Showing papers in "Canadian Journal of Anaesthesia-journal Canadien D Anesthesie in 2003"
TL;DR: PDPH is a common complication for parturients undergoing neuraxial blockade and occurs as early as one day and as late as seven days after durai puncture and lasts 12 hrto seven days.
Abstract: Purpose
Postdural puncture headache (PDPH) is an iatrogenic complication of neuraxial blockade. We systematically reviewed the literature on parturients to determine the frequency onset, and duration of PDPH.
323 citations
TL;DR: This new videolaryngoscope provided excellent laryngeal exposure in a patient whom multiple experienced anesthesiologists had repeatedly found to be difficult or impossible to intubate using direct laryngoscopy.
Abstract: Purpose: To describe the clinical use of a new videolaryngoscope in a patient who had repeatedly been difficult or impossible to intubate by conventional direct laryngoscopy. This device provided excellent glottic visualization and permitted easy endotracheal intubation. Clinical features: A 74-yr-old male presenting for repeat elective surgery had a history of failed intubations by direct laryngoscopy and pulmonary aspiration with a laryngeal mask airway. He refused awake flexible fibreoptic intubation. After the induction of general anesthesia, laryngoscopy was performed using a GlideScope®. This provided complete glottic exposure and easy endotracheal intubation. Conclusion: This new videolaryngoscope provided excellent laryngeal exposure in a patient whom multiple experienced anesthesiologists had repeatedly found to be difficult or impossible to intubate using direct laryngoscopy. The clinical role of this device awaits confirmation in a large series of difficult airways. Objectif : Decrire l’utilisation clinique d’un nouveau videolaryngoscope chez un patient pour qui l’intubation avait ete difficile ou impossible a quelques reprises en laryngoscopie directe traditionnelle. Ce dispositif a fourni une excellente visualisation glottique et permis une intubation endotracheale facile. Elements cliniques : Un homme de 74 ans, vu a maintes reprises en chirurgie elective, avait subi des intubations souvent impossibles par laryngoscopie directe et une aspiration pulmonaire lors de l’usage d’un masque larynge. Il refusait l’intubation vigile avec un fibroscope flexible. Apres l’induction de l’anesthesie generale, la laryngoscopie a ete realisee avec un GlideScope®. L’appareil a fourni une exposition glottique complete et permis une intubation endotracheale facile. Conclusion : Ce nouveau videolaryngoscope a fourni une excellente exposition laryngee chez un patient qui avait subi a de multiples reprises des difficultes ou meme l’impossibilite d’intubation par laryngoscopie directe. Le role clinique de cet appareil devrait etre confirme par une grande serie sur les intubations difficiles. NTUBATION using direct laryngoscopy is successful in the majority of patients, even when a line-of-sight view of the glottis is not possible. Although poor glottic visualization is encountered between 1.5–8.5% of attempts, 1 success can generally be achieved with additional force, external laryngeal manipulation, the use of airway adjuncts such as articulated laryngoscopes, bougies and stylets or alternative techniques such as a lightwand or intubating laryngeal mask. Poor glottic exposure is more likely to require prolonged or multiple attempts and be associated with complications. 2 Flexible fibreoptic devices are well suited for many settings where a line-of-sight cannot be achieved, however after the fibrescope is introduced into the trachea, tube advancement is usually accomplished without visual control. Though rigid fibreoptic laryngoscopes do not suffer from the above limitation, they are not widely used, perhaps in part because they are perceived as being difficult to use. 3 A new videolaryngoscope is described which is similar in technique to direct laryngoscopy but does not depend upon a line-of-sight. The image is captured by a miniature video camera embedded in the undersurface of the blade and transmitted to a monitor, permitting verifiable glottic exposure and video capture of the image. Larger studies, however will be required to determine its role in routine and complex airway cases.
241 citations
TL;DR: The use of adjuvant magnesium during perioperative analgesia may be beneficial for its antagonist effects on N-methyl-D-aspartate receptors and others have been suggested by recent publications.
