Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2009
Comparative StudyThe feasibility of epicardial echocardiography for measuring aortic valve area by the continuity equation.
Measuring the aortic valve area (AVA) remains an important component of a comprehensive intraoperative echocardiographic examination in patients undergoing aortic valve surgery. Epicardial echocardiography (EE) represents an accessible alternative to transesophageal echocardiography (TEE), however, its agreement and correlation with other imaging modalities for measuring AVA has not been systematically validated. ⋯ EE measurements of AVA by the continuity equation show high agreement and closely correlate with established techniques of AVA assessment.
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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
Comparative StudyIntrathecal morphine preconditioning induces cardioprotection via activation of delta, kappa, and mu opioid receptors in rats.
Small doses of intrathecal morphine provide cardioprotection similar to that conferred by IV morphine. However, the extent of intrathecal morphine preconditioning (IT-MPC) relative to that resulting from ischemic preconditioning (IPC) is unknown. Further, it is uncertain whether IT-MPC is mediated by opioid receptor dependent pathways. In this study, we compared the extent of cardioprotection conferred by IT-MPC with IPC and investigated the role of opioid receptors in this effect. ⋯ IT-MPC produced comparable cardioprotection to myocardial IPC and IV morphine. Myocardial preconditioning from intrathecal morphine seems to involve delta, kappa, and mu opioid receptors.
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Anesthesia and analgesia · Jan 2009
Six-year follow-up on work force and finances of the United States anesthesiology training programs: 2000 to 2006.
In the mid 1990s, interest in the field of anesthesiology decreased significantly among medical students, resulting in a decreasing resident class size and, subsequently, fewer anesthesiologists entering the United States workforce. This apparent practitioner shortage was associated with increased salary demands, which placed anesthesiology training departments in financial jeopardy. Starting in 1999, a survey was sent to the department chairs of the United States anesthesiology training programs to assess the status of faculty and finances of their departments. Follow-up surveys have been conducted each year thereafter. We present the results of the 2006 survey and 7 yr trend data. ⋯ This current survey reveals a continuing need for institutional support to keep anesthesiology training departments financially solvent. The amount of support is associated with the reimbursement for anesthesia work. There is also a continuing, but decreasing, number of open faculty anesthesiologist positions nationwide.
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Anesthesia and analgesia · Jan 2009
Failure of augmentation of labor epidural analgesia for intrapartum cesarean delivery: a retrospective review.
In this study, we aimed to identify the incidence and predictive factors associated with failed labor epidural augmentation for cesarean delivery. Data of parturients, who had received neuraxial labor analgesia and who subsequently required intrapartum cesarean delivery during an 18-mo period, were retrospectively studied. ⋯ Of the 1025 parturients, 1.7% had failed epidural extension. Predictors of failed epidural anesthesia included initiation of labor analgesia with plain epidural technique (compared to combined spinal-epidural) (P = 0.001), >or=2 episodes of breakthrough pain during labor (P < 0.001) and prolonged duration of neuraxial labor analgesia (P = 0.02).