Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2009
The effect of obesity on neuraxial technique difficulty in pregnant patients: a prospective, observational study.
Practitioners often presuppose that obesity will increase neuraxial technique difficulty in pregnant patients, but few investigators have systematically examined this population for risk factors associated with difficult epidural or spinal needle placement. We designed this study to prospectively identify factors that predict neuraxial technique difficulty in pregnant patients. ⋯ Despite concerns that obesity may cause difficulty with neuraxial technique, some obese patients have surprisingly easy neuraxial block placements. When approaching any neuraxial anesthetic in a pregnant patient, and especially in the obese parturient, back flexion and landmark palpation predict neuraxial technique difficulty.
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Anesthesia and analgesia · Oct 2009
Comparative StudyProlonged propofol anesthesia is not associated with an increase in blood lactate.
Lactic acidosis is considered an early sign of propofol infusion syndrome. In this study, we investigated the changes in lactate and pH with propofol versus volatile anesthesia (VA) of long duration. ⋯ During prolonged spine surgery >8 h, VA was associated with higher serum lactate, when compared with propofol infusion. Prospective studies are needed to elucidate the exact mechanisms and clinical implications of this finding.
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Anesthesia and analgesia · Oct 2009
The risk factors for hypoxemia in children younger than 5 years old undergoing rigid bronchoscopy for foreign body removal.
Removal of an airway foreign body (FB) is usually performed by rigid bronchoscopy under general anesthesia, but the choice of anesthesia and ventilation techniques varies greatly among anesthesiologists and institutions. Hypoxemia is the most commonly observed adverse event during rigid bronchoscopy. It is influenced by a variety of factors including the patient's medical condition, the type of surgical procedure, and the anesthetic technique. In the current study, we investigated risk factors that statistically correlate with intraoperative or postoperative hypoxemia in young patients undergoing rigid bronchoscopy. ⋯ We identified risk factors associated with intraoperative or with postoperative hypoxemia in rigid bronchoscopy which included patient age, type of FB, duration of surgical procedure, pneumonia before the procedure, ventilation mode, and duration of emergence from anesthesia. These results provide evidence that will help clinicians to reduce the incidence of hypoxemia in high-risk children.
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Anesthesia and analgesia · Oct 2009
Case ReportsDelayed quadriparesis after an interscalene brachial plexus block and general anesthesia: a differential diagnosis.
Interscalene brachial plexus block has been widely used for upper limb surgery. Different neurological complications related to this technique have been published. ⋯ Central progression of an interscalene block can produce acute or subacute quadriparesis depending on technical factors of the placement of the local anesthetic and its subsequent spread. The symptomatology and the imaging enabled us to refine the differential diagnoses and to exclude other causes of neurologic compromise.
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Anesthesia and analgesia · Oct 2009
Comparative StudyThe electrocortical effects of enflurane: experiment and theory.
High concentrations of enflurane will induce a characteristic electroencephalogram pattern consisting of periods of suppression alternating with large short paroxysmal epileptiform discharges (PEDs). In this study, we compared a theoretical computer model of this activity with real local field potential (LFP) data obtained from anesthetized rats. ⋯ It is possible to use a mean field theory of neocortical dynamics to replicate the PED pattern observed in LFPs in rats under enflurane anesthesia. This pattern requires a combination of a moderately increased total area under the IPSP, prolonged IPSP decay time, and also activity-dependent modulation of EPSP amplitude.