Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2010
Meta AnalysisCochrane corner: sugammadex, a selective reversal medication for preventing postoperative residual neuromuscular blockade.
Sugammadex is the first selective relaxant binding agent that has been studied for reversal of neuromuscular blockade induced by rocuronium and other steroidal non-depolarizing neuromuscular blocking agents (NMBAs). ⋯ Sugammadex was shown to be effective in reversing rocuronium-induced neuromuscular blockade. This review has found no evidence of a difference in the instance of unwanted effects between sugammadex, placebo or neostigmine. These results need to be confirmed by future trials on larger patient populations and with more focus on patient-related outcomes.
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Anesthesia and analgesia · Apr 2010
Randomized Controlled TrialBrief report: improved pain relief using intermittent bupivacaine injections at the donor site after breast reconstruction with deep inferior epigastric perforator flap.
Deep inferior epigastric perforator flap surgery usually results in postoperative pain from the donor site requiring opioids. ⋯ We conclude that intermittent delivery of bupivacaine at the abdominal donor site significantly reduces the postoperative pain and need for narcotic rescue medication.
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Anesthesia and analgesia · Apr 2010
The influence of age on sample size calculation in acute pain trials using morphine consumption as an end point.
Many trials in acute postoperative pain use morphine consumption as an end point. Age has been shown to have a significant influence on morphine consumption but is rarely considered in end point analysis. ⋯ The model suggests that variations in age have a profound effect on sample size. Researchers may need to account for this to prevent both type 1 and type 2 error.
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Anesthesia and analgesia · Apr 2010
Real-time assessment of perioperative behaviors in children and parents: development and validation of the perioperative adult child behavioral interaction scale.
Behavior in response to distressful events during outpatient pediatric surgery can contribute to postoperative maladaptive behaviors, such as temper tantrums, nightmares, bed-wetting, and attention seeking. Currently available perioperative behavioral assessment tools have limited utility in guiding interventions to ameliorate maladaptive behaviors because they cannot be used in real time, are only intended to be used during 1 phase of the experience (e.g., perioperative), or provide only a static assessment of the child (e.g., level of anxiety). A simple, reliable, real-time tool is needed to appropriately identify children and parents whose behaviors in response to distressful events at any point in the perioperative continuum could benefit from timely behavioral intervention. Our specific aims were to (1) refine the Perioperative Adult Child Behavioral Interaction Scale (PACBIS) to improve its reliability in identifying perioperative behaviors and (2) validate the refined PACBIS against several established instruments. ⋯ The PACBIS is a simple, easy to use, real-time instrument to evaluate perioperative behaviors of both children and parents. It has good to excellent interrater reliability and strong concurrent validity against currently accepted scales. The PACBIS offers a means to identify maladaptive child or parental behaviors in real time, making it possible to intervene to modify such behaviors in a timely fashion.
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Anesthesia and analgesia · Apr 2010
Case ReportsCase report: continuous interscalene block associated with neck hematoma and postoperative sepsis.
Continuous peripheral nerve blockade is often used for the management of postoperative pain, even in ambulatory patients. The reported incidence of infectious complications after continuous nerve blockade is low. ⋯ Preoperatively, the patient had received a continuous interscalene block for analgesia that was associated with a neck hematoma. After readmission, exploratory laparotomy, and extensive hospital stay, the patient was discharged to an extended care facility in good condition.