Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2013
ReviewReview article: Intrapartum neuraxial analgesia and breastfeeding outcomes: limitations of current knowledge.
Although numerous studies have addressed the relationship between intrapartum neuraxial analgesia, particularly epidural fentanyl, and breastfeeding, substantial study design limitations have precluded the current literature from furnishing strong, clinically significant conclusions. Lack of randomized controlled trials, nonstandardization of breastfeeding evaluations across studies, and failure to control for confounding variables all pose significant problems. Further research is needed to elucidate the specific relationship between neuraxial opioids and breastfeeding and, if there are significant associations, whether these drugs act directly on neonatal brain tissue to attenuate exhibition of breastfeeding behaviors. In this review, I will detail the deficiencies of the current literature and make recommendations for future research.
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Anesthesia and analgesia · Feb 2013
Review GuidelineReview article: Extubation of the difficult airway and extubation failure.
Respiratory complications after tracheal extubation are associated with significant morbidity and mortality, suggesting that process improvements in this clinical area are needed. The decreased rate of respiratory adverse events occurring during tracheal intubation since the implementation of guidelines for difficult airway management supports the value of education and guidelines in advancing clinical practice. Accurate use of terms in defining concepts and describing distinct clinical conditions is paramount to facilitating understanding and fostering education in the treatment of tracheal extubation-related complications. ⋯ Planning for tracheal extubation is a critical component of a successful airway management strategy, particularly when dealing with situations at increased risk for extubation failure and in patients with difficult airways. Adequate planning requires identification of patients who have or may develop a difficult airway, recognition of situations at increased risk of postextubation airway compromise, and understanding the causes and underlying mechanisms of extubation failure. An effective strategy to minimize postextubation airway complications should include preemptive optimization of patients' conditions, careful timing of extubation, the presence of experienced personnel trained in advanced airway management, and the availability of the necessary equipment and appropriate postextubation monitoring.
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Anesthesia and analgesia · Feb 2013
Case ReportsCase report: Volitional delay of self-reported outcomes: insights from a case of intraoperative awareness with explicit recall.
Intraoperative awareness with explicit recall (AWR) is a self-reported outcome of interest in clinical practice, quality assurance initiatives, and clinical trials. Combining structured postoperative interviews with a preoperative description of AWR is assumed to ensure prompt patient disclosure. ⋯ Volitionally delayed self-reported outcomes may affect statistical comparisons in clinical trials and quality assurance initiatives, and delay the treatment of subsequent sequelae in clinical practice. This limitation should be considered, even when using structured outcome assessment and preoperative education.
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Anesthesia and analgesia · Feb 2013
Technical communication: First robotic ultrasound-guided nerve blocks in humans using the Magellan system.
Ultrasound-guided nerve blocks are becoming a standard of modern anesthesia. We developed a robotic system, Magellan, to perform nerve blocks using a remote control center. ⋯ We present the first human testing of a robotic ultrasound-guided nerve block system. The success rate was 100%. The total performance time was approximately 3 minutes to 4 minutes.