Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2013
The impact of video laryngoscopy use during urgent endotracheal intubation in the critically ill.
The video laryngoscope (VL) has been shown to improve laryngoscopic views and first-attempt success rates in elective operating room and simulated tracheal intubations compared with the direct laryngoscope (DL). However, there are limited data on the effectiveness of the VL compared with the DL in urgent endotracheal intubations (UEIs) in the critically ill. We assessed the effectiveness of using a VL as the primary intubating device during UEI in critically ill patients when performed by less experienced operators. ⋯ UEI using a VL as the primary device improved intubation success and decreased complications compared with a DL when PCCM fellows were the primary operators. These data suggest that the VL should be used as the primary device when urgent intubations are performed by less experienced operators.
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Anesthesia and analgesia · Jul 2013
Review Meta AnalysisThe facilitatory effects of intravenous dexmedetomidine on the duration of spinal anesthesia: a systematic review and meta-analysis.
Central mechanisms have been proposed to explain the prolongation of effect reported with the off-label use of dexmedetomidine as an adjuvant in local anesthetic admixtures. We evaluated whether IV dexmedetomidine can prolong the duration of sensory block associated with spinal anesthesia. ⋯ IV dexmedetomidine can prolong the duration of sensory block, motor block, and time to first analgesic request associated with spinal anesthesia.
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Anesthesia and analgesia · Jul 2013
Randomized Controlled Trial Comparative StudyA comparison of 4 airway devices on cervical spine alignment in cadaver models of global ligamentous instability at c1-2.
The effects of advanced airway management on cervical spine alignment in patients with upper cervical spine instability are uncertain. ⋯ In cadavers with instability at C1-2, the Lightwand technique produced less motion than the Macintosh and intubating LMA.
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Anesthesia and analgesia · Jul 2013
ReviewBrief report: a cost analysis of neuraxial anesthesia to facilitate external cephalic version for breech fetal presentation.
In this study, we sought to determine whether neuraxial anesthesia to facilitate external cephalic version (ECV) increased delivery costs for breech fetal presentation. ⋯ The total cost of delivery in women with breech presentation may be decreased (up to $720) or increased (up to $112) if ECV is attempted/performed with neuraxial anesthesia compared with ECV without neuraxial anesthesia. Increased ECV success with neuraxial anesthesia and the subsequent reduction in breech cesarean delivery rate offset the costs of providing anesthesia to facilitate ECV.
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Anesthesia and analgesia · Jul 2013
Multicenter StudyValue of a scheduled duration quantified in terms of equivalent numbers of historical cases.
Probabilistic estimates of case duration are important for several decisions on and soon before the day of surgery, including filling or preventing a hole in the operating room schedule, and comparing the durations of cases between operating rooms with and without use of specialized equipment to prevent resource conflicts. Bayesian methods use a weighted combination of the surgeon's estimated operating room time and historical data as a prediction for the median duration of the next case of the same combination. Process variability around that prediction (i.e., the coefficient of variation) is estimated using data from similar procedures. A Bayesian method relies on a parameter, τ, that specifies the equivalence between the scheduled estimate and the information contained in the median of a certain number of historical data. ⋯ Understanding performance of Bayesian methods for case duration is important because variability in durations has a large influence on appropriate management decisions the working day before and on the day of surgery. Both scheduled durations and historical data need to be used for these decisions. What matters is not the choice of τ but quantifying the variability using the Bayesian method and using it in managerial decisions.