Abstract: Purpose
To review current knowledge concerning the use of magnesium in anesthesiology, intensive care and emergency medicine.
221 citations
TL;DR: Using ultrasound imaging for teaching epidural anesthesia in obstetrics the authors found a higher rate of success during the first 60 attempts compared to conventional teaching, which shows the possible value of ultrasound Imaging for teaching and learning obstetric regional anesthesia.
Abstract: Epidural anesthesia may be difficult in pregnancy. We intended to evaluate the teaching possibilities of ultrasonography as a diagnostic approach to the epidural region. Two groups of residents performed their first 60 obstetric epidurals under supervision. One proceeded in the conventional way using the loss of resistance technique (control group = CG). The other group proceeded in the same way but was supported by prepuncture ultrasound imaging, giving them information about the optimal puncture point, depth and angle (ultrasound group = UG). Success was defined as adequate epidural anesthesia requiring a maximum of three attempts, reaching a visual analogue scale score of less than I, while neither changing the anesthesia technique, nor starting at another vertebral level. In addition, intervention by the supervisor was defined as failure. In the CG we observed asuccess rate of 60% ± 16% after the first ten attempts followed by a nearly continuous rise of the learning curve. Within the next 50 epidurals the rate of success increased to 84%. In the UG the rate of success started at 86% ± 15%. Wthin 50 epidural insertions it rose up to a level of 94%. The difference between the two groups remained significant (P < 0.001). Using ultrasound imaging for teaching epidural anesthesia in obstetrics we found a higher rate of success during the first 60 attempts compared to conventional teaching. We believe this shows the possible value of ultrasound imaging for teaching and learning obstetric regional anesthesia.
201 citations
TL;DR: Preoperative dexamethasone 0.5 mg·kg−1iv reduced both postoperative vomiting and pain in children after electrocautery tonsillectomy.
Abstract: Previous studies on dexamethasone’s antiemetic and analgesic potential in children undergoing tonsillectomy have produced conflicting results. The aim of this study was to evaluate the effects of a single dose of dexamethasone on the incidence and severity of postoperative vomiting and pain in children undergoing electrocautery tonsillectomy under standardized general anesthesia. In a double-blinded study 120 patients were randomly allocated to receive either dexamethasone 0.5 mg·kg−1 (maximum dose 8 mg)iv or an equivalent volume of saline preoperatively. The incidence of early and late vomiting, need for rescue antiemetics, time to first oral intake, time to first demand of analgesia and analgesic consumption were compared in both groups. Pain scores used included Children’s Hospital Eastern Ontario Pain Scale, “faces”, and a 0–10 visual analogue pain scale. Compared with placebo, dexamethasone significantly decreased the incidence of early and late vomiting (P < 0.05,P < 0.001 respectively). Fewer patients in the dexamethasone group needed antiemetic rescue (P < 0.01). The time to first oral intake was shorter, and the time to first dose of analgesic was longer in the dexamethasone group (P < 0.01). Pain scores 30 min after extubation were lower (P < 0.05) in the dexamethasone group. At 12 and 24 hr postoperative swallowing was still significantly less painful in the dexamethasone group than in the control group (P < 0.01). Preoperative dexamethasone 0.5 mg·kg−1
iv reduced both postoperative vomiting and pain in children after electrocautery tonsillectomy.
163 citations
TL;DR: Anesthesiologists, nurses, human factors engineers, and device manufacturers can work together to enhance the safety of PCA pumps by redesigning user interfaces, drug cassettes, and hospital operating procedures to minimize programming errors and to enhance their detection before patients are harmed.
Abstract: Purpose
To identify the factors that threaten patient safety when using patient-controlled analgesia (PCA) and to obtain an evidence-based estimate of the probability of death from user programming errors associated with PCA,
159 citations
TL;DR: Increased age, male sex, TMJ pathology, Mallampati 3 and 4, a history of obstructive sleep apnea and abnormal upper teeth were associated with a higher incidence of DL and the magnitude of BMI had no influence on difficulty with laryngoscopy.
