Anesthesia and analgesia
-
The perioperative period may have long-term consequences on cognitive function in the elderly patient. In this special article, we summarize the rationale and evidence that the anesthetic per se is a contributor. The evidence at this point is considered suggestive and further research is needed, especially in humans.
-
Anesthesia and analgesia · Feb 2010
Randomized Controlled TrialPlacement of the Univent tube without fiberoptic bronchoscope assistance.
In this study, we evaluated the feasibility and accuracy of Univent tube (Fuji Systems, Tokyo, Japan) placement with the aid of auscultation (AUS) or as guided by a lighted stylet (LS) compared with placement guided by the fiberoptic bronchoscope (FOB) or the blind intubation technique as recommended by the manufacturer's guidelines. ⋯ The placement of the Univent tube with the aid of AUS or an LS is feasible, and both techniques require less time than placement aided by an FOB or as recommended by the manufacturer.
-
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.
-
Anesthesia and analgesia · Feb 2010
Serum ropivacaine concentrations and systemic local anesthetic toxicity in trauma patients receiving long-term continuous peripheral nerve block catheters.
Ropivacaine is a long-acting local anesthetic used frequently for peripheral nerve blocks and continuous peripheral nerve block catheters. Combat trauma patients at Walter Reed Army Medical Center often receive continuous peripheral nerve block catheters as part of their pain regimen. These catheters remain in situ for several days to weeks. In this study, we evaluated the free ropivacaine drug levels over time in trauma patients by measuring the serum concentration of bound and unbound local anesthetic. The corresponding alpha(1)-acid glycoprotein concentration in patients with prolonged ropivacaine infusions was also measured. ⋯ Although 2 patients demonstrated isolated serum ropivacaine concentration spikes into a previously identified toxic range, continuous peripheral nerve block catheter management and local anesthetic doses as practiced at Walter Reed Army Medical Center did not result in clinically evident systemic ropivacaine toxicity. There was no correlation between free ropivacaine concentration and alpha(1)-acid glycoprotein concentration except in patients who had already been receiving ropivacaine infusions before entering the study. Despite this lack of correlation, the total duration of local anesthetic infusion did not seem to influence the free concentration of the drug.
-
Anesthesia and analgesia · Feb 2010
ReviewIntraosseous infusions: a review for the anesthesiologist with a focus on pediatric use.
Intraosseous (IO) access is used most frequently for emergency care of critically ill infants and children when IV access cannot be rapidly achieved. Despite its efficacy in such situations, applications outside of the emergency room or resuscitation scenario have been limited. ⋯ Anyone providing anesthesia care for infants and children may want to become facile with the use of IO infusions for selected indications. We present the history of IO infusions, review the anatomy of the bone marrow space, discuss the potential role of IO infusions in the perioperative period, and analyze its adverse effect profile.