Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2010
Randomized Controlled Trial Comparative StudyAirway scope and Macintosh laryngoscope for tracheal intubation in patients lying on the ground.
Direct laryngoscopy of a patient lying on the ground is difficult because the intubator's head is far above the head of the patient, making alignment of the intubator's visual axis with the patient's tracheal axis difficult. The Airway Scope is a laryngoscope designed to facilitate tracheal intubation without requiring alignment of the oral, pharyngeal, and tracheal axes. We thus tested the hypothesis that intubation with the Airway Scope is faster than with the Macintosh laryngoscope in subjects lying on the ground. ⋯ Both the Airway Scope and the Macintosh laryngoscope offer high success rates in adequately prepared paralyzed patients lying supine at ground level in the hands of a skilled practitioner. However, the Airway Scope facilitated faster tracheal intubation.
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Anesthesia and analgesia · Aug 2010
Comparative StudyAn evaluation of remifentanil-sevoflurane response surface models in patients emerging from anesthesia: model improvement using effect-site sevoflurane concentrations.
We previously reported models that characterized the synergistic interaction between remifentanil and sevoflurane in blunting responses to verbal and painful stimuli. This preliminary study evaluated the ability of these models to predict a return of responsiveness during emergence from anesthesia and a response to tibial pressure when patients required analgesics in the recovery room. We hypothesized that model predictions would be consistent with observed responses. We also hypothesized that under non-steady-state conditions, accounting for the lag time between sevoflurane effect-site concentration (Ce) and end-tidal (ET) concentration would improve predictions. ⋯ Results confirmed, in part, our study hypothesis; accounting for the lag time between Ce and ET sevoflurane concentrations improved model predictions of responsiveness but had no effect on predicting a response to a noxious stimulus in the recovery room. These models may be useful in predicting events of clinical interest but large-scale evaluations with numerous patients are needed to better characterize model performance.
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Anesthesia and analgesia · Aug 2010
Randomized Controlled TrialIsocapnic hyperpnoea shortens postanesthetic care unit stay after isoflurane anesthesia.
We conducted a prospective controlled clinical trial of the effect of isocapnic hyperpnoea (IH) on the times-to-recovery milestones in the operating room (OR) and postanesthetic care unit (PACU) after 1.5 to 3 hours of isoflurane anesthesia. ⋯ IH accelerates recovery after 1.5 to 3 hours of isoflurane anesthesia and shortens OR and PACU stay.
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Anesthesia and analgesia · Aug 2010
Preoperative statin therapy is not associated with a reduced incidence of postoperative acute kidney injury after cardiac surgery.
Our objective was to examine the association between preoperative statin therapy and the prevalence of postoperative acute kidney injury (AKI) in patients undergoing cardiac surgery with the use of cardiopulmonary bypass. ⋯ These results suggest that previously reported reductions in perioperative mortality for patients taking preoperative statins and undergoing cardiac surgery is likely not mediated through a reduction in postoperative AKI.
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Anesthesia and analgesia · Aug 2010
Comparative StudyThe incremental value of thrombelastography for prediction of excessive blood loss after cardiac surgery: an observational study.
Accurate risk stratification may help reduce the burden of excessive blood loss after cardiac surgery. We measured the incremental value of thrombelastography to an existing risk prediction model for excessive blood loss in cardiac surgery. ⋯ Risk stratification for excessive blood loss after cardiac surgery is improved when on-CPB thrombelastography is added to an existing risk prediction model that incorporates readily available patient- and surgery-related variables, but large, multicenter trials are needed to verify this finding and create a new risk prediction model.