Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2008
The use of bispectral index to monitor barbiturate coma in severely brain-injured patients with refractory intracranial hypertension.
Barbiturate therapy in severely traumatic brain-injured (TBI) patients is usually monitored by an electroencephalogram (EEG) with burst-suppression pattern as a target. The Bispectral Index (BIS) is derived from EEG and considers cortical silence. We sought to determine whether a BIS range could predict a specific burst-suppression pattern. ⋯ The relationship between BIS and SR(EEG) was high in TBI patients treated with barbiturates. The rate of barbiturate infusion might be decreased if BIS is <6 or increased if BIS is >15. Correspondence between BIS and suppression pattern should periodically be checked by observation of the EEG analogical signal (as displayed by BIS-XP).
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Anesthesia and analgesia · Nov 2008
Randomized Controlled TrialThe effectiveness of noninvasive positive pressure ventilation to enhance preoxygenation in morbidly obese patients: a randomized controlled study.
Noninvasive positive-pressure ventilation (NPPV) with pressure support-ventilation and positive end-expiratory pressure are effective in providing oxygenation during intubation in hypoxemic patients. We hypothesized administration of oxygen (O2) using NPPV would more rapidly increase the end-tidal O2 concentration (ETO2) than preoxygenation using spontaneous ventilation (SV) in morbidly obese patients. ⋯ Administration of O2 via a facemask with NPPV in the operating room is safe, feasible, and efficient in morbidly obese patients. In this population NPPV provides a more rapid O2 administration, achieving a higher ETO2.
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Anesthesia and analgesia · Nov 2008
Randomized Controlled TrialA randomized, prospective, double-blind trial comparing 3% chloroprocaine followed by 0.5% bupivacaine to 2% lidocaine followed by 0.5% bupivacaine for interscalene brachial plexus block.
The combination of 2-chloroprocaine and bupivacaine (C/B) for regional anesthesia has been described, but its use was largely abandoned due to equivocal results in efficacy. In this prospective, double-blind, randomized study, we compared the onset of an interscalene block using C/B versus a combination of lidocaine and bupivacaine (L/B). ⋯ This study demonstrates that a successful block was more rapid using C/B than L/B for interscalene blocks.
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Anesthesia and analgesia · Nov 2008
Randomized Controlled TrialIs albumin administration in hypoalbuminemic elderly cardiac surgery patients of benefit with regard to inflammation, endothelial activation, and long-term kidney function?
Because patients with low albumin levels may benefit from human albumin (HA) administration, we studied correction of hypovolemia with HA in hypoalbuminic elderly cardiac surgery patients. ⋯ Use of HA in hypoalbuminemic cardiac surgery patients aged >80 yr was without benefit with regard to inflammatory response, endothelial activation, and renal function compared to 6% HES 130/0.4.
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Anesthesia and analgesia · Nov 2008
Randomized Controlled TrialPlethysmographic pulse wave amplitude is an effective indicator for intravascular injection of epinephrine-containing epidural test dose in sevoflurane-anesthetized pediatric patients.
Plethysmographic pulse wave amplitude (PPWA) was effective in detecting intravascular injection of epidural test dose with 100% sensitivity and specificity in adults. We evaluated the efficacy of PPWA in detecting intravascular injection of a simulated epidural test dose during sevoflurane anesthesia in pediatric patients. ⋯ PPWA is effective for detection of an intravascular injection of a simulated epidural epinephrine-containing test dose in pediatric patients.