Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2011
Randomized Controlled Trial Comparative StudyMaternal cardiac output changes after crystalloid or colloid coload following spinal anesthesia for elective cesarean delivery: a randomized controlled trial.
Minimizing hypotension associated with spinal anesthesia for cesarean delivery by administration of IV fluids and vasopressors reduces fetal and maternal morbidity. Most studies have concentrated on noninvasive systolic blood pressure (SBP) measurements to evaluate the effect of such regimens. We used a suprasternal Doppler flow technique to measure maternal cardiac output (CO) variables in parturients receiving a phenylephrine infusion combined with the rapid administration of crystalloid or colloid solution at the time of initiation of anesthesia (coload). We hypothesized that a colloid coload compared with a crystalloid coload would produce a larger sustained increase in CO and therefore reduce vasopressor requirements. ⋯ We found no difference in CO in women randomized to colloid or crystalloid coload. In addition, there were no differences in vasopressor requirements or hemodynamic stability. We conclude that there is no advantage in using colloid over crystalloid when used in combination with a phenylephrine infusion during spinal anesthesia for elective cesarean delivery.
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Anesthesia and analgesia · Oct 2011
Randomized Controlled Trial Multicenter Study Comparative StudyThe impact of anesthesia on glycine absorption in operative hysteroscopy: a randomized controlled trial.
Operative hysteroscopy requires the use of a distension medium and its absorption can lead to serious consequences from intravascular volume overload and water intoxication. We compared the impact of 2 types of anesthesia (general anesthesia and local anesthesia with sedation) on the absorption of glycine solution in operative hysteroscopy. ⋯ Compared with general anesthesia, local anesthesia with sedation is associated with less glycine absorption and should be considered the preferred method of anesthesia for operative hysteroscopy.
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Anesthesia and analgesia · Oct 2011
Review Meta AnalysisA comparison between remifentanil and meperidine for labor analgesia: a systematic review.
Remifentanil is an ultrashort-acting opioid with favorable pharmacokinetic properties that make it suitable as a labor analgesic. Although it crosses the placenta freely, it is eliminated quickly in the neonate by rapid metabolism and redistribution. We aimed to determine whether remifentanil compared with meperidine is effective in reducing pain scores in laboring parturients. Other effects on the mother, the labor process, and the neonate were also examined. ⋯ Compared with meperidine, remifentanil is superior in reducing mean VAS scores for labor pain after 1 hour.
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Anesthesia and analgesia · Oct 2011
Comparative StudyThe effect of cross-training with adjustable airway model anatomies on laryngoscopy skill transfer.
A problem with learning endotracheal intubation on airway mannequins is poor transfer of direct laryngoscopy skills from model to patient. We developed an airway model with adjustable anatomic features and investigated whether practicing on a model with frequent adjustments improved laryngoscopy skills transfer. ⋯ The results verify that proficiency on one model does not guarantee success on another. However, subjects who trained with a laryngoscopy mannequin in multiple configurations did not show better skill transfer than subjects practicing on fixed configuration airway models.
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Anesthesia and analgesia · Oct 2011
Randomized Controlled Trial Comparative StudyA mannequin study of intubation with the AP advance and GlideScope Ranger videolaryngoscopes and the Macintosh laryngoscope.
The AP Advance (APA) is a videolaryngoscope with interchangeable blades: intubators can choose standard Macintosh blades or a difficult-airway blade with increased curvature and a channel to guide the tube to the larynx. The APA may therefore be comparably effective in both normal and difficult airways. We tested the hypotheses that intubation with the APA is no slower than Macintosh laryngoscopy for normal mannequin airways, and that it is no slower than videolaryngoscopy using a GlideScope Ranger in difficult mannequin airways. ⋯ Intubation times were similar with the APA and Macintosh laryngoscopes in mannequins with normal airways. However, intubation with the APA was significantly faster than with the GlideScope in the difficult mannequin simulation.