Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2008
Randomized Controlled Trial Multicenter Study Comparative StudyDoes hyperventilation improve operating condition during supratentorial craniotomy? A multicenter randomized crossover trial.
Hyperventilation has been an integral, but poorly validated part of neuroanesthetic practice. We conducted a two-period, crossover, randomized trial to evaluate surgeon-assessed brain bulk and measured intracranial pressure (ICP) in patients undergoing craniotomy for removal of supratentorial brain tumors during moderate hypocapnia or normocapnia. ⋯ In patients with supratentorial brain tumors, intraoperative hyperventilation improves surgeon-assessed brain bulk which was associated with a decrease in ICP.
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Anesthesia and analgesia · Feb 2008
Multicenter Study Comparative Study Clinical TrialIntrathecal ziconotide for severe chronic pain: safety and tolerability results of an open-label, long-term trial.
Ziconotide is a non-opioid drug indicated for management of severe chronic pain in patients for whom intrathecal (IT) therapy is warranted and who are intolerant of or refractory to other treatments. ⋯ We conclude that long-term IT ziconotide is an option for patients with severe, refractory chronic pain.
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Anesthesia and analgesia · Feb 2008
ReviewAnaphylaxis during cardiac surgery: implications for clinicians.
During surgery, patients are exposed to multiple foreign substances including anesthetic drugs, antibiotics, blood products, heparin, polypeptides (aprotinin, latex, and protamine), and intravascular volume expanders, which have the potential to produce life-threatening allergic reactions termed "anaphylaxis." The hallmark of perioperative anaphylaxis is acute cardiovascular and pulmonary dysfunction. Patients undergoing cardiac surgery have extensive monitoring that permits rapid recognition and treatment when anaphylaxis occurs. ⋯ Arginine vasopressin should also be considered for patients with vasodilatory shock. In this review, we focus on recent concepts in understanding the incidence and management approaches for patients at risk for anaphylaxis in the operating room setting, with an emphasis on cardiac surgical patients.
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Anesthesia and analgesia · Feb 2008
Comparative StudyCandida albicans versus non-albicans intensive care unit-acquired bloodstream infections: differences in risk factors and outcome.
In this study we sought to identify differences in risk factors and outcome of critically ill patients with Candida albicans and non-albicans candidemia. ⋯ In the subset of critically ill nonimmunosuppressed patients, candidemia caused by non-albicans species occurred more frequently in those with medical devices or receiving steroids. Candidemia due to non-albicans species was also associated with higher mortality.
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Anesthesia and analgesia · Feb 2008
Comparative StudyMinimizing stomach inflation versus optimizing chest compressions.
In a bench model, we evaluated a bag-valve device (Smart Bag MO) with limited maximum inspiratory gas flow developed to reduce the risk of stomach inflation in an unprotected airway. During simulated cardiopulmonary resuscitation with uninterrupted chest compressions, ventilation with the "disabled" Smart Bag MO or an adult self-inflating bag-valve device provided only adequate tidal volumes if inspiratory time was 0.5 s. Ventilation with the "enabled" Smart Bag MO, even in ventilation windows of 0.5 s, provided inadequate tidal volumes during simulated cardiopulmonary resuscitation and would result in hypoventilation in a patient.