Clinical MarkersB. Functional CapacityC. Surgery-Specific RiskIII. Management of Specific Preoperative Cardiovascular Condition
421 citations
TL;DR: TEA with preoperative initiation is a preferable method in preventing acute and long-term thoracotomy pain and was associated with decreased pain compared with the other groups.
Abstract: In this clinical, randomized, prospective study, we compared the effects of three different analgesia techniques (thoracic epidural analgesia [TEA] with and without preoperative initiation and IV patient-controlled analgesia [IV-PCA]) on postthoracotomy pain in 69 patients. In two groups, a thoracic epidural catheter was inserted preoperatively. Group Pre-TEA had bupivacaine and morphine solution preoperatively and intraoperatively. Postoperative analgesia was maintained with epidural PCA with a similar solution. Group Post-TEA, with no intraoperative medication, had the same postoperative analgesia as Group Pre-TEA plus the bolus dose. Group IV-PCA received only IV-PCA with morphine for postoperative analgesia. Pain was evaluated every 4 h during the first 48 h at rest, cough, and movement. Pre-TEA was associated with decreased pain compared with the other groups. Six months later, the patients were asked about their pain. The incidence and the intensity of pain were most frequent in Group IV-PCA (78%) and were the least in Group Pre-TEA (45%) (Group Pre-TEA versus Group IV-PCA, P = 0.0233; Group Pre-TEA versus Group IV-PCA, P = 0.014). Patients having pain on the second postoperative day had 83% chronic pain. TEA with preoperative initiation is a preferable method in preventing acute and long-term thoracotomy pain.
384 citations
TL;DR: It is clear that the anesthetic technique can influencethe analgesic requirement in the early postoperative period, and Optimizing pain management is necessary to maximize the benefits of ambulatory sur-gery for both patients and health care providers.
Abstract: Summary As more extensive and painful surgical procedures(e.g., laparoscopic cholecystectomy, adrenalectomy,and nephrectomy, as well as prostatectomy, laminec-tomy, shoulder and knee reconstructions, and hyster-ectomy) are performed on an outpatient or short-staybasis, the use of multimodal perioperative analgesicregimens containing non-opioid analgesic therapieswill probably assume an increasingly important rolein facilitating the recovery process and improving pa-tient satisfaction (3). Optimizing pain management isnecessary to maximize the benefits of ambulatory sur-gery for both patients and health care providers. Ad-ditional outcome studies are needed to validate thebeneficial effects of these newer therapeutic ap-proaches with respect to important recovery variables(e.g., resumption of normal activities and return towork). Although many factors other than pain per se must be controlled to minimize postoperative morbid-ity and facilitate the recovery process after ambulatorysurgery, pain remains a major concern of all patientsundergoing surgical procedures (102).It is clear that the anesthetic technique can influencethe analgesic requirement in the early postoperative
319 citations
TL;DR: The results indicate that sustained NMDA-receptor blocking could be a fruitful therapy for improving postoperative morphine effectiveness and that sustained ketamine pretreatment had no analgesic effect per se at the dose used herein.
Abstract: Perioperative opioids increase postoperative pain and morphine requirement, suggesting acute opioid tolerance. Furthermore, opioids elicit N-methyl-d-aspartate (NMDA)-dependent pain hypersensitivity. We investigated postfentanyl morphine analgesic effects and the consequences of NMDA-receptor antago
318 citations
TL;DR: Elective case scheduling at hospitals and surgical centers at which surgeons and patients choose the day of surgery, cases are not turned away, and anesthesia and nursing staffing are adjusted to maximize the efficiency of use of operating room (OR) time is considered.
Abstract: We considered elective case scheduling at hospitals and surgical centers at which surgeons and patients choose the day of surgery, cases are not turned away, and anesthesia and nursing staffing are adjusted to maximize the efficiency of use of operating room (OR) time. We investigated scheduling a new case into an OR by using two patient-scheduling rules: Earliest Start Time or Latest Start Time. By using several scenarios, we showed that the use of Earliest Start Time is rational economically at such facilities. Specifically, it maximizes OR efficiency when a service has nearly filled its regularly scheduled hours of OR time. However, Latest Start Time will perform better at balancing workload among services’ OR time. We then used historical case duration data from two facilities in computer simulations to investigate the effect of errors in predicting case durations on the performance of these two heuristics. The achievable incremental reduction in overtime by having perfect information on case duration versus using historical case durations was only a few minutes per OR. The differences between Earliest Start Time and Latest Start Time were also only a few minutes per OR. We conclude that for facilities at which the goals are, in order of importance, safety, patient and surgeon access to OR time, and then efficiency, few restrictions need to be placed on patient scheduling to achieve an efficient use of OR time. (Anesth Analg 2002;94:933–42)
311 citations
TL;DR: Investigation of the analgesic efficacy of mexiletine and gabapentin on acute and chronic pain associated with cancer breast surgery in 75 patients found pain at rest and after movement was reduced by both drugs on the third postoperative day.
