Journal of anesthesia
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Journal of anesthesia · Aug 2012
Review Meta AnalysisA comprehensive appraisal of meta-analyses focusing on nonsurgical treatments aimed at decreasing perioperative mortality or major cardiac complications.
Millions of patients worldwide who undergo surgical procedures face significant morbidity and mortality risks. Several systematic reviews have been performed on ancillary treatments aimed at improving surgical outcomes, but their features and scholarly impact are unclear. We describe characteristics of meta-analyses on ancillary treatments aimed at improving surgical outcomes and explore factors associated with scholarly citations. ⋯ Systematic reviews currently represent a key element in defining state of the art ancillary treatments of patients undergoing surgery. However, the citation success of available meta-analyses is not significantly associated with prognostically relevant findings or quality features.
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Journal of anesthesia · Aug 2012
Randomized Controlled Trial Comparative StudyOral gastric tube-guided insertion of the ProSeal™ laryngeal mask is an easy and noninvasive method for less experienced users.
The ProSeal™ laryngeal mask airway (PLMA) can be more difficult to insert than the classic laryngeal mask, especially in patients who have a thin palate with a steep oropharyngeal curve. Here, an oral gastric (OG) tube-guided technique is considered as a method that makes it easier to successfully insert a PLMA. ⋯ OG tube-guided PLMA insertion is easier for less experienced users, trainees, and experts as well as less invasive for patients than the standard digital insertion.
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Journal of anesthesia · Aug 2012
Randomized Controlled TrialThe effect of dexmedetomidine on arterial-cardiac baroreflex function assessed by spectral and transfer function analysis.
The α(2)-adrenergic receptor agonist dexmedetomidine reportedly weakens heart rate (HR) responses to 'rapid' (during a few seconds) reduction in arterial pressure, but does not affect HR responses to 'gradual' (during 60 s) reduction in arterial pressure. As the speed of neurotransmission along the parasympathetic nerve is relatively rapid, alteration of parasympathetic-mediated arterial-cardiac baroreflex function plays a more important role in HR responses to 'rapid' changes in arterial pressure. We therefore hypothesized that dexmedetomidine attenuates parasympathetic-mediated arterial-cardiac baroreflex function. ⋯ The present results suggest that dexmedetomidine attenuates parasympathetic-mediated arterial-cardiac baroreflex function, implying weakened HR response to 'rapid' reduction in arterial pressure.
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Journal of anesthesia · Aug 2012
Randomized Controlled TrialFlurbiprofen axetil provides a prophylactic benefit against mesenteric traction syndrome associated with remifentanil infusion during laparotomy.
Mesenteric traction syndrome (MTS) is caused by PGI(2) release during abdominal procedures and is often observed during abdominal surgery. We have demonstrated that MTS occurs more frequently in cases using remifentanil than in those that are not. The aim of this study was to assess the prophylactic benefit of flurbiprofen axetil on MTS in patients undergoing abdominal surgery using remifentanil. ⋯ We found that preoperative administration of flurbiprofen axetil reduced the incidence of MTS during abdominal surgery with remifentanil analgesia.
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Journal of anesthesia · Aug 2012
Randomized Controlled Trial Comparative StudyEfficacy of Coopdech videolaryngoscope: comparisons with a Macintosh laryngoscope and the Airway Scope in a manikin with difficult airways.
We studied the efficacy of the Coopdech videolaryngoscope Portable VLP-100, by comparing it with a Macintosh laryngoscope, and another videolaryngoscope, the Airway Scope (AWS), in a manikin with four simulated difficult airways. In a randomized, crossover design, each of 50 residents inserted the three devices, in turn, and graded the view of the glottis at laryngoscopy. Time to see the glottis, time to intubate the trachea, and the success rate of tracheal intubation (within 120 s) were recorded. ⋯ In a manikin with cervical spine rigidity or pharyngeal obstruction, the AWS and the VLP-100 provided significantly higher success rates of intubation than the Macintosh laryngoscope (P < 0.05). In a manikin with laryngospasm, no one could intubate the trachea using any device. Our results indicate that, in patients with difficult airways, the videolaryngoscopes (VLP-100 and AWS) would provide higher success rates of tracheal intubation than the Macintosh laryngoscope, but the VLP-100 may be inferior to the AWS.