Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2001
Comparative Study Clinical TrialA videographic analysis of laryngeal exposure comparing the articulating laryngoscope and external laryngeal manipulation.
Activation of the articulating laryngoscope and external laryngeal manipulation (ELM) improve laryngeal exposure during direct laryngoscopy. We used a head-mounted direct laryngoscopy imaging system and a previously validated scoring system for assessing laryngeal view (the percentage of glottic opening or POGO score) on 33 adult patients undergoing laryngoscopy. On each patient, we videotaped the initial laryngeal exposure (blade not activated), the view with activation of the blade, and the view with operator-directed external laryngeal manipulation. ⋯ We conclude that ELM is superior to articulating laryngoscope blade activation in improving POGO scores during laryngoscopy on adult patients in standard sniffing position. Using recordings from a direct laryngoscopy video system, we compared laryngeal views in 33 patients with a special articulating laryngoscope blade to views achieved by external laryngeal manipulation (pressing on the patient's neck). Laryngeal exposure, which is important for placement of tracheal tubes, was better with external laryngeal manipulation.
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Anesthesia and analgesia · Jan 2001
The division of the sciatic nerve in the popliteal fossa: anatomical implications for popliteal nerve blockade.
The sciatic nerve (SN) originates from the L4-S3 roots in the form of two nerve trunks: the tibial nerve (TN) and the common peroneal nerve (CPN). The TN and CPN are encompassed by a single epineural sheath and eventually separate (divide) in the popliteal fossa. This division of the SN occurs at a variable level above the knee and may account for frequent failures reported with the popliteal block. We studied the level of division of the SN in the popliteal fossa and its relationship to the common epineural sheath of the SN. The level of division of the SN sheath into TN and CPN above the knee was measured in 28 cadaver leg specimens. The SN was invariably formed of independent trunks (TN and CPN) encompassed in one common epineural sheath. The SN divided at a mean distance of 60.5 +/- 27.0 mm (range 0 to 115 mm) above the popliteal fossa crease. We conclude that the TN and CPN leave the common SN sheath at variable distances from the popliteal crease. This finding and the relationship of the TN and CPN sheaths may have significant implications for popliteal block. ⋯ When performing popliteal block, insertion of the needle at 100 mm above the popliteal crease is more likely to result in placement of the needle proximal to the division of the sciatic nerve than placement at 50 or 70 mm, according to the classical teaching.
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Anesthesia and analgesia · Jan 2001
A prospective survey of patients after cessation of patient-controlled analgesia.
Cessation of IV patient-controlled analgesia (PCA) in the postoperative period is often an arbitrary clinical decision. We conducted a prospective survey of patients 24 h after cessation of IV PCA morphine to determine whether they wished to be restarted on PCA, and to evaluate factors affecting this decision. One hundred and fifteen patients were surveyed over a 3-mo period. Thirty-eight patients (33%) wished to restart PCA. The most common reason was the expectation that IV PCA would be more effective. Age, sex, type of surgery, duration of PCA use, side effects, pain scores, and reasons for cessation of PCA did not affect the decision. The reasons given by those who did not wish to restart PCA were minimal pain (51.9%), inconvenient PCA machine (15.6%), ineffective analgesia by IV PCA (11.7%), side effects during PCA (11.7%), and wishing to tolerate pain (7.8%). PCA morphine consumption in the 24-h period before cessation of PCA (mean [SD]) was larger in patients wishing to restart PCA than in those who did not (21.1 [14.8] mg vs 15.1 [15.1] mg; P < 0.05). In conclusion, the clinical decisions to cease IV PCA do not predict patient acceptance of and satisfaction with the decision and with subsequent pain treatment. Morphine consumption may predict a patient's acceptance of ceasing PCA. ⋯ We surveyed patients 24 h after cessation of IV patient-controlled analgesia (PCA). This survey revealed that the usual clinical reasons to stop IV PCA might not be the most appropriate. Patients have different reasons why they wish to restart or not restart IV PCA. The cessation of PCA should be individualized.
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Anesthesia and analgesia · Jan 2001
Comment Letter Comparative StudyPotencies and probabilities: one-sided P values suggest a one-sided story!