Journal of clinical anesthesia
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Randomized Controlled Trial
The effects of preoperative, video-assisted anesthesia education in Spanish on Spanish-speaking patients' anxiety, knowledge, and satisfaction: a pilot study.
We studied the effect of an instructional video in Spanish on self-reported anxiety, knowledge about general anesthesia procedures, and satisfaction with the preoperative anesthesia process in patients requiring a Spanish interpreter. This prospective, randomized, nonblinded pilot study took place at Massachusetts General Hospital (MGH), a university-affiliated tertiary-care hospital. Twenty adult, ASA physical status 1, 2, and 3 patients, scheduled for elective surgery (gynecological, orthopedic, and intrabdominal surgery) during general anesthesia were studied. ⋯ There was an increase in satisfaction score in the video group (median increase 2 vs 0; P = 0.046). There was no difference in reported knowledge-improvement scores between the two groups (3.5 vs 4; P = 0.908). In Spanish-speaking patients, the addition of an instructional video in Spanish to a preanesthesia interview decreased anxiety and increased patient satisfaction.
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To investigate the potential benefit of postoperatively providing a patient-controlled anxiolytic agent, midazolam, in addition to morphine. ⋯ Patients who received both midazolam and morphine experienced a more rapid decline in anxiety and used less opioid medication than those receiving morphine alone.
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Randomized Controlled Trial
Effects of dexmedetomidine on the ratio of T Helper 1 to T Helper 2 cytokines in patients undergoing laparoscopic cholecystectomy.
To investigate the effect of dexmedetomidine on T helper 1 (Th1) and T helper 2 (Th2) cytokines and their ratio during and after surgery. ⋯ Dexmedetomidine plays an immunomodulatory role, shifting the Th1/Th2 cytokine balance toward Th1 in patients with surgical and anesthetic stress.
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To propose a set of recommendations for the perioperative management of patients with Eisenmenger syndrome and similar physiology, based on 20 years of experience at a single institution. ⋯ Hypotension is more common in patients with Eisenmenger syndrome and similar physiology when a vasopressor is not used during the peri-induction period, regardless of induction agent. Etomidate tended to have better hemodynamic stability than other induction agents. The use of a vasopressor is recommended. We present general recommendations for anesthesiologists and strongly recommend use of a vasopressor before or during induction to reduce hypotension along with complete avoidance of inhalational induction. Further, MAC anesthesia has been associated with perioperative and 30-day mortality.
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A case of a preoperative airway examination performed using telemedicine is presented. The use of this technology has the ability to provide crucial information regarding the feasibility of office-based anesthesia in advance and limit schedule interruptions on the day of surgery.