Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2009
Randomized Controlled TrialSystemic lidocaine decreased the perioperative opioid analgesic requirements but failed to reduce discharge time after ambulatory surgery.
In this randomized, blinded, placebo-controlled trial, we evaluated whether systemic lidocaine would reduce pain and time to discharge in ambulatory surgery patients. ⋯ Perioperative systemic lidocaine significantly reduces opioid requirements in the ambulatory setting without affecting time to discharge.
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Anesthesia and analgesia · Dec 2009
Randomized Controlled TrialThe effect of single-dose propofol injection on pain and quality of life in chronic daily headache: a randomized, double-blind, controlled trial.
On the basis of a small number of case studies, IV propofol has been advocated for the treatment of chronic daily headache (CDH). There has been no randomized controlled trial of this therapy. Our objective in this randomized, double-blind, placebo-controlled trial was to determine whether a single IV dose of propofol 2.4 mg/kg results in clinically significant reduction in disability or pain in CDH for the next 30 days. ⋯ A single IV infusion of propofol 2.4 mg/kg produces a statistically significant, but not clinically meaningful, reduction in disability from CDH 30 days after infusion and does not reduce pain intensity or analgesic use. This study does not support this regimen of IV propofol for clinical management of CDH.
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Anesthesia and analgesia · Dec 2009
Randomized Controlled Trial Multicenter Study Comparative StudyThe Flex-It stylet is less effective than a malleable stylet for orotracheal intubation using the GlideScope.
The GlideScope videolaryngoscope (Verathon Medical, Bothell, WA) usually provides excellent glottic visualization, but directing an endotracheal tube through the vocal cords can be challenging. The goal of the study was to compare the dedicated Flex-It stylet (FIS, Parker Medical, Highlands Ranch, CO) with a malleable stylet, as assessed by time to intubation (TTI). ⋯ In a group of experienced operators using the GlideScope, the FIS was less effective for orotracheal intubation than a malleable endotracheal tube stylet.
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Anesthesia and analgesia · Dec 2009
A new index derived from the cerebrovascular pressure transmission and correlated with consciousness recovery in severely head-injured intensive care patients.
In patients with serious head trauma, a moderate (20-25 mm Hg) mean level of intracranial pressure (ICP) may fail to distinguish patients with a real deteriorated intracranial status from those who are stable or improving. Because of these limitations, we analyzed the ICP curve in search of other relevant information regarding cerebrovascular pressure transmission. We looked for parameters with physiological meaning extracted from spectral analysis of cerebrovascular pressure transmission and correlated with consciousness recovery in patients with severe head injuries. ⋯ Gr/Gc, which characterizes the cerebrovascular transmission, better discriminates bad evolution than high values of ICP or low values of cerebral perfusion pressure in patients with severe head trauma. A reduction in Gr/Gc ratio might be an early alarm signaling worsening intracranial hemodynamic conditions.
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Anesthesia and analgesia · Dec 2009
ReviewA core review of temperature regimens and neuroprotection during cardiopulmonary bypass: does rewarming rate matter?
Despite a half century of research and the implementation of various risk-reduction strategies among clinicians and basic scientists, patients continue to experience strokes and cognitive dysfunction related to the use of cardiopulmonary bypass (CPB) for cardiac surgery. One strategy to reduce these detrimental effects has been the use of hypothermia. ⋯ Selecting and understanding the impact of the temperature-monitoring site is important to accurately estimate cerebral temperature and to avoid inadvertent surges in brain temperature. In this article, we review the literature regarding the impact of hypothermia and rewarming rates during cardiac surgery.