Anesthesia and analgesia
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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.
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Anesthesia and analgesia · Dec 2009
Clinical TrialUltrasound-assisted and evoked motor response stimulation of the deep peroneal nerve.
We performed an observational volunteer study to document an ultrasound-guided evoked motor response blockade of the deep peroneal nerve. ⋯ Visualization of the deep peroneal nerve with ultrasound followed by elicitation of an evoked motor response, or paresthesia, predicts successful blockade of the deep peroneal nerve.
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There is a need for safe, effective, and easy-to-administer systemic analgesia that ideally has rapid onset and offset, matches the time course of uterine contractions, and does not compromise the fetus. Although neuraxial blockade is the "gold standard" for labor analgesia, systemic analgesia is useful in those cases in which neuraxial analgesia is contraindicated, refused or simply not needed by the parturient, or when skilled anesthesia providers are not available. Because of its unique pharmacologic properties, remifentanil has been investigated, and is used clinically, to provide IV labor analgesia. In this focused review, we summarize the efficacy of remifentanil as a labor analgesic and review the current literature regarding its dose, mode of delivery, safety for the mother and fetus/neonate, as well as the scope for future research.
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Anesthesia and analgesia · Dec 2009
Randomized Controlled Trial Comparative StudyThe effects of crystalloid and colloid preload on cardiac output in the parturient undergoing planned cesarean delivery under spinal anesthesia: a randomized trial.
Hypotension after spinal anesthesia for cesarean delivery remains a major clinical problem. Fluid preloading regimens together with vasopressors have been used to reduce its incidence. Previous studies have used noninvasive arterial blood pressure measurement and vasopressor requirements to evaluate the effect of preload. We used a suprasternal Doppler flow technique to measure maternal cardiac output (CO) and corrected flow time (FTc, a measure of intravascular volume) before and after spinal anesthesia after 3 fluid preload regimens. We hypothesized that colloid solutions, compared with crystalloid, would produce the largest increase in CO and have the lowest incidence of hypotension. ⋯ Despite CO and FTc increases after fluid preload, particularly with HES 1.0 L, hypotension still occurred. The data suggest that CO increases after these preload regimens cannot compensate for reductions in arterial blood pressure after spinal anesthesia.
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Mask ventilation is the most fundamental skill in airway management. In this review, we summarize the current knowledge about difficult mask ventilation (DMV) situations. Various definitions for DMV have been used in the literature. ⋯ These signs should, therefore, be recognized and documented during the preoperative evaluation. DMV can be even more challenging in infants and children, because they develop hypoxemia much faster than adults. Finally, difficult tracheal intubation is more frequent in patients who experience DMV, and thus, clinicians should be familiar with the corrective measures and management options when faced with a challenging, difficult, or impossible mask ventilation situation.