Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2016
Randomized Controlled TrialAn Evaluation of Ultrasound-Guided Adductor Canal Blockade for Postoperative Analgesia After Medial Unicondylar Knee Arthroplasty.
Unicondylar knee arthroplasty (UKA) is a commonly performed procedure with significant expected postoperative pain. Peripheral nerve blocks are 1 analgesic option, but some approaches may decrease quadriceps motor strength and interfere with early ambulation. In this study, we compared the analgesia provided by an adductor canal block (ACB) and a psoas compartment block (PCB) after UKA. We hypothesized that the ACB would provide equivalent analgesia, defined as a difference of <2 points on the pain scale (0-10 numeric rating scale [NRS]), at rest and with movement 6 hours after block placement. ⋯ An ACB provides equivalent analgesia after medial UKA when compared with a PCB. In addition, the ACB caused significantly less motor weakness. An ACB should be considered for postoperative analgesia after medial UKA.
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Anesthesia and analgesia · Apr 2016
Randomized Controlled Trial Multicenter StudyAmnesia of the Operating Room in the B-Unaware and BAG-RECALL Clinical Trials.
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Anesthesia and analgesia · Apr 2016
Randomized Controlled Trial Comparative StudyDexmedetomidine Combined with General Anesthesia Provides Similar Intraoperative Stress Response Reduction When Compared with a Combined General and Epidural Anesthetic Technique.
Epidural anesthesia may attenuate the sympathetic hyperactivity and stress response from surgery. In this study, we compared the stress response, hemodynamic variables, and recovery profiles of patients undergoing total IV anesthesia (TIVA) and intraoperative dexmedetomidine with those receiving epidural anesthesia and TIVA. ⋯ When used in conjunction with TIVA, intraoperative dexmedetomidine blunts surgical stress responses to an extent comparable to combined epidural and general anesthesia without compromising hemodynamic stability and with minimal adverse effects during the intraoperative period.
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Anesthesia and analgesia · Apr 2016
Randomized Controlled TrialA Randomized Controlled Trial to Determine the Effect of Depth of Anesthesia on Emergence Agitation in Children.
The cause of emergence agitation (EA) in children is unknown. Rapid emergence from inhaled anesthesia has been implicated because EA is more common with sevoflurane than with halothane. A dose-dependent effect of sevoflurane, which increases seizure-like electroencephalogram activity, has also been proposed. ⋯ There was no significant effect of BIS-guided deep versus light anesthesia on severe EA.
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Anesthesia and analgesia · Apr 2016
Economic and Environmental Considerations During Low Fresh Gas Flow Volatile Agent Administration After Change to a Nonreactive Carbon Dioxide Absorbent.
Reducing fresh gas flow (FGF) during general anesthesia reduces costs by decreasing the consumption of volatile anesthetics and attenuates their contribution to greenhouse gas pollution of the environment. The sevoflurane FGF recommendations in the Food and Drug Administration package insert relate to concern over potential toxicity from accumulation in the breathing circuit of compound A, a by-product of the reaction of the volatile agent with legacy carbon dioxide absorbents containing strong alkali such as sodium or potassium hydroxide. Newer, nonreactive absorbents do not produce compound A, making such restrictions moot. We evaluated 4 hypotheses for sevoflurane comparing intervals before and after converting from a legacy absorbent (soda lime) to a nonreactive absorbent (Litholyme): (1) intraoperative FGF would be reduced; (2) sevoflurane consumption per minute of volatile agent administration would be reduced; (3) cost savings due to reduced sevoflurane consumption would (modestly) exceed the incremental cost of the premium absorbent; and (4) residual wastage in discarded sevoflurane bottles would be <1%. ⋯ We showed that an anesthesia department can transition to a premium, nonreactive carbon dioxide absorbent in a manner that is at least cost neutral by reducing FGF below the lower flow limits recommended in the sevoflurane package insert. This was achieved, in part, by electronically monitoring PICO2, automatically notifying the anesthesia technicians when to change the absorbent, and by providing personalized feedback via e-mail to the anesthesia providers.