Abstract: We investigated the analgesic efficacy of mexiletine and gabapentin on acute and chronic pain associated with cancer breast surgery in 75 patients. They were randomized to receive, in a double-blinded manner, mexiletine 600 mg/d, gabapentin 1200 mg/d, or placebo for 10 days. Anesthesia was standardi
307 citations
TL;DR: Patients seeking surgical weight loss must have proven attempts at medically supervised weight loss, and Documentation of loss of 5% to 10% excess body weight or weight gain after at least 6 mo of diet modification, exercise, and medical therapy or nonimprovement in comorbid conditions during this period indicates failure.
Abstract: According to the National Institutes of Health, obesity is a major health problem with clearly established health implications, including an increased risk for coronary artery disease, hypertension, dyslipidemia, diabetes mellitus, gallbladder disease, degenerative joint disease, obstructive sleep apnea, and socioeconomic and psychosocial impairment (1). The risk of developing one or more of these obesityrelated conditions is based on body mass index (BMI), with 25–30 kg/m 2 being low risk and 40 kg/m 2 being very high risk (2). The prevalence of obesity in the 18- to 29-yr-old group increased from 12% in 1991 to 18.9% in 1999 (3). Bariatric surgery encompasses a variety of surgical weight loss procedures used to treat morbid obesity. Obesity is clinically expressed in terms of BMI or Quetelet’s index (4), which is derived by dividing weight by the square of height to estimate the degree of obesity. Thus, BMI body weight (kg)/height 2 (m 2 ). Morbid obesity is a BMI more than 35 kg/m 2 , and super morbid obesity is BMI more than 55 kg/m 2 . The indications for surgical treatment of severe obesity, as outlined in the 1991 National Institutes of Health Consensus Development Conference Panel, include an absolute BMI more than 40 kg/m 2 or BMI more than 35 kg/m 2 in combination with lifethreatening cardiopulmonary problems or severe diabetes mellitus (1). Patients seeking surgical weight loss must have proven attempts at medically supervised weight loss. Documentation of loss of 5% to 10% excess body weight or weight gain after at least 6 mo of diet modification, exercise, and medical therapy or nonimprovement in comorbid conditions during this period indicates failure. Studies have shown that weight loss of 5%–10% of initial body weight improves glucose intolerance and Type II diabetes, hypertension, and dyslipidemia (5–7). The average expenditure is approximately $7000 per year per patient on weight loss programs and equipment. Unfortunately, long-term weight loss is the exception, and most patients regain weight, sometimes more than they initially lost.
TL;DR: This survey surveyed ambulatory surgery patients to determine pain severity, analgesic use, relationship of pain to duration of recovery, and the relative importance of various factors to predicting these outcomes.
Abstract: Pain complicates the recovery process after ambulatory surgery. We surveyed 175 ambulatory surgery patients to determine pain severity, analgesic use, relationship of pain to duration of recovery, and the relative importance of various factors to predicting these outcomes. Multivariate regression an
TL;DR: Sedation was achieved more rapidly with propofol but was similar between groups 25 min after initiating infusions, and there were no differences between groups in psychomotor performance and respiratory rate during recovery.
