Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2013
Randomized Controlled TrialPostoperative residual neuromuscular blockade is associated with impaired clinical recovery.
In this investigation, we sought to determine the association between objective evidence of residual neuromuscular blockade (train-of-four [TOF] ratio <0.9) and the type, incidence, and severity of subjective symptoms of muscle weakness in the postanesthesia care unit (PACU). ⋯ The incidence and severity of symptoms of muscle weakness were increased in the PACU in patients with a TOF <0.9.
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Anesthesia and analgesia · Jul 2013
Randomized Controlled Trial Comparative StudyA comparative trial of the GlideScope(R) video laryngoscope to direct laryngoscope in children with difficult direct laryngoscopy and an evaluation of the effect of blade size.
GlideScope® video laryngoscope (GVL) has been proposed to be useful for airway management, but its efficacy for difficult airways has not been confirmed in pediatric patients. In this study, we evaluated the usefulness of the GVL for improving the laryngoscopic view in patients whose Cormack and Lehane grade (C&L grade) was ≥3 under direct laryngoscopy. We also assessed the effect of GVL blade size on the laryngoscopic view. ⋯ In patients with C&L grade ≥3 under direct laryngoscopy, GVLs significantly improved the laryngoscopic view when compared with DL or GVLw. The GVLs is recommended for improving the laryngoscopic view in patients with a difficult airway.
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Anesthesia and analgesia · Jul 2013
Thromboelastometric maximum clot firmness in platelet-free plasma is influenced by the assay used.
Viscoelastic tests such as functional fibrinogen polymerization assays (FFPAs) in thrombelastography (TEG(®)) or thromboelastometry (ROTEM(®)) measure the elasticity of extrinsically activated clotting under conditions of platelet inhibition. There are no reports on whether components of the FFPAs have any effects on fibrin polymerization, aside from the effects of platelet inhibition. ⋯ We speculate that FIBTEM and FIBTEM PLUS may contain stabilizing agents that enhance fibrin polymerization whereas FFTEG might contain less tissue factor than the ROTEM assays.
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Anesthesia and analgesia · Jul 2013
The accuracy, precision and reliability of measuring ventilatory rate and detecting ventilatory pause by rainbow acoustic monitoring and capnometry.
Current methods for monitoring ventilatory rate have limitations including poor accuracy and precision and low patient tolerance. In this study, we evaluated a new acoustic ventilatory rate monitoring technology for accuracy, precision, reliability, and the ability to detect pauses in ventilation, relative to capnometry and a reference method in postsurgical patients. ⋯ In this study of a population of postsurgical patients, the acoustic monitor and capnometer both reliably monitored ventilatory rate. The acoustic monitor was statistically more accurate and more precise than the capnometer, but differences in performance were modest. It is not known whether the observed differences are clinically significant. The acoustic monitor was more sensitive to detecting pauses in ventilation. Acoustic monitoring may provide an effective and convenient means of monitoring ventilatory rate in postsurgical patients.
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Anesthesia and analgesia · Jul 2013
Randomized Controlled TrialLateral parasagittal versus midline interlaminar lumbar epidural steroid injection for management of low back pain with lumbosacral radicular pain: a double-blind, randomized study.
Epidural steroid injections are commonly used for management of low back pain with lumbosacral radicular pain and can be administered by either interlaminar or transforaminal routes. The transforaminal route is reported to be more effective than the interlaminar route due to higher delivery of drug at the ventral epidural space. However, the transforaminal route has been associated with serious complications including spinal cord injury and permanent paralysis. Hence, there is a search for a technically better route with fewer complications for drug delivery into the ventral epidural space. Recently, a parasagittal interlaminar (PIL) approach of epidural contrast injection was reported to have 100% ventral epidural spread. However, the therapeutic efficacy of this route has never been investigated. We compared the therapeutic efficacy of the PIL approach and midline interlaminar (MIL) approach. We hypothesized that the PIL approach may produce a better clinical outcome because of better ventral epidural spread of the drug compared with MIL approach. ⋯ Epidural steroid injection administered with the PIL approach was significantly more effective for pain relief and improvement in disability than the MIL approach for 6 months in the management of low back pain with lumbosacral radicular pain.