Current Issue : July - September Volume : 2014 Issue Number : 3 Articles : 6 Articles
Objectives. To compare the analgesic efficacy of intrathecal clonidine and fentanyl added to bupivacaine after cesarean section.\r\nMethods. Ninety patients scheduled for cesarean section under spinal anesthesia were randomly allocated to one of the three\r\nfollowing groups to receive bupivacaine 10 mg combined with 75 ??g clonidine (group C), bupivacaine 10mg combined with 0.5mL\r\nfentanyl (group F), and bupivacaine 10mg combined with 0.5mL distilled water (group P), intrathecally. The time to first analgesic\r\nrequest, analgesic requirement in the first 24 hours after surgery, sensory and motor blockade onset time, duration of sensory\r\nand motor blockade, the incidence of hypotension, ephedrine requirements, bradycardia, and hypoxemia were recorded. Results.\r\nThe duration of anesthesia in clonidine group (275.10 �± 96.09) was longer compared to the placebo (211.73 �± 74.80) and fentanyl\r\n(192.33 �± 30.36) groups. This difference between group C versus F (P = 0.006) and P groups (P < 0.001) was significant. Similarly,\r\nthe mean time to first analgesic request was also longer in group C (519.44 �± 86.25) than in groups F (277.88 �± 94.25) and P\r\n(235.43 �± 22.35 min). This difference between group C versus F (P < 0.001) and P groups (P < 0.001) was significant. Conclusion.\r\nIntrathecal clonidine 75 �µg with bupivacaine prolonged the time to first analgesic request compared to fentanyl; however, the total\r\nanalgesic consumption within the first 24 h postoperative was similar in fentanyl and clonidine groups following cesarean section.\r\nThis trial is registered with ACTRN12611000909921 and ClinicalTrials.gov NCT01425658....
Despite great advancements in themanagement of aneurysmal subarachnoid hemorrhage (SAH), outcomes following SAH rupture\r\nhave remained relatively unchanged. In addition, little data exists to guide the anesthetic management of intraoperative aneurysm\r\nrupture (IAR), though intraoperative management may have a significant effect on overall neurological outcomes. This review\r\nhighlights the various controversies related to different anesthetic management related to aneurysm rupture. The first controversy\r\nrelates to management of preexisting factors that affect risk of IAR. The second controversy relates to diagnostic techniques,\r\nparticularly neurophysiological monitoring.The third controversy pertains to hemodynamic goals. The neuroprotective effects of\r\nvarious factors, including hypothermia, various anesthetic/pharmacologic agents, and burst suppression, remain poorly understood\r\nand have yet to be further elucidated. Differentmanagement strategies for IAR during aneurysmal clipping versus coiling also need\r\nfurther attention....
Background. Tracheal intubation is a potentially life-saving procedure. This skill is taught to many anesthetic healthcare\r\nprofessionals, including nurse anesthetists. Our goal was to evaluate the learning ability of nurse anesthetist trainees in their\r\nperformance of orotracheal intubation with theMacintosh laryngoscope. Methods. Eleven nurse anesthetist trainees were enrolled\r\nin the study during the first three months of their training. All trainees attended formal lectures and practice sessions with manikins\r\nat least one time on performing successful tracheal intubation under supervision of anesthesiology staff. Learning curves for each\r\nnurse anesthetist trainee were constructed with the standard cumulative summation (cusum) methods. Results. Tracheal intubation\r\nwas attempted on 388 patients. Three hundred and six patients (78.9%) were successfully intubated on the traineesââ?¬â?¢ first attempt\r\nand 17 patients (4.4%) on the second attempt. The mean Ã?± SD number of orotracheal intubations per trainee was 35.5 Ã?± 5.1 (range\r\n30ââ?¬â??47). Ten (90.9%) of 11 trainees crossed the 20% acceptable failure rate line. A median of 22 procedures was required to achieve\r\nan 80% orotracheal intubations success rate. Conclusion. At least 22 procedures were required to reach an 80% success rate for\r\norotracheal intubation using Macintosh laryngoscope in nonexperienced nurse anesthetist trainees....
