Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2001
Case ReportsAnesthetic management of acquired tracheoesophageal fistula: a brief report.
Tracheoesophageal fistula may be either a congenital lesion or an acquired condition, most often resulting from foreign body ingestion. Location of the lesion has implications for anesthetic management and single lung ventilation may be required to facilitate surgical repair. In pediatric patients, intentional mainstem intubation may be required.
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Anesthesia and analgesia · Oct 2001
The incidence of class "zero" airway and the impact of Mallampati score, age, sex, and body mass index on prediction of laryngoscopy grade.
In an earlier study we proposed the addition of a new airway class, zero (visualization of the epiglottis), to the four classes of the modified Mallampati classification. In this prospective study, 764 surgical patients were assessed with regard to their airway class (including class zero), laryngoscopy grade, and the effect of the airway class and other predictors on the laryngoscopy grade.
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Anesthesia and analgesia · Oct 2001
Randomized Controlled Trial Clinical TrialIntrathecal morphine for postpartum tubal ligation postoperative analgesia.
Intrathecal morphine (ITM) provides effective postoperative cesarean delivery analgesia but has not been reported for postoperative postpartum tubal ligation (PPTL) analgesia. We designed this prospective, randomized, double-blinded study to determine the efficacy of 100 microg ITM for postoperative PPTL analgesia. Sixty-six women received spinal anesthesia with 60 mg (1.2 mL) of 5% hyperbaric lidocaine, 10 microg (0.2 mL) of fentanyl, and either 0.2 mL of 0.9% saline (normal saline; NS) or 100 microg (0.2 mL) of morphine (morphine sulfate, MS). Postoperative analgesia was limited to patient-controlled IV analgesia morphine. Six women (three NS and three MS) were excluded because of major protocol violations. Twenty-four-hour patient-controlled IV analgesia morphine use was (mean +/- SD) 39.6 +/- 19.6 mg in the NS group and 1.1 +/- 2.5 mg in the MS group (P < 0.0000001). Visual analog scale scores for crampy and incisional pain (rest and movement) were significantly higher in the NS group compared with the MS group at 4, 8, 12, and 24 h (P < 0.001). The adverse effect profile was similar between groups. Visual analog scale satisfaction scores (mean +/- SD) were 96.6 +/- 16.0 in the MS group and 84.2 +/- 23.6 in NS group (P < 0.05). The results of this study indicate that women experience significant postoperative pain after PPTL surgery, and this pain is effectively obviated by 100 microg ITM. ⋯ This investigation documents the extent of the significant postoperative pain experienced by women after routine postpartum tubal ligation surgery and demonstrates the efficacy of a small dose (100 microg) of intrathecal morphine to obviate this pain with minimal adverse effects.
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Anesthesia and analgesia · Oct 2001
Randomized Controlled Trial Comparative Study Clinical TrialAmbulatory surgery: room air versus nasal cannula oxygen during transport after general anesthesia.
We compared outpatients transported to the postanesthesia care unit (PACU) while breathing room air to 2-4 L/min nasal cannula oxygen (O2) to test the hypothesis that routine supplemental O2 during transport is not required after general anesthesia in an ambulatory surgery center. We also examined whether the arbitrary arrival PACU O2 saturations of > 92% may be used to predict an infrequent incidence of subsequent significant desaturations (< 90%) in the PACU. One-hundred-ninety patients were randomized to receive either room air or 2-4 L/min nasal cannula for transport to PACU after receiving general anesthesia. O2 saturations were recorded before surgery, just before leaving the operating room, and upon arrival in the PACU. The lowest O2 saturation occurring in the PACU was also recorded. The mean arrival PACU O2 saturation was 95.0 in the Room Air group, compared with 97.2 for the Nasal Cannula (NC) group, a statistically significant difference (P < 0.001). In the Room Air group, 20% had arrival O2 saturations < or = 92%, and half of these (10%) had O2 saturations < 90%. In the NC group, 6% had O2 saturations < or = 92%, of which one third (2%) were < 90% on arrival in the PACU. All of these initial desaturations were easily corrected with face-tent O2 administration, deep breathing, or both. Subgroup analysis revealed that patients whose ages were 60 yr or older or those weighing 100 kg or more had lower arrival room air saturations than their younger or slimmer counterparts. In the Room Air group, only three (3.9%) of the patients that arrived in PACU with O2 saturations > 92% had subsequent desaturations < 90%, compared with seven (7.9%) in the NC group. We conclude that most adult patients undergoing ambulatory surgery can be transported safely to the PACU breathing room air after general anesthesia. However, patients whose age was > or = 60 yr or weight was > or = 100 kg, or for whom transient O2 desaturation on transport may be harmful, should be transported while breathing nasal O2 via nasal cannula. ⋯ Most adult patients undergoing ambulatory surgery can be transported safely to the PACU breathing room air after general anesthesia. However, patients whose age was > or = 60 yr or weight > or = 100 kg, or for whom transient O2 desaturation on transport may be harmful, should be transported while breathing oxygen via nasal cannula.
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Anesthesia and analgesia · Oct 2001
Meta AnalysisEpidural analgesia reduces postoperative myocardial infarction: a meta-analysis.
Postoperative cardiac morbidity and mortality continue to pose considerable risks to surgical patients. Postoperative epidural analgesia is considered to have beneficial effects on cardiac outcomes. The use in high-risk cardiac patients remains controversial. No study has shown that postoperative epidural analgesia decreases postoperative myocardial infarction (PMI) or death. All studies are underpowered to show such a result, and the cost of conducting a large trial is prohibitive. We performed a metaanalysis to determine whether postoperative epidural analgesia continued for more than 24 h after surgery reduces PMI or in-hospital death. The available databases were searched for randomized controlled trials of epidural analgesia that was extended at least 24 h into the postoperative period. The search yielded 17 studies, of which 11 were randomized controlled trials comprising 1173 patients. Metaanalysis was conducted by using the fixed-effects model, calculating both an odds ratio and a rate difference. Postoperative epidural analgesia resulted in better analgesia for the first 24 h after surgery. The rate of PMI was 6.3%, with lower rates in the Epidural group (rate difference, -3.8%; 95% confidence interval [CI] -7.4%, -0.2%; P = 0.049). The frequency of in-hospital death was 3.3%, with no significant difference between Epidural and Nonepidural groups (rate difference, -1.3%; 95% CI, -3.8%, 1.2%, P = 0.091). Subgroup analysis of postoperative thoracic epidural analgesia showed a significant reduction in PMI in the Epidural group (rate difference, -5.3%; 95% CI, -9.9%, -0.7%; P = 0.04). ⋯ Postoperative epidural analgesia, especially thoracic epidural analgesia, continued for more than 24 h reduces postoperative myocardial infarctions.