Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2009
Randomized Controlled TrialEpidural ropivacaine concentrations for intraoperative analgesia during major upper abdominal surgery: a prospective, randomized, double-blinded, placebo-controlled study.
The postoperative beneficial effects of thoracic epidural analgesia (TEA) within various clinical pathways are well documented. However, intraoperative data are lacking on the effect of different epidurally administered concentrations of local anesthetics on inhaled anesthetic, fluid and vasopressor requirement, and hemodynamic changes. We performed this study among patients undergoing major upper abdominal surgery under combined TEA and general anesthesia. ⋯ Epidural administration of 0.5% ropivacaine leads to a more pronounced sparing effect on desflurane concentration for an adequate anesthetic depth when compared with a 0.2% concentration of ropivacaine at comparable levels of vasopressor support and i.v. fluid requirement.
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Anesthesia and analgesia · Jun 2009
Randomized Controlled Trial Comparative StudyDoes ultrasound guidance improve the success rate of infraclavicular brachial plexus block when compared with nerve stimulation in children with radial club hands?
The classical response to nerve stimulation may be altered in cases of radial club hand. Ultrasound guidance may prove to be a useful tool in such situations. In this study, we compared the success rate of ultrasound-guided infraclavicular brachial plexus block with nerve stimulation for children undergoing radial club hand repair. ⋯ Ultrasound-guided infraclavicular brachial plexus block improves the success rate in patients with radial club hands when compared with nerve stimulation in patients undergoing radial club hand correction.
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Anesthesia and analgesia · Jun 2009
Improvement in the quality of randomized controlled trials among general anesthesiology journals 2000 to 2006: a 6-year follow-up.
We previously assessed all randomized controlled trials (RCTs) from four anesthesiology journals from January 2000 to December 2000. We identified key areas for improvement in the study protocol design and implementation and in data analyses. This study was repeated for the year 2006 to determine if improvements have occurred during the 6-yr interval. ⋯ There appears to have been a general improvement in the overall quality of RCT reporting among the major anesthesiology journals from the year 2000 to 2006. However, many articles could be improved with respect to randomization blinding, observer blinding to continuing study results (i.e., no unplanned interim data analysis), and a full discussion of Type II error in negative trials. Responsibility to improve the quality of the anesthesiology literature rests with investigators to design, implement and report high quality RCTs, and with peer reviewers and journal editors to set the standard for manuscript reporting. Periodic reassessments of the literature can serve to improve and maintain the quality of clinical trials reporting.
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Anesthesia and analgesia · Jun 2009
Lack of sensitivity of staffing for 8-hour sessions to standard deviation in daily actual hours of operating room time used for surgeons with long queues.
At multiple facilities including some in the United Kingdom's National Health Service, the following are features of many surgical-anesthetic teams: i) there is sufficient workload for each operating room (OR) list to almost always be fully scheduled; ii) the workdays are organized such that a single surgeon is assigned to each block of time (usually 8 h); iii) one team is assigned per block; and iv) hardly ever would a team "split" to do cases in more than one OR simultaneously. ⋯ For surgical teams with 8 h sessions, use the following decision rule for anesthesiology and OR nurse staffing. If actual hours of OR time used averages < or = 8 h 25 min, plan 8 h staffing. If average > or = 8 h 50 min, plan 10 h staffing. For averages in between, perform the full analysis of McIntosh et al. (Anesth Analg 2006;103:1499-516).