Journal of clinical anesthesia
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When spinal and epidural anesthesia were introduced into clinical practice, their primary use was as an alternative to general anesthesia. Later, largely as a result of the realization that opioids could be safely and effectively used to produce selective spinal analgesia, spinal and epidural (neuraxial) analgesia began to be used specifically for the treatment of perioperative pain. We present a systematic review of the literature on neuraxial anesthesia and analgesia, new meta-analyses that illustrate the powerful effect of improvements in perioperative safety in general on the ability of neuraxial techniques to make a difference, and a consideration of why a literature analysis does not provide clear answers.
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Leroy D Vandam, MD was a remarkable man--an intricate amalgamation of an artist, scientist, and physician. He was a bastion of medical historical knowledge. Dr Vandam became a most influential anesthesiologist, some say, a giant. ⋯ Dr Vandam published more than 250 original articles, chapters, abstracts, and other reports on a wide variety of subjects including history, art, and pharmacology. His classic article on the complications of neuroaxial blocks is a seminal work in anesthesiology. This article describes how an anesthesiologist who shared an interest with Dr Vandam in the history of anesthesiology came to produce a movie based on his career, the evolution of anesthesia equipment, and the transformation of our specialty.
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To define the depth of the thoracic epidural space in the paramedian axis. ⋯ Body weight, body mass index, and anatomical levels determine the paramedian thoracic epidural depth. The greater the patient's weight and the higher the puncture level, the deeper the thoracic epidural space from the body surface.
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Randomized Controlled Trial Comparative Study
Propofol concentration requirement for laryngeal mask airway insertion was highest with the ProSeal, next highest with the Fastrach, and lowest with the Classic type, with target-controlled infusion.
To determine propofol concentration of plasma 50% (Cp50, concentration at which there is a 50% chance that patients show no movement in response) for the Classic-, Fastrach-, and ProSeal-type laryngeal mask airway (LMA) insertion using target-controlled infusion (TCI) technique. ⋯ Required propofol TCI concentrations for LMA insertion were significantly highest for the ProSeal, second highest for the Fastrach, and lowest for the Classic LMA.
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Randomized Controlled Trial
Effect of catheter site on the agreement of peripheral and central venous pressure measurements in neurosurgical patients.
Previous studies suggest a correlation of central venous pressure (CVP) with peripheral venous pressure (PVP) in different clinical setups. The aim of this study was to investigate the effect of measurement site on PVP and its agreement with CVP in patients undergoing general anesthesia. ⋯ Peripheral venous pressure measurement may be a noninvasive alternative for estimating CVP in patients undergoing elective neurosurgical operations. Measuring PVP from hand dorsum does not interfere with the agreement of CVP and PVP.