Journal of anesthesia
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Journal of anesthesia · Dec 2020
Meta AnalysisThe analgesic efficacy of quadratus lumborum block in caesarean delivery: a meta-analysis and trial sequential analysis.
Quadratus lumborum block (QLB) has recently gained popularity for postoperative analgesia after cesarean delivery (CD) as it provides both visceral and somato-sensory blockade of the abdomen. Aim of this meta-analysis was to evaluate the analgesic potential of QLB after CD. ⋯ QLB significantly reduces opioid requirements in CD and may have analgesic effects lasting 24 h.
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Journal of anesthesia · Dec 2020
Randomized Controlled TrialDesflurane and sevoflurane concentrations in blood passing through the oxygenator during cardiopulmonary bypass: a randomized prospective pilot study.
Volatile anesthetics (VAs) protect myocardial cells in cardiovascular surgery. A recent clinical trial of cardiopulmonary bypass (CPB) surgery reported no significant difference in mortality rates between the use of VAs and total intravenous anesthetics at 1 year postoperatively. However, oxygenator function may affect the VA pharmacokinetics. Thus, we measured the VA blood concentrations during CPB in patients managed with four different microporous polypropylene hollow fiber membrane oxygenators. ⋯ Our results demonstrated that the blood concentrations of desflurane and sevoflurane passing through oxygenators used during CPB were similar to those in the human lung control.
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Journal of anesthesia · Dec 2020
Postoperative renal morbidity and mortality after volume replacement with hydroxyethyl starch 130/0.4 or albumin during surgery: a propensity score-matched study.
We aimed to compare retrospectively the rates of renal morbidity and mortality in surgical patients receiving 6% HES 130/0.4 to those receiving albumin. ⋯ Postoperative renal morbidity and mortality did not differ between patients receiving HES 130/0.4 and those receiving albumin. HES 130/0.4 was associated with shorter hospital stay and less fluid requirement compared to albumin. These findings support the use of 6% HES 130/0.4 for perioperative volume replacement as an alternative to albumin.
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Journal of anesthesia · Dec 2020
Why the natural frequency and the damping coefficient do not evaluate the dynamic response of clinically used pressure monitoring circuits correctly.
The dynamic response of pressure monitoring circuits must be evaluated to obtain true invasive blood pressure values. Since Gardner's recommendations in 1981, the natural frequency and the damping coefficient have become standard parameters for anesthesiologists. In 2006, we published a new dynamic response evaluation method (step response analysis) that can plot frequency spectrum curves instantly in clinical situations. We also described the possibility of the defect of the standard parameters. However, the natural frequency and the damping coefficient are considered the gold standard and are even included in a major anesthesiology textbook. Therefore, we attempted to clarify the issues of these parameters with easy-to-understand pressure waves and basic numerical formulae. ⋯ The natural frequency and the damping coefficient are inadequate for the dynamic response evaluation. These parameters are primarily obtained from the phase spectrum curve and not from the amplitude spectrum curve. We strongly recommend an evaluation using the amplitude spectrum curve with our step response analysis method. It is crucial to maintain an amplitude gain of 1 (input amplitude = output amplitude) in the pressure wave frequency range of 0-20 Hz.