Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2009
ReviewPerioperative management of children with obstructive sleep apnea.
Obstructive sleep apnea syndrome (OSA) affects 1%-3% of children. Children with OSA can present for all types of surgical and diagnostic procedures requiring anesthesia, with adenotonsillectomy being the most common surgical treatment for OSA in the pediatric age group. Thus, it is imperative that the anesthesiologist be familiar with the potential anesthetic complications and immediate postoperative problems associated with OSA. ⋯ However, management of OSA in children younger than 1 yr-of-age was excluded from the guideline, as were other issues related specifically to the pediatric patient. Hence, many questions remain regarding the perioperative care of the child with OSA. In this review, we examine the literature on pediatric OSA, discuss its pathophysiology, current treatment options, and recognized approaches to perioperative management of these young and potentially high-risk patients.
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Anesthesia and analgesia · Jul 2009
Randomized Controlled Trial Comparative StudyThe effect of sedation on intracranial pressure in patients with an intracranial space-occupying lesion: remifentanil versus propofol.
In this study, we compared the effect of light sedation with remifentanil versus propofol on intracranial (ICP) and cerebral perfusion pressure (CPP) of patients undergoing stereotactic brain tumor biopsy under regional anesthesia. ⋯ Light sedation with remifentanil does not result in a higher ICP than propofol in patients undergoing stereotactic brain tumor biopsy. CPP might be better preserved with remifentanil.
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Anesthesia and analgesia · Jul 2009
Comparative StudyThe Narcotrend index indicates age-related changes during propofol induction in children.
The Narcotrend electroencephalogram monitor is designed to measure hypnotic state during anesthesia. We performed this study to evaluate the effectiveness and reliability of the Narcotrend monitor in assessing hypnotic state and loss of consciousness (LOC) during propofol anesthesia induction in children. ⋯ During propofol induction in children, the Narcotrend electroencephalogram monitor was capable of following changes in the sedation level of children to some extent, but also had a relatively high probability (0.18) of incorrectly predicting changes in conscious state. Therefore, the monitor should not solely be used to guide sedation and anesthesia. NI was age-dependent and younger children had higher NI-values than older children at the same level of sedation.
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Anesthesia and analgesia · Jul 2009
Comparative StudyWhole blood multiple electrode aggregometry is a reliable point-of-care test of aspirin-induced platelet dysfunction.
Aspirin is one of the most commonly ingested over-the-counter drugs. In addition to its analgesic and antiinflammatory actions, it also potently inhibits platelet aggregation. Evaluation of aspirin-induced platelet dysfunction is relevant in various clinical situations, including during complex surgeries with high bleeding risk in individuals who have ingested aspirin. In this study, we examined the suitability of multiple electrode aggregometry (MEA) for time course assessment of the antiplatelet effects of a single oral dose of 500 mg aspirin. We also determined the applicability of this method in the point-of-care (POC) setting by comparing the results of the test after different time intervals after blood sampling. ⋯ MEA reliably detected the effects of aspirin. Notably, 500 mg aspirin caused complete inhibition of arachidonic acid-induced platelet aggregation for 2 days in all volunteers. Aggregation returned to baseline values with a wide interindividual variation in time course by day 5. No resting time for the blood sample was required for ASPItest or TRAPtest. These assays can be implemented as real POC tests. The reproducibility of the assays studied here is within the range of modern POC analyzers.
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Anesthesia and analgesia · Jul 2009
Case Reports Comparative StudyNeuromodulation in patients deployed to war zones.
Four active duty military personnel and two retired soldiers/military contractors were treated with spinal or peripheral nerve stimulators. All six personnel were able to deploy after the stimulators were placed. ⋯ One patient completed four deployments but had mechanical complications that necessitated eventual revisions. Considering the risks and limitations of reoperation, nerve blocks, and pharmacotherapy in a forward-deployed area, spinal cord stimulation provides an appealing alternative in soldiers who desire to remain deployable on active duty.