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Anesthesia management

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125 papers 25 to 100 followers
https://www.readbyqxmd.com/read/23744953/the-analgesic-efficacy-of-subcostal-transversus-abdominis-plane-block-compared-with-thoracic-epidural-analgesia-and-intravenous-opioid-analgesia-after-radical-gastrectomy
#1
RANDOMIZED CONTROLLED TRIAL
Yiquan Wu, Fuli Liu, Hongli Tang, Quanguang Wang, Limei Chen, Hui Wu, Xuezheng Zhang, Jianxia Miao, Meizhen Zhu, Chenggang Hu, Mark Goldsworthy, Jing You, Xuzhong Xu
BACKGROUND: The transversus abdominis plane (TAP) block has been shown to provide effective postoperative analgesia in lower abdominal surgery. Subcostal TAP block has also been proposed as a new technique to provide analgesia for the supraumbilical abdomen. We compared the analgesic and opioid-sparing effects of a single-injection subcostal TAP block with continuous thoracic epidural analgesia and IV opioid analgesia. METHODS: Ninety patients undergoing elective radical gastrectomy were randomized to receive either combined general-subcostal TAP anesthesia (group TAP), combined general-epidural anesthesia (group EA), or general anesthesia (group GA), and were analyzed on an intention-to-treat basis...
August 2013: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28288050/pain-management-modalities-after-total-knee-arthroplasty-a-network-meta-analysis-of-170-randomized-controlled-trials
#2
Abdullah Sulieman Terkawi, Dimitris Mavridis, Daniel I Sessler, Megan S Nunemaker, Khaled S Doais, Rayan Sulieman Terkawi, Yazzed Sulieman Terkawi, Maria Petropoulou, Edward C Nemergut
BACKGROUND: Optimal analgesia for total knee arthroplasty remains challenging. Many modalities have been used, including peripheral nerve block, periarticular infiltration, and epidural analgesia. However, the relative efficacy of various modalities remains unknown. The authors aimed to quantify and rank order the efficacy of available analgesic modalities for various clinically important outcomes. METHODS: The authors searched multiple databases, each from inception until July 15, 2016...
May 2017: Anesthesiology
https://www.readbyqxmd.com/read/22748212/the-optimal-dose-of-remifentanil-for-acceptable-intubating-conditions-during-propofol-induction-without-neuromuscular-blockade
#3
Mustafa Demirkaya, Ebru Kelsaka, Binnur Sarihasan, Yüksel Bek, Emre Üstün
STUDY OBJECTIVE: To determine the optimal remifentanil dose required to provide acceptable intubating conditions following induction of anesthesia with propofol without using neuromuscular blockade. DESIGN: Dose-response study. SETTING: Operating room of a university hospital. PATIENTS: 50 ASA physical status 1 men, aged between 20 and 40 years, who were scheduled for general anesthesia. INTERVENTIONS: Intubating conditions were evaluated according to the scoring system described by Viby-Mogensen et al...
August 2012: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/20705788/dexmedetomidine-infusion-for-analgesia-and-prevention-of-emergence-agitation-in-children-with-obstructive-sleep-apnea-syndrome-undergoing-tonsillectomy-and-adenoidectomy
#4
RANDOMIZED CONTROLLED TRIAL
Anuradha Patel, Melissa Davidson, Minh C J Tran, Huma Quraishi, Catherine Schoenberg, Manasee Sant, Albert Lin, Xiuru Sun
BACKGROUND: Dexmedetomidine, a specific α(2) agonist, has an analgesic-sparing effect and reduces emergence agitation. We compared an intraoperative dexmedetomidine infusion with bolus fentanyl to reduce perioperative opioid use and decrease emergence agitation in children with obstructive sleep apnea syndrome undergoing adenotonsillectomy (T&A). METHODS: One hundred twenty-two patients with obstructive sleep apnea syndrome undergoing T&A, ages 2 to 10 years, completed this prospective, randomized, U...
