Journal of clinical anesthesia
-
Comparative Study
A retrospective study of open thoracotomies versus thoracoscopic surgeries for persistent postthoracotomy pain.
Persistent thoracotomy pain syndrome (PTPS) is a recognized complication and is considered to be less after video-assisted thoracoscopic surgery (VATS) compared with open thoracic surgery (OTS). The primary objective was to compare the incidence of PTPS at 6 months. Secondary objectives were to compare the incidence of neuropathic pain between VATS and OTS and to report perioperative factors associated with the development of PTPS. ⋯ Our study indicates that PTPS is significantly more common and has a higher chance of being neuropathic with OTS. Despite being relatively less traumatic, VATS still carries a significant potential for PTPS. A diagnosis of cancer and history of previous pain are highly predictive of its development.
-
Comparative Study
Does nitrous oxide labor analgesia influence the pattern of neuraxial analgesia usage? An impact study at an academic medical center.
To compare the rate of epidural use before and after the implementation of nitrous oxide (N2O). ⋯ The introduction of N2O for labor analgesia was not associated with any change in our rate of labor epidural utilization. Under the conditions of our study, these results suggest that N2O does not discourage neuraxial use for labor pain relief.
-
Comparative Study
Comparison of the effects of Truview PCD™ video laryngoscopy and Macintosh blade direct laryngoscopy in geriatric patients.
To compare the effects of Truview PCD™ video laryngoscopy (TVL) and Macintosh blade direct laryngoscopy (MDL) on hemodynamic responses observed during laryngoscopy and orotracheal intubation conditions in geriatric patients. ⋯ The TVL system does not provide significant hemodynamic response sparing or shorten orotracheal intubation times when compared to MDL in geriatric patients.
-
Comparative Study
Continuous intra-articular local anesthetic drug instillation versus discontinuous sciatic nerve block after total knee arthroplasty.
Sciatic nerve block (SNB) is commonly used as adjunct to femoralis nerve block (FNB) to achieve high-quality pain relief after total knee arthroplasty (TKA). However, this combination is associated with considerable muscle weakness, foot drop and surgically related nerve injuries may be masked. The purpose of this study was to assess whether low risk continuous intra-articular anesthetic drug instillation is an adequate alternative to SNB when adding to FNB after TKA. ⋯ SNB technique resulted in superior pain relief in comparison to continuous intra-articular local anesthetic drug instillation as adjunct to continuous FNB after TKA.
-
Anesthetic management of the child with an anterior mediastinal mass is challenging. The surgical/procedural goal typically is to obtain a definitive tissue diagnosis to guide treatment; the safest approach to anesthesia is often one that alters cardiorespiratory physiology the least. ⋯ Distraction techniques, designed to shift attention away from procedure-related pain (such as counting, listening to music, non-procedure-related talk), may be of great benefit, allowing for avoidance of pharmaceuticals. In this report, we present an approach in children where the anesthetic risk is deemed excessive.