Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2014
Sodium Homeostasis During Liver Transplantation and Correlation with Outcomes.
Reports of perioperative serum sodium increase in liver transplant (LT) recipients are mostly restricted to unintentional rapid serum sodium overcorrection with subsequent development of central pontine myelinolysis. We examined intraoperative serum sodium changes and their effect on short-term outcomes after LT. ⋯ A larger intraoperative increase in ΔNa is associated with worse recipient short-term outcomes. Patients with preoperative hyponatremia may be at particular risk. ΔNa increases with the intraoperative use of NaHCO3, quantity of FFP, and PRBCs transfused, as well as with intraoperative hyperglycemia. Potential differences on sodium homeostasis between NaHCO3 and tromethamine use for intraoperative pH adjustment should be prospectively investigated.
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Anesthesia and analgesia · Dec 2014
Absolute and trend accuracy of a new regional oximeter in healthy volunteers during controlled hypoxia.
Traditional patient monitoring may not detect cerebral tissue hypoxia, and typical interventions may not improve tissue oxygenation. Therefore, monitoring cerebral tissue oxygen status with regional oximetry is being increasingly used by anesthesiologists and perfusionists during surgery. In this study, we evaluated absolute and trend accuracy of a new regional oximetry technology in healthy volunteers. ⋯ Masimo O3 regional oximetry provided absolute root-mean-squared error of 4% and relative root-mean-squared error of 2.1% in healthy volunteers undergoing controlled hypoxia.
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Anesthesia and analgesia · Dec 2014
Patterns of Second-Line Uterotonic Use in a Large Sample of Hospitalizations for Childbirth in the United States: 2007-2011.
The incidence of postpartum hemorrhage due to uterine atony has increased significantly in the United States during the past decade. For patients with refractory uterine atony after oxytocin administration, second-line uterotonics including methylergonovine maleate, carboprost, and misoprostol are recommended. In this study, we describe hospital-level patterns of second-line uterotonic use in a large, nationwide sample of admissions for childbirth in the United States. ⋯ We observed wide interhospital variation in the use of second-line uterotonics that was not explained by patient-level or hospital-level characteristics. Studies aimed at defining the optimal pharmacologic strategies for the management of uterine atony are needed, particularly in light of the increasing incidence of atonic postpartum hemorrhage in the United States and other developed countries.
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Anesthesia and analgesia · Dec 2014
The Analgesic Effect of a Vapocoolant Stream Spray in Reducing Heat Nociception on the Glabrous Skin of Rat Pups.
Blood sampling is a common screening and diagnostic test in newborn infants in the neonatal intensive care unit, and heel lancing accounts for two-thirds of these tests. Heel lancing causes acute pain and distress, and most infants rarely receive analgesics because of fear of respiratory depression from opioids and lack of effectiveness of topical local anesthetics on the glabrous skin. To circumvent this latter problem, we investigated the analgesic efficacy and safety of a topical vapocoolant spray. ⋯ Vapocoolant spray treatment of the glabrous skin is effective and safe after a single treatment.