Anesthesiology
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Randomized Controlled Trial Comparative Study
Propofol and remifentanil differentially modulate frontal electroencephalographic activity.
The purpose of this study was to evaluate a new, physiologically inspired method for the analysis of the electroencephalogram during propofol-remifentanil anesthesia. Based on fixed-order autoregressive moving-average modeling, this method was hypothesized to be capable of dissociating the effects that hypnotic and analgesic agents have on brain electrical activity. ⋯ Because Cortical State responds principally to variations in CePROP, it is a potential measure of hypnosis, whereas the dependence of Cortical Input on effect-site remifentanil concentration suggests that it may be useful as a measure of analgesic efficacy and the nociceptive-antinociceptive balance.
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Randomized Controlled Trial Comparative Study
Cosyntropin for prophylaxis against postdural puncture headache after accidental dural puncture.
The aim of the current study was to investigate the effect of administration of cosyntropin after accidental dural puncture (ADP) on the incidence of postdural puncture headache (PDPH) and the need for therapeutic epidural blood patch (EBP). ⋯ Administration of cosyntropin after ADP in parturients was associated with significant reduction in the incidence of PDPH and need for EBP and significant prolongation of the time from ADP to occurrence of PDPH.
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Comparative Study
Anesthetic management and surgical site infections in total hip or knee replacement: a population-based study.
Epidural or spinal anesthesia involves several mechanisms hypothesized to reduce risk of surgical site infections (SSIs) during this decisive period. This study aims to compare the risk of SSI within 30 days of surgery for patients receiving total hip or knee replacement under general anesthesia versus those under epidural or spinal anesthesia. ⋯ Total hip or knee replacement under general anesthesia is associated with higher risk of SSI compared with epidural or spinal anesthesia. Our results support the evolving concept of long-term consequences of anesthesia and emphasize the anesthesiologist's role in preventing SSIs.
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Comparative Study
Lumbar intrathecal administration of the quaternary lidocaine derivative, QX-314, produces irritation and death in mice.
We recently found that peripheral administration of the quaternary lidocaine derivative, QX-314, produces long-lasting sensory and motor blockade in animals. The goal of this study was to test whether intrathecal QX-314 has similar properties. ⋯ Lumbar intrathecal QX-314 concentration-dependently produced irritation and death in mice, at lower concentrations than those associated with robust motor blockade. Although QX-314 did produce long-lasting neural blockade, these findings indicate that QX-314 is unlikely to be a suitable candidate for spinal anesthesia in humans.
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Comparative Study Clinical Trial
Increase of oxygen consumption during a progressive decrease of ventilatory support is lower in patients failing the trial in comparison with those who succeed.
The aim of this study was to test the hypothesis that, during weaning from mechanical ventilation, when the pressure support level is reduced, oxygen consumption increases more in patients unable to sustain the decrease in ventilatory assistance (weaning failure). ⋯ Patients failing a decremental pressure support trial, in comparison with those who succeed, had an higher baseline oxygen consumption and were not able to increase their oxygen consumption in response to an increased demand.