Abstract: Purpose
We investigated the association between morbid obesity and difficult laryngoscopy (DL).
150 citations
TL;DR: A correctly placed LMA-C or PLMA is as effective as an ETT for positive pressure ventilation without clinically important gastric distension in non-obese and obese patients.
Abstract: Purpose
To compare the laryngeal mask airways (LMA), LMA-Classic™ (LMA-C) and LMA-ProSeal™ (PLMA) with the endotracheal tube (ETT) with respect to pulmonary ventilation and gastric distension during gynecologic laparoscopy.
127 citations
TL;DR: Measurements with the aortic transpulmonary thermodilution technique give continuous and intermittent values that agree with the pulmonary thermodillution method which is still the current clinical standard.
Abstract: Purpose
The PiCCO System is a relatively new device allowing intermittent cardiac output monitoring by aortic transpulmonary thermodilution technique (Aorta intermittent) and continuous cardiac output monitoring by pulse contour analysis (Aorta continuous) The objective of this study was to assess the level of agreement of Aorta intermittent and Aorta continuous with intermittent (PA intermittent) and continuous cardiac output (PA continuous) measured through a special pulmonary artery catheter (Vigilance System SvO2/CCO Monitor) in patients undergoing singleor double-lung transplantation
119 citations
TL;DR: Administration of remifentanii followed by propofol provides adequate conditions for tracheal intubation without muscle relaxants and the frequency of excellent conditions was significantly higher in the prop ofol group compared with the thiopentone and etomidate groups.
Abstract: Purpose
Administration of remifentanii followed by propofol provides adequate conditions for tracheal intubation without muscle relaxants. Other hypnotic drugs have not been thoroughly investigated in this regard. Intubating conditions with remifentanil followed by propofol, thiopentone or etomidate are compared in this study.
115 citations
TL;DR: The term “respiratory depression” has no clear definition from a review of the literature on ITM use for postoperative analgesia, and the consistent use of terms with specific meanings will facilitate understanding the true incidence of ITM’s respiratory effects.
Abstract: Purpose
To review the postoperative intrathecal morphine (ITM) analgesia literature for their definitions of “respiratory depression” (RD).
TL;DR: The use of salbutamol, beclomethasone or sodium chromoglycate aerosol 15 min prior to fentanyl administration minimizes fentanyl-induced coughing and has compared their efficacy.
Abstract: Purpose
Fentanyl, a synthetic opioid, is a popular choice amongst anesthesiologists in the operating room. Preinductioniv fentanyl bolus is associated with coughing in 28–45% of patients. Coughing due to fentanyl is not always benign and at times may be explosive requiring immediate intervention. We have studied the role of aerosol inhalation of salbutamol, beclomethasone and sodium chromoglycate in preventing fentanyl induced coughing and have compared their efficacy.
TL;DR: Research during the last 15 years has greatly enhanced knowledge about how muscles react differently to muscle relaxants and has enabled us to achieve better surgical conditions with safer use of muscle relaxant and the “ideal” method of neuromuscular monitoring.
Abstract: Purpose
To review recent findings concerning neuromuscular blockade and monitoring at the larynx, the diaphragm, and the corrugator supercilii muscle.
TL;DR: The use of the alpha2 agonist, dexmedetomidine, with low-dose ketamine is reported as a safe and effective treatment strategy to provide adequate comfort and sedation for a patient who fulfilled criteria of a difficult airway and required awake fibreoptic intubation (AFOI).
Abstract: Purpose
We report the use of the alpha2 agonist, dexmedetomidine, with low-dose ketamine as a safe and effective treatment strategy to provide adequate comfort and sedation for a patient who fulfilled criteria of a difficult airway and required awake fibreoptic intubation (AFOI).
