Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2008
Comparative StudyNoninvasive cardiac output determination using applanation tonometry-derived radial artery pulse contour analysis in critically ill patients.
Conventional thermodilution cardiac output (CO) monitoring is limited mainly to intensive care units and operating rooms because it requires the use of invasive techniques. To reduce the potential for complications and to broaden the applicability of hemodynamic monitoring, noninvasive methods for CO determination are being sought. Applanation tonometry allows noninvasive CO estimation through pulse contour analysis, but the method has not been evaluated in critically ill patients. ⋯ There was no significant difference in bias between the patients who were receiving vasopressor support and those who were not (P = 0.874) or between patients with good and poor applanation tonometry pressure waveform signal quality (P = 0.071). Whereas a significant increase in the invasively determined CO was observed when a fluid bolus was administered (n = 7, P = 0.016), these changes were not reflected by the noninvasive method. We conclude that radial artery applanation tonometry is not suitable to determine CO in critically ill hemodynamically unstable patients.
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Anesthesia and analgesia · Jan 2008
Clinical TrialContinuous infraclavicular brachial plexus block: a modified technique to better secure catheter position in infants and children.
The infraclavicular approach to the brachial plexus provides suitable anesthesia and also lends itself well to stabilizing and securing a catheter for a continuous infusion. We describe an approach for continuous infusions using an infraclavicular approach in children. ⋯ A modified technique for continuous infraclavicular brachial plexus block helps secure the catheter and provides effective intra- and postoperative pain relief in pediatric patients.
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Anesthesia and analgesia · Jan 2008
The effectiveness of a simple novel approach on electroencephalograph instruction for anesthesiology residents.
The electroencephalogram (EEG) measures cerebral activity and, because of its use as an intraoperative monitor, the Accreditation Council for Graduate Medical Education requires EEG monitoring experience during anesthesiology residency. To improve the anesthesiology residents' education at the University of Kentucky, a new learning module was created in collaboration with a neurologist expert in EEGs. ⋯ This educational effort using the department of neurology expertise provided a significant improvement in EEG assessment tool scores.
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Anesthesia and analgesia · Jan 2008
Clinical TrialThe effects of dexmedetomidine on cardiac electrophysiology in children.
Dexmedetomidine (DEX) is an alpha2-adrenergic agonist that is approved by the Food and Drug Administration for short-term (<24 h) sedation in adults. It is not approved for use in children. Nevertheless, the use of DEX for sedation and anesthesia in infants and children appears to be increasing. There are some concerns regarding the hemodynamic effects of the drug, including bradycardia, hypertension, and hypotension. No data regarding the effects of DEX on the cardiac conduction system are available. We therefore aimed to characterize the effects of DEX on cardiac conduction in pediatric patients. ⋯ DEX significantly depressed sinus and atrioventricular nodal function in pediatric patients. Heart rate decreased and arterial blood pressure increased during administration of DEX. The use of DEX may not be desirable during electrophysiology study and may be associated with adverse effects in patients at risk for bradycardia or atrioventricular nodal block.
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Anesthesia and analgesia · Jan 2008
The prolonged analgesic effect of epidural ropivacaine in a rat model of neuropathic pain.
In clinical practice, the analgesic effects of epidurally administered local anesthetics on chronic pain sometimes outlast the duration of drug action expected from their pharmacokinetics. To investigate the underlying mechanisms of this prolonged effect, we examined the effects of ropivacaine, a local anesthetic, on pain-related behavior in a rat model of neuropathic pain. We also analyzed changes in the expression of nerve growth factor (NGF), which is involved in plasticity of the nociceptive circuit after nerve injury. ⋯ Repetitive administration of ropivacaine into the epidural space in CCI rats exerts an analgesic effect, possibly by inducing a plastic change in the nociceptive circuit.