Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2012
Editorial CommentNoncardiac surgery: widening the gap in pulse pressure.
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Anesthesia and analgesia · Jun 2012
Acute kidney injury after lung resection surgery: incidence and perioperative risk factors.
Postoperative acute kidney injury (AKI) is associated with increased perioperative morbidity and mortality in a variety of surgical settings, but has not been well studied after lung resection surgery. In the present study, we defined the incidence of postoperative AKI, identified risk factors, and clarified the relationship between postoperative AKI and outcome in patients undergoing lung resection surgery. ⋯ Preoperative risk factors for AKI after lung resection surgery overlap with those established for other surgical procedures. Perioperative management seems to influence the risk of AKI after lung resection; in particular, the use of synthetic colloids may increase the risk, whereas thoracoscopic procedures may decrease the risk of AKI. Early postoperative AKI is associated with respiratory complications and prolonged hospitalization.
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Anesthesia and analgesia · Jun 2012
The variability of response to propofol is reduced when a clinical observation is incorporated in the control: a simulation study.
When using a target-controlled infusion of propofol to produce sedation, the operator assumes that the individual patient's pharmacokinetic parameters match those in the control system so that the specified effect-site target is achieved, and that the specified target is appropriate for the individual patient's sensitivity. These inaccuracies cascade, and this produces error in the desired level of sedation, termed "target error." To address this issue, we designed a control system that incorporates the operator's observation of loss of responsiveness to determine patient sensitivity. Our hypothesis was that this control system would reduce the impact of pharmacokinetic parameter error and uncertainty in sensitivity on the system's target error. ⋯ Our system reduces the impact of biological variability by including the operator in the control loop. The utility of this approach in clinical practice will require further evaluation.
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Anesthesia and analgesia · Jun 2012
Quantification of serum fentanyl concentrations from umbilical cord blood during ex utero intrapartum therapy.
Fetal IM injection of fentanyl is frequently performed during ex utero intrapartum therapy (EXIT procedure). We quantified the concentration of fentanyl in umbilical vein blood. Thirteen samples from 13 subjects were analyzed. ⋯ The dose of fentanyl was 60 μg (45-65 μg). The time between IM administration of fentanyl and collection of the sample was 37 minutes (5-86 minutes). Fentanyl was detected in all of the samples, with a median serum concentration of 14.0 ng/mL (4.3-64.0 ng/mL).