TL;DR: In this article, the effets du remplissage intravasculaire are verifié pendant an abdominal intervention chirurgicale majeure, and the remplssage vasculaire dependait de parametres physiologiques.
Abstract: Objectif : Verifier les effets du remplissage intravasculaire sur la reaction inflammatoire pendant une intervention chirurgicale majeure. Methode : Trente-six patients devant subir une intervention abdominale reglee ont ete repartis au hasard et ont recu soit de l'hydroxyethylamidon a 6 % (poids moleculaire moyen de 130 000 Dalton, degre de substitution de 0,4 ; n = 18, groupe HEA), soit une solution de Ringer-lactate (groupe RL ; n = 18) comme remplissage intravasculaire. Les liquides ont ete administres avant l'operation et, pendant 48 h a l'unite des soins intensifs. Le remplissage vasculaire dependait de parametres physiologiques. Les concentrations seriques d'interleukine (IL-6, IL-8 et IL-10 et molecules d'adhesion solubles (sELAM-I et sICAM-I) ont ete mesurees apres l'induction de l'anesthesie, quatre heures apres la fin de l'operation, de meme que 24 h et 48 h apres l'operation. Resultats : Les donnees biometriques et perioperatoires, l'hemodynamique et l'oxygenation ont ete similaires chez les patients des deux groupes. Une moyenne de 4470 ± 340 mL de HEA 130/0,4 par patient ont ete administres dans le groupe HEA et de 14310 ± 750 mL de RL par patient du groupe RL pendant l'experimentation. La liberation de cytokines pro-inflammatoires IL-6 et IL-8 a ete significativement plus faible dans le groupe HEA [(valeurs maximales) 47,8 ± 12,1 pg.dL -1 de IL-6 et 35,8 ± 11,2 pg.mL -1 de IL-8 (groupe HEA) vs 61,2 ± 11,2 pg.dL -1 de IL-6 et 57,9 ± 9, 7 pg.mL -1 de IL-8 (groupe RL); P < 0,05]. Les concentrations seriques de sICAM-I ont ete significativement plus elevees dans le groupe RL [(valeurs maximales) 1007 ± 152 ng.mL -1 (groupe RL) vs 687 ± 122 ng.mL -1 (groupe HEA); P < 0,05)]. Les valeurs de sELAM- I ont ete similaires dans les deux groupes. Conclusion: Le remplissage vasculaire avec de l'HEA 130/0,4, compare a la therapie liquidienne a base de solutes cristalloides, peut reduire la reaction inflammatoire chez des patients qui subissent une operation majeure. Nous pensons que cette situation releve d'une microcirculation meilleure accompagnee d'une activation endotheliale reduite et d'une lesion endotheliale moindre.
TL;DR: PCEA in comparison to preceding CEI provides equivalent analgesia with lower local anesthetic doses and plasma levels, and without motor blocking side effects, irrespective of the applied drug regimen.
Abstract: Purpose
To compare the quality of pain relief and incidence of side effects between 24-hr postoperative continuous epidural infusion (CEI) and subsequent patient-controlled epidural analgesia (PCEA) with different analgesics after major abdominal surgery.
TL;DR: This study illustrates that some residents may need as many as 75 attempts to ensure proficiency, and training programs could use cusum to track the progress of their residents’ technical skills in order to guarantee an adequate experience.
Abstract: Purpose
Cumulative sum (cusum) analysis is a statistical and graphical tool that examines trends for sequential events over time. It has been used to determine proficiency in technical procedures. We used cusum to determine the number of labour epidural attempts necessary for proficiency in our training program.
TL;DR: TheUse of a gum elastic bougie was more effective than the use of a stylet to facilitate intubation, and applying cricoid pressure worsened laryngeal view.
Abstract: Purpose
To compare the ease of tracheal intubation facilitated by the gum elastic bougie or the malleable stylet while applying cricoid pressure.