Outcomes research is emerging as an invaluable approach to the scientific evaluation of healthcare in a real-world rather than an\r\nexperimental environment. There is much interest in the differential evaluation of existing interventions with regard to different\r\npatient populations.Moreover, various comorbid conditions necessitate analysis for the specific additional risk those factors convey\r\nin the perioperative arena, a task often difficult to accomplish without population-based techniques. The authors� group has\r\nconducted significant work in perioperative outcomes research utilizing CER and database analysis methodology, with focus on\r\northopedic surgery and anesthesiology. Our research resulted in numerous publications affecting policy and patient care over the\r\nlast number of years. Knowledge on immediate perioperative outcomes of anesthesia and surgery is of very high interest not only\r\nto clinicians but also to administrators and policymakers, as it allows for risk assessment and allocation of resources. This review is\r\nnot intended to be a systematic review but rather to (1) provide a brief overview over the theoretical basis of CER and populationbased\r\ndatabase research, (2) give an overview of our work with various points of focus, and (3) offer a perspective on the future\r\ndevelopment in perioperative medicine....
Background. Since data on pain evaluation and management in patients admitted to internal medicine wards (IMWs) are limited,we\r\naimed to evaluate these aspects in a cohort of internistic patients. Methods.We considered all patients consecutively admitted from\r\nJune to December 2011 to our unit. Age, gender, and length-of-hospital-stay (LOS) were recorded. Comorbidities were arbitrarily\r\ndefined, and pain severity was evaluated by Numeric Rating Scale (NRS) on admission and discharge. Results. The final sample\r\nconsisted of 526 patients (mean age 74�±14 years; 308 women). Significant pain (NRS = 3) was detected in 63% of cases, and severe\r\n(NRS = 7) in 7.6%. Pain was successfully treated, and NRS decreased from 4.65 �± 2.05 to 0.89 �± 1.3 (P < 0.001). Compared with\r\nsubjects with NRS < 3, those with significant pain were older (75.5 �± 13.9 versus 72.9 �± 14.5 years,P = 0.038), and had a higher LOS\r\n(7.9 �± 6.1 versus 7.3 �± 6.8, P = 0.048). Significant pain was independently associated with age (OR 0.984, P = 0.018), cancer (OR\r\n3.347,P < 0.001), musculoskeletal disease (OR 3.054, P < 0.0001), biliary disease (OR 3.100,P < 0.01), and bowel disease (OR\r\n3.100, P< 0.003). Conclusion. In an internal medicine setting, multiple diseases represent significant cause of pain. Prompt pain\r\nevaluation and management should be performed as soon as possible, in order to avoid patientsâ�� suffering and reduce the need of\r\nhospital stay....
Theobjective of this study was to determine the point after sugammadex administration atwhich sufficient or insufficient dose could\r\nbe determined, using first twitch height of train-of-four (T1 height) or train-of-four ratio (TOFR) as indicators. Groups A and B\r\nreceived 1mg/kg and 0.5mg/kg of sugammadex, respectively, as a first dose when the second twitch reappeared in train-of-four\r\nstimulation, andGroups C andDreceived 1mg/kg and 0.5mg/kg of sugammadex, respectively, as the first dose at posttetanic counts\r\n1ââ?¬â??3. Five minutes after the first dose, an additional 1mg/kg of sugammadex was administered and changes in T1 height and TOFR\r\nwere observed. Patients were divided into a recovered group and a partly recovered group, based on percentage changes in T1 height\r\nafter additional dosing. T1 height and TOFR during the 5 min after first dose were then compared. In the recovered group, TOFR\r\nexceeded 90% in all patients at 3 min after sugammadex administration. In the partly recovered group, none of the patients had a\r\nTOFR above 90% at 3 min after sugammadex administration. An additional dose of sugammadex can be considered unnecessary\r\nif the train-of-four ratio is =90% at 3 min after sugammadex administration. This trial is registered with UMIN000007245....
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