Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2009
Randomized Controlled TrialThe effect of low-dose remifentanil on responses to the endotracheal tube during emergence from general anesthesia.
Emergence from general anesthesia can be associated with coughing, agitation, and hemodynamic disturbances. Remifentanil may attenuate these responses. ⋯ Low-dose remifentanil during emergence did not prolong wake-up but reduced the incidence and severity of coughing from the endotracheal tube.
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Anesthesia and analgesia · Apr 2009
Randomized Controlled Trial Comparative StudyA comparison of lighted stylet (Surch-Lite) and direct laryngoscopic intubation in patients with high Mallampati scores.
A lighted stylet is an effective alternative to a direct laryngoscope and has been reported to be particularly useful in patients with difficult airways. A high Mallampati class indicates poor visibility of the oropharyngeal structures. Because a lighted stylet does not require direct oropharyngeal visualization, we hypothesized that the lighted stylet would be easier to use than a direct laryngoscope in patients with a high Mallampati score. To examine our hypothesis, we performed a prospective, randomized study comparing a lighted stylet (Surch-Lite) with direct laryngoscopy in patients with high Mallampati scores. Success rate, time required for intubation, and hemodynamic changes were compared. ⋯ The Surch-Lite showed a higher success rate on the first intubation attempt and produced an attenuated hemodynamic response to endotracheal intubation of patients with high Mallampati score. Thus, the Surch-Lite is an effective alternative to direct laryngoscopy in these patients.
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Anesthesia and analgesia · Apr 2009
Randomized Controlled TrialCerebral oximetry during infant cardiac surgery: evaluation and relationship to early postoperative outcome.
We examined changes in cerebral oxygen saturation during infant heart surgery and its relationship to anatomic diagnosis and early outcome. ⋯ Intraoperative rSO(2) varies according to anatomic diagnosis but accounts for very little of the variance in early outcome. As measured by frontal near-infrared spectroscopy, higher levels of hematocrit and current perfusion techniques appear to provide an adequate oxygen reservoir prior to relatively short periods of DHCA.
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Anesthesia and analgesia · Apr 2009
Current threshold for nerve stimulation depends on electrical impedance of the tissue: a study of ultrasound-guided electrical nerve stimulation of the median nerve.
Understanding the mechanisms causing variation in current thresholds for electrical nerve stimulation may improve the safety and success rate of peripheral nerve blocks. Electrical impedance of the tissue surrounding a nerve may affect the response to nerve stimulation. In this volunteer study, we investigated the relationship between impedance and current threshold needed to obtain a neuromuscular response. ⋯ Our results demonstrate an inverse relationship between impedance measurements and current thresholds and suggest that current settings used for nerve stimulation may require adjustment based on the tissue type. Further studies should be performed to investigate the clinical impact of our findings.
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Anesthesia and analgesia · Apr 2009
The counteraction of opioid-induced ventilatory depression by the serotonin 1A-agonist 8-OH-DPAT does not antagonize antinociception in rats in situ and in vivo.
Spontaneous breathing during mechanical ventilation is gaining increasing importance during intensive care but is depressed by narcotics, such as opioids. Serotonin 1A-receptor (5-HT(1A)-R) agonists have been shown to antagonize opioid-induced ventilatory depression, but both enhancement and attenuation of nociceptive reflexes have been found with different experimental models. To clarify contradictory findings, we simultaneously determined dose-response functions of the standard 5-HT(1A)-R-agonist 8-OH-DPAT and two different opioids for spontaneous ventilation and nociception. Two hypotheses were tested: 1) 8-OH-DPAT at a dose to stimulate spontaneous breathing does not activate nociceptive reflexes. 2) 8-OH-DPAT does not diminish opioid-induced antinociception. ⋯ 5-HT(1A)-R-agonist 8-OH-DPAT activates spontaneous breathing without diminishing opioid-induced antinociception in rats.