TL;DR: Infraclavicular block by the coracoid approach provides an extensive sensory distribution with an excellent tourniquet tolerance and is concluded that this approach provides highly consistent brachial plexus anesthesia for upper extremity surgery.
Abstract: Purpose: To evaluate the sensory distribution, motor block and the clinical efficacy of the infraclavicular block by the coracoid approach. Methods: In this prospective descriptive study, 150 patients received an infraclavicular block by the coracoid approach performed by a single anesthesiologist. Neurostimulation was used and 40 mL of mepivacaine 1.5% with adrenaline were injected. Block performance time, sensory distribution, motor block and tourniquet tolerance were evaluated. Results: Time to perform the block was 5 ± 2 min (mean ± SD). Success rate defined as analgesia in the five nerves distal to the elbow (musculocutaneous, median, ulnar, radial and medial cutaneous nerve of the forearm) was 91% (137 patients). A proximal block of the axillary nerve was present in 98.5% of the patients and of the medial cutaneous nerve of the arm in 60%. An arm tourniquet ( 250 mmHg of pressure ) was applied to 115 of the 137 patients with a successful block and all tolerated the tourniquet for a duration of 37 ± 21 min ( mean ± SD). Conclusion: Infraclavicular block by the coracoid approach provides an extensive sensory distribution with an excellent tourniquet tolerance. We conclude that this approach provides highly consistent brachial plexus anesthesia for upper extremity surgery.
TL;DR: Laryngoscopy was better with straight blades but curved blades provided better intubating conditions, and the best results were obtained with the MC and M blades.
Abstract: Purpose
To compare the Macintosh (M), McCoy (MC), Miller (MIL), Belscope (BP) and Lee-Fiberview (LF) laryngoscopes with respect to the grade of laryngeal visualization and the difficulty of intubation.
TL;DR: The data show that these two anesthetic techniques allow the early extubation of myasthenic patients in the operating room and any other significant differences between the two groups studied are not observed.
Abstract: Purpose: To compare two non-muscle relaxant anesthetic techniques in myasthenic patients undergoing trans-sternal thymectomy, evaluating the intra- and postoperative conditions including the early extubation in the operating room. Methods: Sixty-eight consecutive myasthenic patients undergoing trans-sternal thymectomy were prospectively randomized in two groups: propofol and sevoflurane. In both groups anesthesia was induced with propofol (1–2 mg·kg –1 ) and intubation performed after topical anesthesia of the airway with lidocaine. Anesthesia was maintained in the propofol group (36 patients) with a continuous propofol infusion (3–6 mg·kg –1 ·hr –1 ) and nitrous oxide and, in the sevoflurane group (32 patients), with sevoflurane (end-tidal 1–1.5%) in O 2 :N 2 O. Intubating conditions, hemodynamic changes, neuromuscular transmission, postoperative intensive care unit and hospital length of stay and complications were evaluated. Data were analyzed with repeated measure two-way analysis of variance (ANOVA), Chi square test and Student's t test. Results: Intubating conditions were good in all patients. There were no hemodynamic changes. All patients were extubated in the operating room and none had to be re-intubated for postoperative respiratory depression. Neuromuscular transmission showed minimal changes, more important in the sevoflurane group, and at the end of the procedure the recovery was complete in all patients. We did not observe any other significant differences between the two groups studied. Conclusion: Our data show that these two anesthetic techniques allow the early extubation of myasthenic patients in the operating
TL;DR: The results show that non-opioid analgesia produced pain relief and less sedation during recovery from gastric bypass surgery compared to fentanyl.
Abstract: Purpose
Several non-opioid drugs have been shown to provide analgesia during and after surgery. We compared sevoflurane anesthesia with fentanyl analgesia to sevoflurane and non-opioid drug treatment for gastric bypass surgery and recovery.
TL;DR: Intranasal administration of s-ketamine and midazolam is an appropriate premedication in preschool children and adverse effects observed were within an acceptable range and similar for the three groups.
