Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2014
Randomized Controlled TrialInfra-Additive Effects of Nefopam and Meperidine on Shivering in Humans Nefopam and Meperidine Are Infra-Additive on the Shivering Threshold in Humans.
Induction of therapeutic hypothermia is often complicated by shivering. Nefopam, a nonsedative benzoxazocine analgesic, reduces the shivering threshold (triggering core temperature) with minimal side effects. Consequently, nefopam is an attractive drug for inducing therapeutic hypothermia. However, nefopam alone is insufficient and thus needs to be combined with another drug. Meperidine also reduces the shivering threshold. We therefore determined whether the combination of nefopam and meperidine is additive, infra-additive, or synergistic on the shivering threshold. ⋯ The combination of nefopam and meperidine should be avoided for induction of therapeutic hypothermia. Better options would be combinations of drugs that are at least additive or even synergistic.
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Anesthesia and analgesia · Jul 2014
The Sevoflurane Washout Profile of Seven Recent Anesthesia Workstations for Malignant Hyperthermia-Susceptible Adults and Infants: A Bench Test Study.
Preoperative flushing of an anesthesia workstation is an alternative for preparation of the anesthesia workstation before use in malignant hyperthermia-susceptible patients (MHS). We studied in vitro, using a test lung, the washout profile of sevoflurane in 7 recent workstations during adult and, for the first time, pediatric ventilation patterns. ⋯ This descriptive study strongly suggests that washout profiles may differ for each anesthesia workstation. We advise the use of maximal FGF during preparation and anesthesia. Required flushing times are longer when preparing an anesthesia workstation before providing anesthesia for MHS infants.
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Anesthesia and analgesia · Jul 2014
Abdominal Girth, Vertebral Column Length, and Spread of Spinal Anesthesia in 30 Minutes after Plain Bupivacaine 5 mg/mL.
The spread of spinal anesthesia is highly unpredictable. In patients with increased abdominal girth and short stature, a greater cephalad spread after a fixed amount of subarachnoidally administered plain bupivacaine is often observed. We hypothesized that there is a strong correlation between abdominal girth/vertebral column length and cephalad spread. ⋯ Multiple regression analysis revealed that the combination of a patient's 5 general characteristics, especially abdominal girth and vertebral column length, had a high predictive value for the spread of spinal anesthesia after a given dose of plain bupivacaine.
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Anesthesia and analgesia · Jul 2014
Emergency Pages Using a Computer-Based Anesthesiology Paging System in Ambulatory Surgical Centers: A Retrospective Review.
The nature of pages associated with periprocedural emergency events in ambulatory centers has never being examined. Our institution has a proprietary anesthesiology paging system with hierarchical paging capabilities (emergency versus routine) and maintains a log of all events. Here, we describe emergency pages in our ambulatory surgery centers. ⋯ The rates of emergency page activations, especially those that are critical events, in our surgical ambulatory center are rare. Many emergency pages originated outside the procedural room; therefore, providers within these areas should be trained to promptly recognize and treat these events.
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Anesthesia and analgesia · Jul 2014
Long-term psychosocial outcomes after intraoperative awareness with recall.
Posttraumatic stress disorder, a common psychiatric disorder in the general population, may follow a traumatic experience of awareness with recall during general anesthesia. ⋯ We found no indication that intraoperative awareness with recall had any deleterious long-term effects on patients' psychosocial outcome.