The American journal of anesthesiology
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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.
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One thousand three hundred thirty-seven anesthesiologists randomly selected from the current American Society of Anesthesiologists' directory were surveyed to discover if their attitudes toward the policy of allowing preoperative patients nothing by mouth (NPO) have changed. One thousand forty surveys were returned. For each response to a survey question, the percentage of respondents giving that response was calculated. ⋯ Nearly all anesthesiologists surveyed used less than an 8-hour fast for elective pediatric surgery. At least 50% of the anesthesiologists surveyed no longer use NPO after midnight as an order for elective surgery for adults. Of the demographic variables, only geography and the question of whether or not a hospital was a teaching institution were statistically related to NPO practice.