Abstract: To evaluate the efficacy and safety of intranasally administered s-ketamine and midazolam for premedication in pediatric patients. Ninety children were randomly allocated to receive intranasally administered s-ketamine 1 mg·kg−1 and midazolam 0.2 mg·kg−1 (Group K1, n = 30), s-ketamine 2 mg·kg−1 and midazolam 0.2 mg·kg−1 (Group K2, n = 30), or midazolam 0.2 mg·kg−1 (Group M, n = 30) as premedicants, using a double-blind study design. Sedation and anxiolysis were evaluated using a sedation and cooperation scale and recorded at several time points. Acceptable conditions (K1: 23; K2: 26, M:19) for parental separation were not different between groups. Induction conditions were acceptable in 26 patients in K2 (P < 0.05 vs M) (K1: 23; M: 19). Compared to baseline values individual conditions significantly improved in groups K1 and K2 from 2.5 min after premedication until induction of anesthesia (P < 0.003), in group M conditions improved only five minutes after premedication (P < 0.05). Adverse effects observed in this series were within an acceptable range and similar for the three groups. Intranasal administration of s-ketamine and midazolam is an appropriate premedication in preschool children.
TL;DR: Desmopressin did not reduce intraoperative blood loss or transfusion requirements during hepatectomy despite raising clotting factor levels and improving tests of hemostasis.
Abstract: To determine the effects of desmopressin on coagulation and blood loss in patients undergoing elective partial hepatectomy. A randomized, controlled and double-blind study on 59 patients who received either 0.3 μg·kg−1 of desmopressin or an equal volume of normal saline (control) infused intravenously over 20 min after induction of general anesthesia. There was an increase in plasma levels of factors VIII and von Willebrand after the infusion of study drug in both groups (P < 0.001). The activated partial thromboplastin time was shortened in Group D whereas prothrombin time was prolonged in Group C; (P = 0.02). A large range of intraoperative blood loss (400–7128 mL) was observed, with no significant differences between groups. There were no changes in plasma electrolyte levels or osmolality. Transfusion requirements were similar in both groups. Desmopressin did not reduce intraoperative blood loss or transfusion requirements during hepatectomy despite raising clotting factor levels and improving tests of hemostasis.
TL;DR: The interaction between anesthesia and muscle relaxation to produce adequate intubating conditions is confirmed and intubation conditions were more dependent on atracurium-induced neuromuscular blockade than on anesthetics, but both atracuium and propofol improved intubated conditions.
Abstract: Muscle relaxants and anesthetics are usually associated during intubation. However, their relative role to facilitate the process is not dearly defined. This study was designed to determine, during intubation: i) the relative role of anesthetics and atracurium-induced neuromuscular block and; ii) the effect of different doses of propofol in the presence of complete muscle block. Patients were randomized to four groups and received fentanyl and a standardized anesthetic procedure. Patients from groups high (H;n = 45), medium (M;n = 48) and low(L;n = 47) received 2.5 mg· kg−1, 2.0 mg· kg−1, and 1.5 mg· kg−1 of propofol respectively, Atracurium (0.5 mg· kg−1) was then injected and tracheal intubation performed once complete block was achieved at the orbicularis oculi. Patients from group without atracurium (WA;n = 20) received propofol as in group H. Intubation was performed at the expected onset time of action of atracurium. Using the same dose of propofol, the incidence of good or excellent intubating conditions was 35% without atracurium and 95% with atracurium (P < 0,0001), In patients receiving atracurium, clinically acceptable intubating conditions were more frequently achieved in groups receiving the highest propofol doses (group H or M vs group L;P < 0.03). Our study confirms the interaction between anesthesia and muscle relaxation to produce adequate intubating conditions. In the conditions described, intubating conditions were more dependent on atracurium-induced neuromuscular blockade than on anesthetics, but both atracurium and propofol improved intubating conditions.
TL;DR: Vigilance and strict infection control are important in containing the spread of SARS, and this results in the rediscovery of standards of infection control measures in daily anesthesia practice.
