BMC anesthesiology
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Randomized Controlled Trial
Peep titration based on the open lung approach during one lung ventilation in thoracic surgery: a physiological study.
During thoracic surgery in lateral decubitus, one lung ventilation (OLV) may impair respiratory mechanics and gas exchange. We tested a strategy based on an open lung approach (OLA) consisting in lung recruitment immediately followed by a decremental positive-end expiratory pressure (PEEP) titration to the best respiratory system compliance (CRS) and separately quantified the elastic properties of the lung and the chest wall. Our hypothesis was that this approach would improve gas exchange. Further, we were interested in documenting the impact of the OLA on partitioned respiratory system mechanics. ⋯ In our patients, the OLA strategy performed during OLV improved oxygenation and increased CL and had no clinically significant hemodynamic effects. Although our study was not specifically designed to study ΔPRS and ΔPL, we observed a parallel reduction of both after the OLA.
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Multicenter Study
Preoperative anxiety and associated factors among adult surgical patients in Debre Markos and Felege Hiwot referral hospitals, Northwest Ethiopia.
Anxiety during the preoperative period is the most common problem with a number of postoperative complications such as an increase in postoperative pain, delay of healing and prolong the hospital stay. Further, patients with a high level of preoperative anxiety require higher doses of anesthetic agents and recover poorly. Despite its serious health complications, its magnitude and associated factors have been poorly explored in Ethiopia particularly in the selected study areas. ⋯ The prevalence of preoperative anxiety was high. The level of preoperative anxiety significantly associated with sex, preoperative information provision, and previous surgical experience. Preoperative psychosocial assessment should be incorporated into a routine nursing practice and every patient should be provided with preoperative information before surgery.
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Randomized Controlled Trial Comparative Study
Programmed intermittent epidural bolus versus continuous epidural infusion for postoperative analgesia after major abdominal and gynecological cancer surgery: a randomized, triple-blinded clinical trial.
Continuous epidural infusion (CEI) is the standard application setting for epidural infusion. A new mode, the programmed intermittent epidural bolus (PIEB) technique, showed reduced local anesthetic (LA) consumption and improved analgesia in obstetric analgesia. Goal of this trial was to evaluate the effects of PIEB versus CEI [combined with patient-controlled bolus (PCEA)] on LA consumption and pain scorings in major abdominal cancer surgery. ⋯ This trial demonstrates reduced needs for PCEA bolus in the PIEB group. There were no clinically relevant benefits regarding morphine consumption, pain scorings, or other secondary outcome parameters.
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Randomized Controlled Trial
Ultrasound guided repositioning of a new suture-method catheter for adductor canal block - a randomized pilot study in healthy volunteers.
We performed a randomized, blinded pilot study in 12 volunteers to assess the feasibility to reposition an intentionally displaced suture-method catheter for two different insertion techniques for adductor canal block. ⋯ Placement and secondary repositioning after displacement of a suture-method catheter within the adductor canal is achievable. A perpendicular technique seems more reliable.
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Positive end-expiratory pressure (PEEP) has been demonstrated to decrease ventilator-induced lung injury in patients under mechanical ventilation (MV) for acute respiratory failure. Recently, some studies have proposed some beneficial effects of PEEP in ventilated patients without lung injury. The influence of PEEP on respiratory mechanics in children is not well known. Our aim was to determine the effects on respiratory mechanics of setting PEEP at 5 cmH2O in anesthetized healthy children. ⋯ Analysis of respiratory mechanics in anesthetized healthy children shows that PEEP at 5 cmH2O places the respiratory system in a better position in the P/V curve. A better understanding of lung mechanics may lead to changes in the traditional ventilatory approach, limiting injury associated with MV.