Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2013
Randomized Controlled TrialHigh- versus low-stimulation current threshold for axillary plexus blocks: a prospective randomized triple-blinded noninferiority trial in 205 patients.
For nerve stimulator-guided regional anesthesia, one has to compromise between a presumed low success rate (using a high-current threshold) and a presumed increased risk of nerve damage (using a low-current threshold). We hypothesized that high-current thresholds in the range of 0.9 to 1.1 mA are not inferior with respect to the procedural and latency times compared with low threshold currents in the range of 0.3 to 0.5 mA for nerve stimulation in brachial plexus blocks. ⋯ Noninferiority for the high-current threshold technique could neither be confirmed for the primary end point nor for secondary end points. However, we consider a difference in mean times of approximately 8.5 minutes to achieve readiness for surgery acceptable for clinical practice.
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Anesthesia and analgesia · Jan 2013
ReviewCurrent status of pharmacologic therapies in patient blood management.
Patient blood management(1,2) incorporates patient-centered, evidence-based medical and surgical approaches to improve patient outcomes by relying on the patient's own (autologous) blood rather than allogeneic blood. Particular attention is paid to preemptive measures such as anemia management. ⋯ Patient blood management(3) structures its goals by avoiding blood transfusion(4) with effective use of alternatives to allogeneic blood transfusion.(5) These alternatives include autologous blood procurement, preoperative autologous blood donation, acute normovolemic hemodilution, and intra/postoperative red blood cell (RBC) salvage and reinfusion. Reviewed here are the available pharmacologic tools for anemia and blood management: erythropoiesis-stimulating agents (ESAs), iron therapy, hemostatic agents, and potentially, artificial oxygen carriers.
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Anesthesia and analgesia · Jan 2013
Beat-to-beat tracking of systolic blood pressure using noninvasive pulse transit time during anesthesia induction in hypertensive patients.
Pulse transit time (PTT) has been reported to show good agreement with arterial blood pressure (BP) in awake humans. We evaluated whether noninvasive beat-to-beat PTT accurately correlated with invasively measured continuous arterial BP during anesthesia induction in hypertensive patients. ⋯ Beat-to-beat PTT was fairly well correlated with invasive systolic BP and could predict a reduction in systolic BP during anesthesia induction. Beat-to-beat PTT may show potential as a useful noninvasive index of systolic BP when invasive BP is unavailable in high-risk hypertensive patients.