Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2016
Randomized Controlled Trial Comparative StudyForced-Air Warming During Pediatric Surgery: A Randomized Comparison of a Compressible with a Noncompressible Warming System.
Perioperative hypothermia is a common problem, challenging the anesthesiologist and influencing patient outcome. Efficient and safe perioperative active warming is therefore paramount; yet, it can be particularly challenging in pediatric patients. Forced-air warming technology is the most widespread patient-warming option, with most forced-air warming systems consisting of a forced-air blower connected to a compressible, double layer plastic and/or a paper blanket with air holes on the patient side. We compared an alternative, forced-air, noncompressible, under-body patient-warming mattress (Baby/Kleinkinddecke of MoeckWarmingSystems, Moeck und Moeck GmbH; group MM) with a standard, compressible warming mattress system (Pediatric Underbody, Bair Hugger, 3M; group BH). ⋯ Both devices are feasible choices for active pediatric patient warming, with the compressible mattress system being better suited to increase core temperature. The use of lower pediatric forced-air temperature settings, as recommended by the manufacturer, in the noncompressible mattress group resulted in more stable core temperature conditions, with fewer forced-air temperature adjustments necessary to avoid hyperthermia.
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Anesthesia and analgesia · Jan 2016
Randomized Controlled TrialPerioperative Duloxetine to Improve Postoperative Recovery After Abdominal Hysterectomy: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Study.
Postsurgical quality of recovery is worse in female than that in male patients. Duloxetine has been used successfully for the treatment of chronic pain conditions, but its use for preventing acute postoperative pain has been limited to a single previous study. More importantly, the effect of preoperative duloxetine on global postoperative quality of recovery has yet to be evaluated. The main objective of the current investigation was to evaluate the effect of perioperative duloxetine on postoperative quality of recovery in women undergoing abdominal hysterectomy. ⋯ Duloxetine improves postoperative quality of recovery after abdominal hysterectomy. In addition, duloxetine reduces postoperative opioid consumption, even in the presence of a robust multimodal analgesic strategy. Duloxetine seems to be a viable pharmacologic strategy to improve postoperative quality of recovery in female patients undergoing abdominal hysterectomy.
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Anesthesia and analgesia · Jan 2016
Review Historical ArticleThe History of Target-Controlled Infusion.
Target-controlled infusion (TCI) is a technique of infusing IV drugs to achieve a user-defined predicted ("target") drug concentration in a specific body compartment or tissue of interest. In this review, we describe the pharmacokinetic principles of TCI, the development of TCI systems, and technical and regulatory issues addressed in prototype development. We also describe the launch of the current clinically available systems.
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Methylene blue (MB) has received much attention in the perioperative and critical care literature because of its ability to antagonize the profound vasodilation seen in distributive (also referred to as vasodilatory or vasoplegic) shock states. This review will discuss the pharmacologic properties of MB and review the critical care, liver transplantation, and cardiac anesthesia literature with respect to the efficacy and safety of MB for the treatment of shock. Although improved blood pressure has consistently been demonstrated with the use of MB in small trials and case reports, better oxygen delivery or decreased mortality with MB use has not been demonstrated. Large randomized controlled trials are still necessary to identify the role of MB in hemodynamic resuscitation of the critically ill.
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Target-controlled infusion of IV anesthetic drugs is approved worldwide with the exception of the United States. The purpose of this special article is to review regulatory pathways that could lead to target-controlled infusion (TCI) clearance or approval in the United States.