Journal of anesthesia
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Journal of anesthesia · Jan 2009
Randomized Controlled TrialLow dose of fentanyl reduces predicted effect-site concentration of propofol for flexible laryngeal mask airway insertion.
In contrast to reports on the classical laryngeal mask airway (classical LMA; CLMA), no report has calculated the 50% and 95% effect-site concentrations (EC(50) and EC(95), respectively) of propofol required for flexible LMA (FLMA) insertion. This study was designed to determine the EC(50) and EC(95) of propofol for FLMA insertion, using probit analysis, and to investigate whether supplemental 0.25 microg x kg(-1) fentanyl decreased these concentrations. ⋯ The propofol EC(50) for FLMA insertion was decreased by supplemental 0.25 microg x kg(-1) fentanyl without BIS, hemodynamic, or respiratory depression.
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Journal of anesthesia · Jan 2009
Randomized Controlled TrialPerineural morphine in patients with chronic ischemic lower extremity pain: efficacy and long-term results.
To compare the efficacy, safety, and impact on daily activity of peripherally administered morphine plus a local anesthetic with that of a local anesthetic alone in patients with chronic ischemic lower extremity pain. ⋯ A peripherally administered bupivacaine plus morphine combination provided better and longer analgesia for ischemic pain compared to bupivacaine alone for the short term, but not for the long term. On the other hand, our results show that continuous popliteal treatment is an effective, safe, and comfortable modality for long-term use in the home setting for patients with intractable chronic pain.
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Journal of anesthesia · Jan 2009
ReviewEthical issues in anesthesia: the need for a more practical and contextual approach in teaching.
Teaching ethics to medical students is one of the current topics of major interest. Issues of ethics pertaining to anesthesia are unique. This article reviews these issues with respect to the preoperative, intraoperative, and postoperative periods. ⋯ In addition to separate modules in didactic and clinical formats, incorporating the ethical aspects into every clinical problem has many advantages. This approach will stimulate students to ponder over the ethical dimension of every clinical scenario, and the reinforcement of this approach during teaching in the clinical setting may help in inculcating these qualities in the students. Additionally, this approach contextualizes these issues to the local and regional perspective, instead of lecturing on the ethical codes developed elsewhere.
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Journal of anesthesia · Jan 2009
Randomized Controlled TrialPostoperative analgesia with minidose intrathecal morphine for bipolar hip prosthesis in extremely elderly patients.
It is known that an optimal dose of intrathecal morphine for analgesia after total hip arthroplasty in older patients is 0.1 mg. On the other hand, minidose intrathecal morphine (0.05 mg) is useful for analgesia after the transurethral resection of the prostate in elderly patients. We evaluated the postoperative analgesic effect of minidose intrathecal morphine after bipolar hip prosthesis in seniors (age 85 years or more) undergoing spinal anesthesia. ⋯ The results show that minidose intrathecal morphine provides a good analgesic effect without side effects, and it would be an effective and safe procedure for bipolar hip prosthesis in seniors.
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Journal of anesthesia · Jan 2009
ReviewComplexity of blood volume control system and its implications in perioperative fluid management.
The use of fluid therapy attempts to optimize blood circulation by manipulating the circulating blood volume (BV). BV may be a key intermediate parameter between fluid therapy and the blood circulation, and it has been assumed that BV can be controlled by fluid therapy. In order to construct a fluid therapy protocol, firstly, we have to confirm whether BV can actually be controlled by fluid therapy. ⋯ Because inflammation and some hormones control vascular permeability and the renal adjustment of solutes and fluids, such factors may readjust the BV even after interventional fluid therapy. Perioperative BV may be predominantly controlled by an internal regulatory system, regardless of whether "restrictive" or "liberal" fluid management strategies are employed. Recognizing this physiological control of BV may help us to develop individualized fluid management strategies.