Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2008
Randomized Controlled TrialA comparison of sedation with dexmedetomidine or propofol during shockwave lithotripsy: a randomized controlled trial.
Dexmedetomidine, because it has both sedative and analgesic properties, may be suitable for conscious sedation during painful procedures. Extracorporeal shockwave lithotripsy (ESWL) is a minimal to mildly painful procedure that requires conscious sedation. We thus evaluated the utility of dexmedetomidine compared with propofol during an ESWL procedure. ⋯ A combination of dexmedetomidine with fentanyl can be used safely and effectively for sedation and analgesia during ESWL.
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Anesthesia and analgesia · Jan 2008
Clinical TrialIlioinguinal/iliohypogastric blocks in children: where do we administer the local anesthetic without direct visualization?
Ultrasonographic observation of peripheral nerve blocks enables direct visualization of the spread of local anesthetic around the targeted nerves. Similarly, ultrasonography may be used to determine the site of local anesthetic placement when landmark-based techniques are used. We performed a study to determine the actual location of local anesthetic when ilioinguinal/iliohypogastric nerve blocks are performed using landmark-based techniques in children in an attempt to explain a failed block. ⋯ Accurate placement of local anesthetic around the ilioinguinal/iliohypogastric nerves in children is seldom possible when landmark-based techniques are used. In the majority of patients, the local anesthetic was inaccurately placed in adjacent anatomical structures with unpredictable block results.
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Anesthesia and analgesia · Jan 2008
Randomized Controlled Trial Multicenter StudyDisposition and clinical outcome after intraperitoneal meperidine and ropivacaine administration during laparoscopic surgery.
Limited evidence supports the efficacy of intraperitoneal (IP) meperidine or local anesthetic for postoperative analgesia. Our study aims were to investigate analgesic efficacy and to quantify the plasma concentrations of meperidine and ropivacaine after IP administration. The null hypothesis was that there was no significant difference among groups for dynamic pain in the first 24 h after major abdominal laparoscopic surgery. ⋯ Compared with systemic opioid, IP meperidine and ropivacaine, alone or in combination, did not produce better pain relief or opioid dose-sparing after laparoscopic surgery.
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Anesthesia and analgesia · Jan 2008
Randomized Controlled TrialEpinephrine 4 microg/mL added to a low-dose mixture of ropivacaine and fentanyl for lumbar epidural analgesia after total knee arthroplasty.
Epinephrine 2 microg/mL added to a local anesthetic-opioid mixture has been found to improve postoperative continuous epidural analgesia at the thoracic (TEA) but not at lumbar (LEA) level. Therefore, we studied whether a higher dose of epinephrine could improve LEA. ⋯ As part of the multimodal pain treatment used, the epidural adjuvant epinephrine 4 microg/mL (12-32 microg/h) did not improve LEA after total knee arthroplasty.
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Anesthesia and analgesia · Jan 2008
ReviewMonitoring intracranial pressure in traumatic brain injury.
Increased intracranial pressure (ICP) is an important cause of secondary brain injury, and ICP monitoring has become an established component of brain monitoring after traumatic brain injury. ICP cannot be reliably estimated from any specific clinical feature or computed tomography finding and must actually be measured. Different methods of monitoring ICP have been described but intraventricular catheters and microtransducer systems are most widely used in clinical practice. ⋯ There is considerable variability in the use of ICP monitoring and treatment modalities among head injury centers. However, there is a large body of clinical evidence supporting the use of ICP monitoring to detect intracranial mass lesions early, guide therapeutic interventions, and assess prognosis, and it is recommended by consensus guidelines for head injury management. There remains a need for a prospective, randomized, controlled trial to identify the value of ICP monitoring and management after head injury.