Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2010
Randomized Controlled TrialNocebo-induced hyperalgesia during local anesthetic injection.
Common practice during local anesthetic injection is to warn the patient using words such as: "You will feel a big bee sting; this is the worst part." Our hypothesis was that using gentler words for administration of the local anesthetic improves pain perception and patient comfort. One hundred forty healthy women at term gestation requesting neuraxial analgesia were randomized to either a "placebo" ("We are going to give you a local anesthetic that will numb the area and you will be comfortable during the procedure") or "nocebo" ("You are going to feel a big bee sting; this is the worst part of the procedure") group. ⋯ Median verbal analog scale pain scores were lower when reassuring words were used compared with the harsher nocebo words (3 [2-4] vs 5 [3-6]; P < 0.001). Our data suggest that using gentler, more reassuring words improves the subjective experience during invasive procedures.
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Anesthesia and analgesia · Mar 2010
Randomized Controlled Trial Multicenter StudyThe effect of bispectral index monitoring on long-term survival in the B-aware trial.
When anesthesia is titrated using bispectral index (BIS) monitoring, patients generally receive lower doses of hypnotic drugs. Intraoperative hypotension and organ toxicity might be avoided if lower doses of anesthetics are administered, but whether this translates into a reduction in serious morbidity or mortality remains controversial. The B-Aware Trial randomly allocated 2463 patients at high risk of awareness to BIS-guided anesthesia or routine care. We tested the hypothesis that the risks of death, myocardial infarction (MI), and stroke would be lower in patients allocated to BIS-guided management than in those allocated to routine care. ⋯ Monitoring with BIS and absence of BIS values <40 for >5 min were associated with improved survival and reduced morbidity in patients enrolled in the B-Aware Trial.
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Anesthesia and analgesia · Mar 2010
Randomized Controlled Trial Comparative StudyA comparison of 3% hypertonic saline and mannitol for brain relaxation during elective supratentorial brain tumor surgery.
In this study, we compared the effects of 3% hypertonic saline (HTS) and 20% mannitol on brain relaxation during supratentorial brain tumor surgery, intensive care unit (ICU) stays, and hospital days. ⋯ Our results suggest that HTS provided better brain relaxation than did mannitol during elective supratentorial brain tumor surgery, whereas it did not affect ICU stays or hospital days.
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Anesthesia and analgesia · Mar 2010
Randomized Controlled Trial Comparative StudyLocal administration of morphine for analgesia after autogenous anterior or posterior iliac crest bone graft harvest for spinal fusion: a prospective, randomized, double-blind, placebo-controlled study.
Harvesting of iliac crest graft for spinal fusions is associated with a number of patients reporting residual or chronic pain at the harvest site. Various interventions, including morphine infiltration, have been proposed to minimize the associated pain. ⋯ This study has demonstrated that there are no additional benefits for the use of intraoperative infiltration of morphine into the iliac crest harvest site during spinal fusions.
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Anesthesia and analgesia · Mar 2010
Randomized Controlled Trial Comparative StudyResistive-heating or forced-air warming for the prevention of redistribution hypothermia.
We evaluated the efficacy of resistive-heating or forced-air warming versus no prewarming, applied before induction of anesthesia for prevention of hypothermia. ⋯ Prewarming should be considered part of the anesthetic management when patients are at risk for postoperative hypothermia.