Journal of clinical anesthesia
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To examine the impact on perioperative care of routine Bispectral Index (BIS) monitoring during general anesthesia throughout an entire operating room (OR) suite. ⋯ Routine application of BIS monitoring throughout an OR suite impacted clinical outcome only if guideline targets were met. BIS values within the last 30 minutes of surgery were not predictive of emergence or recovery. Hypnotic maintenance at BIS < 50 did not confer any clinical advantage over unmonitored cases. Anesthetic maintenance at BIS values between 50 and 65 was associated with shortened emergence and recovery from general anesthesia.
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Continuous interscalene brachial plexus blockade can provide anesthesia and analgesia in the shoulder region. Difficulty accessing the interscalene space and premature displacement of interscalene catheters may preclude their use in certain situations. We present two case reports in which a catheter was advanced from the axilla along the brachial plexus sheath to the interscalene space to provide continuous cervicobrachial plexus analgesia. ⋯ In the second case report, a catheter was inserted in a similar fashion from the axillary to the interscalene space to provide 14 days of continuous analgesia in the management of complex regional pain syndrome. We have found that this technique allows us to secure the catheter more easily than with the traditional interscalene approach and thus prevents premature dislodgment. This approach may be a suitable alternative when either an interscalene or an infraclavicular catheter may not be inserted.
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Hyperbaric 5% lidocaine has been available for intrathecal use since 1954. The initial studies concluded that it was a safe drug for short procedures. Recently, the use of this drug for spinal anesthesia has been questioned. ⋯ There are safe alternatives to lidocaine for outpatient spinal anesthesia, such as bupivacaine, prilocaine, or mepivacaine. These drugs have a lower incidence of transient neurologic symptoms and do not delay discharge. Given the possibility of permanent neurologic injury and given that safe alternatives exist, one has to question whether intrathecal lidocaine should still be used in the 21st century.
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Randomized Controlled Trial Clinical Trial
Preoperative clonidine attenuates stress response during emergence from anesthesia.
To investigate whether a single preoperative IV dose of clonidine blunts the hemodynamic and hyperadrenergic responses not only to intubation, but also to extubation. ⋯ A single preoperative IV dose of clonidine (3 microg/kg) blunts the hemodynamic responses due to extubation in noncardiac surgery of intermediate duration.
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Randomized Controlled Trial Clinical Trial
Low-dose intrathecal clonidine combined with sufentanil as analgesic drugs in abdominal gynecological surgery.
To determine whether a low dose of spinal clonidine either alone or combined with sufentanil would provide effective analgesia following abdominal surgery, as a supplement to bupivacaine spinal anesthesia. ⋯ Intrathecal 15- and 30-microg clonidine doses expanded the anesthesia sensory block and duration of motor block, and provided analgesia.