Abstract: Purpose
To describe the outbreak of severe acute respiratory syndrome (SARS) in Toronto, its impact on anesthesia practice and the infection control guidelines adopted to manage patients in the operating room (OR) and to provide emergency intubation outside the OR.
TL;DR: The systemic effects of inhaled nitric oxide, which include modulation of the distribution of systemic blood flow, increase in renal output, interaction with coagulation, fibrinolysis and platelet functions, alteration of the inflammatory response, and the mechanisms ofNitric oxide transport are described.
Abstract: Purpose: To review the pulmonary and systemic effects of endogenous nitric oxide and inhaled nitric oxide administered to patients. Source: A systematic search for experimental data, human case reports, and randomized clinical trials since 1980, the year of discovery of endothelium-derived relaxing factor. Principal findings: Nitric oxide has pulmonary and systemic effects. Inhaled nitric oxide not only causes selective pulmonary vasodilation but also results in pulmonary vasoconstriction of the vessels perfusing non-ventilated alveolae. The systemic effects of inhaled nitric oxide, which include modulation of the distribution of systemic blood flow, increase in renal output, interaction with coagulation, fibrinolysis and platelet functions, alteration of the inflammatory response, are described and the mechanisms of nitric oxide transport are explained. The possible toxicity of inhaled nitric oxide is also discussed. Conclusion: The multiple effects of inhaled nitric oxide support its role as a pulmonary and extra-pulmonary medication.
TL;DR: In the clinical setting of low stress laparoscopic surgery, the type of volatile anesthetic significantly affected the stress response; the changes associated with sevoflurane suggested a more favourable metabolic and immune response compared to isoflURane.
Abstract: Stress response to surgery is modulated by several factors, including magnitude of the injury type of procedure (e.g., laparoscopy vs laparotomy) and type of anesthesia. Our purpose was to compare intra- and postoperative hormonal changes during isoflurane vs sevoflurane anesthesia, in a clinical model of well defined operative stress (laparoscopic pelvic surgery). In this prospective randomized clinical study, 20 women requiring laparoscopic pelvic surgery for benign ovarian cysts received either a standard isoflurane plus fentanyl (Group A) or sevoflurane plus fentanyl anesthesia (Group B). Blood samples were collected preoperatively 30 min after the beginning of surgery, at the end of surgery after extubation, and “two and four hours after the end of surgery. Intra- and postoperative plasma levels of norepinephrine, epinephrine, adrenocorticotropic hormone (ACTH), cortisol, growth hormone (GH) and prolactin (PRL) were measured. Catecholamine levels and postoperative pain were similar in both groups. Nonetheless, in comparison to Group A, Group B showed a significant decrease of ACTH, cortisol and GH levels (A vs B at the end of surgery: ACTH 160 ± 45 vs 100 ± 40 pg·mL−1; cortisol 45 ± 8 vs 23 ± 7 μg·dL−1; GH 3 ± 2 vs 0.8 ± 0.4 ng·mL−1; P < 0.001 for all), but enhanced PRL levels (A vs B, at 30 min after the beginning of surgery: 139 ± 54 vs 185 ± 22 ng·mL−1; at the end of surgery: 100±27 vs 141 ± 45 ng·mL−1; P < 0.001 for both). In the clinical setting of low stress laparoscopic surgery, the type of volatile anesthetic significantly affected the stress response; the changes associated with sevoflurane suggested a more favourable metabolic and immune response compared to isoflurane.
TL;DR: This study found that patient assessments documented using acute pain software developed for use on a PDA were as efficient and content-rich as paper assessments.
Abstract: Purpose
Handheld computer technology provides a unique opportunity for health care professionals to access real time or near real time patient information and evidence-based resources at the point-of-care. The purpose of this study was to assess one physician’s experience using acute pain assessment software on a personal digital assistant (PDA) to assess patients on an acute pain management service (APMS).