Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2010
Review Meta Analysis Comparative StudyBrief reports: paravertebral block for anesthesia: a systematic review.
The objective of this review was to assess the safety and efficacy of thoracic and lumbar paravertebral blocks (PVBs) for surgical anesthesia through a systematic review of the peer-reviewed literature. PVBs for surgical anesthesia were compared with general anesthesia (GA) or other regional anesthetic techniques. ⋯ In conclusion, based on the current evidence, PVBs for surgical anesthesia at the level of the thoracic and lumbar vertebrae are associated with less pain during the immediate postoperative period, as well as less postoperative nausea and vomiting, and greater patient satisfaction compared with GA.
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Anesthesia and analgesia · Jun 2010
Clinical TrialThe influence of perioperative coagulation status on postoperative blood loss in complex cardiac surgery: a prospective observational study.
Coagulopathy leading to excessive blood loss is a serious complication of cardiac surgery. In this prospective cohort study, we measured patients' coagulation status before and after cardiopulmonary bypass (CPB) and examined their relationships with postoperative blood loss. ⋯ In complex cardiac surgery, blood loss is directly influenced by reduced pre-CPB thrombin generation rate, increased post-CPB consumption and dilution of clotting factors, as well as inadequate post-CPB clot stabilization. This information can aid in identifying patients at high risk for excessive blood loss and testing new interventions aimed at reducing the burden of this complication. The validity and generalizability of these findings need to be assessed by other studies.
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Anesthesia and analgesia · Jun 2010
Reduced incidence of postoperative nausea and vomiting in black South Africans and its utility for a modified risk scoring system.
Postoperative nausea and vomiting (PONV) is a common occurrence with a reported incidence between 20% and 40%. In this prospective observational study, we sought to determine the incidence of PONV in a South African population, differentiating between black South African (African) and the remainder of the multiethnic South African population (non-African). We attempted to identify individual risk factors for PONV and to test the performance of the Apfel PONV predictive scoring system in our patient population. ⋯ We were able to identify black South African ethnicity as an independent risk factor for decreasing the incidence of PONV. The reason for this observation remains speculative and further investigation is warranted. The inclusion of ethnicity as a risk factor into PONV scoring systems should be explored.
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Anesthesia and analgesia · Jun 2010
Review article: the role of the perioperative period in recurrence after cancer surgery.
A wealth of basic science data supports the hypothesis that the surgical stress response increases the likelihood of cancer dissemination and metastasis during and after cancer surgery. Anesthetic management of the cancer patient, therefore, could potentially influence long-term outcome. ⋯ Retrospective clinical trials suggest that the addition of regional anesthesia might decrease recurrence after cancer surgery. Other factors such as blood transfusion, temperature regulation, and statin administration may also affect long-term outcome.