Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2005
Postoperative nausea and vomiting are strongly influenced by postoperative opioid use in a dose-related manner.
We prospectively examined the incidence of postoperative nausea and vomiting (PONV) in a group of 193 elderly surgical inpatients receiving no postoperative antiemetic prophylaxis. Risk factors for PONV and detailed data on postoperative opioid use were recorded. The overall postoperative vomiting (POV) rate was 23.8%, whereas postoperative nausea (PON) was 51.3%. ⋯ There was a strong logarithmic dose-response relationship between postoperative opioid dose and POV (r2= 0.98, P < 0.01), as well as PON (r2= 0.98, P = 0.01). Use of patient-controlled analgesia or epidural analgesia was a marker for large-dose opioid use (P < 0.001) and was associated with POV in the 24-h postoperative period of 41% and 31% respectively, compared with 11% for other patients (P < 0.001). Future studies defining risk factors for POV should treat postoperative opioid use as a continuous variable, rather than treat it as a dichotomous variable.
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Anesthesia and analgesia · Nov 2005
Validation of a behavioral pain scale in critically ill, sedated, and mechanically ventilated patients.
Assessing pain in critically ill patients, particularly in nonverbal patients, is a great challenge. In this study, we validated a behavioral pain scale (BPS) in critically ill, sedated, and mechanically ventilated patients. The BPS score was the sum of 3 subscales that have a range score of 1-4: facial expression, upper limb movements, and compliance with mechanical ventilation. ⋯ Validity was demonstrated by the change in BPS scores, which were significantly higher during painful procedures, with averages of 3.9 +/- 1.1 at rest and 6.8 +/- 1.9 during procedures (P < 0.001), and by the principal components factor analysis, which revealed a large first-factor accounting for 65% of the variance in pain expression. The BPS exhibited excellent responsiveness, with an effect size ranging from 2.2 to 3.4. This study demonstrated that the BPS can be valid and reliable for measuring pain in noncommunicative intensive care unit patients.
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Anesthesia and analgesia · Nov 2005
Denaturing high performance liquid chromatography screening of ryanodine receptor type 1 gene in patients with malignant hyperthermia in Taiwan and identification of a novel mutation (Y522C).
We performed the present study to identify the mutation in patients in Taiwan with malignant hyperthermia (MH). We also test the hypothesis that a denaturing high-performance liquid chromatography (DHPLC) protocol can be used for mutation detection in these patients. We identified five Taiwanese patients with typical clinical presentations of MH after general anesthesia. ⋯ None of the MH-related mutations were found in the control group. In conclusion, we identified RYR1 mutations in 5 Taiwanese patients with MH using a DHPLC-based approach. A DHPLC-based genetic test may be developed as a noninvasive and convenient test for MH.
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Anesthesia and analgesia · Nov 2005
Slight increase of serum S-100B during porcine endotoxemic shock may indicate blood-brain barrier damage.
Septic shock is a condition that affects many organs, but little is known about the effects on the central nervous system. S-100B, an acidic low molecular weight protein, has attracted considerable interest as a marker for brain damage and disintegration of the blood-brain barrier. It is released into the cerebrospinal fluid and blood from brain tissue after brain damage. ⋯ Low levels of plasma S-100B were detected, but there was a significant increase in S-100B during Hours 1-5 in comparison with the 0 values. We determined that endotoxemia causes a very small but significant increase in the levels of the widely used brain damage marker serum S-100B. However, it cannot be excluded that the increase in S-100B could be caused by release from organs other than the brain.
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Anesthesia and analgesia · Nov 2005
Case ReportsHypoxemia during one-lung ventilation: jet ventilation of the middle and lower lobes during right upper lobe sleeve resection.
A 64-yr-old man underwent right thoracotomy and upper lobectomy for lung carcinoma. Hypoxemia on one-lung ventilation was being managed with continuous positive airway pressure to the nondependent lung when a sleeve resection had to be performed. ⋯ This report describes the successful use of jet ventilation via an airway exchange catheter placed in the bronchus intermedius through the tracheal lumen of a left-sided double-lumen endobronchial tube. Oxygenation was maintained and surgical access was good during the 15-min resection.