Anesthesiology
-
Randomized Controlled Trial Multicenter Study Comparative Study
Epidural Steroid Injections, Conservative Treatment, or Combination Treatment for Cervical Radicular Pain: A Multicenter, Randomized, Comparative-effectiveness Study.
Cervical radicular pain is a major cause of disability. No studies have been published comparing different types of nonsurgical therapy. ⋯ For the primary outcome measure, no significant differences were found between treatments, although combination therapy provided better improvement than stand-alone treatment on some measures. Whereas these results suggest an interdisciplinary approach to neck pain may improve outcomes, confirmatory studies are needed.
-
Comparative Study
Effects of Sevoflurane and Propofol on Frontal Electroencephalogram Power and Coherence.
The neural mechanisms of anesthetic vapors have not been studied in depth. However, modeling and experimental studies on the intravenous anesthetic propofol indicate that potentiation of γ-aminobutyric acid receptors leads to a state of thalamocortical synchrony, observed as coherent frontal alpha oscillations, associated with unconsciousness. Sevoflurane, an ether derivative, also potentiates γ-aminobutyric acid receptors. However, in humans, sevoflurane-induced coherent frontal alpha oscillations have not been well detailed. ⋯ The study results indicate that sevoflurane, like propofol, induces coherent frontal alpha oscillations and slow oscillations in humans to sustain the anesthesia-induced unconscious state. These results suggest a shared molecular and systems-level mechanism for the unconscious state induced by these drugs.
-
Observational Study
Effects of Neostigmine Reversal of Nondepolarizing Neuromuscular Blocking Agents on Postoperative Respiratory Outcomes: A Prospective Study.
We tested the hypothesis that neostigmine reversal of neuromuscular blockade reduced the incidence of signs and symptoms of postoperative respiratory failure. ⋯ Neostigmine reversal did not affect oxygenation but was associated with increased atelectasis. High-dose neostigmine or unwarranted use of neostigmine may translate to increased postoperative respiratory morbidity.
-
Whether carotid artery stenosis predicts stroke after noncardiac surgery remains unknown. We therefore tested the primary hypothesis that degree of carotid artery stenosis is associated with in-hospital stroke or 30-day all-cause mortality after noncardiac surgery. As carotid artery stenosis is also a marker for cardiovascular disease, our secondary hypothesis was that degree of carotid artery stenosis is associated with postoperative myocardial injury. ⋯ This cohort represents a high-risk population, as carotid duplex examinations were likely prompted by neurological symptoms. There was nonetheless no association between carotid artery stenosis and perioperative stroke or 30-day mortality after noncardiac surgery.