Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2010
Plasma neutrophil gelatinase-associated lipocalin and acute postoperative kidney injury in adult cardiac surgical patients.
Acute kidney injury (AKI) after coronary artery bypass graft (CABG) surgery is associated with increased postoperative morbidity and mortality. We hypothesized that increased plasma neutrophil gelatinase-associated lipocalin (NGAL) measured immediately after separating from cardiopulmonary bypass (CPB) would predict AKI after CABG surgery. ⋯ An early increase of post-CPB plasma NGAL is associated with AKI in adult patients undergoing CABG surgery, although the sensitivity is low. Therefore, assessing early plasma NGAL alone has limited utility for predicting AKI in this patient population.
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Anesthesia and analgesia · Jun 2010
Facemask pressure-controlled ventilation in children: what is the pressure limit?
In this study, we sought to determine the level of inspiratory pressures allowing adequate and safe ventilation without any risk of gastric insufflation (GI) in children according to age. ⋯ The inspiratory pressure threshold at which GI can occur depends on age. It is low in infants and increases with age. In most cases, proper ventilation without GI was obtained with an inspiratory pressure
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Anesthesia and analgesia · Jun 2010
Electroencephalographic seizures after neonatal cardiac surgery with high-flow cardiopulmonary bypass.
Postoperative electroencephalographic (EEG) seizures are reported to occur in 14% to 20% of neonates after cardiac surgery with cardiopulmonary bypass (CPB). EEG seizures are associated with prolonged deep hypothermic circulatory arrest and with adverse long-term neurodevelopmental outcomes. We performed video/EEG monitoring before and for 72 hours after neonatal cardiac surgery, using a high-flow CPB protocol and cerebral oxygenation monitoring, to ascertain incidence, severity, and factors associated with EEG seizures. ⋯ EEG seizures are infrequent in neonates undergoing surgery with high-flow CPB. Cerebral desaturation did not affect EEG seizure occurrence; however, benzodiazepines may play a role in suppressing postoperative seizures caused by cerebral hypoxemia in this patient population. Using this anesthetic and surgical protocol, EEG seizures are a poor surrogate marker for acute neurological injury in this population.
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Anesthesia and analgesia · Jun 2010
Ultrasound-guided thoracic paravertebral blockade: a cadaveric study.
Multiple approaches to the paravertebral space have been described to produce analgesia after thoracic surgery. Ultrasound-guided regional anesthesia has the potential to improve efficacy and reduce complications via real-time visualization of the paravertebral space, surrounding structures, and the approaching needle. We compared a single- versus dual-injection technique for ultrasound-guided paravertebral blockade in a cadaver model, evaluating the spread of contrast dye and location of a catheter. ⋯ Transverse in-plane ultrasound-guided needle insertion into the thoracic paravertebral space is both feasible and reliable. However, paravertebral spread of contrast is highly variable with intercostal and epidural spread likely contributing significantly to the analgesic efficacy. A dual-injection technique at separate levels seems to cover more thoracic dermatomes because of greater segmental intercostal spread (rather than paravertebral spread) than a single-injection approach. Catheters are located in nonideal positions in 40% of cases using this in-plane technique.
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Anesthesia and analgesia · Jun 2010
Brief reports: nerve stimulator evoked motor response predicting a successful supraclavicular brachial plexus block.
We examined the success rate of supraclavicular brachial plexus block after the different evoked motor responses to nerve stimulation. ⋯ Simultaneous flexion of the third and fourth digits with or without other digits is associated with the highest success rate of supraclavicular brachial plexus block.