Anesthesia and analgesia
-
The provision of health services has been transforming from a largely top-down, paternalistic model into a construct in which patients play a substantive role in decision making over their care. Two articles in this month's issue of Anesthesia & Analgesia and an accompanying editorial address the growing momentum behind transparency in health care. Firstly, Quinonez et al consider the increasing expectation of family presence during surgical procedures and resuscitation of loved ones. ⋯ In conjunction with the increased desire for physical presence of loved ones during clinical procedures, so too is there a demand for complete access to all medical records, including even the arcane hieroglyphics of an anesthesia record as detailed by Ramaswamy et al. As federal law now mandates such access, questions naturally arise as to their utility and medicolegal implications. The reader is strongly encouraged to review the concepts elaborated in these articles for in depth appreciation of their considerations.
-
Anesthesia and analgesia · Oct 2022
Randomized Controlled Trial Multicenter StudyThe Influence of Positive End-Expiratory Pressure on Leakage and Oxygenation Using a Laryngeal Mask Airway: A Randomized Trial.
The value of positive end-expiratory pressure (PEEP) in maintaining oxygenation during ventilation with a laryngeal mask airway (LMA) mask is unclear. To clarify the potential benefit or harm to PEEP application during positive pressure ventilation with a ProSeal LMA® mask, we compared the effect of PEEP versus zero end-expiratory pressure (ZEEP) on gas leakage and oxygenation. We hypothesized that a PEEP of 8 mbar (8.2 cm H 2 O) would be associated with an increased incidence of gas leakage compared to ZEEP. ⋯ Use of PEEP did not affect the overall incidence of gas leakage. However, PEEP did result in a higher incidence of attempts to reseat the LMA mask compared to ZEEP, whereas the incidence of rescue intubation did not differ between groups. We concluded that a PEEP of 8 mbar did not increase overall gas leakage during positive pressure ventilation with an LMA mask, but it did slightly improve gas exchange and compliance. Overall, our study does not provide strong arguments for using PEEP during ventilation with an LMA mask in elective surgery.
-
Anesthesia and analgesia · Oct 2022
Pharmacokinetics a>nd Tolerability of Intraperitoneal Chloroprocaine After Fetal Extraction in Women Undergoing Cesarean Delivery.
Intraperitoneal chloroprocaine has been used during cesarean delivery to supplement suboptimal neuraxial anesthesia for decades. The short in vitro half-life of chloroprocaine (11-21 seconds) has been cited to support the safety of this approach. However, there are no data regarding the rate of absorption, representing patient drug exposure, through this route of administration. Accordingly, we designed a study to determine the in vivo half-life of intraperitoneal chloroprocaine and assess clinical tolerability. ⋯ The in vivo half-life of intraperitoneal chloroprocaine (5.3 minutes) is more than an order of magnitude greater than the in vitro half-life (11-21 seconds). However, maximum plasma concentrations of chloroprocaine (C max range, 0.05-79.9 µg/kg) were not associated with local anesthetic systemic toxicity and remain well below our predefined safe level of exposure (970 µg/kg) and levels associated with clinical symptoms (2.6-2.9 mg/kg). Therefore, our study suggests that intraperitoneal chloroprocaine, in a dosage ≤1200 mg, administered after fetal extraction, is well tolerated during cesarean delivery.