Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2007
Randomized Controlled TrialThe addition of a small-dose ketamine infusion to tramadol for postoperative analgesia: a double-blinded, placebo-controlled, randomized trial after abdominal surgery.
There are few data on combining ketamine with tramadol for postoperative analgesia in humans. We tested the hypothesis that adding ketamine to tramadol would improve analgesia after major abdominal surgery. ⋯ Small-dose ketamine was a useful addition to tramadol and morphine after major abdominal surgery.
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Anesthesia and analgesia · Apr 2007
Randomized Controlled TrialA comparison of laser-assisted drug delivery at two output energies for enhancing the delivery of topically applied LMX-4 cream prior to venipuncture.
Laser-assisted drug delivery (LAD) has the potential for facilitating topical anesthesia with reduced onset time. ⋯ LAD at an energy of 2.0 J/cm2 (570 mJ) is as effective, with similar adverse events, as an energy of 3.5 J/cm2 (1000 mJ) in facilitating topical anesthesia.
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Anesthesia and analgesia · Apr 2007
Randomized Controlled TrialThe effects of levosimendan in cardiac surgery patients with poor left ventricular function.
Patients with poor left ventricular function often require inotropic drug support immediately after cardiopulmonary bypass. Levosimendan improves cardiac function by a novel mechanism of action compared to currently available drugs. We hypothesized that, in patients with severely compromised ventricular function, the use of levosimendan would be associated with better postoperative cardiac function than with inotropic drugs that increase myocardial oxygen consumption. ⋯ In cardiac surgery patients with a low preoperative ejection fraction, stroke volume was better maintained with the combination of dobutamine with levosimendan than with the combination of dobutamine with milrinone.
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Anesthesia and analgesia · Apr 2007
ReviewNeurological complications after regional anesthesia: contemporary estimates of risk.
Regional anesthesia (RA) provides excellent anesthesia and analgesia for many surgical procedures. Anesthesiologists and patients must understand the risks in addition to the benefits of RA to make an informed choice of anesthetic technique. Many studies that have investigated neurological complications after RA are dated, and do not reflect the increasing indications and applications of RA nor the advances in training and techniques. In this brief narrative review we collate the contemporary investigations of neurological complications after the most common RA techniques. ⋯ Our review suggests that the rate of neurological complications after central nerve blockade is <4:10,000, or 0.04%. The rate of neuropathy after PNB is <3:100, or 3%. However, permanent neurological injury after RA is rare in contemporary anesthetic practice.
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We describe three cases of previously unreported failures of the Bag-Ventilator Switch in Aestiva/5 anesthesia machines (GE Healthcare/Datex-Ohmeda, Madison, WI). Each failure mode produced a large breathing-circuit leak. ⋯ These cases demonstrate that it is imperative to always be prepared to immediately use an alternate method for ventilation. Cases describing failure to ventilate due to sudden equipment malfunction underscore the need to always have functioning backup ventilation equipment available.