Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2009
Randomized Controlled TrialA transdermal nicotine patch is not effective for postoperative pain management in smokers: a pilot dose-ranging study.
Nicotine has an antinociceptive effect in animal models. The analgesic effect in humans has been examined, but studies have had mixed results. A proposed etiology is variability in chronic nicotine exposure because of differences in tobacco smoking rates and second-hand smoke exposure. In this study, we examined the postoperative analgesic effect of a transdermal nicotine patch in smokers in a parallel design to a previous study in nonsmokers. ⋯ Transdermal nicotine, 5-15 mg, failed to relieve postoperative pain or reduce opioid use in smokers.
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Anesthesia and analgesia · Dec 2009
Randomized Controlled Trial Comparative StudyIncisional continuous fascia iliaca block provides more effective pain relief and fewer side effects than opioids after pelvic osteotomy in children.
Intravenous opioid therapy is frequently used for postoperative pain management in children after orthopedic surgery but causes side effects such as respiratory depression, vomiting, sedation, and urinary retention. To investigate whether a continuous incisional fascia iliaca compartment (FIC) block provides more effective postoperative pain relief with fewer side effects than IV morphine, we performed a prospective, double-blind, randomized study to compare both techniques. ⋯ Continuous incisional FIC block provides excellent postoperative pain relief, less sedation, and better return of appetite than morphine IV after pelvic osteotomy in children.
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Anesthesia and analgesia · Dec 2009
ReviewRadial artery cannulation: a comprehensive review of recent anatomic and physiologic investigations.
Consistent anatomic accessibility, ease of cannulation, and a low rate of complications have made the radial artery the preferred site for arterial cannulation. Radial artery catheterization is a relatively safe procedure with an incidence of permanent ischemic complications of 0.09%. Although its anatomy in the forearm and the hand is variable, adequate collateral flow in the event of radial artery thrombosis is present in most patients. ⋯ Limited clinical experience with the ultrasound-guided arterial cannulation method suggests that this technique is associated with increased success of cannulation with fewer attempts. Whether use of the latter technique is associated with a decrease in complications has not yet been verified in prospective studies. Research is needed to assess the safety of using the ulnar artery as an alternative to radial artery cannulation because the proximity and attachments of the ulnar artery to the ulnar nerve may potentially expose it to a higher risk of injury.
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Anesthesia and analgesia · Dec 2009
Randomized Controlled Trial Comparative StudyThe correlation between bispectral index and observational sedation scale in volunteers sedated with dexmedetomidine and propofol.
Bispectral index (BIS) is a widely used quantitative parameter for evaluating anesthesia and sedation levels. Dexmedetomidine is a novel sedative, providing sedation while patients remain cooperative and can be easily aroused; as a consequence, BIS used with dexmedetomidine may poorly characterize sedation. Thus, we tested the hypothesis that BIS values are lower with dexmedetomidine than with propofol at comparable Observer's Assessment of Alertness and Sedation (OAA/S) scores. ⋯ The combination of both BIS and sedative scales could provide different and complementary data to the clinician evaluating the patient's response to sedation than would either tool alone, especially when dexmedetomidine is used.
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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.