Abstract: We evaluated the cardio-respiratory effects of equisedative doses of dexmedetomidine and propofol for intraoperative sedation. Secondary comparison end points were time to achieve and terminate sedation and postoperative analgesia and psychomotor performance. Forty patients scheduled for elective surgery provided informed consent and were randomized equally to receive either dexmedetomidine (1 g/kg initial loading dose for 10 min; maintenance, 0.4 – 0.7 g·k g 1 ·h 1 ) or propofol (75 g·k g 1 · min 1 10 min; maintenance, 12.5–75 g·k g 1 · min 1 ). Hemodynamic variables (heart rate and mean arterial blood pressure), sedation (visual analog scale and Observer Assessment of Alertness/Sedation), bispectral index score of sedation, ventilation (respiratory rate, O2 sat, and ETco2), psychomotor performance (digital symbol substitution test), and pain (visual analog scale) were determined during surgery and up to 95 min after surgery. Intraoperative sedation levels were targeted to achieve a bispectral index score of 70 – 80. Patient demographics, ASA class, surgical procedure, and baseline cardio-respiratory variables were similar between groups. Sedation was achieved more rapidly with propofol but was similar between groups 25 min after initiating infusions. The average infusion rate for dexmedetomidine was 0.7 g·k g 1 ·h 1 and 38 g·k g 1 · min 1 for propofol. There were no differences between groups in psychomotor performance and respiratory rate during recovery. The previous use of dexmedetomidine resulted in more sedation, lower blood pressure, and improved analgesia (less morphine use) in recovery.
TL;DR: The data suggest that the FLACC tool may be useful as an objective measure of postoperative pain in children with CI and good validity and reliability was supported.
Abstract: Pain assessment remains difficult in children with cognitive impairment (CI). In this study, we evaluated the validity and reliability of the Face, Legs, Activity, Cry, Consolability (FLACC) tool for assessing pain in children with CI. Each child’s developmental level and ability to self-report pain were evaluated. The child’s nurse observed and scored pain with the FLACC tool before and after analgesic administration. Simultaneously, parents scored pain with a visual analog scale, and scores were obtained from children who were able to self-report pain. Observations were videotaped and later viewed by nurses blinded to analgesics and pain scores. One-hundred-forty observations were recorded from 79 children. FLACC scores correlated with parent scores (P 0.001) and decreased after analgesics (P 0.001), suggesting good validity. Correlations of total scores (r 0.5– 0.8; P 0.001) and of each category (r 0.3– 0.8; P 0.001), as well as measures of exact agreement ( 0.2– 0.65), suggest good reliability. Test-retest reliability was supported by excellent correlations (r 0.8 – 0.883; P 0.001) and categorical agreement (r 0.617– 0.935; 0.400 – 0.881; P 0.001). These data suggest that the FLACC tool may be useful as an objective measure of postoperative pain in children with CI.
TL;DR: This investigation examined the hypothesis that music may decrease the anxiety experienced by patients before surgery while using a rigorous study design and objective outcome measures.
Abstract: Music may decrease the anxiety experienced by patients before surgery. Previous studies of this issue were hindered with multiple methodological problems. In this investigation, we examined this hypothesis while using a rigorous study design and objective outcome measures. Adult patients undergoing
TL;DR: Meta-analyses of published controlled studies that used hypnosis with surgical patients found a significant effect size, indicating that surgical patients in hypnosis treatment groups had better outcomes than 89% of patients in control groups, and support the position that hypnosis is an effective adjunctive procedure for a wide variety of surgical patients.
Abstract: Hypnosis is a nonpharmacologic means for managing adverse surgical side effects. Typically, reviews of the hypnosis literature have been narrative in nature, focused on specific outcome domains (e.g., patients’ selfreported pain), and rarely address the impact of different modes of the hypnosis administration. Therefore, it is important to take a quantitative approach to assessing the beneficial impact of adjunctive hypnosis for surgical patients, as well as to examine whether the beneficial impact of hypnosis goes beyond patients’ pain and method of the administration. We conducted metaanalyses of published controlled studies (n 20) that used hypnosis with surgical patients to determine: 1) overall, whether hypnosis has a significant beneficial impact, 2) whether there are outcomes for which hypnosis is relatively more effective, and 3) whether the method of hypnotic induction (live versus audiotape) affects hypnosis efficacy. Our results revealed a significant effect size (D 1.20), indicating that surgical patients in hypnosis treatment groups had better outcomes than 89% of patients in control groups. No significant differences were found between clinical outcome categories or between methods of the induction of hypnosis. These results support the position that hypnosis is an effective adjunctive procedure for a wide variety of surgical patients. (Anesth Analg 2002;94:1639 –45)
TL;DR: A computed tomographic scan was obtained in 35 patients to measure the depth and the relationship of the branches of the lumbar plexus to the posterior superior iliac spine projection and the vertebral column.
