Anesthesia and analgesia
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Anesthesia and analgesia · May 2009
Randomized Controlled TrialColloid preload versus coload for spinal anesthesia for cesarean delivery: the effects on maternal cardiac output.
Spinal anesthesia for cesarean delivery may cause severe maternal hypotension, and a decrease in cardiac output (CO) and blood flow to the placenta. Fluid preloading with crystalloid is ineffective due to rapid redistribution. A "coload" given at the time of cerebrospinal fluid identification may be more effective. Our null hypothesis was that there would be no difference between the effect of a colloid preload (15 mL/kg hydroxyethyl starch (HES) 130/0.4 [Voluven 6%]) and an identical coload on maternal CO and the incidence of hypotension after spinal anesthesia for cesarean delivery. Secondary outcomes studied were neonatal acid- base status and predelivery vasopressor requirements. ⋯ Intravascular volume expansion with 15 mL/kg HES 130/0.4 given as a preload, but not coload, significantly increased maternal CO for the first 5 min after spinal anesthesia for cesarean delivery, however, maternal and neonatal outcomes were not different.
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Anesthesia and analgesia · May 2009
Randomized Controlled Trial Comparative StudyUltrasound versus landmark-based technique for ilioinguinal-iliohypogastric nerve blockade in children: the implications on plasma levels of ropivacaine.
Ilioinguinal-iliohypogastric nerve blockade (INB) is associated with high plasma concentrations of local anesthetics (LAs) in children. Ultrasonographic guidance enables exact anatomical administration of LA, which may alter plasma levels. Accordingly, we compared plasma levels of ropivacaine after ultrasonographic versus landmark-based INB. ⋯ The pharmacokinetic data indicate faster absorption and higher maximal plasma concentration of LA when ultrasound was used as a guidance technique for INB compared with the landmark-based technique. Thus, a reduction of the volume of LA should be considered when using an ultrasound-guided technique for INB.
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Anesthesia and analgesia · May 2009
Comparative StudyVentilation strategies in the obstructed airway in a bench model simulating a nonintubated respiratory arrest patient.
The Smart Bag MO(R) is an adult flow-limited bag-valve device designed to reduce the risk of stomach inflation in an unprotected airway. Its properties in severe airway obstruction are as yet unknown. ⋯ In a simulated severely obstructed unprotected airway, the use of a flow-limited bag-valve device resulted in longer inspiratory times, higher tidal volumes, lower inspiratory pressures, and no stomach inflation compared with a standard bag-valve device.
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Anesthesia and analgesia · May 2009
Propofol produces immobility via action in the ventral horn of the spinal cord by a GABAergic mechanism.
We investigated the actions of propofol and isoflurane on nociceptive responses of neurons in the spinal cord. ⋯ Propofol acts in the spinal cord to produce immobility. This depressive effect occurs in the ventral horn and is mediated mainly by GABA(A) receptors. Isoflurane also depresses neurons in the ventral horn; however, isoflurane actions at the GABA(A) receptor are either weak or overridden by other effects in the ventral horn.
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Workload has increased greatly over the past decade for anesthesia providers administering general anesthesia and/or sedation for pediatric diagnostic imaging. ⋯ Future workload for anesthesia providers administering general anesthesia and/or sedation for pediatric diagnostic imaging will depend on trends in the total number of scans performed. Workload may also be sensitive to factors that increase scan duration or alter the percentage of patients in the 3-5 yr age group. It may additionally depend on reimbursements from insurance companies.