Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2007
Randomized Controlled Trial Comparative StudyEpidural anesthesia and analgesia decrease the postoperative incidence of insulin resistance in preoperative insulin-resistant subjects only.
Insulin resistance (IR) is a feature of the endocrine stress response to surgery. It is not known whether a preoperative state of IR would affect the postoperative endocrine response. We sought to characterize the preoperative state of IR in a group of patients undergoing elective hip and knee arthroplasty, and to determine to what extent perioperative epidural analgesia modifies the postoperative state of IR in those who are and are not insulin-resistant before surgery. ⋯ Epidural anesthesia and analgesia compared to general anesthesia followed by patient-controlled analgesia decreased the incidence of IR soon after surgery and 48 h after surgery only in patients who were insulin-resistant before surgery.
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Anesthesia and analgesia · Jun 2007
Comparative StudyBispectral index monitoring does not improve anesthesia performance in patients with movement disorders undergoing deep brain stimulating electrode implantation.
Deep brain stimulation (DBS) has emerged as a promising therapy for movement disorders. During the implantation procedure for the electrodes, the patient emerges from anesthesia repeatedly to facilitate neurological testing. We investigated whether Bispectral Index (BIS) monitoring would be beneficial in patients receiving "sleep-awake-sleep" anesthesia with respect to time of arousal, consumption of propofol, and cardiopulmonary stability (i.e., heart rate, arterial blood pressure, and end-tidal carbon dioxide). ⋯ BIS monitoring does not improve anesthesia management for DBS electrode implantation in patients with movement disorders.
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Anesthesia and analgesia · Jun 2007
Comparative StudyAn observational study of anesthesia record completeness using an anesthesia information management system.
Studies of the accuracy and completeness of handwritten anesthesia records demonstrate deficiencies in documentation, suggesting that the quality of anesthesia records can be improved. ⋯ We found that electronic clinical anesthesia documentation was often incomplete. Dependence on free text remarks and the record keeping system's inability to automatically present entries in logical sequences consistent with workflow were associated with incomplete data entry. Our results suggest that the user interface for data entry, and the logic that an electronic system uses for preventing omissions and inconsistencies, merit further study and development in order to facilitate clinically useful documentation.
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Anesthesia and analgesia · Jun 2007
Comment Letter Case ReportsUse of remifentanil for labor analgesia: the good and the bad.