Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2010
Comparative StudyA retrospective effectiveness study of loss of resistance to air or saline for identification of the epidural space.
Randomized trials comparing air to saline for loss of resistance (LOR) for identification of the epidural space have suggested the superiority of saline. We hypothesized that, in actual clinical practice, anesthesiologists using their preferred technique would produce similar analgesic outcomes with either air or saline. ⋯ When used at the anesthesiologist's discretion, there is no significant difference in block success between air and saline for localization of the epidural space by LOR.
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Anesthesia and analgesia · Feb 2010
The influence of inspired oxygen fraction and end-tidal carbon dioxide on post-cross-clamp cerebral oxygenation during carotid endarterectomy under general anesthesia.
Ten to fifteen percent of awake patients develop neurological deficits secondary to cerebral hypoperfusion after carotid artery cross-clamping. The reversal of such deficits by increasing the inspired oxygen fraction (Fio(2)) has been demonstrated, and regional cerebral oxygenation (rSO(2)) has been shown to improve during carotid cross-clamping in awake patients by increasing Fio(2). Paradoxical improvements in cerebral blood flow during carotid endarterectomy (CEA) at the time of cross-clamping and normalization of post-cross-clamp electroencephalographic abnormalities have been induced by hypocapnia. We performed this study to determine the influence of Fio(2) and end-tidal carbon dioxide (Petco(2)) on rSO(2) in patients undergoing CEA with general anesthesia during carotid cross-clamping. ⋯ rSO(2) is reliably improved during carotid cross-clamping by increasing Fio(2) in patients undergoing CEA with general anesthesia. Additional improvement in rSO(2) may be gained by increasing Petco(2).
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Anesthesia and analgesia · Feb 2010
The effect of an anatomically classified procedure on antiemetic administration in the postanesthesia care unit.
The effect of the type of surgical procedure on postoperative nausea and vomiting (PONV) rate has been debated in the literature. Our goal in this retrospective database study was to investigate the effect the type of surgical procedure (categorized and compared anatomically) has on antiemetic therapy within 2 h of admission to the postanesthesia care unit (PACU). ⋯ Using our automated anesthesia information system database, we found that the type of surgery, when categorized anatomically, was associated with an increased frequency of early PACU antiemetic administration in our population.
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Anesthesia and analgesia · Feb 2010
Pulse dye densitometry and indocyanine green plasma disappearance in ASA physical status I-II patients.
Indocyanine green plasma disappearance rate (ICG-PDR) is used to evaluate hepatic function. Although hepatic failure is generally said to occur with an ICG-PDR <18%/min, ICG disappearance rate is poorly defined in the healthy population, and a clear cutoff value of ICG-PDR that discriminates between normal hepatic function and hepatic failure has not yet been described. We therefore defined the ICG disappearance rate in an otherwise healthy patient population. In addition, we evaluated the noninvasive measurement of ICG-PDR (transcutaneously by pulse dye densitometry [PDD] at the finger and the nose) and compared these with the simultaneously performed invasive measurements of ICG-PDR (in arterial blood). ⋯ ICG-PDR values in a population without liver failure ranged well below 18%/min, cited as the cutoff value for hepatic failure. This cutoff value needs reconsideration. In addition, we conclude that the ICG concentration is adequately determined noninvasively by PDD.
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Anesthesia and analgesia · Feb 2010
Case ReportsIntranasal self-administration of remifentanil as the foray into opioid abuse by an anesthesia resident.
Remifentanil is a potent micro-opioid receptor agonist that produces intense analgesia. This anilidopiperidine analog of fentanyl was approved by the United States Food and Drug Administration and became commercially available in the United States in 1997. ⋯ Although remifentanil's package insert warns against the potential for addiction, because of its rapid rate of degradation there was little concern that health care workers would abuse this drug. Herein, we report a case of intranasal remifentanil abuse by an anesthesiology resident.