Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2001
Randomized Controlled Trial Clinical TrialLevobupivacaine for epidural analgesia in labor: the sparing effect of epidural fentanyl.
Evidence suggests that levobupivacaine has similar pharmacodynamic properties to racemic bupivacaine. We sought to investigate whether this similarity extends to opioid sparing when levobupivacaine is used for epidural analgesia in laboring women by quantifying the effect of fentanyl on the minimum local analgesic concentration (MLAC) of levobupivacaine. One-hundred-six women requesting epidural analgesia for labor pain were recruited in this randomized, double-blinded, up-down sequential allocation study. ⋯ Fentanyl at concentrations of 2 microg/mL and 3 microg/mL significantly reduced the MLAC of levobupivacaine to 0.047% wt/vol (95% CI, 0.023-0.072) and 0.050% wt/vol (95% CI, 0.035-0.065), respectively (P < 0.001). A dose-dependent effect was not demonstrated. We conclude that fentanyl significantly reduces levobupivacaine requirements for epidural analgesia in labor.
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Anesthesia and analgesia · Feb 2001
Case ReportsValidation of a simple algorithm for tracheal intubation: daily practice is the key to success in emergencies--an analysis of 13,248 intubations.
A fundamental skill of the anesthesiologist is airway management. We validated a simple endotracheal intubation algorithm with a large proportion of fiberoptic tracheal intubations used for years in daily practice. Over 2 yr, 13,248 intubations (>90% of all intubations, including obstetrics and ear, nose, and throat patients) in a heterogeneous patient population at our acute care hospital were evaluated prospectively. ⋯ By following our algorithm, intubation failed in 6 out of 13,248 cases (0.045%; 95% confidence interval 0.02%-0.11%). We demonstrate that a simple algorithm for endotracheal intubation, basically limited to fiberoptics as the only aid, is successful in daily practice. Only methods that are practiced daily can be used successfully in emergencies.
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Anesthesia and analgesia · Feb 2001
Anterior approach to the sciatic nerve block: the effects of leg rotation.
In the anterior approach to the sciatic nerve block, the femur often obstructs the passage of the needle toward the sciatic nerve. In this study, by using a human cadaver model, we assessed how internal and external rotation of the leg influences the accessibility of the sciatic nerve with the anterior approach. Ten lower extremities from five adult cadavers were studied. ⋯ Medial redirection of the needle (10 degrees--15 degrees) allowed it to pass the lesser trochanter but brought the tip of the needle too medial to the sciatic nerve. Internal rotation of the leg facilitated passage of all needles inserted at the level of the lesser trochanter. We conclude that internal rotation of the leg may significantly facilitate needle insertion in the anterior approach to sciatic block.
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Anesthesia and analgesia · Feb 2001
Case ReportsThe use of lepirudin for anticoagulation in patients with heparin-induced thrombocytopenia during major vascular surgery.
The method of anticoagulation in patients undergoing major vascular surgery with a history of heparin-induced thrombocytopenia (HIT) is controversial. We present two cases in which a bolus only technique using recombinant hirudin (Lepirudin or Refludan) was used successfully in patients with HIT scheduled for vascular surgery.
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Anesthesia and analgesia · Feb 2001
Monitoring end-tidal carbon dioxide during weaning from cardiopulmonary bypass in patients without significant lung disease.
End-tidal carbon dioxide tension (PETCO(2)) changes with fluctuations in cardiac output (CO). We compared PETCO(2) to pulmonary artery blood flow (PAQt) during weaning from cardiopulmonary bypass (CPB) in normothermic patients without significant pulmonary disease. Fifteen consecutive adult cardiac surgical patients were prospectively studied during and shortly after weaning from CPB. ⋯ One patient had TDCO of 4.69 L/min (2.39 L/min/m(2)). In normothermic patients without significant pulmonary disease, PETCO(2) is a useful index of PAQt during separation from CPB. Under the clinical settings in this study, a PETCO(2) greater than 30 mm Hg was invariably associated with a CO more than 4.0 L/min or a cardiac index >2.0 L/min/m(2).