Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2013
Randomized Controlled Trial Comparative StudyThe analgesic efficacy of subcostal transversus abdominis plane block compared with thoracic epidural analgesia and intravenous opioid analgesia after radical gastrectomy.
The transversus abdominis plane (TAP) block has been shown to provide effective postoperative analgesia in lower abdominal surgery. Subcostal TAP block has also been proposed as a new technique to provide analgesia for the supraumbilical abdomen. We compared the analgesic and opioid-sparing effects of a single-injection subcostal TAP block with continuous thoracic epidural analgesia and IV opioid analgesia. ⋯ Single-injection subcostal TAP block was more effective than IV opioid analgesia, while continuous thoracic epidural analgesia was more effective than the single-injection subcostal TAP block.
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Anesthesia and analgesia · Aug 2013
ReviewReview article: the anesthetic considerations of intraoperative electrocorticography during epilepsy surgery.
Epilepsy surgery is a well-established therapeutic intervention for patients with medically refractory seizures. Success of epilepsy surgery depends on the accurate localization and complete removal of the epileptogenic zone. Despite the advances in presurgical localization modalities, electrocorticography is still used in approximately 60% to 70% of the epilepsy centers in North America to guide surgical resection of the epileptogenic lesion and to assess for completeness of surgery. In this review, we discuss the principles and intraoperative use of electrocorticography, the effect of anesthetic drugs on electrocorticography, and the use of pharmacoactivation for intraoperative localization of epileptogenic zone.
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Anesthesia and analgesia · Aug 2013
Outcomes of early delirium diagnosis after general anesthesia in the elderly.
Postoperative delirium in the elderly, measured days after surgery, is associated with significant negative clinical outcomes. In this study, we evaluated the prevalence and in-hospital outcomes of delirium diagnosed immediately after general anesthesia and surgery in elderly patients. ⋯ Delirium in the PACU is common, but not universal. It is associated with subsequent delirium on the ward, and potentially with a decline in cognitive function and increased institutionalization at hospital discharge.
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Anesthesia and analgesia · Aug 2013
ReviewReview article: endotracheal tube cuff leaks: causes, consequences, and management.
The consequences of endotracheal tube (ETT) cuff leak may range from a bubbling noise to a life-threatening ventilatory failure. Although the definitive solution is ETT replacement, this is often neither needed nor safe to perform. Frequently, the leak is not caused by a structural defect in the ETT. ⋯ A risk/benefit analysis of each individual situation is warranted before decisions are made on how best to proceed. Alternative back-up ventilation plans should be preformulated and the necessary equipment ready before the exchange. In this review, various management concerns and plans are discussed, and a simple algorithm to manage leaky ETT cuff situations is presented.