Abstract: A computed tomographic scan was obtained in 35 patients to measure the depth and the relationship of the branches of the lumbar plexus to the posterior superior iliac spine projection and the vertebral column. In addition, we prospectively studied 80 patients scheduled for total hip arthroplasty who
TL;DR: The use of OPE for potential inpatients leads to a significant reduction of cancelled cases and of length of admission, and further increase of these benefits from OPE requires changes in institutional policy, such as forcing surgical departments to increase their number of same-day admissions.
Abstract: To evaluate the possible effects of outpatient preoperative evaluation (OPE) for new surgical patients who will be inpatients, we conducted an observational study at a university hospital in The Netherlands. Various outcomes before and after the introduction of an OPE clinic were compared. The study
TL;DR: An update on the anesthetic management of patients undergoing ECT is provided to understand the physiologic responses to the electrical stimulus, the effect of anesthetic drugs on the ECT response, and the pharmacologic effects of the drugs used to attenuate the side effects related to ECT.
Abstract: T he use of electroconvulsive therapy (ECT) to provoke a generalized epileptic seizure was first described in 1938 and was performed without anesthesia for almost 30 yr (1). Now the number of ECT procedures performed each year under general anesthesia in the United States exceeds the number of coronary revascularization, appendectomy, and herniorrhaphy procedures (2). In recent years, ECT has assumed an increasingly important role in the treatment of severe and medicationresistant depression and mania, as well as in the treatment of schizophrenic patients with affective disorders, suicidal drive, delusional symptoms, vegetative dysregulation, inanition, and catatonic symptoms (2,3). Typically, the acute phase of ECT is performed three times a week for 6 to 12 treatments. In successful cases, initial clinical improvement is usually evident after three to five treatments (3,4). Maintenance therapy can be performed at progressively increasing intervals from once a week to once a month to prevent relapses. To optimize the anesthetic management of patients undergoing ECT, it is important to understand the physiologic responses to the electrical stimulus, the effect of anesthetic drugs on the ECT response, and the pharmacologic effects of the drugs used to attenuate the side effects related to ECT. In 1986, Gaines and Rees (5) published a comprehensive review regarding the psychiatric and anesthetic considerations in caring for patients undergoing ECT. More recently, Folk et al. (6) reviewed the preanesthetic management of ECT patients with coexisting diseases. This review article is intended to provide an update on the anesthetic management of patients undergoing ECT. Physiologic Responses to ECT
TL;DR: This study aimed at constructing learning curves for basic procedural skills in anesthesiology using the cumulative sum method and recorded 1234 peripheral venous cannulations, 895 orotracheal intubations, 688 spinals, and 344 epidurals performed by residents during the first 10 mo of training.
Abstract: This study aimed at constructing learning curves for basic procedural skills in anesthesiology using the cumulative sum method. We recorded 1234 peripheral venous cannulations, 895 orotracheal intubations, 688 spinals, and 344 epidurals performed by residents during the first 10 mo of training. Lear
TL;DR: It is suggested that a slower rewarming rate with lower peak temperatures during CPB may be an important factor in the prevention of neurocognitive decline after hypothermic CPB.
Abstract: Neurocognitive dysfunction is a common complication after cardiac surgery. We evaluated in this prospective study the effect of rewarming rate on neurocognitive outcome after hypothermic cardiopulmonary bypass (CPB). After IRB approval and informed consent, 165 coronary artery bypass graft surgery p
TL;DR: The largest single-institution review of adverse reactions to injection of isosulfan blue dye during sentinel lymph node mapping in breast cancer is reported, indicating that bronchospasm and respiratory compromise are unusual and that most patients do not require emergent intubation and can be managed with short-term pressor support.
