Anesthesia and analgesia
-
Anesthesia and analgesia · Nov 2005
Randomized Controlled Trial Clinical TrialThe efficacy of plethysmographic pulse wave amplitude as an indicator for intravascular injection of epinephrine-containing epidural test dose in anesthetized adults.
In this study, I evaluated the efficacy of plethysmographic pulse wave amplitude (PPWA) in detecting intravascular injection of a simulated epidural test dose containing 15 microg of epinephrine in adults during either sevoflurane or isoflurane inhaled anesthesia and compared its reliability to the classical heart rate (HR; positive if > or =10 bpm) and systolic blood pressure (SBP; positive if > or =15 mm Hg) criteria. Eighty patients were randomized to receive either 1 mean alveolar anesthetic concentration of sevoflurane or 1 mean alveolar anesthetic concentration of isoflurane (n = 40 for each anesthesia group). Patients in each anesthesia group microg of epinephrine IV or 3 mL of saline IV (n = 20 each). ⋯ Using this value, the sensitivity, specificity, positive predictive, and negative predictive values of PPWA were 100% in both anesthetic groups. On the contrary, sensitivities of 85% and 95% were obtained based on HR criterion in the sevoflurane and isoflurane patients, respectively, and a sensitivity of 90% was obtained in both anesthesia groups on the basis of SBP criterion. In conclusion, PPWA is a reliable alternative to conventional hemodynamic criteria for detection of an intravascular injection of epidural test dose.
-
Anesthesia and analgesia · Nov 2005
Comparative StudyA comparison of the laryngeal tube and bag-valve mask ventilation by emergency medical technicians: a feasibility study in anesthetized patients.
Airway management is of major importance in emergency care. The basic technique for all health care providers is bag-valve mask (BVM) ventilation, which requires skill and may be difficult to perform. Endotracheal intubation, which is the advanced method for securing the airway, is a demanding technique that has been shown to be associated with infrequent success, even when used by experienced paramedical personnel. ⋯ Those who inserted the LT on the first attempt (73%) required 48.2 +/- 14.7 s for the insertion. Both the LT and BVM provided adequate oxygenation and ventilation. In this study, we found that inexperienced fire-EMT students inserted LT and performed 1-min ventilation with a reasonable success rate and insertion time in anesthetized patients.
-
Anesthesia and analgesia · Nov 2005
Case ReportsContinuous maxillary and mandibular nerve block for perioperative pain relief: the excision of a complicated pleomorphic adenoma.
A 68-yr-old hypertensive patient with ischemic heart disease and intractable atrial fibrillation with stable hemodynamics and poor chest compliance underwent pleomorphic adenoma of the parotid gland using regional anesthesia with continuous propofol sedation. Continuous maxillary and mandibular nerve blocks were performed and excision was performed with complete intraoperative and postoperative pain relief without compromising the patient's hemodynamic variables.
-
Anesthesia and analgesia · Nov 2005
Letter Case ReportsSubdural hematoma following accidental dural puncture.
-
Anesthesia and analgesia · Nov 2005
Meta AnalysisDoes neostigmine administration produce a clinically important increase in postoperative nausea and vomiting?
Neostigmine is used to antagonize neuromuscular blocker-induced residual neuromuscular paralysis. Despite the findings of a previous meta-analysis, the effect of neostigmine on postoperative nausea and vomiting remains unresolved. We reevaluated the effect of neostigmine on postoperative nausea and vomiting while considering the different anticholinergics as potentially confounding factors. ⋯ The combination of neostigmine with either atropine or glycopyrrolate did not significantly increase the incidence of overall (0-24 h) vomiting (relative risk, 0.91; 95% confidence interval, 0.70-1.18; P = 0.48) or nausea (relative risk, 1.24; 95% confidence interval, 0.98-1.59; P = 0.08). Multiple logistic regression analysis indicated that there was not a significant increase in the risk of vomiting with large compared with small doses of neostigmine. Contrasting a previous analysis, we conclude that there is insufficient evidence to conclude that neostigmine increases the risk of postoperative nausea and vomiting.