Anesthesiology
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Randomized Controlled Trial Clinical Trial
Deliberate mild intraoperative hypothermia for craniotomy.
Despite enthusiasm for the use of mild hypothermia during neurosurgical procedures, this therapy has not been evaluated systematically. This study examined the feasibility and safety of deliberate mild hypothermia and rewarming. ⋯ Although deliberate mild hypothermia is easily achieved intraoperatively, complete rewarming may be difficult to attain during craniotomy with current methods. In addition to the need for determining whether deliberate mild hypothermia confers cerebral protection in humans, the potential risks of the therapy need to be further characterized.
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Randomized Controlled Trial Comparative Study Clinical Trial
A prospective, randomized, double-blind comparison of epidural and intravenous sufentanil infusions.
The site of action (spinal vs. central) of epidurally administered lipid-soluble opioids has been the subject of controversy. We compared the efficacy, plasma concentration and side effects of epidural and intravenously administered sufentanil for postoperative pain relief. ⋯ Many clinical similarities were found when epidural and intravenous sufentanil infusions were compared. The higher incidence of excessive sedation in the patients receiving intravenous sufentanil could not be explained on the basis of plasma sufentanil concentrations alone. This study indicates that little clinical difference exists between epidural and intravenous administration of sufentanil.
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Randomized Controlled Trial Clinical Trial
Propofol causes a dose-dependent decrease in the thermoregulatory threshold for vasoconstriction but has little effect on sweating.
Volatile anesthetics increase the core temperature required to trigger sweating and decrease the core temperature required to trigger vasoconstriction. However, little is known about the effects of intravenous anesthetics on thermoregulation. We therefore tested the hypothesis that propofol increases the sweating threshold and decreases the vasoconstriction threshold, thereby increasing the inter-threshold range (core temperatures not triggering autonomic thermoregulatory responses). The study was conducted using a new model in which thermal manipulations were restricted to insensate skin, and sensate skin temperature was controlled. ⋯ Like volatile anesthetics, propofol reduces the vasoconstriction threshold and increases the inter-threshold range. However, propofol differs in leaving the sweating threshold unchanged.
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Randomized Controlled Trial Clinical Trial
Thermoregulatory thresholds during epidural and spinal anesthesia.
There are significant physiologic differences between spinal and epidural anesthesia. Consequently, these two types of regional anesthesia may influence thermoregulatory processing differently. Accordingly, in volunteers and in patients, we tested the null hypothesis that the core-temperature thresholds triggering thermoregulatory sweating, vasoconstriction, and shivering are similar during epidural and spinal anesthesia. ⋯ Comparable sweating, vasoconstriction, and shivering thresholds during epidural and spinal anesthesia suggest that thermoregulatory processing is similar during each type of regional anesthesia. However, thermoregulatory control was impaired during regional anesthesia, as indicated by the significantly enlarged inter-threshold and sweating-to-shivering ranges.
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Previous studies have noted a high incidence of adverse outcomes in the postanesthesia care unit (PACU), but few have examined associated factors and patient outcomes. To determine the frequency of acute, unanticipated respiratory problems and to examine the associated patient, surgical, and anesthetic factors, we prospectively collected preoperative, intraoperative, and postoperative data on 24,157 consecutive PACU patients who received a general anesthetic during a 33-month period. ⋯ A CRE is relatively rare. Multiple patient and surgical factors and specific aspects of anesthetic management are associated with the occurrence of a CRE in the PACU.