Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2009
Randomized Controlled TrialFacial nerve electromyographic monitoring to predict movement in patients titrated to a standard anesthetic depth.
Facial nerve (FN) monitoring has been accepted as a standard of care in craniofacial, middle ear, and skull-based surgeries as a means of reducing iatrogenic injury, localizing the FN, and predicting postoperative neurologic function. Past studies have also shown that FN electromyographic monitoring (FNEMG) may have some clinical utility as a monitor of anesthetic depth and predicting patient movement. In this study, we evaluated Bispectral Index (BIS) and FNEMG using two different anesthetic techniques to determine whether these monitors can be used to predict movement in patients undergoing skull-based surgical procedures. ⋯ This study shows that FNEMG may be an effective monitor for predicting patient movement when undergoing craniofacial and skull-based surgeries. BIS monitoring, however, was not an adequate monitor to predict movement in this patient population. The DES group had more hemodynamic variability and FNEMG activity, whereas TIVA proved to be a more effective anesthetic in preventing patient movement when clinically titrated to produce stable operation conditions. FNEMG was a useful clinical tool to help predict and prevent movement in these patients.
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Anesthesia and analgesia · Aug 2009
Randomized Controlled TrialThe effect of intravenous alanyl-glutamine supplementation on plasma glutathione levels in intensive care unit trauma patients receiving enteral nutrition: the results of a randomized controlled trial.
We sought to investigate the effect of IV alanyl-glutamine supplementation on plasma glutathione levels in severely traumatized patients receiving enteral nutrition. ⋯ This study demonstrates that IV alanyl-glutamine supplementation for 7 days increases total plasma glutathione levels in critically ill trauma patients receiving standard enteral nutrition.
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Anesthesia and analgesia · Aug 2009
Can the outcome of spinal cord stimulation in chronic complex regional pain syndrome type I patients be predicted by catastrophizing thoughts?
In this study, we examined whether pain catastrophizing is a predictor of spinal cord stimulation (SCS) outcome in patients with complex regional pain syndrome type I (CRPS-I). ⋯ This study showed that the efficacy of SCS in reduction of pain intensity, GPE, and QOL in a well-defined chronic CRPS-I population was not predicted by pain catastrophizing. Therefore, we conclude that a high level of pain catastrophizing in patients with CRPS-I is not a contraindication for SCS treatment.
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Anesthesia and analgesia · Aug 2009
Management of anesthesia equipment failure: a simulation-based resident skill assessment.
Intraoperative anesthesia equipment failures are a cause of anesthetic morbidity. Our purpose in this study was 1) to design a set of simulated scenarios that measure skill in managing intraoperative equipment-related errors and 2) to evaluate the reliability and validity of the measures from this multiple scenario assessment. ⋯ Anesthesia residents' performances could be reliably evaluated using a set of simulated intraoperative equipment problems. This multiple scenario assessment was an effective method to evaluate individual performance. The summary results, by training year, could be used to determine how successful current instructional methods are for acquiring skill.
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Anesthesia and analgesia · Aug 2009
Children with infantile neuronal ceroid lipofuscinosis have an increased risk of hypothermia and bradycardia during anesthesia.
Neuronal ceroid lipofuscinoses (NCLs) are a group of autosomal recessive neurodegenerative diseases characterized by lysosomal accumulation of autofluorescent material in neurons and other cell types. The infantile NCL (INCL) subtype is rare (1 in >100,000 births), the most devastating of childhood subtypes, and is caused by mutations in the gene CLN1, which encodes palmitoyl-protein thioesterase-1. ⋯ We report that patients with INCL have lower baseline body temperature and during general anesthesia, despite rewarming interventions, are at increased risk for hypothermia and bradycardia. This suggests a previously unknown INCL phenotype, impaired thermoregulation. Therefore, when anesthetizing these children, careful monitoring and routine use of warming interventions are warranted.