Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2008
Multicenter StudyPulse pressure and risk of adverse outcome in coronary bypass surgery.
Among ambulatory patients, an increase in pulse pressure (PP) is a well-established determinant of vascular risk. The relationship of PP and acute perioperative vascular outcome among patients having coronary artery bypass graft (CABG) surgery is less well known. ⋯ An increase in PP was independently and significantly associated with greater fatal and nonfatal adverse cerebral and cardiac outcomes in patients having CABG surgery. These findings highlight the associated risks of preoperative PP on acute postoperative vascular outcomes.
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Anesthesia and analgesia · Oct 2008
Biography Historical ArticleGaston Labat's Regional Anesthesia: the missing years.
Gaston Labat's textbook Regional Anesthesia: Its Technique and Clinical Application was one of the earliest regional anesthesia texts, and certainly one of the most successful. Although Dr. Labat was working on a third edition at the time of his death, its fate and the reason for a more than 30-year delay in publishing a third edition have often been speculated upon. ⋯ Lundy Archive revealed communications between Dr. Lundy and Labat's widow which help explain the delay. Further searches into the collections of John Adriani, MD, help explain how he came to be the one to publish the long-awaited third edition.
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Anesthesia and analgesia · Oct 2008
Randomized Controlled TrialThe effect of intranasal administration of remifentanil on intubating conditions and airway response after sevoflurane induction of anesthesia in children.
Intubation without the use of muscle relaxants in children is frequently done before IV access is secured. In this randomized controlled trial, we compared intubating conditions and airway response to intubation (coughing and/or movement) after sevoflurane induction in children at 2 and 3 min after the administration of intranasal remifentanil (4 mcg/kg) or saline. ⋯ Nasal administration of remifentanil produces good-to-excellent intubating conditions in 2-3 min after sevoflurane induction of anesthesia.
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Anesthesia and analgesia · Oct 2008
Randomized Controlled TrialThe side effects of morphine and hydromorphone patient-controlled analgesia.
Despite "clinical lore" among health care providers that treatment with hydromorphone results in improved pain control and fewer adverse side effects, morphine continues to be the first-line medication for postoperative patient-controlled analgesia (PCA). In this study, we compared the efficacy and side-effect profiles of morphine and hydromorphone at concentrations producing equivalent drug effect measured by pain score and miosis. ⋯ We found no systematic difference between morphine and hydromorphone in opioid-related side effects. Neither was there any difference in efficacy of pain control or patient satisfaction when patients self-titrated to equal drug effect as measured by equianalgesia and pupillary miosis. The choice between morphine and hydromorphone for use in PCA should be guided by patient history, as there may be idiosyncratic reactions to either drug.
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Anesthesia and analgesia · Oct 2008
ReviewInfusate contamination in regional anesthesia: what every anesthesiologist should know.
Infection can be a devastating complication of regional anesthesia. Contaminated infusate as a cause of infection in neuraxial anesthesia or peripheral nerve blockade has rarely been reported in the literature. However, it may be an important source of morbidity, especially as increasing numbers of patients are being discharged with perineural catheters and portable pumps of local anesthetic, which may infuse for several days at home. ⋯ In the United States, there are currently no national guidelines on the hang-times of regional anesthesia infusates. On the other hand, guidelines for the sterile compounding of infusions used in regional anesthesia are now established by United States Pharmacopeia and The National Formulary Chapter 797, entitled "Pharmaceutical Compounding, Sterile Preparations." These guidelines have significant implications for the anesthesiologist. In this review, we examined the available literature regarding contaminated infusate as a cause of infection in regional anesthesia, to discuss strategies for the prevention of such contamination including the appropriate hang-time for infusates, and to discuss the implications of United States Pharmacopeia and The National Formulary Chapter 797 for anesthesiologists.