Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2009
Comparative StudyPositive end-expiratory pressure improves survival in a rodent model of cardiopulmonary resuscitation using high-dose epinephrine.
Multiple interventions have been tested in models of cardiopulmonary resuscitation (CPR) to optimize drug use, chest compressions, and ventilation. None has studied the effects of positive end-expiratory pressure (PEEP) on outcome. We hypothesized that because PEEP can reverse pulmonary atelectasis, lower pulmonary vascular resistance, and potentially improve cardiac output, its use during CPR would increase survival. ⋯ In asphyxial cardiac arrest in a small rodent model, continuous application of PEEP (5 cm H(2)O) during and after CPR had beneficial effects on survival that were independent of oxygenation and without adverse cardiovascular effects.
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Anesthesia and analgesia · Oct 2009
Forecasting and perception of average and latest hours worked by on-call anesthesiologists.
We studied the value of providing information to anesthesia providers about the length of time typically worked during on-call shifts. The mean time at which a shift ends can be used for purposes of trades, payments, or reverse auctions, because the mean is proportional to the total time. The 80th percentile (with a suitable upper confidence limit for uncertainty due to limited sample sizes) can be used for judging the earliest time by which after-work activities reasonably can be planned. ⋯ Historical data from OR or anesthesia information management systems, or from anesthesia billing systems, can be used months before staff scheduling to provide insight to anesthesia providers on respective calls. The data are useful because experience provides limited intuition. Updates on scheduled workload available closer to the day of surgery provided only marginal increases in knowledge over the use of historical data.
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Anesthesia and analgesia · Oct 2009
Case ReportsMalignant hyperthermia-like syndrome and carnitine palmitoyltransferase II deficiency with heterozygous R503C mutation.
We describe a child who developed a malignant hyperthermia-like syndrome after exposure to succinylcholine and halothane. Many features of a typical malignant hyperthermia episode were present, including tachydysrhythmia, tachypnea, and fever in association with metabolic acidosis, hyperCKemia, myglobinemia, and rapid recovery without residual effects upon administration of dantrolene, sodium bicarbonate, and active cooling. Muscle rigidity, hypercarbia, and hyperkalemia were not observed. The patient was found to be heterozygous for a mutation in the carnitine palmitoyltransferase II gene (CPT2) encoding an arginine to cysteine substitution at amino acid 503 (R503C) with reduced activity of the enzyme.
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Anesthesia and analgesia · Oct 2009
Randomized Controlled Trial Comparative StudyThe analgesic effect of paracetamol when added to lidocaine for intravenous regional anesthesia.
In this study, we evaluated the effect of paracetamol on sensory and motor block onset time, tourniquet pain, and postoperative analgesia, when added to lidocaine in IV regional anesthesia (IVRA). ⋯ The addition of paracetamol during IVRA with lidocaine decreased tourniquet pain, increased anesthesia quality, and decreased postoperative analgesic consumption.