Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2011
Performance characteristics and validation of the Opioid-Related Symptom Distress Scale for evaluation of analgesic side effects after orthopedic surgery.
The Opioid-Related Symptom Distress Scale (ORSDS) is a 4-point scale that evaluates 3 symptom distress dimensions (frequency, severity, bothersomeness) for 12 symptoms. The symptom-specific ORSDS is the average of the 3 symptom distress dimensions. The composite ORSDS is the average of 12 symptom-specific scores. The ORSDS was validated for outpatient laparoscopic cholecystectomy (under general anesthesia) by assessment of internal consistency, content validity, construct validity, principal components analysis, known group validity, responsiveness, and opioid dose dependency. Additional validation studies were suggested. We investigated performance characteristics and validity of the ORSDS for postoperative analgesia after 4 types of anesthetic and analgesic regimens. ⋯ Validity of the ORSDS was supported by predetermined validation criteria, including measures of internal consistency, content validity, construct validity, principal components analysis, known group validity, responsiveness, and correlation with opioid intake. The ORSDS is a valid tool for assessment of opioid side effects after orthopedic surgery, and can be used in clinical trials involving a wide variety of anesthetic and analgesic regimens.
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Anesthesia and analgesia · Aug 2011
Forced needle advancement during needle-nerve contact in a porcine model: histological outcome.
In this study, we determined whether needle advancement during needle-nerve contact (forced needle-nerve contact) is associated with a higher risk of nerve injury compared with needle-nerve contact without needle advancement (nonforced needle-nerve contact). ⋯ The severity of structural nerve injury after needle-nerve contact was directly related to force exposure via needle advancement.
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Anesthesia and analgesia · Aug 2011
Hyperglycemia during craniotomy for adult traumatic brain injury.
Hyperglycemia after traumatic brain injury (TBI) is associated with poor outcome, but previous studies have not addressed intraoperative hyperglycemia in adult TBI. In this study, we examined glucose value variability and risk factors for hyperglycemia during craniotomy in adults with TBI. ⋯ Intraoperative hyperglycemia was common in adults undergoing urgent/emergent craniotomy for TBI and was predicted by severe TBI, the presence of subdural hematoma, preoperative hyperglycemia, and age ≥65 years. However, there was significant variability in intraoperative glucose values.
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Anesthesia and analgesia · Aug 2011
Airway collapse with an anterior mediastinal mass despite spontaneous ventilation in an adult.
Patients with anterior mediastinal masses are at increased risk for perioperative complications. Our case demonstrates that airway collapse and inability to ventilate may occur in the asymptomatic adult despite spontaneous ventilation with inhaled anesthesia and an endotracheal tube. ⋯ Though repositioning the pediatric patient lateral or prone has been reported to reestablish airway patency, this maneuver may be of limited benefit in the adult population because of a more ossified and developed chest wall. Lastly, if a high-risk patient requires a general anesthetic, strong consideration should be given to preinduction placement of femoral cardiopulmonary bypass cannulae and the availability to immediately initiate cardiopulmonary bypass.