Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2000
Segmental cervical spine movement with the intubating laryngeal mask during manual in-line stabilization in patients with cervical pathology undergoing cervical spine surgery.
We quantified the extent and distribution of segmental cervical movement produced by the intubating laryngeal mask (ILM) during manual in-line stabilization in 20 anesthetized patients with cervical pathology undergoing cervical spine surgery. All patients had neurological symptoms preoperatively. The ILM was inserted with the head and neck in the neutral position. Intubation was facilitated by transillumination of the neck with a lightwand. Cervical movement was recorded with single-frame lateral radiographic images taken 1) immediately before induction (baseline); 2) during ILM insertion (insertion); 3) when transillumination was first seen at the cricothyroid membrane (intubation A); 4) when the tube was being advanced into the trachea (intubation B); and 5) during ILM removal (removal). Radiographic images were digitized and the degree of flexion/extension and posterior movement measured for the occiput (C0) through to C5. During ILM insertion, C0-5 were flexed by an average of 1-1.6 degrees (all P < 0.05). During intubation A/B, C0-4 were flexed by an average of 1.4-3.0 degrees (all P < 0.01), but C5 was unchanged. During ILM removal, C0-3 were flexed by an average of 1 degree (all: P < 0.05), but C3-5 were unchanged. During insertion and intubation A/B, C2-5 were displaced posteriorly by an average of 0.5-1.0 mm (all: P < 0.05). During removal, there was no change at C1-5. Neurological symptoms improved in all patients. We conclude that the ILM produces segmental movement of the cervical spine despite manual in-line stabilization in patients with cervical spine pathology undergoing cervical spine surgery. This motion is in the opposite direction to direct laryngoscopy, suggesting that different approaches to airway management may be more appropriate depending on the nature of the cervical instability. ⋯ The intubating laryngeal mask produces segmental movement of the cervical spine, despite manual in-line stabilization in patients with cervical spine pathology undergoing cervical spine surgery. This motion is in the opposite direction to direct laryngoscopy, suggesting that different approaches to airway management may be more appropriate depending on the nature of the cervical instability.
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Anesthesia and analgesia · Jul 2000
Randomized Controlled Trial Comparative Study Clinical TrialExtended "three-in-one" block after total knee arthroplasty: continuous versus patient-controlled techniques.
This prospective, randomized, double-blinded study assessed the efficacy of patient-controlled analgesia (PCA) techniques for extended "3-in-1" block after total knee arthroplasty. A total of 45 patients were divided into three groups of 15. Over 48 h, all patients received 0.125% bupivacaine with 1 microg/mL clonidine via a femoral nerve sheath catheter in the following manner: as a continuous infusion at 10 mL/h in Group 1; as a continuous infusion at 5 mL/h plus PCA boluses (2.5 mL/30 min) in Group 2; or as PCA boluses only (10 mL/60 min) in Group 3. Pain scores, sensory block, supplemental analgesia, bupivacaine consumption, side effects, and satisfaction scores were recorded. Pain scores and supplemental analgesia were comparable in the three groups. Bupivacaine consumption was significantly less in Groups 2 and 3 than in Group 1 (P < 0.01), and in Group 3 than in Group 2 (P < 0.01). Side effects and satisfaction were comparable in the three groups. We conclude that extended "3-in-1" block provides efficient pain relief after total knee arthroplasty and that, compared with a continuous infusion, PCA techniques reduce the local anesthetic consumption without compromise in patient satisfaction or visual analog scale scores. Of the two PCA techniques tested, PCA boluses (10-mL lockout; time, 60 min) of 0.125% bupivacaine with 1 microg/mL clonidine was associated with the smallest local anesthetic consumption, and is, therefore, the recommended extended "3-in-1" block technique. ⋯ We demonstrated that, after total knee arthroplasty, an extended "3-in-1" block consisting of patient-controlled analgesia boluses (10 mL/60 min) of 0.125% bupivacaine with 1 microg/mL clonidine provides efficient postoperative analgesia and significantly minimizes local anesthetic consumption.
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Anesthesia and analgesia · Jul 2000
Meta Analysis Comparative StudySevoflurane versus propofol for anesthetic induction: a meta-analysis.
We performed this meta-analysis to compare the characteristics of sevoflurane and propofol for the induction of routine anesthesia and for laryngeal mask airway (LMA) insertion. The variables assessed were 1) time to loss of consciousness, 2) incidence of apnea during induction, 3) induction complications, 4) time for successful LMA insertion, 5) success with LMA insertion on first attempt, 6) patient dissatisfaction, and 7) postoperative nausea and vomiting. MEDLINE, Embase, and the Cochrane library databases between January 1992 and October 1999 were reviewed for randomized, controlled trials comparing anesthetic induction between sevoflurane/nitrous oxide and propofol. Data from the 12 randomized, controlled studies were used for the meta-analysis. Sevoflurane induction was associated with a trend toward higher patient dissatisfaction and higher first-time success with LMA. Apnea was less common in the sevoflurane group. The incidence of postoperative nausea and vomiting was significantly more frequent in the sevoflurane group (P < 0.05). This effect was still present when all other variables, except the induction methods, were controlled. The other pooled variables did not show a significant difference between sevoflurane and propofol. Sevoflurane and propofol had similar efficacy for anesthetic induction. However, for routine outpatient surgery, propofol may still be the preferred induction anesthetic because of its favorable induction of anesthesia characteristics, high patient satisfaction, and less frequent incidence of postoperative nausea and vomiting. ⋯ Sevoflurane and propofol had similar efficacy for anesthetic induction. However, for routine outpatient surgery, propofol may still be the preferred induction anesthetic because of its favorable induction of anesthesia characteristics, high patient satisfaction, and less frequent incidence of postoperative nausea and vomiting.
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Anesthesia and analgesia · Jul 2000
Randomized Controlled Trial Clinical TrialThe effects of intracuff lidocaine on endotracheal-tube-induced emergence phenomena after general anesthesia.
Coughing during emergence from general anesthesia is a common clinical problem. We sought to determine whether inflating the endotracheal tube cuff with lidocaine would create a reservoir of local anesthetic, which might diffuse across the cuff membrane to anesthetize the mucosa, thus attenuating stimulation during extubation of the trachea. A total of 63 patients undergoing elective surgery were enrolled in a prospective, randomized, double-blinded study. After intubation of the trachea with an endotracheal tube, the cuff of the tube was inflated with either lidocaine 4%, saline, or air. After extubation, a blinded observer noted heart rate, blood pressure, oxygen saturation, end-tidal isoflurane concentration, and the incidence of coughing. Data were analyzed by using analysis of variance, Student's t-test, and the chi(2) test for multiple variables. The groups were demographically comparable. There was no difference in hemodynamic or oxygen saturation data between either group. The incidence of coughing was decreased in the lidocaine group for the time period of 4-8 min postextubation (P < 0.05). We conclude that inflation of the cuff of the endotracheal tube can reduce the incidence of coughing in the initial postextubation period, a finding that may benefit certain patient groups in which this is particularly desirable. ⋯ Tracheal intubation with an endotracheal tube is often necessary during anesthesia. After intubation, inflating a cuff around the endotracheal tube maintains a seal. This can result in coughing during emergence from anesthesia. Our study shows that inflating the cuff of an endotracheal tube with lidocaine rather than air can reduce the incidence of postextubation coughing.