Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2019
Controlled Clinical TrialMinimum Alveolar Concentration-Awake of Sevoflurane Is Decreased in Patients With End-Stage Renal Disease.
MAC-awake of sevoflurane is modestly lower in patients with end-stage renal failure compared with normal controls.
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Anesthesia and analgesia · Jan 2019
Meta AnalysisRegional Analgesia Added to General Anesthesia Compared With General Anesthesia Plus Systemic Analgesia for Cardiac Surgery in Children: A Systematic Review and Meta-analysis of Randomized Clinical Trials.
The aim of this systematic review was to compare the effects of regional analgesic (RA) techniques with systemic analgesia on postoperative pain, nausea and vomiting, resources utilization, reoperation, death, and complications of the analgesic techniques in children undergoing cardiac surgery. ⋯ Compared to systemic analgesia, RA techniques reduce postoperative pain up to 24 hours in children undergoing cardiac surgery. Currently, there is no evidence that RA for pediatric cardiac surgery has any impact on major morbidity and mortality. These results should be interpreted cautiously because they represent a meta-analysis of small and heterogeneous studies. Further studies are needed.
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There is a continued mandate for practicing evidence-based medicine and the prerequisite rigorous analysis of the comparative effectiveness of alternative treatments. There is also an increasing emphasis on delivering value-based health care. Both these high priorities and their related endeavors require correct information about the outcomes of care. ⋯ Assessing validity is answering whether the instrument is actually measuring what it is intended to measure. This includes content validity, criterion validity, and construct validity. In evaluating a reported set of research data and its analyses, in a similar manner, it is important to assess the overall internal validity of the attendant study design and the external validity (generalizability) of its findings.
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Anesthesia and analgesia · Jan 2019
Biography Historical ArticleRecognizing the Chinese Pioneer of Neuraxial Labor Analgesia: Dr Guang-Bo Zhang and Her Unpublished Manuscript From More Than a Half-Century Ago.
Dr Guang-Bo Zhang was the first anesthesiologist to administer and study the effects of labor epidural analgesia in China. Between September 1963 and March 1964, she conducted an observational study evaluating the effects of neuraxial analgesia for laboring women. ⋯ She successfully preserved her unpublished article, notes, and slides throughout the Cultural Revolution by hiding them in a countryside location near Beijing. These 54-year-old, previously unpublished documents represent the first known clinical trial of neuraxial labor analgesia conducted in China.
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Anesthesia and analgesia · Jan 2019
ReviewBivalirudin for Pediatric Procedural Anticoagulation: A Narrative Review.
Bivalirudin (Angiomax; The Medicines Company, Parsippany, NJ), a direct thrombin inhibitor, has found increasing utilization as a heparin alternative in the pediatric population, most commonly for the treatment of thrombosis secondary to heparin-induced thrombocytopenia. Due to the relative rarity of heparin-induced thrombocytopenia as well as the lack of Food and Drug Administration-approved indications in this age group, much of what is known regarding the pharmacokinetics and pharmacodynamics of bivalirudin in this population has been extrapolated from adult data. This narrative review will present recommendations regarding the use of bivalirudin for procedural anticoagulation in the pediatric population based on the published literature.