Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2011
Randomized Controlled Trial Comparative StudyA randomized comparison between the Pentax AWS video laryngoscope and the Macintosh laryngoscope in morbidly obese patients.
The Pentax AWS is a novel video laryngoscope designed to facilitate tracheal intubation by providing indirect visualization of the laryngeal inlet. We sought to compare the intubation success rate and time to intubation for the Pentax AWS and the classic Macintosh laryngoscope. Specifically, we tested the hypothesis that intubation with the Pentax AWS would be easier and faster than with a standard Macintosh #4 blade in obese patients. ⋯ The time required for tracheal intubation using the Pentax AWS was longer than for the Macintosh laryngoscope and #4 blade. The AWS should not routinely be substituted for a conventional Macintosh #4 blade in morbidly obese patients.
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Anesthesia and analgesia · Nov 2011
Hemodynamic perturbations during robot-assisted laparoscopic radical prostatectomy in 45° Trendelenburg position.
Robot-assisted laparoscopic radical prostatectomy has gained widespread use. However, circulatory effects in patients subjected to an extreme Trendelenburg position (45°) are not well characterized. ⋯ Pneumoperitoneum and 45° Trendelenburg position caused 2- to 3-fold increases in filling pressures, without effects on cardiac performance. Filling pressures were normalized immediately after surgery. Lung compliance was halved. Gas exchange was unaffected. No perioperative cardiovascular complications occurred.
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Anesthesia and analgesia · Nov 2011
Multicenter StudyLack of effectiveness of the pulmonary artery catheter in cardiac surgery.
The pulmonary artery catheter (PAC) continues to be used for monitoring of hemodynamics in patients undergoing coronary artery bypass graft (CABG) surgery despite concerns raised in other settings regarding both effectiveness and safety. Given the relative paucity of data regarding its use in CABG patients, and given entrenched practice patterns, we assessed the impact of PAC use on fatal and nonfatal CABG outcomes as practiced at a diverse set of medical centers. ⋯ Use of a PAC during CABG surgery was associated with increased mortality and a higher risk of severe end-organ complications in this propensity-matched observational study. A randomized controlled trial with defined hemodynamic goals would be ideal to either confirm or refute our findings.
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Anesthesia and analgesia · Nov 2011
Hyperfibrinolysis diagnosed by rotational thromboelastometry (ROTEM) is associated with higher mortality in patients with severe trauma.
We investigated whether hyperfibrinolysis and its severity was associated with outcome of traumatized and nontraumatized patients. ⋯ Mortality from hyperfibrinolysis is significantly higher in trauma compared with nontrauma patients, and hyperfibrinolysis is an independent factor predicting mortality in trauma patients. Rotational thromboelastometry provides real-time recognition of hyperfibrinolysis allowing early treatment.
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Anesthesia and analgesia · Nov 2011
Ketamine activates the L-arginine/Nitric oxide/cyclic guanosine monophosphate pathway to induce peripheral antinociception in rats.
The involvement of the L-arginine/nitric oxide (NO)/cyclic guanosine monophosphate (cGMP) pathway in antinociception has been implicated as a molecular mechanism of antinociception produced by several antinociceptive agents, including μ-, κ-, or δ-opioid receptor agonists, nonsteroidal analgesics, cholinergic agonist, and α2C adrenoceptor agonist. In this study, we investigated whether ketamine, a dissociative anesthetic N-methyl-D-aspartate receptor antagonist, was also capable of activating the L-arginine/NO/cGMP pathway and eliciting peripheral antinociception. ⋯ Our results suggest that ketamine stimulates the L-arginine/NO/cyclic GMP pathway via neuronal NO synthase to induce peripheral antinociceptive effects.