The American journal of anesthesiology
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Comparative Study
A computer model comparing normovolemic hemodilution, hypervolemic hemodilution, and neither on intraoperative blood loss and final hematocrit.
Homologous blood transfusion, while frequently life-saving, is attended by risks and complications. Autologous blood transfusions have become an increasingly common alternative. Volume expansion, which is simpler, also is used. ⋯ Volume expansion by hypervolemic hemodilution provides almost the same low level of benefit. Benefits (3% higher HCT) are not seen until larger volumes are phlebotomized or hemodiluted and accompanied by large intraoperative blood losses. Autologous blood drawn by preoperative phlebotomy for intraoperative transfusion should not be used until studies show that these large volumes are safe and actually save blood.
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Randomized Controlled Trial Clinical Trial
Analgesia after inguinal herniorrhaphy with laparoscopic inspection of the peritoneum in children. Caudal block versus ilioinguinal/iliohypogastric block.
The authors prospectively evaluated the efficacy of caudal epidural block versus local infiltration combined with ilioinguinal/iliohypogastric block for analgesia after inguinal herniorrhaphy with laparoscopic inspection of the peritoneum. During standardized anesthetic care, 24 children were randomized to Group I (caudal epidural block with 1.2 mL/kg of 0.25% bupivacaine) or to Group II (local infiltration with an ilioinguinal/iliohypogastric block). Postoperative pain scores were significantly lower at all four evaluation points in Group I than in Group II. ⋯ Time to extubation was 3.8 +/- 0.5 minutes in Group I and 8.2 +/- 1.1 minutes in Group II. The time from arrival in the postanesthesia care unit until discharge home was 113 +/- 3 minutes in Group I and 152 +/- 11 minutes in Group II. Caudal epidural block was more effective than local infiltration in controlling pain after herniorrhaphy with laparoscopy in children and resulted in earlier discharge home.
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Review Comparative Study
The laryngeal mask airway. Safety, efficacy, and current use.
In 1983, the laryngeal mask airway (LMA) was introduced as a new airway device. It can be inserted without the aid of a laryngoscope or neuromuscular blockade. Compared with the face mask, the LMA allows for a more "hands-free approach" to airway management providing the anesthesiologist the freedom of not holding a mask. ⋯ For this reason, it is believed that the LMA should not be used in place of an endotracheal tube during emergency rescue, but rather as an adjunct to airway management prior to intubation. It is possible that the risk of regurgitation with or without aspiration may be minimized if proper screening of patients is employed prior to use of the LMA. The current literature concerning its safety and efficacy is reviewed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of patient-controlled sedation on recovery from ambulatory monitored anesthesia care.
Patient-controlled sedation (PCS) with propofol has been shown to be an effective means of conscious sedation during monitored anesthesia care. The purpose of this study was to assess both the intraoperative conduct and postoperative recovery of patients receiving propofol for conscious sedation, randomized to either PCS or anesthetist-controlled sedation (ACS). Forty-three patients scheduled for outpatient procedures requiring monitored anesthesia care were randomized to PCS or ACS. ⋯ More patients in the PCS group required oxygen supplementation (saturation < 90%) on admission to recovery (P < 0.05). At 1 hour after recovery admission, however, there were no differences between groups. These results indicate that when patients determine their own sedation, they are more sedated at the end of a procedure than when the anesthetist determines the level of sedation.
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There is growing interest in the use of hypertonic crystalloid solutions for intravascular volume replacement. Such solutions rapidly restore nutrient blood flow to vital organs by a combination of increased perfusion pressure and vascular dilation. The addition of colloid to the solution appears to improve survival by limiting the tissue damage caused by ischemic injury and may avert the development of multisystem organ failure. Low cost and long shelf life make hypertonic solutions attractive for acute resuscitation after major trauma, but further investigations are warranted as to their efficacy and safety in the clinical setting.