October 2010: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/26332857/dexmedetomidine-as-a-rapid-bolus-for-treatment-and-prophylactic-prevention-of-emergence-agitation-in-anesthetized-children
#5
RANDOMIZED CONTROLLED TRIAL
John A Hauber, Peter J Davis, Laima P Bendel, Slava V Martyn, Denise L McCarthy, Minh-Chau Evans, Franklyn P Cladis, Sarah Cunningham, Robert Scott Lang, Neal F Campbell, Jay B Tuchman, Michael C Young
BACKGROUND: Administration of dexmedetomidine (DEX) in the pediatric population for its sedative, analgesic, and anxiolytic properties has been widely reported, despite there being no label indication approved by the U.S. Food and Drug Administration for pediatric patients. Infusions of DEX, rather than bolus administration, are recommended to attenuate the hemodynamic response caused by the α2-adrenoreceptor agonist. In this prospective, double-blind, randomized study, we examined the effect of rapid IV bolus injection of DEX on emergence agitation and the hemodynamic response in a large sample of children undergoing tonsillectomy with or without adenoidectomy, with or without myringotomy, and/or tympanostomy tube insertion...
November 2015: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28403427/new-persistent-opioid-use-after-minor-and-major-surgical-procedures-in-us-adults
#6
Chad M Brummett, Jennifer F Waljee, Jenna Goesling, Stephanie Moser, Paul Lin, Michael J Englesbe, Amy S B Bohnert, Sachin Kheterpal, Brahmajee K Nallamothu
Importance: Despite increased focus on reducing opioid prescribing for long-term pain, little is known regarding the incidence and risk factors for persistent opioid use after surgery. Objective: To determine the incidence of new persistent opioid use after minor and major surgical procedures. Design, Setting, and Participants: Using a nationwide insurance claims data set from 2013 to 2014, we identified US adults aged 18 to 64 years without opioid use in the year prior to surgery (ie, no opioid prescription fulfillments from 12 months to 1 month prior to the procedure)...
April 12, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/25695674/needleless-connectors-substantially-reduce-flow-of-crystalloid-and-red-blood-cells-during-rapid-infusion
#7
Robert A Lehn, Jeffrey B Gross, Joseph H McIsaac, Keith E Gipson
Although needleless connectors (NC) are frequently used in the perioperative setting, the potential of modern NCs to slow delivery of IV fluids has not been thoroughly studied. We examined flow characteristics of 5 NC models during pressurized delivery of crystalloid and banked red blood cells from a Level 1 warmer through various IV catheters. Crystalloid flow rates were reduced by 29% to 85% from control in catheters >18 gauge, while red blood cell flow reductions ranged from 22% to 76% in these catheters (all P < 0...
April 2015: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28386401/the-efficacy-and-safety-of-intravenous-lidocaine-for-analgesia-in-the-older-adult-a-literature-review
#8
REVIEW
Harriet Daykin
Opioids remain the mainstay of analgesia for the treatment of moderate to severe acute pain. Even in the young, the use of opioids can be associated with an increased incidence of post-operative complications such as respiratory depression, vomiting, pruritus, excessive sedation, slowing of gastrointestinal function, and urinary retention. The need to manage acute pain in the older patient is becoming more common as the population ages, and increasingly older patients are undergoing more major surgery. Medical conditions are more common in older people and can result in the requirement of systemic analgesia for fractures, malignancy, nociceptive or neuropathic pain and peripheral vascular disease...
February 2017: British Journal of Pain
https://www.readbyqxmd.com/read/28186263/change-in-end-tidal-carbon-dioxide-outperforms-other-surrogates-for-change-in-cardiac-output-during-fluid-challenge
#9
K Lakhal, M A Nay, T Kamel, B Lortat-Jacob, S Ehrmann, B Rozec, T Boulain
Background.: During fluid challenge, volume expansion (VE)-induced increase in cardiac output (Δ VE CO) is seldom measured. Methods.: In patients with shock undergoing strictly controlled mechanical ventilation and receiving VE, we assessed minimally invasive surrogates for Δ VE CO (by transthoracic echocardiography): fluid-induced increases in end-tidal carbon dioxide (Δ VE E'CO2 ); pulse (Δ VE PP), systolic (Δ VE SBP), and mean systemic blood pressure (Δ VE MBP); and femoral artery Doppler flow (Δ VE FemFlow)...
