Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2012
Randomized Controlled TrialUse of a disposable acupressure device as part of a multimodal antiemetic strategy for reducing postoperative nausea and vomiting.
There is still controversy regarding the optimal strategy for managing postoperative nausea and vomiting (PONV) in high-risk surgical populations. Although acustimulation at the P6 acupoint has been demonstrated to be effective in preventing PONV, the effect of this nonpharmacologic therapy on the patient's recovery with respect to resumption of normal activities of daily living has not been previously assessed when it is used as part of a multimodal antiemetic regimen. Therefore, we designed this randomized, sham-controlled, and double-blind study to assess the efficacy of a disposable acupressure device (Pressure Right®; Pressure Point Inc., Grand Rapids, MI) on the incidence of emetic episodes and quality of recovery when used in combination with ondansetron and dexamethasone for antiemetic prophylaxis. ⋯ Use of the Pressure Right acupressure device in combination with antiemetic drugs provided a reduction in the incidence of vomiting from 0 to 72 hours after surgery with an associated improvement in patient satisfaction with their PONV management. However, recovery and outcome variables failed to demonstrate any improvement with the addition of the acupressure device.
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Anesthesia and analgesia · Jul 2012
Multicenter StudyA scoring system to predict unplanned intubation in patients having undergone major surgical procedures.
Unplanned tracheal intubation after surgery has been associated with high mortality. Few studies have examined the risk factors for this complication. ⋯ A scoring system based on clinical risk factors was able to accurately predict unplanned intubation after surgery. Further investigation is needed to assess the utility of the Unplanned Intubation Risk Index in reducing the incidence of unplanned intubation through improved risk stratification and management in perioperative care.
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Anesthesia and analgesia · Jul 2012
ReviewProphylactic epidural blood patch after unintentional dural puncture for the prevention of postdural puncture headache in parturients.
Unintentional dural puncture is a source of significant morbidity in obstetric patients undergoing neuraxial anesthesia. In this focused review, we discuss the use of a prophylactic epidural blood patch to prevent postdural puncture headache, particularly as it relates to the obstetric population. Although epidural blood patch is thought to be an effective treatment for postdural puncture headache, there is insufficient evidence to support its use as a prophylactic procedure.
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Anesthesia and analgesia · Jul 2012
Modified rapid sequence induction and intubation: a survey of United States current practice.
Rapid sequence induction and intubation (RSII) is a technique commonly used to resist regurgitation of gastric contents and protect the airway. A modification of this technique is implemented in certain clinical circumstances. However, there is currently no standard definition for a modified RSII. Therefore, we surveyed clinicians at academic centers across the United States to establish a working definition of a modified RSII as well as the clinical scenarios in which it is being used. ⋯ Based on our survey we have established three defining features of a modified RSII: (1) oxygen administration before induction; (2) the use of cricoid pressure; and (3) an attempt to ventilate the patient's lungs before securing the airway. Although this definition seems intuitively obvious, no previous work has tested whether it is commonly accepted.
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Anesthesia and analgesia · Jul 2012
Comparative StudyCarboetomidate inhibits alpha4/beta2 neuronal nicotinic acetylcholine receptors at concentrations affecting animals.
Carboetomidate is an etomidate derivative that produces hypnosis without inhibiting adrenal corticosteroid synthesis. Similar to etomidate, carboetomidate modulates γ-aminobutyric acid type A receptors, but its effects on other ion channel targets of general anesthetics are unknown. ⋯ Compared with etomidate, carboetomidate's higher hydrophobicity is associated with greater inhibition of nnAChRs.