Journal of clinical anesthesia
-
Randomized Controlled Trial Comparative Study Clinical Trial
Remifentanil used to supplement propofol does not improve quality of sedation during spontaneous respiration.
To evaluate whether the use of remifentanil to supplement propofol during spontaneous respiration confers any benefits in terms of quality of sedation and recovery, or in terms of reduction in propofol requirements. ⋯ The addition of remifentanil to propofol during spontaneous ventilation offered no benefits compared with the use of propofol alone.
-
Comparative Study
Nausea and vomiting after outpatient ACL reconstruction with regional anesthesia: are lumbar plexus blocks a risk factor?
To track the incidence of in-hospital postoperative nausea and vomiting (PONV) requiring postoperative parenteral nursing interventions after outpatient reconstruction of the anterior cruciate ligament (ACL) with one of two types of regional anesthesia to determine the extent to which various anesthetic techniques, preemptive antiemetics, and other factors were associated with the lowest probability of PONV. ⋯ For ACL reconstruction with regional anesthesia, use of LUM-SCI was associated with a higher rate of PONV, whereas combination antiemetic prophylaxis with perphenazine and dexamethasone was associated with less PONV.
-
Anticipatory decision-making in airway management requires the integration of both history and physical examination findings. Though all airways can be managed along some branch of the American Society of Anesthesiologists' (ASA) Difficult Airway Algorithm, by predicting specific difficulties and integrating this information into an airway approach strategy, emergency branches of the ASA algorithm may be avoided. ⋯ A positive answer to any question leads the clinician to the next, whereas a negative answer directs the operator to a root point of the ASA algorithm. The AAA is introduced with the anticipation that trainees in Anesthesiology, as well as others, will find it helpful in organizing preoperative information concerning the airway.
-
Lumbar discography is a diagnostic modality to determine whether the intervertebral disc is the cause of pain. The injection of radiopaque contrast into the nucleus pulposus of the disc can reveal the internal details of the disc. We describe a case of inadvertent lumbar discogram resulting from an attempted lumbar interlaminar epidural injection at L5-S1 under fluoroscopy. ⋯ Hence, the patient did not suffer from postdural puncture headache. The needle was probably inferior to the nerve root, and no obvious nerve root trauma or irritation occurred. This potential triangle may provide alternative access for lumbar discography at the L5-S1 level.
-
To determine whether postoperative "difficult airway" letters, which inform a patient that he has a difficult airway, are an effective way to communicate with patients and future caregivers. ⋯ The majority of patients who were sent a "difficult airway" letter did not obtain a MedicAlert bracelet, although frequently recommended. However, most of the patients who subsequently had surgery informed their anesthesiologist or surgeon of their airway history. "Difficult airway" letters may have significant utility even if patients do not obtain identifying jewelry.