Journal of anesthesia
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Journal of anesthesia · Jan 2009
Randomized Controlled Trial Comparative StudyIsoflurane and sevoflurane decrease entropy indices more than halothane at equal MAC values.
Recently, bispectral index (BIS) values were demonstrated to be different for various anesthetics as a result of differential effects on electroencephalographic (EEG) signals. Entropy is similar to the BIS monitor, as both process raw EEG to derive a number. We hypothesized that entropy may also be anesthetic agent-specific. ⋯ During the study period, for a given MAC value, both RE and SE remained low in the isoflurane and sevoflurane groups compared to the halothane group. For a given MAC, the RE and SE were comparable during wash-in and wash-out phases. Halothane produced higher entropy values as compared to isoflurane and sevoflurane at equivalent MAC levels.
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There is growing evidence that early detection and response to physiological deterioration can improve outcomes for hospitalized infants, children, and adults. A rapid response system (RRS) is a multidisciplinary system to decrease the incidence of in-hospital cardiopulmonary arrests by detecting a crisis event and triggering a response and by dispatching a responding team. ⋯ The system is designed to locate and respond rapidly to a suddenly critically ill patient who lacks necessary critical care resources. Over the past decade, RRSs have been widely implemented in adult practice in the United States, Canada, Australia, the United Kingdom, and Scandinavian countries.
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Journal of anesthesia · Jan 2009
Randomized Controlled TrialA randomized study of the effects of perioperative i.v. lidocaine on hemodynamic and hormonal responses for cesarean section.
Intravenous infusion of lidocaine attenuates the stress response to surgery. We aimed to evaluate the effects of perioperative lidocaine on the hemodynamic and hormonal responses for cesarean delivery. ⋯ Perioperative lidocaine is safe and effective in attenuating the maternal stress response to surgery for cesarean delivery.
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Journal of anesthesia · Jan 2009
Randomized Controlled TrialInsertion length and resistance during advancing of epidural catheter.
The migration of an epidural catheter into the intravascular and subarachnoid spaces sometimes occurs. This study was designed to investigate where the resistance was felt during the advancing of the catheter into the epidural space and whether the length of catheter advanced in the epidural space affected the incidence of catheter migration. ⋯ At approximately 2.5 cm in the epidural space, advancing an epidural catheter causes resistance. Further advancing past this point may cause migration of the catheter into the vessels, or the coiling of the catheter.
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Journal of anesthesia · Jan 2009
Case ReportsThe videolaryngoscope is less traumatic than the classic laryngoscope for a difficult airway in an obese patient.
This report describes the anesthetic management of an obese patient with a difficult airway and the merits of videolaryngoscopy, specifically in terms of the reduced risk of dental damage during intubation. A 49-year-old woman (body mass index; BMI, 36 kg.m(-2)), was scheduled to undergo an elective laparoscopic cholecystectomy because of cholelithiasis. ⋯ Intubation using a video-assisted Macintosh laryngoscope (V-Mac; Karl Storz, Tuttlingen, Germany) was successful upon the first attempt. The maximum force exerted on the patient's maxillary incisors was 61 N by direct laryngoscopy and 7.6 N using the indirect videolaryngoscope, both using a Macintosh blade.