Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2010
Randomized Controlled Trial Comparative StudyIschemic preconditioning attenuates pulmonary dysfunction after unilateral thigh tourniquet-induced ischemia-reperfusion.
Acute lung injury is a recognized complication of lower limb ischemia-reperfusion that has been demonstrated experimentally and in the clinical setting of aortic surgery. The application of a tourniquet can cause lower limb ischemia-reperfusion in orthopedic surgery. We studied the effect of unilateral thigh tourniquet-induced lower limb ischemia-reperfusion on pulmonary function, and the role of ischemic preconditioning in attenuating pulmonary dysfunction. ⋯ Pulmonary gas exchange is impaired after lower limb ischemia-reperfusion associated with the clinical use of a tourniquet for lower limb surgery. Ischemic preconditioning preceding tourniquet-induced ischemia attenuates lipid peroxidation and systemic inflammatory response and mitigates pulmonary dysfunction.
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Anesthesia and analgesia · Aug 2010
Randomized Controlled Trial Comparative StudyThe impact of Trendelenburg position and positive end-expiratory pressure on the internal jugular cross-sectional area.
Increasing the cross-sectional area (CSA) of the right internal jugular vein facilitates cannulation and decreases complications. Maneuvers such as the Trendelenburg tilt position and ventilation with a positive end-expiratory pressure (PEEP) may increase the CSA of the right internal jugular vein. We determined the changes in the CSA in response to different maneuvers. ⋯ In a comparison of the effectiveness of applying different PEEP levels and/or the Trendelenburg tilt position on the CSA of the right internal jugular vein, the Trendelenburg tilt position was most effective.
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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.