Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2015
Comparative StudyShoulder Surgery in the Beach Chair Position Is Associated with Diminished Cerebral Autoregulation but No Differences in Postoperative Cognition or Brain Injury Biomarker Levels Compared with Supine Positioning: The Anesthesia Patient Safety Foundation Beach Chair Study.
Although controversial, failing to consider the gravitational effects of head elevation on cerebral perfusion is speculated to increase susceptibility to rare, but devastating, neurologic complications after shoulder surgery in the beach chair position (BCP). We hypothesized that patients in the BCP have diminished cerebral blood flow autoregulation than those who undergo surgery in the lateral decubitus position (LDP). A secondary aim was to examine whether there is a relationship between patient positioning during surgery and postoperative cognition or serum brain injury biomarker levels. ⋯ : Compared with patients in the LDP, patients undergoing shoulder surgery in the BCP are more likely to have higher COx indicating diminished cerebral autoregulation and lower rScO2. There were no differences in the composite cognitive outcome between the BCP and the LDP groups after surgery after accounting for baseline Z-score.
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Anesthesia and analgesia · Jan 2015
Randomized Controlled Trial Comparative StudyPropofol anesthesia for children undergoing magnetic resonance imaging: a comparison with isoflurane, nitrous oxide, and a laryngeal mask airway.
Both propofol infusions with oxygen delivered through nasal cannula and isoflurane/N2O (nitrous oxide) delivered via a laryngeal mask airway (LMA) are used to provide anesthesia for children undergoing magnetic resonance imaging scans. We compared the incidence of adverse events and perioperative physiologic responses in children anesthetized with these 2 regimens. ⋯ The frequency of adverse airway events during emergence and recovery after propofol infusion with oxygen by nasal cannula is less than with isoflurane/N2O/LMA in children.
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Anesthesia and analgesia · Jan 2015
Observational StudyBlinded Observer Evaluation of Distal Skin Temperature for Predicting Lateral Infraclavicular Block Success.
Changes in digit skin temperature may be used to predict and determine upper limb nerve block success. We investigated whether a temperature difference between the blocked and the nonblocked hands, simply registered by touching the skin of the 5th and 2nd digit was valid and reliable as a diagnostic test for predicting a successful lateral infraclavicular block. ⋯ We found that a qualitative difference in skin temperature between the blocked and nonblocked hands, measured distally on the 2nd and 5th digits, was a valid and reliable diagnostic test for predicting successful lateral infraclavicular block.
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Anesthesia and analgesia · Jan 2015
Postoperative morbidity and mortality in type-2 diabetics after fast-track primary total hip and knee arthroplasty.
Diabetes is a risk factor for postoperative morbidity, which includes total hip and knee arthroplasty. However, no previous studies have been done in a fast-track setting with optimized perioperative care, including spinal anesthesia, multimodal opioid-sparing analgesia, early mobilization, and discharge to home, which improved postoperative outcome. ⋯ Type 2 diabetes per se has limited influence on postoperative morbidity in fast-track total hip and knee arthroplasty.
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Anesthesia and analgesia · Jan 2015
Comparative StudyA Comparison of Hemoglobin Measured by Co-Oximetry and Central Laboratory During Major Spine Fusion Surgery.
Many factors affect the accuracy of hemoglobin concentration values. In this study, we evaluated whether the hemoglobin concentration obtained by means of arterial blood gas (ABG) co-oximetry and complete blood count (CBC) central laboratory techniques clinically correlate when using simultaneous measurements of hemoglobin concentration obtained during complex spine fusion surgery. ⋯ The hemoglobin values obtained from ABG and CBC cannot be used interchangeably when verifying accuracy of novel point-of-care hemoglobin measurement modalities or when managing a patient with critical blood loss.