Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2013
Cesarean Delivery in the Hybrid Operating Suite: A Promising New Location for High-Risk Obstetric Procedures.
The increasing cesarean delivery rate and attendant placental implantation abnormalities, coupled with increasing general medical complexity in the obstetric population, has driven innovation to optimize the care of high-risk parturients during delivery. Novel and multidisciplinary approaches and locations may enhance the options available for care. ⋯ The hybrid operating suite may be an alternative location for obstetric delivery, and our experience suggests that this environment may prove advantageous for patients with a variety of comorbid conditions.
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Anesthesia and analgesia · Nov 2013
Randomized Controlled Trial Comparative StudyA Comparison Between the Bonfils Intubation Fiberscope and McCoy Laryngoscope for Tracheal Intubation in Patients with a Simulated Difficult Airway.
The Bonfils Intubation Fibrescope (Bonfils) and the McCoy laryngoscope (McCoy) are airway devices designed to assist tracheal intubation in difficult cases. Individually, both the Bonfils and McCoy have demonstrated superiority to the Macintosh laryngoscope in a simulated difficult airway. In this study, we compared the Bonfils with the McCoy laryngoscope in patients whose tracheal intubation had been intentionally hindered. Our primary hypothesis was that there is a significant difference in the rate of success for tracheal intubation when using the Bonfils or McCoy laryngoscope in patients with an intentionally hindered airway. ⋯ In the hands of trained operators, there appears to be no clinically significant difference in success, time to intubation, or adverse outcomes, when comparing the Bonfils with the McCoy laryngoscope, in the setting of a simulated difficult airway. The choice to use either device should remain based on appropriate patient selection, available aids, individual operator's experience, and economic circumstances.
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Anesthesia and analgesia · Nov 2013
Randomized Controlled TrialLiposomal Bupivacaine as a Single-Injection Peripheral Nerve Block: A Dose-Response Study.
Currently available local anesthetics approved for single-injection peripheral nerve blocks have a maximum duration of <24 hours. A liposomal bupivacaine formulation (EXPAREL, Pacira Pharmaceuticals, Inc., San Diego, CA), releasing bupivacaine over 96 hours, recently gained Food and Drug Administration approval exclusively for wound infiltration but not peripheral nerve blocks. ⋯ The results of this investigation suggest that deposition of a liposomal bupivacaine formulation adjacent to the femoral nerve results in a partial sensory and motor block of >24 hours for the highest doses examined. However, the high variability of block magnitude among subjects and inverse relationship of dose and response magnitude attests to the need for a phase 3 study with a far larger sample size, and that these results should be viewed as suggestive, requiring confirmation in a future trial.