Abstract: UNLABELLED In the United States, identification of the sentinel lymph node (SLN) requires the use of (99m)Tc-labeled colloid, 1% isosulfan blue dye, or both to trace the lymphatic drainage of a given neoplasm. We report our experience with adverse reactions to isosulfan blue dye during SLN mapping in breast cancer. A chart review of the breast cancer SLN database was performed; it included 2392 sequential patients who underwent SLN biopsy involving isosulfan blue dye at Memorial Sloan-Kettering Cancer Center from September 12, 1996, to August 17, 2000. Thirty-nine of 2392 patients (1.6%) had a documented allergic reaction during the mapping procedure. Most reactions (69%) produced urticaria, blue hives, a generalized rash, or pruritus. The incidence of hypotensive reactions was 0.5%. Although anaphylaxis after the injection of isosulfan blue dye is rare, this article highlights the need to suspect anaphylaxis when hemodynamic instability occurs after the injection of this compound. Our experience indicates that bronchospasm and respiratory compromise are unusual and that most patients do not require emergent intubation and can be managed with short-term pressor support. In addition, our data indicate that patients with a sulfa allergy do not display a cross-sensitivity to isosulfan blue dye. IMPLICATIONS We report the largest single-institution review of adverse reactions to injection of isosulfan blue dye during sentinel lymph node mapping in breast cancer. Bronchospasm and respiratory compromise are unusual, and most patients can be treated with short-term pressor support. Patients with a sulfa allergy do not display a cross-sensitivity to isosulfan blue dye.
TL;DR: The objective of this study was to critically review the literature on acute pain services regarding outcome: pain relief, side effects of the postoperative pain treatment, patient satisfaction, therapy-related adverse events, morbidity, hospitalstay, and cost issues.
Abstract: ain relief after surgical procedures continues tobe a major medical challenge Alleviation of painhas been given a high priority by the medicalprofession and the health authorities Improvement inperioperative analgesia not only is desirable for hu-manitarian reasons, but is also essential for its poten-tial to reduce postoperative morbidity (1–4) and mor-tality (2)Inadequacies in postoperative pain relief have beenevident for decades (5,6) The importance of establish-ing an organization for the management of postoper-ative pain relief, with special attention to a team ap-proach, was proposed more than 40 yr ago (7)Although several editorials (8–10) from 1976 to 1980again advocated the introduction of an analgesia teamto supervise and administer pain relief and to takeresponsibility for teaching and training in postopera-tive pain management, almost a decade passed beforea specialized in-hospital postoperative pain serviceemerged Thus, in 1985 the first acute pain services(APSs) were introduced in the United States (11,12)and in Germany (13) Immediate and sustained formalsupport and authoritative recommendations from var-ious medical and health care organizations promoteda widespread introduction of APSs (14–22) One doc-ument explicitly stated “that this service should beintroduced in all major hospitals performing surgeryin the UK” (15); this is in agreement with recommen-dations from the Agency for Health Care Policy andResearch (United States) and the National Health andMedical Research Council (Australia), which state thatall major acute care centers should have an APS(14,18)Furthermore, provision of an APS is presently aprerequisite for accreditation for training by the RoyalCollege of Anaesthetists (23) and the Australian andNew Zealand College of Anaesthetists A Canadiansurvey from 1991, including 47 university-affiliatedteaching hospitals, showed that 25 hospitals (53%)operated an APS and that an additional 17 (35%) wereattempting to organize one (24) (Table 1) A survey inAustralia and New Zealand in 1992–1993 from 111larger institutions showed that 37 (33%) had an APSand 58 (53%) would have liked to or had plans toimplement the service (25) Repeated surveys in 1994and 1996 from New Zealand indicated in 22 largerinstitutions an increase from 12 to 17 APSs (29) In aEuropean survey from 1993, including 105 represen-tative hospitals from 17 countries, 34% of the hospitalshad a formal APS (26) Forty-two percent to 73% of UShospitals, depending on size and academic affiliation,had an APS in 1995 (31,32) In the United Kingdom,the number of hospitals providing APSs increasedfrom 3% in 1990 to 43% in 1994 (27,28,36), to 47% in1996 (37), and to 49% in 1999 (35) In a recent surveyfrom Germany, 36% of hospitals operated an APS, butthe quality of criteria for the service was very variable(34)The introduction of APSs has led to an increase inthe use of specialized pain relief methods, such aspatient-controlled analgesia (PCA) and epidural infu-sions of local anesthetic/opioid mixtures, in surgicalwards Implementation of these methods may repre-sent real advances in improving patient well-beingand in reducing postoperative morbidity (38)However, a pertinent question is whether the exten-sive resources allocated to these commitments havebeen successful and cost-effective The objective of thisstudy, therefore, was to critically review the literatureon APSs regarding outcome: pain relief, side effects ofthe postoperative pain treatment, patient satisfaction,therapy-related adverse events, morbidity, hospitalstay, and cost issues
TL;DR: Intrathecal magnesium prolongs spinal opioid analgesia in humans and suggest that the availability of an intrathecal N-methyl-d-aspartate receptor antagonist could be of clinical importance for pain management.
