Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2010
Randomized Controlled Trial Comparative StudyUltrasound-guided sciatic nerve block in the popliteal fossa using a lateral approach: onset time comparing separate tibial and common peroneal nerve injections versus injecting proximal to the bifurcation.
We hypothesized that blocking the tibial and common peroneal nerves individually using ultrasound distal to sciatic bifurcation would decrease time to complete block compared with a block proximal to the bifurcation. ⋯ Blocking the tibial and common peroneal nerves in the popliteal fossa separately provides for a faster onset than a prebifurcation sciatic block.
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Anesthesia and analgesia · Feb 2010
Randomized Controlled TrialThe effects of nabilone on sleep in fibromyalgia: results of a randomized controlled trial.
Sleep disorders affect many patients with chronic pain conditions. Cannabis has been reported by several patient populations to help sleep. We evaluated the safety and efficacy of nabilone, a synthetic cannabinoid, on sleep disturbance in fibromyalgia (FM), a disease characterized by widespread chronic pain and insomnia. ⋯ Nabilone is effective in improving sleep in patients with FM and is well tolerated. Low-dose nabilone given once daily at bedtime may be considered as an alternative to amitriptyline. Longer trials are needed to determine the duration of effect and to characterize long-term safety.
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Anesthesia and analgesia · Feb 2010
Meta Analysis Comparative StudyStatistical modeling of average and variability of time to extubation for meta-analysis comparing desflurane to sevoflurane.
The recovery profile of an ideal anesthetic or technique would be fast (e.g., mean of 5 min from end of surgery to extubation) with little variability (e.g., always 4-7 min). We used anesthesia information management system (AIMS) data to learn how to model the time from end of surgery to extubation. We applied that knowledge for meta-analyses of trials comparing extubation times after use of desflurane and sevoflurane. ⋯ Desflurane reduces the average extubation time and the variability of extubation time by 20%-25% relative to sevoflurane. The principal economic value of these end points is their reductions of direct (labor) costs of OR time. However, reductions in intangible costs of prolonged extubation are real, being associated with subsequent delays. Reductions in the average and variance of times to extubation can be interpreted and monitored in terms of corresponding expected 75% reductions in the incidences of prolonged extubation times by using desflurane relative to sevoflurane.
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Anesthesia and analgesia · Feb 2010
Case ReportsPreamputation mirror therapy may prevent development of phantom limb pain: a case series.
We report the cases of 4 patients who performed daily mirror therapy for 2 wk before undergoing elective limb amputation. One patient experienced no phantom limb pain (PLP). ⋯ These results indicate that preoperative mirror therapy may improve postamputation PT compliance and decrease the incidence of PLP. Future prospective studies are needed to confirm the results of this case series.
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Anesthesia and analgesia · Feb 2010
The young: neuroapoptosis induced by anesthetics and what to do about it.
Millions of human fetuses, infants, and children are exposed to anesthetic drugs every year in the United States and throughout the world. Anesthesia administered during critical stages of neurodevelopment has been considered safe and without adverse long-term consequences. However, recent reports provide mounting evidence that exposure of the immature animal brain to anesthetics during the period of rapid synaptogenesis, also known as the brain growth spurt period, triggers widespread apoptotic neurodegeneration, inhibits neurogenesis, and causes significant long-term neurocognitive impairment. Herein, we summarize currently available evidence for anesthesia-induced pathological changes in the brain and associated long-term neurocognitive deficits and discuss promising strategies for protecting the developing brain from the potentially injurious effects of anesthetic drugs while allowing the beneficial actions of these drugs to be realized.