March 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/26171895/non-pharmacological-interventions-for-assisting-the-induction-of-anaesthesia-in-children
#10
REVIEW
Anne Manyande, Allan M Cyna, Peggy Yip, Cheryl Chooi, Philippa Middleton
BACKGROUND: Induction of general anaesthesia can be distressing for children. Non-pharmacological methods for reducing anxiety and improving co-operation may avoid the adverse effects of preoperative sedation. OBJECTIVES: To assess the effects of non-pharmacological interventions in assisting induction of anaesthesia in children by reducing their anxiety, distress or increasing their co-operation. SEARCH METHODS: In this updated review we searched CENTRAL (the Cochrane Library 2012, Issue 12) and searched the following databases from inception to 15 January 2013: MEDLINE, EMBASE, PsycINFO and Web of Science...
July 14, 2015: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/19247779/an-evidence-based-review-of-parental-presence-during-anesthesia-induction-and-parent-child-anxiety
#11
REVIEW
Josie Chundamala, James G Wright, Sheelagh M Kemp
PURPOSE: The purpose of this evidence-based review was to examine the effect of parental presence during anesthesia induction on parents' and children's anxiety. SOURCE: MEDLINE (1950 to 2008) and EMBASE (1980 to 2008) were searched. Studies were restricted to randomized controlled trials (RCTs) and comparative studies only (levels of evidence I-III). PRINCIPAL FINDINGS: Fourteen studies that provided level II or level III evidence were included (nine RCTs, four prospective comparative studies, and one retrospective comparative study)...
January 2009: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/25851018/efficacy-of-dexmedetomidine-on-postoperative-shivering-a-meta-analysis-of-clinical-trials
#12
REVIEW
Zhen-Xiu Liu, Feng-Ying Xu, Xiao Liang, Miao Zhou, Liang Wu, Jing-Ru Wu, Jian-Hua Xia, Zui Zou
PURPOSE: Shivering is a frequent complication in the postoperative period. The aim of the current meta-analysis was to assess the efficacy of dexmedetomidine on postoperative shivering. METHODS: Two researchers independently searched PubMed, EMBASE and the Cochrane Central Register of Controlled Trials for controlled clinical trials. The meta-analysis was performed by Review Manager. RESULTS: Thirty-nine trials with 2,478 patients were included in this meta-analysis...
July 2015: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28096514/tonsillectomy-for-obstructive-sleep-disordered-breathing-a-meta-analysis
#13
REVIEW
Sivakumar Chinnadurai, Atia K Jordan, Nila A Sathe, Christopher Fonnesbeck, Melissa L McPheeters, David O Francis
CONTEXT: The effectiveness of tonsillectomy or adenotonsillectomy (hereafter, "tonsillectomy") for obstructive sleep-disordered breathing (OSDB) compared with watchful waiting with supportive care is poorly understood. OBJECTIVE: To compare sleep, cognitive or behavioral, and health outcomes of tonsillectomy versus watchful waiting with supportive care in children with OSDB. DATA SOURCES: Medline, Embase, and the Cochrane Library. STUDY SELECTION: Two investigators independently screened studies against predetermined criteria...
February 2017: Pediatrics
https://www.readbyqxmd.com/read/28248702/norepinephrine-intermittent-intravenous-boluses-to-prevent-hypotension-during-spinal-anesthesia-for-cesarean-delivery-a-sequential-allocation-dose-finding-study
#14
Desire N Onwochei, Warwick D Ngan Kee, Lillia Fung, Kristi Downey, Xiang Y Ye, Jose C A Carvalho
BACKGROUND: The use of phenylephrine as the first-line agent for prevention and treatment of maternal hypotension during cesarean delivery (CD) may reduce cardiac output, posing a theoretical risk to mother and fetus. Norepinephrine has been suggested as a potential alternative, because its β-adrenergic effects might result in greater heart rate and cardiac output than phenylephrine. The use of norepinephrine to prevent and treat hypotension during CD is new, and its use as a bolus has not been fully determined in this context...
February 28, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/26106831/ketorolac-use-and-postoperative-complications-in-gastrointestinal-surgery
#15
Meera Kotagal, Timo W Hakkarainen, Vlad V Simianu, Sara J Beck, Rafael Alfonso-Cristancho, David R Flum
OBJECTIVE: To study the association between ketorolac use and postoperative complications. BACKGROUND: Nonsteroidal anti-inflammatory drugs may impair wound healing and increase the risk of anastomotic leak in colon surgery. Studies to date have been limited by sample size, inability to identify confounding, and a focus limited to colon surgery. METHODS: Ketorolac use, reinterventions, emergency department (ED) visits, and readmissions in adults (≥ 18 years) undergoing gastrointestinal (GI) operations was assessed in a nationwide cohort using the MarketScan Database (2008-2012)...
