Anesthesia and analgesia
-
Anesthesia and analgesia · Jun 2005
The effect of peripheral resistance on impedance cardiography measurements in the anesthetized dog.
In the vasodilated and septic patient, the impedance method of measuring cardiac output (CO) may underestimate the true value. In this study, we sought to determine whether impedance CO (COIC) measurements are influenced by total peripheral resistance (TPR). In eight anesthetized and ventilated dogs, a high-precision flowprobe was placed on the ascending aorta, and direct CO was measured (CO flowprobe (COFP)). ⋯ Correlation coefficients (r) between the CO bias and TPR ranged from 0.46 to 0.89 (P < 0.0001). The bias changed by 0.62 +/- 1.8 L/min, or by 34%, every time TPR halved or doubled. This finding explains the poor agreement between COIC and other methods of CO measurement found in validation studies involving critically ill patients.
-
Anesthesia and analgesia · Jun 2005
Randomized Controlled Trial Comparative Study Clinical TrialA triple-blinded randomized trial comparing the hemostatic effects of large-dose 10% hydroxyethyl starch 264/0.45 versus 5% albumin during major reconstructive surgery.
In Canada, hydroxyethyl starch 264/0.45 (HES 264/0.45; molar weight 264 kDa, molar substitution 0.45) has largely replaced albumin as the colloidal fluid of choice for perioperative intravascular volume expansion. The maximum recommended dose of HES 264/0.45 is 28 mL/kg; however, there are no clinical data supporting this limit. In this study we compared the hemostatic effects of HES 264/0.45 versus 5% albumin in doses up to 45 mL/kg over 24 h during major reconstructive head and neck surgery. ⋯ Factor VIII activity and von Willebrand factor level were significantly reduced in the HES 264/0.45 group compared with the albumin group after infusion of 15 mL/kg, 30 mL/kg, and 45 mL/kg (P < 0.05). Significantly more subjects in the HES 264/0.45 group received allogeneic red blood cell transfusions (P < 0.02). We conclude that HES 264/0.45 infusions >30 mL/kg over 24 h impair coagulation to a greater extent than albumin, possibly leading to more allogeneic transfusions.
-
Anesthesia and analgesia · Jun 2005
Randomized Controlled Trial Comparative Study Clinical TrialPatient satisfaction and information gain after the preanesthetic visit: a comparison of face-to-face interview, brochure, and video.
In this study we compared 3 methods of conducting the preanesthetic visit. We prospectively studied 197 consecutive surgical patients who were to undergo general anesthesia. The patients were randomized to a routine preanesthetic interview, a brochure plus an interview, or a self-made documentary video plus an interview. ⋯ In contrast, the patients of the brochure plus interview group revealed 93% for patient satisfaction and 80% for information gain, and in the standard interview group, the corresponding figures were 91% and 72%, respectively. The maximum sum scores in patient satisfaction and information gain were significantly different between the interview and the video groups, but not between the interview and the brochure groups. Therefore, these data suggest that the use of a documentary video to supplement a preoperative interview may enhance patient satisfaction and maximize information gain.
-
Postoperative analgesia is generally limited to 12-16 h or less after single-injection regional nerve blocks. Postoperative analgesia may be provided with a local anesthetic infusion via a perineural catheter after initial regional block resolution. ⋯ In this review article, we summarize the available published data related to this new analgesic technique and highlight important issues related specifically to perineural infusion provided in patients' own homes. Topics include infusion benefits and risks, indications and patient selection criteria, catheter, infusion pump, dosing regimen, and infusate selection, and issues related specifically to home-care.