Journal of anesthesia
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Journal of anesthesia · Jan 2009
Randomized Controlled TrialEffects of adding magnesium to bupivacaine and fentanyl for spinal anesthesia in knee arthroscopy.
The aim of the study was to investigate the effects of adding intrathecal magnesium sulfate 50 mg to low-dose bupivacaine-fentanyl on the spread, duration, regression of spinal block, and postoperative analgesia in patients undergoing knee arthroscopy. ⋯ Even though the time to first analgesic requirement was prolonged significantly by magnesium, the addition of intrathecal magnesium sulfate to spinal anesthesia is not desirable in patients undergoing knee arthroscopy due to the prolonged time to ambulation and the lack of effect of magnesium on postoperative analgesic consumption.
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Journal of anesthesia · Jan 2009
Case ReportsCombination of oral ketamine and midazolam as a premedication for a severely autistic and combative patient.
Patients with impaired ability to understand and communicate can be difficult to manage perioperatively. They frequently require lateral thinking on the part of the anesthesiologists to make the induction process as smooth as possible. ⋯ A combination of oral ketamine and midazolam was mixed in the beverage Dr Pepper to mask the taste and the appearance of the drugs. The unique flavor of Dr Pepper is well suited to increase the palatibility and the acceptability of medications in children and patients with developmental delay.
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Memory loss and lack of concentration are symptoms that frequently occur in patients who have undergone a surgical procedure. Although cognitive function can be assessed using neuropsychological tests, reliable diagnosis of postoperative cognitive decline (POCD) appears to be difficult. Therefore, the true incidence of POCD is unknown. ⋯ In these cases, POCD probably reflects microembolic brain injury. Apart from the nature of the surgical procedure, advanced age is the most important risk factor for POCD. The anesthetic technique is not a determinant of POCD: the risk of POCD appears to be similar after both general and regional anesthesia.
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Journal of anesthesia · Jan 2009
Randomized Controlled Trial Comparative StudyA comparison of intra-articular magnesium and/or morphine with bupivacaine for postoperative analgesia after arthroscopic knee surgery.
Both magnesium and morphine provide enhanced patient analgesia after arthroscopic knee surgery when administered separately via the intra-articular route. Magnesium sulfate amplifies the analgesic effect of morphine. This study was designed to compare the analgesic effects of intra-articular magnesium and morphine, with bupivacaine, when used separately and in combination. ⋯ Intra-articular administration of magnesium sulfate or morphine, with bupivacaine, had comparable analgesic effects in the doses used. Their combination provided more effective postoperative analgesia than either drug alone.
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Journal of anesthesia · Jan 2009
Randomized Controlled TrialAn individualized recruitment maneuver for mechanically ventilated patients after cardiac surgery.
The recruitment maneuver (RM) has been shown to improve oxygenation for post-cardiopulmonary bypass (CPB) patients; however, sustained inflation of the lung gives rise to hypotension. The primary goal of our study was to evaluate the safety and efficacy of our proposed RM, defined on the basis of dynamic lung compliance (Cdyn). ⋯ The present study indicates that the individualized RM resulted in minimum changes of hemodynamics and brought about improvement in oxygenation and lung compliance.