Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2010
Clinical TrialHigh-dose bupivacaine remotely loaded into multivesicular liposomes demonstrates slow drug release without systemic toxic plasma concentrations after subcutaneous administration in humans.
Depot formulations prolong the analgesic effect of local anesthetics and reduce peak plasma drug concentration. This allows for safer administration of larger doses of local anesthetics, which further prolongs the duration of analgesic effect. We previously reported the development of large multivesicular vesicles (LMVVs) remotely loaded with bupivacaine (LMVV liposomal bupivacaine) and demonstrated a >5-fold prolongation of analgesic effect in animals and humans. In this study, we present pharmacokinetic data of LMVV liposomal bupivacaine in humans. ⋯ Peak plasma bupivacaine concentrations were not different in the 2 groups, despite a 4-fold increase in total bupivacaine dose administered in the novel liposomal preparation. The delayed elimination and prolonged redistribution of liposomal bupivacaine to plasma is compatible with the depot-related slow-release effect leading to the prolonged pharmacodynamic effect previously reported.
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Anesthesia and analgesia · Apr 2010
Comparative StudyA comparison of four techniques of emergency transcricoid oxygenation in a manikin.
Cricothyroidotomy is the final rescue maneuver in difficult airway management. We compared 4 techniques of oxygenation via the cricothyroid membrane in a manikin. The techniques were wire guided, trocar, cannula with jet ventilation, and blade technique (scalpel with endotracheal tube). ⋯ There were no differences between the other groups at any time. Time to ventilation improved with repetition in all groups. Skills were retained at 1 month.
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We developed an IV regional anesthesia (IVRA) model using the tails of rats to allow preclinical evaluation of the safety and efficacy of drugs used in IVRA and analgesia. ⋯ A reliable model for studying IVRA and analgesia has been developed in rats.
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Anesthesia and analgesia · Apr 2010
Use of state discharge abstract data to identify hospitals performing similar types of operative procedures.
A hospital or anesthesia or surgical group that is making decisions to expand its practice benefits from knowledge of the types of surgical procedures performed at other hospitals. ⋯ The similarity index is a robust and valid method for quantitatively comparing the numbers and types of inpatient surgical procedures performed at different hospitals. The similarity index, when combined with CCS categories, is useful for identifying opportunities that enable surgeons and anesthesiologists to better meet the needs of their communities.
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Anesthesia and analgesia · Apr 2010
The relationship among thromboelastography, hemostatic variables, and bleeding after cardiopulmonary bypass surgery in children.
Mediastinal bleeding is common after pediatric cardiopulmonary bypass (CPB) surgery. Thromboelastography (TEG) may predict bleeding and provide insight into likely mechanisms. We aimed to (a) compare perioperative temporal profiles of TEG and laboratory hemostatic variables between patients with significant hemorrhage (BLEED) and those without (CONTROL), (b) investigate the relationship between TEG variables and routine hemostatic variables, and (c) develop a model for prediction of bleeding. ⋯ Hypofibrinogenemia and inadequate heparin reversal are 2 important factors contributing to clot strength and perioperative hemorrhage after pediatric CPB. TEG may be a useful tool for predicting and guiding early treatment of mediastinal bleeding in this group.