January 2016: Annals of Surgery
https://www.readbyqxmd.com/read/17959952/intraoperative-esmolol-infusion-in-the-absence-of-opioids-spares-postoperative-fentanyl-in-patients-undergoing-ambulatory-laparoscopic-cholecystectomy
#16
RANDOMIZED CONTROLLED TRIAL
Vincent Collard, Giovanni Mistraletti, Ali Taqi, Juan Francisco Asenjo, Liane S Feldman, Gerald M Fried, Franco Carli
BACKGROUND: The use of opioids during ambulatory surgery can delay hospital discharge or cause unexpected hospital admission. Preliminary studies using an intraoperative continuous infusion of esmolol in place of an opioid have inconsistently reported a postoperative opioid-sparing effect. In this study, we compared esmolol versus either intermittent fentanyl or continuous remifentanil on postoperative opioid-sparing, side effects, and time of discharge. METHODS: Ninety patients (consisting of three groups) were enrolled in this prospective, randomized, and observer-blinded study...
November 2007: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27685346/the-optimal-analgesic-block-for-total-knee-arthroplasty
#17
Thomas Fichtner Bendtsen, Bernhard Moriggl, Vincent Chan, Jens Børglum
Peripheral nerve block for total knee arthroplasty is ideally motor sparing while providing effective postoperative analgesia. To achieve these goals, one must understand surgical dissection techniques, distribution of nociceptive generators, sensory innervation of the knee, and nerve topography in the thigh.
November 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/27555197/the-effects-of-caudal-or-intravenous-dexmedetomidine-on-postoperative-analgesia-produced-by-caudal-bupivacaine-in-children-a-randomized-controlled-double-blinded-study
#18
RANDOMIZED CONTROLLED TRIAL
Khaled R Al-Zaben, Ibraheem Y Qudaisat, Aboud N Alja'bari, Omar A Ababneh, Al-Motassem M Yousef, Abdulrahman M Al-Shudifat
STUDY OBJECTIVES: The aim of this study was to compare the effects of caudal and intravenous (IV) dexmedetomidine (1 μg/kg) on postoperative analgesia after caudal bupivacaine in pediatric patients undergoing lower abdominal and perineal surgeries. DESIGN: A randomized controlled double-blind study. SETTING: University-affiliated teaching hospital. PATIENTS: Seventy-five American Society of Anesthesiologists I children, aged 1 to 6 years...
September 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/25537312/the-ekg-in-hypothermia-and-hyperthermia
#19
REVIEW
Hardik H Doshi, Michael C Giudici
Hypothermia and hyperthermia are relatively common clinical conditions that are associated with significant morbidity and mortality, especially if not promptly recognized and treated. Both of these conditions associated with extreme alterations in core body temperatures can be accompanied by alteration in cardiac function, often with manifest EKG changes. However, some of the EKG changes associated with hypothermia and heat stroke are non-specific and lead to diagnostic dilemmas. We here present 2 clinical cases, one each for hypothermia and hyperthermia to describe the EKG changes associated with these clinical conditions...
March 2015: Journal of Electrocardiology
https://www.readbyqxmd.com/read/26936022/a-comparison-of-intranasal-dexmedetomidine-for-sedation-in-children-administered-either-by-atomiser-or-by-drops
#20
COMPARATIVE STUDY
B L Li, N Zhang, J X Huang, Q Q Qiu, H Tian, J Ni, X R Song, V M Yuen, M G Irwin
Intranasal dexmedetomidine has been used successfully for sedation in children. A mucosal atomisation device delivers an atomised solution to the nasal mucosa which facilitates rapid and effective delivery of medication to the systemic circulation. We compared intranasal delivery of dexmedetomidine in a dose of 3 μg.kg(-1) by either atomiser or drops from a syringe in children < 3 years old undergoing transthoracic echocardiography. Two hundred and seventy-nine children were randomly assigned to one or other group...
May 2016: Anaesthesia
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