Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2004
Randomized Controlled Trial Comparative Study Clinical TrialA single injection ultrasound-assisted femoral nerve block provides side effect-sparing analgesia when compared with intrathecal morphine in patients undergoing total knee arthroplasty.
Postoperative pain after total knee arthroplasty (TKA) is severe, and achieving adequate analgesia remains a clinical challenge. We tested the hypothesis that, in patients having unilateral TKA under intrathecal (IT) anesthesia, the addition of a femoral nerve block would provide superior analgesia when compared with IT morphine and demonstrate fewer adverse side effects. In a single-blinded and controlled trial, 41 ASA I-III patients undergoing unilateral TKA were randomized into 2 groups. ⋯ However, group FNB had fewer perioperative side effects including nausea, vomiting, and pruritus (P < 0.05 for each event). This corresponded to a decrease in patient satisfaction in group ITM, in which 20% of the patients rated their experience as "unsatisfactory" (P < 0.05). We conclude that, in comparison with IT morphine, a single injection femoral nerve block provides equivalent analgesia but with a significant reduction in side effects for patients having TKA under bupivacaine intrathecal anesthesia.
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Anesthesia and analgesia · Nov 2004
ReviewA proposed classification and scoring system for supraglottic sealing airways: a brief review.
We provide an approach to evaluating sealing supraglottic airways by using a classification based on a sealing mechanism. Three main sealing mechanisms are identified, thus defining three groups: cuffed perilaryngeal sealers, cuffed pharyngeal sealers, and uncuffed anatomically preshaped sealers. We provide a brief overview of supraglottic airways and present a scoring system that is relevant to particular requirements. Scoring airways for routine applications is the example provided.
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Anesthesia and analgesia · Nov 2004
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialA multicenter randomized controlled trial comparing patient-controlled epidural with intravenous analgesia for pain relief in labor.
In this multicenter, randomized, controlled trial, we sought to determine whether patient-controlled epidural analgesia (PCEA) for labor affected the incidence of cesarean delivery when compared with patient-controlled IV opioid analgesia (PCIA). Healthy, term nulliparous patients in 4 Canadian institutions were randomly assigned to receive PCIA with fentanyl (n = 118) or PCEA with 0.08% bupivacaine and fentanyl 1.6 microg/mL (n = 124). There was no difference in the incidence of cesarean delivery-10.2% (12 of 118) versus 9.7% (12 of 124)-or instrumental vaginal delivery-21.2% (25 of 118) versus 29% (36 of 124)-between groups. ⋯ More neonates in the PCIA group required active resuscitation (52% versus 31%; P = 0.001) and naloxone (17% versus 3%; P < 0.001). These observations support the hypothesis that PCEA does not result in an increased incidence of obstetrical intervention compared with PCIA. PCEA provides superior analgesia and less maternal and neonatal sedation compared with PCIA.
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Anesthesia and analgesia · Nov 2004
Randomized Controlled Trial Comparative Study Clinical TrialIntraoperative wake-up test and postoperative emergence in patients undergoing spinal surgery: a comparison of intravenous and inhaled anesthetic techniques using short-acting anesthetics.
Surgical procedures on the vertebral column may result in spinal cord damage, leading to neurological deficits that demand immediate therapeutical intervention. We designed this study to determine which anesthetic regimen allows a rapid wake-up test during and after surgery to detect neurological deficits. ⋯ Group PS required significantly longer times for the onset of breathing (8.9 +/- 1.6 min), elevation of the head (17.0 +/- 3.8 min), and motion of the feet (17.0 +/- 7.4 min) than group PR (6.9 +/- 2.6 min, 9.3 +/- 2.2 min, and 9.4 +/- 2.4 min, respectively) or group DR (5.4 +/- 0.8 min, 6.1 +/- 1.0 min, and 6.2 +/- 1.0 min, respectively). The anesthetic regimen with desflurane and remifentanil allowed faster awakening during and after surgery that permitted immediate neurological examination after spinal surgery compared with propofol/remifentanil.
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Anesthesia and analgesia · Nov 2004
Randomized Controlled Trial Comparative Study Clinical TrialXenon does not prolong neuromuscular block of rocuronium.
With the exception of xenon, the interaction between muscle relaxants and inhaled anesthetics is known. We therefore compared the pharmacodynamics of rocuronium during xenon anesthesia versus a total IV anesthesia with propofol. Anesthesia was induced with propofol and remifentanil in both the xenon and propofol groups (each n = 20). ⋯ Anesthesia was maintained with xenon and remifentanil (xenon group) or with propofol and remifentanil (propofol group). There were no significant differences between the groups concerning the onset time (xenon group 125 +/- 33 and propofol group 144 +/- 43 s), duration (xenon group 33.2 +/- 10.8 and propofol group 32.6 +/- 8.4 min), recovery index (xenon group 9.4 +/- 6.6 and propofol group 8.4 +/- 5.3 min), and clinical recovery (xenon group 18.0 +/- 10.2 and propofol group 17.1 +/- 8.5 min). We conclude that the neuromuscular blocking effects of rocuronium are not different when given during propofol versus xenon anesthesia.