Anesthesia and analgesia
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Anesthesia and analgesia · May 2012
Randomized Controlled TrialUltrasound-guided popliteal sciatic block with a single injection at the sciatic division results in faster block onset than the classical nerve stimulator technique.
For successful, fast-onset sciatic popliteal block (SPB), either a single injection above the division of the sciatic nerve, or 2 injections to block the tibial nerve (TN) and common peroneal nerve (CPN) separately have been recommended. In this study, we compared the traditional nerve stimulator (NS)-guided SPB above the division of the sciatic nerve with the ultrasound (US)-guided block with single injection of local anesthetic (LA) between the TN and CPN at the level of their division. We hypothesized that US-SPB with a single injection between TN and CPN would result in faster block onset than a single-injection NS-SPB. ⋯ A single injection of LA in US-SPB with needle insertion at the separation of the TN and CPN results in a similar success rate at 30 minutes; however, more patients in the US-SPB group than in the NS-SPB group had complete block at 15 minutes.
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Anesthetic drugs have the potential to contribute to global warming. There is some debate about the overall impact of anesthetic drugs relative to carbon dioxide, but there is no question that practice patterns can limit the degree of environmental contamination. In particular, careful attention to managing fresh gas flow can use anesthetic drugs more efficiently--reducing waste while achieving the same effect on the patient. ⋯ This article provides background information and discusses strategies for managing fresh gas flow during each phase of anesthesia with the goal of reducing waste when using a circle anesthesia system. Monitoring oxygen and anesthetic gas concentrations is essential to implementing these strategies safely and effectively. Future technological advances in anesthetic delivery systems are needed to make it less challenging to manage fresh gas flow.
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Anesthesia and analgesia · May 2012
Review Comparative StudyA comparison of reusable and disposable perioperative textiles: sustainability state-of-the-art 2012.
Contemporary comparisons of reusable and single-use perioperative textiles (surgical gowns and drapes) reflect major changes in the technologies to produce and reuse these products. Reusable and disposable gowns and drapes meet new standards for medical workers and patient protection, use synthetic lightweight fabrics, and are competitively priced. In multiple science-based life cycle environmental studies, reusable surgical gowns and drapes demonstrate substantial sustainability benefits over the same disposable product in natural resource energy (200%-300%), water (250%-330%), carbon footprint (200%-300%), volatile organics, solid wastes (750%), and instrument recovery. ⋯ In summary, currently available perioperative textiles are similar in comfort, safety, and cost, but reusable textiles offer substantial opportunities for nurses, physicians, and hospitals to reduce environmental footprints when selected over disposable alternatives. Evidenced-based comparison of environmental factors supports the conclusion that reusable gowns and drapes offer important sustainability improvements. The benefit of reusable systems may be similar for other reusables in anesthesia, such as laryngeal mask airways or suction canisters, but life cycle studies are needed to substantiate these benefits.
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Anesthesia and analgesia · May 2012
Meta AnalysisUnplanned endotracheal extubations in the intensive care unit: systematic review, critical appraisal, and evidence-based recommendations.
In this study, we updated the state of knowledge on unplanned tracheal extubations in the intensive care unit. We focused on the following topics: incidence, risk factors, reintubation after unplanned extubation, outcomes, and prevention. Based on this review, recommendations were made for preventing unplanned extubations. ⋯ Despite numerous publications on unplanned extubation, few studies assess preventive strategies for adverse events, and few clinical trials have assessed unplanned extubations. Recommendations are proposed based on the currently available literature.
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Anesthesia and analgesia · May 2012
Hemoglobin desaturation after propofol/remifentanil-induced apnea: a study of the recovery of spontaneous ventilation in healthy volunteers.
In an earlier study investigating the "can't ventilate/can't intubate" clinical scenario, induction of anesthesia with thiopental 5 mg/kg and succinylcholine 1.0 mg/kg was associated with a significant risk of hemoglobin desaturation. It appeared that succinylcholine-induced apnea was responsible for the prolonged apnea. Our hypothesis was that using propofol and remifentanil for tracheal intubation might avoid prolonged apnea and subsequent desaturation attributable to muscle relaxation. ⋯ Administered with propofol 2 mg/kg, the remifentanil dose necessary to produce acceptable intubating conditions, 2 mcg/kg, produces apnea that carries a significant risk of desaturation, whereas a remifentanil dose of 1.5 mcg/kg does not reliably produce acceptable intubating conditions and does not eliminate the risk of desaturation.