Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2013
Comparative StudyAnesthetic induction with etomidate, rather than propofol, is associated with increased 30-day mortality and cardiovascular morbidity after noncardiac surgery.
Because etomidate impairs adrenal function and blunts the cortisol release associated with surgical stimulus, we hypothesized that patients induced with etomidate suffer greater mortality and morbidity than comparable patients induced with propofol. ⋯ Etomidate was associated with a substantially increased risk for 30-day mortality, cardiovascular morbidity, and prolonged hospital stay. Our conclusions, especially on 30-day mortality, are robust to a strong unmeasured binary confounding variable. Although our study showed only an association between etomidate use and worse patients' outcomes but not causal relationship, clinicians should use etomidate judiciously, considering that improved hemodynamic stability at induction may be accompanied by substantially worse longer-term outcomes.
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Anesthesia and analgesia · Dec 2013
Apparent Dead Space with the Anesthetic Conserving Device, AnaConDa®: A Clinical and Laboratory Investigation.
The anesthetic conserving device (ACD) reduces consumption of volatile anesthetic drug by a conserving medium adsorbing exhaled drug during expiration and releasing it during inspiration. Elevated arterial CO2 tension (PaCO2) has been observed in patients using the ACD, despite tidal volume increase to compensate for larger apparatus dead space. In a test lung using room temperature dry gas, this was shown to be due to adsorption of CO2 in the ACD during expiration and release of CO2 during the following inspiration. The effect in the test lung was higher than in patients. We tested the hypothesis that a lesser dead space effect in patients is due to higher temperature and/or moisture attenuating rebreathing of CO2. ⋯ The use of an ACD increases apparent dead space to a greater extent than can be explained by its internal volume. This is caused by adsorption of CO2 in the ACD during expiration and release of CO2 during inspiration. Rebreathing of CO2 was attenuated by moisture. The dead space effect of the ACD could be clinically relevant in acute respiratory distress syndrome and other diseases associated with ventilation difficulties, but investigations with larger sample sizes would be needed to determine the clinical importance.
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Anesthesia and analgesia · Dec 2013
Randomized Controlled Trial Comparative StudyThe effectiveness of pudendal nerve block versus caudal block anesthesia for hypospadias in children.
Pudendal nerve block provides better analgesia in the first 24 hours for children following hypospadias repair than does caudal block.
pearl -
Anesthesia and analgesia · Dec 2013
Randomized Controlled Trial Comparative StudyAnesthesia induction using video glasses as a distraction tool for the management of preoperative anxiety in children.
Distraction technology suitable for the perioperative setting is readily available, but there is little evidence to show how it compares with oral midazolam in managing anxiety. Video glasses, which enable children to view and listen to cartoons and movies, may be used through the completion of inhaled induction. We compared the efficacy of oral midazolam and behavioral distraction with video glasses in managing preoperative anxiety in children. ⋯ The use of video glasses and midazolam alone or in combination maintains baseline levels of anxiety at time of transport to the OR and prevents significantly increased anxiety during induction of anesthesia in children. Video glasses are not inferior to midazolam for preoperative anxiolysis and provide a safe, noninvasive, nonpharmacologic, and pleasant alternative.
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Anesthesia and analgesia · Dec 2013
Comparative StudyPulse Wave Transit Time Measurements of Cardiac Output in Patients Undergoing Partial Hepatectomy: A Comparison of the esCCO System with Thermodilution.
Measuring cardiac output accurately during anesthesia is thought to be helpful for safely controlling hemodynamics. Several minimally invasive methods to measure cardiac output have been developed as alternatives to thermodilution with pulmonary artery catheterization. We evaluated the reliability of a novel pulse wave transit time method of cardiac output assessment to trend with thermodilution cardiac output in patients undergoing partial hepatectomy. ⋯ The pulse wave transit time method had good concordance but fairly wide limits of agreement with regard to trending in patients with changes in preload and systemic vascular resistance. There are potential inaccuracies when vasopressors are used to treat hypotension associated with decreased systemic vascular resistance. The study limitations are that the cardiac output data were collected in a nonblinded fashion, and an existing intraarterial catheter was used, although the system requires only routine, noninvasive cardiovascular monitors. This is a promising technique that currently has limitations and will require further improvements and clinical assessment.