Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2006
Randomized Controlled Trial Comparative StudyP6 acupressure does not prevent emesis during spinal anesthesia for cesarean delivery.
Nausea and vomiting are major adverse effects during spinal anesthesia for cesarean delivery. Stimulation of the P6 (Neiguan) acupoint is a traditional Chinese acupuncture technique used for effective antiemetic purposes. In this study, we evaluated the antiemetic effect of P6 acupressure in parturients during spinal anesthesia for cesarean delivery. ⋯ There were no statistically significant differences in maternal characteristics. Incidence rates for intraoperative nausea were 64% (acupressure group) and 71% (control group) (P = 0.416), with an incidence of intraoperative vomiting of 22% (acupressure group) and 27% (control group) (P = 0.506). The results suggest that prophylactic use of acupressure bands bilaterally on the P6 acupoint failed to prevent nausea and vomiting during spinal anesthesia for cesarean delivery.
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Anesthesia and analgesia · Mar 2006
The effects of stimulation pattern and sevoflurane concentration on intraoperative motor-evoked potentials.
The usefulness of intraoperative monitoring of motor-evoked potentials (MEPs) during inhaled anesthesia is limited by the suppressive effects of volatile anesthetics on MEP signals. We investigated the effects of different stimulation patterns and end-tidal concentrations of sevoflurane on intraoperative transcranial electrical MEPs. In 12 patients undergoing craniotomy, stimulation patterns (300-500 V, 100-1000 Hz, 1-5 stimuli) and multiples (0.5, 0.75, and 1.0) of minimum alveolar concentration (MAC) of sevoflurane were varied randomly while remifentanil was administered at a constant rate of 0.2 microg x kg(-1) x min(-1). ⋯ A significant main effect of sevoflurane concentration (0.5 versus 0.75 and 1 MAC multiple) on MEP amplitude was observed at the thenar recording site only (P < 0.05). In conclusion, MEP characteristics varied significantly with changes in stimulation pattern and less so with changes in sevoflurane concentration. The results suggest that high frequency repetitive stimulation allows intraoperative use of MEP monitoring during up to 1 MAC multiple of sevoflurane and constant infusion of remifentanil up to 0.2 microg x kg(-1) x min(-1).
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Anesthesia and analgesia · Mar 2006
Case ReportsCerebral ischemia as an apparent complication of anterior cervical discectomy in a patient with an incomplete circle of Willis.
A 58-yr-old patient sustained a cerebral ischemic injury in the distribution of the carotid artery ipsilateral to retraction during an anterior cervical discectomy. Relative hypotension was permitted during the anesthetic. Angiography revealed an anatomic variant of the circle of Willis that resulted in minimal collateralizaton of the left internal carotid artery territory. The combination of that vascular variant with relative hypotension and some degree of carotid compression appears to have resulted in clinically significant cerebral ischemia.
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Anesthesia and analgesia · Mar 2006
Comparative StudyPredictive performance of three multivariate difficult tracheal intubation models: a double-blind, case-controlled study.
We performed a case-controlled, double-blind study to examine the performance of three multivariate clinical models (Wilson, Arné, and Naguib models) in the prediction of unanticipated difficult intubation. The study group consisted of 97 patients in whom an unanticipated difficult intubation had occurred. For each difficult intubation patient, a matched control patient was selected in whom tracheal intubation had been easily accomplished. ⋯ The corresponding area under the receiver operating characteristic curve was 0.87, 0.79, and 0.82, respectively. Our new model for prediction of difficult intubation was developed using logistic regression and includes thyromental distance, Mallampati score, interincisor gap, and height. This model is 82.5% sensitive and 85.6% specific with an area under the receiver operating characteristic curve of 0.90.
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Anesthesia and analgesia · Mar 2006
Randomized Controlled Trial Comparative StudyThe analgesic effect of nitroglycerin added to lidocaine on intravenous regional anesthesia.
We evaluated the analgesic effect of nitroglycerine (NTG) when added to lidocaine in IV regional anesthesia. Thirty patients undergoing hand surgery were randomly assigned to two groups. The control group (group C, n = 15) received a total dose of 40 mL with 3 mg/kg of lidocaine diluted with saline, and the NTG group (group NTG, n = 15) received an additional 200 mug NTG. ⋯ First analgesic requirement time was longer in group NTG (225 +/- 74 min versus 39 +/- 33 min) than in group C (P < 0.0001). Postoperative analgesic requirements were significantly smaller in group NTG (P < 0.0001) but the side effects were similar in both groups. We conclude that the addition of NTG to lidocaine for IV regional anesthesia improves sensory and motor block, tourniquet pain, and postoperative analgesia without side effects.