Anesthesiology
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Randomized Controlled Trial Clinical Trial
An intrathecal fentanyl dose-response study in lower extremity revascularization procedures.
Intrathecal opioids routinely are administered to surgical patients to provide prolonged postoperative analgesia. This study evaluated the dose-response effects of intrathecal fentanyl in an elderly patient population undergoing lower extremity revascularization procedures. ⋯ Results indicate that 40 micrograms intrathecal fentanyl provides satisfactory analgesia for approximately 5 h in an elderly patient population, with a low incidence of side effects.
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Comparative Study
Postdural puncture headache and spinal needle design. Metaanalyses.
Attempts have been made to reduce the incidence of postdural puncture headache (PDPH) after spinal anesthesia by changing the size and design of the needle. We wished to determine whether these strategies are effective in reducing PDPH and whether they affect the incidence of back pain and the failure rate of spinal anesthesia. ⋯ We conclude that a noncutting needle should be used for patients at high risk for PDPH, and the smallest gauge needle available should be used for all patients.
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Ulnar neuropathy is well-recognized as a potential complication of procedures performed on anesthetized patients. However, reported outcomes and risk factors for this problem are based on small series and anecdotes. ⋯ These data suggest that perioperative ulnar neuropathies are associated with factors other than general anesthesia and intraoperative positioning. Men at the extremes of body habitus who have prolonged hospitalizations are particularly susceptible to development of ulnar neuropathies.
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Hyperventilation has been recommended to increase blood pH during metabolic acidosis. However, hypocapnia may adversely affect arterial blood oxygenation, especially in the presence of lung disease. We therefore studied the effects of metabolic acidosis, with and without normalization of pH by hyperventilation, on pulmonary gas exchange in dogs with permeability pulmonary edema. ⋯ Hyperventilation to normalize blood pH during hydrochloric acid-induced metabolic acidosis did not adversely affect pulmonary gas exchange in dogs with permeability pulmonary edema.
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Comment Letter Comparative Study
Sympathetically maintained pain and the use of regional anesthesia.