Abstract: UNLABELLED Magnesium is a noncompetitive, N-methyl-D-aspartate receptor antagonist that does not effectively cross the blood-brain barrier when given IV. Intrathecal magnesium potentiates opioid antinociception in rats, and the safety of intrathecal magnesium has been demonstrated in animals. This is the first prospective human study evaluating whether intrathecal magnesium could prolong spinal opioid analgesia. Fifty-two patients requesting analgesia for labor were randomized to receive either intrathecal fentanyl 25 micro g plus saline or fentanyl 25 micro g plus magnesium sulfate 50 mg as part of a combined spinal-epidural technique. The duration of analgesia of the intrathecal drug combination was defined by the time of patient request for additional analgesia. There was significant prolongation in the median duration of analgesia (75 min) in the magnesium plus fentanyl group compared with the fentanyl alone group (60 min). There was no associated increase in adverse events in the group that received intrathecal magnesium. Larger doses of intrathecal magnesium were not studied in this group of patients because of the limitations on cephalad spread when hyperbaric solutions are injected in the sitting position. Our data indicate that intrathecal magnesium prolongs spinal opioid analgesia in humans and suggest that the availability of an intrathecal N-methyl-D-aspartate antagonist could be of clinical importance for pain management. IMPLICATIONS Magnesium occurs naturally in the spinal cord and blocks the NMDA glutamate channel. In animal studies, intrathecal magnesium sulfate improves spinal morphine analgesia. For patients receiving spinal analgesia for labor, the addition of magnesium sulfate to the opioid fentanyl prolonged analgesia with no increase of side effects.
TL;DR: This bronchoscopy simulator was very effective in teaching residents the psychomotor skills necessary for fiberoptic intubation, as well as other performance indicators.
Abstract: In this research, we sought to test the hypothesis that the AccuTouch® Flexible Bronchoscopy Simulator (Simulator) is an effective way to teach clinicians the psychomotor skills necessary to use the fiberoptic bronchoscope as an instrument for intubating the trachea of a pediatric patient. Pediatric
TL;DR: A fatal cardiac arrest during percutaneous vertebroplasty is described, serving to remind us that life threatening intraoperative pulmonary embolism may occur in this minimal invasive procedure.
Abstract: IMPLICATIONS This case report describes a fatal cardiac arrest during percutaneous vertebroplasty. This serves to remind us that life threatening intraoperative pulmonary embolism may occur in this minimal invasive procedure. Surgical precautions and invasive cardiovascular monitoring may be required in high-risk patients.
TL;DR: This study contributes to the identification of patients with a high risk for hypotension after SpA induction, with the risk increasing two- or threefold with each additional risk factor.
Abstract: We sought to identify factors that are associated with hypotension after the induction of spinal anesthesia (SpA) by using an anesthesia information management system. Hypotension was defined as a decrease of mean arterial blood pressure of more than 30% within a 10-min interval, and relevance was d
TL;DR: Small-dose ketamine improved the postoperative depressive state and relieved postoperative pain in depressed patients and depressed mood, suicidal tendencies, somatic anxiety, and hypochondriasis significantly decreased in Group A as compared with Group B.
Abstract: We investigated whether ketamine is suitable for depressed patients who had undergone orthopedic surgery. We studied 70 patients with major depression and 25 patients as the control (Group C). The depressed patients were divided randomly into two groups; patients in Group A (n = 35) were induced wit
TL;DR: A laboratory volunteer experiment to compare the performances of several pulse oximeter manufacturers' instruments, as well as some older models, during combinations of combinations of patient motion.
Abstract: Several pulse oximeter manufacturers have recently developed instruments that are claimed to be resistant to the effects of patient motion. We performed a laboratory volunteer experiment to compare the performances of several of these instruments, as well as some older models, during combinations of
TL;DR: The economic and humanistic burden after total abdominal hysterectomy, total hip replacement (THR), or total knee replacement (TKR) surgery was described and resource use and costs were estimated from the hospital perspective.
Abstract: We sought to describe the economic and humanistic burden after total abdominal hysterectomy (TAH), total hip replacement (THR), or total knee replacement (TKR) surgery. Resource use and costs were estimated from the hospital perspective. The mean worst pain severity was 8.9, 8.1, and 7.6 on a 0- to