Articles: postoperative.
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Anesthesia and analgesia · Oct 2022
Observational StudyKetamine Associated Intraoperative Electroencephalographic Signatures of Elderly Patients With and Without Preoperative Cognitive Impairment.
Ketamine is typically used by anesthesiologists as an adjunct for general anesthesia and as a nonopioid analgesic. It has been explored for prevention of postoperative delirium, although results have been contradictory. In this study, we investigated the association of ketamine with postoperative delirium and specific encephalographic signatures. Furthermore, we examined these associations in the context of baseline neurocognition as measured by a validated assessment. ⋯ Ketamine-related changes in EEG are observed in a heterogeneous group of patients receiving spine surgery. This result was driven primarily by the effect of ketamine on cognitively normal patients and not observed in patients that were cognitively impaired at baseline. Furthermore, patients who were cognitively impaired at baseline and who had received ketamine were more likely to develop postoperative delirium, suggesting that cognitive vulnerability might be predicted by the lack of a neurophysiologic response to ketamine.
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Meta Analysis
The effect of lidocaine patch for postoperative pain: A meta-analysis of randomized controlled trials.
The role of lidocaine patch (LP) in reducing postoperative pain by local anesthetic absorption has been evaluated in several studies; however, these trials have shown inconsistent results. This meta-analysis aimed to identify the benefits of LP, focusing on its pain-reducing and morphine-sparing effect in patients after surgery. ⋯ LP can lower postoperative pain without side effects, compared to placebo or no patch. However, its morphine-sparing effect remains unclear.
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Complex spinal surgery is associated with significant postoperative pain. The purpose of this paper is to review recent literature on postoperative pain management in adult and adolescent patients having complex spinal surgery. ⋯ Pain management after complex spinal surgery remains challenging. Therefore, further studies are still required to determine the optimal multimodal analgesic regimen for these patients.
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Anesthesia and analgesia · Oct 2022
Open Reimplementation of the BIS Algorithms for Depth of Anesthesia.
BIS (a brand of processed electroencephalogram [EEG] depth-of-anesthesia monitor) scores have become interwoven into clinical anesthesia care and research. Yet, the algorithms used by such monitors remain proprietary. We do not actually know what we are measuring. If we knew, we could better understand the clinical prognostic significance of deviations in the score and make greater research advances in closed-loop control or avoiding postoperative cognitive dysfunction or juvenile neurological injury. In previous work, an A-2000 BIS monitor was forensically disassembled and its algorithms (the BIS Engine) retrieved as machine code. Development of an emulator allowed BIS scores to be calculated from arbitrary EEG data for the first time. We now address the fundamental questions of how these algorithms function and what they represent physiologically. ⋯ The openibis algorithm finally provides definitive answers about the BIS: the reliance of the most important signal components on the low-gamma waveband and how these components are weighted against each other. Reverse engineering allows these conclusions to be reached with a clarity and precision that cannot be obtained by other means. These results contradict previous review articles that were believed to be authoritative: the BIS score does not appear to depend on a bispectral index at all. These results put clinical anesthesia research using depth-of-anesthesia scores on a firm footing by elucidating their physiological basis and enabling comparison to other animal models for mechanistic research.
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Pediatr Crit Care Me · Oct 2022
Prophylactic Enoxaparin Against Catheter-Associated Thrombosis in Postoperative Cardiac Children: An Interrupted Time Series Analysis.
The effectiveness of pharmacologic prophylaxis against catheter-associated thrombosis in children is unclear. We evaluated the compliance and outcomes associated with a prophylactic enoxaparin protocol in postoperative cardiac children. ⋯ The temporal association between increase in percentage of catheter-days on enoxaparin and decrease in rate of thrombosis suggests the effectiveness of prophylactic enoxaparin.