Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2023
Meta AnalysisAnalgesic Effect of Buprenorphine for Chronic Noncancer Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
Transdermal & buccal buprenorphine is associated with a small reduction in pain scores in chronic non-cancer pain.
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Anesthesia and analgesia · Jul 2023
Ultrasound Assessment of Gastric Volume in Parturients After High-Flow Nasal Oxygen Therapy.
High-flow nasal oxygen (HFNO) therapy is widely used in critical care obstetrics to improve oxygenation. Much of the benefit of HFNO is linked to the creation of modest levels of positive airway pressure. Pregnant women are generally considered to be at high risk of regurgitation and aspiration. It is unknown whether HFNO may cause gas insufflation into the stomach and further increase this risk. Therefore, this study aimed to systematically evaluate the possible safety effects of HFNO on gastric volume in healthy fasted parturients. ⋯ Treatment with HFNO for 20 minutes at flow rates up to 50 L·min -1 did not increase gastric volume in term pregnant women breathing spontaneously when evaluated by gastric ultrasonography.
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Anesthesia and analgesia · Jul 2023
ReviewA Narrative Review Illustrating the Clinical Utility of Electroencephalogram-Guided Anesthesia Care in Children.
The major therapeutic end points of general anesthesia include hypnosis, amnesia, and immobility. There is a complex relationship between general anesthesia, responsiveness, hemodynamic stability, and reaction to noxious stimuli. This complexity is compounded in pediatric anesthesia, where clinicians manage children from a wide range of ages, developmental stages, and body sizes, with their concomitant differences in physiology and pharmacology. ⋯ This review discusses anesthetic management principles in a variety of clinical scenarios, including infants, children with altered conscious levels, children with atypical neurodevelopment, children with hemodynamic instability, children undergoing total intravenous anesthesia, and those undergoing cardiopulmonary bypass. Each scenario is accompanied by practical illustrations of how the EEG can be visualized to help titrate anesthetic dosage to avoid undersedation or oversedation when patients experience hypotension or other physiological challenges, when surgical stimulation increases, and when a child's anesthetic requirements are otherwise less predictable. Overall, this review illustrates how well-established clinical management principles in children can be significantly complemented by the addition of EEG monitoring, thus enabling personalized anesthesia care to enhance patient safety and experience.