Anesthesia and analgesia
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Anesthesia and analgesia · May 2007
Randomized Controlled Trial Comparative StudyPostoperative ketorolac tromethamine use in infants aged 6-18 months: the effect on morphine usage, safety assessment, and stereo-specific pharmacokinetics.
Nonsteroidal antiinflammatory drugs have been useful for treating postoperative pain in children. The only parenteral nonsteroidal antiinflammatory drug currently available in the United States is ketorolac tromethamine with cyclooxygenase-1 and cyclooxygenase-2 effects. Information on the pharmacokinetics of ketorolac in infants is sparse, making dosing difficult. Ketorolac is administered as a racemic mixture with the S(-) isomer responsible for the analgesic effect. In this study, we describe the population pharmacokinetics of ketorolac in a group of 25 infants and toddlers who received a single IV administration of racemic ketorolac and evaluate the potential influence of patient covariates on ketorolac disposition. ⋯ The stereo-isomer-specific clearance of ketorolac in infants and toddlers (aged 6-18 mo) shows rapid elimination of the analgesic S(-) isomer. No adverse effects on surgical drain output, oximetry measured saturations, renal or hepatic function tests were seen. Simulation of single dosing at 0.5 or 1 mg/kg every 4 or 6 h does not lead to accumulation of S(-) ketorolac, the analgesic isomer, but does result in increases in R(+) ketorolac. Shorter dose intervals may be needed in infants older than 6 mo.
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Anesthesia and analgesia · May 2007
Randomized Controlled Trial Comparative StudyEpidural clonidine for postoperative pain after total knee arthroplasty: a dose-response study.
Combinations of epidural clonidine, local anesthetics, and opioids have improved postoperative analgesia after total knee arthroplasty. In this study we sought to determine the optimal epidural bolus dose of clonidine, which provides the best analgesia and fewest side effects. ⋯ The optimal amount of epidural clonidine in a solution of morphine and ropivacaine for postoperative pain management is 1.0 microg/mL.
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Anesthesia and analgesia · May 2007
Randomized Controlled Trial Comparative StudyNeurostimulation in ultrasound-guided infraclavicular block: a prospective randomized trial.
Ultrasound guidance (USG) for infraclavicular blocks provides real time visualization of the advancing needle and local anesthetic distribution. Whether visualization of local anesthetic spread can supplant neurostimulation as the end point for local anesthetic injection during USG block has never been formally evaluated. Therefore, for this prospective randomized study, we recruited 72 patients scheduled for hand or forearm surgery and compared the speed of execution and quality of USG infraclavicular block with either USG alone (Group U) or USG combined with neurostimulation (Group S). ⋯ Block failure occurred in one patient in Group S because of an inability to obtain a distal stimulation after 20 min. We conclude that USG infraclavicular block is more rapidly performed and yields a higher success rate when visualization of local anesthetic spread is used as the end point for injection. Posterolateral spread of local anesthetic around the axillary artery predicts successful block, circumventing the need for direct nerve visualization.
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Anesthesia and analgesia · May 2007
Comparative StudyPreexisting cognitive impairment in patients scheduled for elective coronary artery bypass graft surgery.
An accurate assessment of the prevalence of cognitive impairment in patients scheduled for coronary artery bypass graft (CABG) surgery is necessary if valid assumptions regarding cognitive change are to be made. Such an assessment requires the use of a healthy control group free of cardiovascular disease. ⋯ Cognitive impairment is prevalent in patients presenting for CABG surgery. Impaired cognition before surgery must be considered when assessing the effects of CABG surgery on cognitive performance.
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Anesthesia and analgesia · May 2007
Randomized Controlled Trial Comparative StudyPressure-controlled versus volume-controlled ventilation during one-lung ventilation for thoracic surgery.
Pressure-controlled ventilation (PCV) has been suggested as a tool to improve oxygenation during one-lung ventilation (OLV) for patients undergoing thoracic surgery. In this study we investigated whether PCV results in improved arterial oxygenation compared with volume-controlled ventilation (VCV) during OLV. ⋯ The use of PCV during OLV does not lead to improved oxygenation during OLV compared with VCV for patients with good preoperative pulmonary function, but PCV did lead to lower peak airway pressures. Further study is needed for patients with severe obstructive or restrictive pulmonary disease.