Anesthesia and analgesia
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Anesthesia and analgesia · May 2009
ReviewPerioperative dental considerations for the anesthesiologist.
Although anesthesiologists consistently work in the mouth of patients, they may not have been exposed to a comprehensive education of teeth, surrounding tissues, and intraoral prostheses. Since perioperative dental damage is one of the most common anesthesia-related adverse events and is responsible for the greatest number of malpractice claims against anesthesiologists, several dental considerations are warranted. The likelihood of perioperative dental trauma increases with the vulnerability of a patient's dentition and the presence of associated anesthesia risk factors. ⋯ Exercising cautionary measures during provocative events, such as laryngoscopy and tracheal extubation, can aid in the prevention of dental trauma. In the event of such an injury, several management tactics can promote a swift and reasonable resolution. Establishing an increased awareness of intraoral conditions and the related perioperative risk factors may diminish the incidence of dental damage and financial costs.
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Anesthesia and analgesia · May 2009
Randomized Controlled TrialMixed-effects modeling of the influence of midazolam on propofol pharmacokinetics.
The combined administration of anesthetics has been associated with pharmacokinetic interactions that induce concentration changes of up to 30%. Midazolam is often used as a preoperative sedative in advance of a propofol-based anesthetic. In this study, we identified the influence of midazolam on the pharmacokinetics of propofol. ⋯ Midazolam reduces the metabolic and rapid and slow distribution clearances of propofol. In addition, a reduction in mean arterial blood pressure is associated with propofol pharmacokinetic alterations that increase the blood propofol concentration.
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Anesthesia and analgesia · May 2009
Randomized Controlled Trial Comparative StudyThe use of remifentanil to facilitate the insertion of the Cobra perilaryngeal airway.
The use of remifentanil before propofol administration facilitates the insertion of the Laryngeal Mask Airway. We designed the present study to determine whether remifentanil would also create more suitable conditions for providing Cobra Perilaryngeal airway (CobraPLA) insertion when administered with propofol. ⋯ An effect-site concentration of remifentanil of 2 ng/mL provides excellent conditions for insertion of the CobraPLA on the first attempt with minimal hemodynamic perturbations and a shorter duration of apnea.
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Anesthesia and analgesia · May 2009
The feasibility of measuring renal blood flow using transesophageal echocardiography in patients undergoing cardiac surgery.
There is no reliable method to monitor renal blood flow intraoperatively. In this study, we evaluated the feasibility and reproducibility of left renal blood flow measurements using transesophageal echocardiography during cardiac surgery. ⋯ In patients undergoing cardiac surgery, it was feasible in 60% of the subjects to measure left renal blood flow using intraoperative transesophageal echocardiography. The interobserver and intraobserver reproducibility of renal blood flow measurements was good to excellent.
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Anesthesia and analgesia · May 2009
Comparative StudyNoninvasive assessment of cardiac index in healthy volunteers: a comparison between thoracic impedance cardiography and Doppler echocardiography.
Thoracic bioimpedance cardiography (ICG) has been proposed as a noninvasive, continuous, operator-independent, and cost-effective method for cardiac output monitoring. In the present study, we compared cardiac index (CI) measurements with ICG (Niccomo device) and transthoracic Doppler echocardiography in resting healthy volunteers undergoing hemodynamic load challenge. ⋯ Poor correlation and lack of agreement between absolute values of CI measured by ICG and transthoracic Doppler echocardiography were found in resting healthy volunteers. The Niccomo device was also unreliable for monitoring changes in CI during hemodynamic load challenge.