Anesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
The Parker Flex-Tip tube versus a standard tube for fiberoptic orotracheal intubation: a randomized double-blind study.
During fiberoptic tracheal intubation, passage of the fiberscope itself to the trachea is often fairly easy, but passage of the tube into the trachea may be difficult or even impossible. A new type of disposable endotracheal tube, the Parker Flex-Tip tube, has a tip that reduces the gap between the fiberscope and the inside of the tube. Thus, theoretically, a smaller risk of impinging on laryngeal structures during insertion in trachea is expected. ⋯ During oral fiberoptic intubation, the use of the Parker Flex-Tip tube is associated with greater incidence of initial success of passage of the tube into trachea when compared to a standard endotracheal tube.
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Randomized Controlled Trial Clinical Trial
Antinociceptive effect of low-dose intrathecal neostigmine combined with intrathecal morphine following gynecologic surgery.
The purpose of this study was to determine whether combination of 1-5 microg intrathecal neostigmine would enhance analgesia from a fixed intrathecal dose of morphine. ⋯ The addition of 1-5 microg spinal neostigmine to 100 microg morphine doubled the duration to first rescue analgesic in the population studied and decreased the analgesic consumption in 24 h, without increasing the incidence of adverse effects. The data suggest that low-dose spinal neostigmine may improve morphine analgesia.
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Randomized Controlled Trial Clinical Trial
Antifibrinolytic therapy and perioperative blood loss in cancer patients undergoing major orthopedic surgery.
Aprotinin has been reported to reduce blood loss and transfusion requirements in patients having major orthopedic operations. Data on whether epsilon amino-caproic acid (EACA) is effective in this population are sparse. ⋯ Under the conditions of this study, we were unable to find a clinical benefit to using aprotinin or EACA to reduce perioperative blood loss or transfusion requirements during major orthopedic surgery in cancer patients.
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The ability of patients to walk without assistance after spinal anesthesia is a determining factor in the time to discharge following ambulatory surgery. The authors compared clinical markers of gross motor recovery with objective data of functional balance after spinal anesthesia. ⋯ The results suggest that the recovery time to unassisted ambulation is longer than has been assumed, and that the standard clinical markers of gross motor function are poor predictors of functional balance following ambulatory surgery.
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A correctly performed cricothyroidotomy may be lifesaving in a cannot-ventilate, cannot-intubate situation. However, many practicing anesthesiologists do not have experience with cricothyroidotomy. The purpose of this study was to determine the minimum training required to perform cricothyroidotomy in 40 s or less in mannequins. ⋯ Practice on mannequins leads to reductions in cricothyroidotomy times and improvement in success rates. By the fifth attempt, 96% of participants were able to successfully perform the cricothyroidotomy in 40 s or less. While clinical correlates are not known, the authors recommend that providers of emergency airway management be trained on mannequins for at least five attempts or until their cricothyroidotomy time is 40 s or less. The most appropriate retraining intervals have yet to be determined for optimal cricothyroidotomy skill retention.