Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2006
Comparative Study Clinical TrialArterial versus plethysmographic dynamic indices to test responsiveness for testing fluid administration in hypotensive patients: a clinical trial.
In the present study, we compared indices of respiratory-induced variation obtained from direct arterial blood pressure measurement with analogous indices obtained from the plethysmogram measured by the pulse oximeter to assess the value of these indices for predicting the cardiac output increase in response to a fluid challenge. Thirty-two fluid challenges were performed in 22 hypotensive patients who were also monitored with a pulmonary artery catheter. Hemodynamic and plethysmographic data were collected before and after intravascular volume expansion. ⋯ Nonresponders were identified by changes in pulse variation both on arterial and plethysmographic waveform (area under ROC curve 0.80 vs 0.87, respectively, P = 0.40) and by changes in arterial and plethysmographic systolic variations (area under ROC curve 0.84 vs 0.80, respectively, P = 0.76). In the population studied, plethysmographic dynamic indices of respiratory-induced variation were just as useful for predicting fluid responsiveness as the analogous indices derived from direct arterial blood pressure measurement. These plethysmographic indices could provide a noninvasive tool for predicting the cardiac output increase by administering fluid.
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Anesthesia and analgesia · Dec 2006
Randomized Controlled TrialDoes monitoring bispectral index or spectral entropy reduce sevoflurane use?
A decrease in volatile anesthetic consumption has been demonstrated using bispectral index (BIS), whereas data concerning spectral entropy are lacking. One hundred and forty adult patients scheduled for surgical procedures lasting more than 1 h were prospectively randomized to receive an anesthetic controlled either by BIS or by spectral entropy or solely by clinical variables. Anesthesia was induced with propofol and sufentanil. ⋯ Compared with standard practice, patients with BIS or spectral entropy monitoring required 29% less sevoflurane (normalized sevoflurane consumption to the weights of the patients and to the durations of anesthesia; both P < 0.03) and a similar sufentanil dose. An unintended improvement in the standard practice group (positive bias) was observed. In conclusion, BIS and spectral entropy monitoring have the same sparing effect of sevoflurane.
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Anesthesia and analgesia · Dec 2006
Randomized Controlled TrialThe effect of a lidocaine test dose on analgesia and mobility after an epidural combination of neostigmine and sufentanil in early labor.
We previously demonstrated the effectiveness of epidural sufentanil and the cholinesterase inhibitor, neostigmine, to initiate selective labor analgesia. Because the traditional lidocaine plus epinephrine test dose (TD) may alter the effect of subsequent epidural drugs, we undertook this investigation to evaluate the impact of a lidocaine TD on analgesia from a combination of epidural neostigmine plus sufentanil administered in early labor. Eighty healthy parturients were randomly allocated to two groups to receive a 3 mL-TD, either lidocaine 2%-epinephrine (1:200,000) or saline-epinephrine (1:200,000), followed 3 min later by epidural neostigmine 500 microg plus sufentanil 10 microg. ⋯ In contrast, the TD did not significantly impair the ability to sit, stand up, or bend the knees. The ability to ambulate, however, was reduced (57% vs 82%; P = 0.04). In conclusion, a traditional lidocaine TD significantly enhances the analgesic effect from the epidural neostigmine plus sufentanil combination, but affects ambulation in early labor.
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Anesthesia and analgesia · Dec 2006
Changes in the serum proteome of patients with sepsis and septic shock.
Sepsis is still the leading cause of death in the intensive care unit. Our goal was to elucidate potential early differences in serum between survivors (SURV) and non-survivors (NON-SURV) on day 28. ⋯ Our results show that proteomic profiling is a useful approach for detecting protein expression dynamics in septic patients, and may bring us closer to achieving a comprehensive molecular profiling compared with genetic studies alone.
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Anesthesia and analgesia · Dec 2006
A system and process redesign to improve perioperative antibiotic administration.
Surgical infection is a leading cause of patient injury, mortality, and excess health care costs. As part of a collaborative effort, we instituted three main focuses for perioperative antibiotic administration: appropriate selection of antibiotics, administration of antibiotics within 60 min before incision, and discontinuation of prophylactic antibiotics within 24 h of surgery. Anesthesiologists were identified as the practitioners most likely to accomplish the successful administration of antibiotics within 60 min before incision. ⋯ Before the institution of the process, the rate of surgical site infections was 3.8%, and is now approximately 1.4%. We describe our process used to improve antibiotic administration. During this time, the surgical site infection rate has been significantly reduced.