Anesthesiology
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Perioperative morbidity in patients randomized to epidural or general anesthesia for lower extremity vascular surgery. Perioperative Ischemia Randomized Anesthesia Trial Study Group.
Perioperative morbidity may be modifiable in high risk patients by the anesthesiologist's choice of either regional or general anesthesia. This clinical trial compared outcomes between epidural (EA) and general (GA) anesthesia/analgesia regimens in a group of patients at high risk for cardiac and other morbidity who were undergoing similarly stressful surgical procedures. ⋯ Carefully conducted epidural and general anesthesia appear to be associated with comparable rates of cardiac and most other morbidity in patients undergoing lower extremity vascular surgery. However, compared with general anesthesia, epidural anesthesia is associated with a lower incidence of reoperation for inadequate tissue perfusion and, therefore, may be advantageous for this surgical population.
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Randomized Controlled Trial Clinical Trial
Postarthroscopy analgesia with intraarticular bupivacaine/morphine. A randomized clinical trial.
Postarthroscopy analgesia has been provided with intraarticular bupivacaine, but the duration of analgesia may be only a few hours. More recently, longer-lasting analgesia has been achieved using intraarticular morphine, although the onset of analgesia may be delayed. The combination of intraarticular morphine and bupivacaine has been suggested as an ideal analgesic after knee arthroscopy. ⋯ Morphine, 1 mg intraarticular, in 30 ml 0.25% bupivacaine, with 1:200,000 epinephrine, may provide superior postoperative analgesia for up to 24 h versus bupivacaine or morphine alone.
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Randomized Controlled Trial Clinical Trial
Autologous platelet-rich plasma does not reduce transfusion of homologous blood products in patients undergoing repeat valvular surgery.
Patients undergoing cardiac surgery employing cardiopulmonary bypass frequently require transfusion of homologous blood products and, therefore, are exposed to the risk of transfusions. Autologous platelet-rich plasma administration may reduce homologous transfusion and attendant risks. ⋯ Autologous platelet-rich plasma did not reduce perioperative bleeding or transfusion requirements in repeat valvular surgery.
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Comparative Study
Continuous calculation of intratracheal pressure in tracheally intubated patients.
Intratracheal pressure (Ptrach) should be the basis for analysis of lung mechanics. If measured at all, Ptrach is usually assessed by introducing a catheter into the trachea via the lumen of the endotracheal tube (ETT). The authors propose a computer-assisted method for calculating Ptrach on a point-by-point basis by subtracting the flow-dependent pressure drop delta PETT(V) across the ETT from the airway pressure (P(aw)), continuously measured at the proximal end of the ETT. ⋯ Ptrach can be monitored by combining our ETT coefficients and the flow and airway pressure continuously measured at the proximal end of the ETT.