Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2009
Randomized Controlled Trial Comparative StudyRapidly degradable hydroxyethyl starch solutions impair blood coagulation after cardiac surgery: a prospective randomized trial.
There is continuing concern about the effect of hydroxyethyl starch (HES) solutions on blood coagulation. Rapidly degradable HES solutions with more favorable effects on clot strength have therefore been developed. Because the risk of bleeding is increased after cardiopulmonary bypass, we examined whether these types of HES solutions could be administered after cardiac surgery without an alteration of coagulation. ⋯ We conclude that a short-time infusion of rapidly degradable HES solutions after cardiac surgery produces impairment in fibrin formation and clot strength in thromboelastometry tracings. In this clinical setting, human albumin does not impair hemostasis.
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Anesthesia and analgesia · Jan 2009
Comparative Study Clinical TrialForces applied to the maxillary incisors during video-assisted intubation.
Modern, video laryngoscopes provide an easier view of the glottis, possibly facilitating easier intubations. We describe an objective method for evaluating the benefits of video-assisted laryngoscopy, compared with standard techniques using force measurements. ⋯ Video-assisted laryngoscopes seem beneficial when considering forces applied to the maxillary incisors as an objective metric of intubation difficulty. In this study, we could not support that Mallampati and C&L grades predict the forces that are applied to the maxillary incisors.
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Anesthesia and analgesia · Jan 2009
Comparative Study Clinical TrialThe influence of arm abduction on the anatomic relations of infraclavicular brachial plexus: an ultrasound study.
Distances from brachial plexus to the coracoid process and the pleura are critical for performing infraclavicular block. We evaluated the influence of arm abduction on the position of the neurovascular bundle relative to the skin, to the coracoid process and to the pleura using ultrasonography. ⋯ Abduction of the arm reduces the depth of the brachial plexus but does not change the position of the axillary artery relative to the coracoid process or the pleura. Ultrasonography may under-estimate the actual depth of the plexus.
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Anesthesia and analgesia · Jan 2009
Randomized Controlled TrialThe efficacy of ilioinguinal-iliohypogastric and intercostal nerve co-blockade for postoperative pain relief in kidney recipients.
Postoperative pain is severe in patients undergoing renal transplantation. Systemic analgesia may produce complications as a result of impaired renal function. We investigated whether combined lower intercostal and Ilioinguinal-Iliohypogastric (IG-IH) nerve block might improve the quality of analgesia and reduce morphine consumption during the first 24 h after surgery. ⋯ Combined IG-IH and lower intercostal nerves blockade after renal transplantation significantly reduced postoperative pain and opioid consumption.
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Anesthesia and analgesia · Jan 2009
What determines the efficacy of forced-air warming systems? A manikin evaluation with upper body blankets.
Forced-air warming has gained acceptance as an effective means to prevent perioperative hypothermia. However, little is known about the influence of air flow and air temperature at the nozzle and the influence of heat distribution in the blankets on the efficacy of these systems. ⋯ The efficacy of forced-air warming systems is primarily determined by the blanket. Modern power units provide sufficient heat energy to maximize the ability of the blanket to warm the patient. Optimizing blanket design by optimizing the mean temperature gradient between the blanket and the manikin (or any other surface) with a very homogeneous temperature distribution in the blanket will enable the manufacturers to develop better forced-air warming systems.