Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2013
Randomized Controlled Trial Comparative StudyA randomized controlled comparison of epidural analgesia and combined spinal-epidural analgesia in a private practice setting: pain scores during first and second stages of labor and at delivery.
There has been no prospective evaluation of combined spinal-epidural (CSE) analgesia in a private practice setting and few studies have focused on pain relief during the second stage of labor and at delivery. In this randomized controlled trial, we compared verbal pain scores during the first and second stages of labor and at delivery in women receiving CSE or traditional epidural analgesia at a busy private maternity hospital. ⋯ Compared with traditional epidural labor analgesia, CSE analgesia provided better first-stage analgesia despite fewer epidural top-up injections by an anesthesiologist.
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Anesthesia and analgesia · Mar 2013
ReviewCerebral near-infrared spectroscopy monitoring and neurologic outcomes in adult cardiac surgery patients: a systematic review.
Near-infrared spectroscopy is used during cardiac surgery to monitor the adequacy of cerebral perfusion. In this systematic review, we evaluated available data for adult patients to determine (1) whether decrements in cerebral oximetry during cardiac surgery are associated with stroke, postoperative cognitive dysfunction (POCD), or delirium; and (2) whether interventions aimed at correcting cerebral oximetry decrements improve neurologic outcomes. ⋯ Reductions in rSco(2) during cardiac surgery may identify cardiopulmonary bypass cannula malposition, particularly during aortic surgery. Only low-level evidence links low rSco(2) during cardiac surgery to postoperative neurologic complications, and data are insufficient to conclude that interventions to improve rSco(2) desaturation prevent stroke or POCD.
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Anesthesia and analgesia · Mar 2013
Point-of-care assessment of hypothermia and protamine-induced platelet dysfunction with multiple electrode aggregometry (Multiplate®) in patients undergoing cardiopulmonary bypass.
Coagulopathy is common after cardiopulmonary bypass (CPB), and platelet dysfunction is frequently considered to be a major contributor to excessive bleeding. Exposure to hypothermia may exacerbate the platelet function defect. We assessed platelet function during and after deep hypothermia with multiple electrode aggregometry (Multiplate(®); Verum Diagnostica GmbH, Munich, Germany). ⋯ Platelet aggregation, assessed by multiple electrode aggregometry (Multiplate), was severely affected during deep, whole-body hypothermia. This effect was partially reversible after rewarming, and was distinct from a general decline of platelet aggregation during CPB. Protamine also caused a significant decrease in platelet aggregation in vivo and in vitro.
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Anesthesia and analgesia · Mar 2013
Magnetic interference of cardiac pacemakers from a surgical magnetic drape.
Sterile magnetic drapes are frequently used during surgery to hold metal instruments on the sterile field. Magnetic fields may potentially interfere with the function of cardiovascular implantable electronic devices such as pacemakers and implantable cardioverter defibrillators. In this study, we evaluated the potential magnetic interference of magnetic drapes on pacemaker function. ⋯ Magnetic drapes may cause magnetic interference with cardiac pacemakers, and this interference ceases at a caudal distance of 15 cm. Magnetic interference seems more likely in patients with lower body weight. Careful monitoring of the pulse and electrocardiogram for asynchronous pacing activity should be considered when magnetic drapes are used in patients with cardiovascular implantable electronic devices.
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Anesthesia and analgesia · Mar 2013
Comparative StudyThe pyrrole etomidate analog carboetomidate potently inhibits human 5-HT3A receptor function: comparisons with etomidate and potential implications for emetogenesis.
5-Hydroxytryptamine type 3 (5-HT(3)) receptors are excitatory ion channels belonging to the cys-loop family of ligand-gated ion channels. They are involved in nausea and vomiting and their antagonists are used clinically as antiemetic drugs. We previously reported the development of a novel pyrrole analog of etomidate, (R)-ethyl 1-(1-phenylethyl)-1H-pyrrole-2-carboxylate (carboetomidate), which retains etomidate's desirable anesthetic and hemodynamic properties, but lacks its potent inhibitory effect on adrenocorticotropic hormone-stimulated steroid synthesis. Also in contrast to etomidate, carboetomidate potently inhibits nicotinic acetylcholine receptors. Because nicotinic acetylcholine and 5-HT(3) receptors are highly homologous, we hypothesized that carboetomidate might also potently inhibit 5-HT(3) receptors with potentially important implications for the drug's emetogenic activity. In the current studies, we investigated and compared modulation of 5-HT(3A) receptors by carboetomidate and etomidate. ⋯ In contrast to etomidate, carboetomidate inhibits 5-HT(3A) receptor-mediated currents at hypnotic concentrations. This inhibition is primarily the result of enhancing the rate of desensitization. Because carboetomidate potently inhibits 5-HT(3A) receptors, it may be less emetogenic than etomidate.