European journal of anaesthesiology
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Case Reports
Paradoxical air embolism during orthoptic liver transplantation: diagnosis by transoesophageal echocardiography.
We describe a case of paradoxical air embolism during orthotopic liver transplantation, early diagnosis, using intra-operative transoesophageal echocardiography after a circulatory failure, allowed early management by hyperbaric oxygen therapy.
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Randomized Controlled Trial Clinical Trial
Dimenhydrinate for prevention of post-operative nausea and vomiting in female in-patients.
Dimenhydrinate is an inexpensive antihistaminic drug, that is frequently used as an anti-emetic during anaesthesia. The popularity of the drug is contrasted by the lack of modern studies concerning its efficacy in reducing the incidence of post-operative nausea and vomiting. Thus, dimenhydrinate was compared with placebo in this prospective, randomized, double-blind study. ⋯ No relevant side effects were observed. Intra-operative dimenhydrinate, followed by three further administrations after surgery, reduces the incidence and the severity of post-operative nausea and vomiting without side effects. However, there still remained an unacceptable high number of patients who were not prevented completely from experiencing post-operative nausea and vomiting.
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A review was undertaken of all 190 patients who were referred over 7 years, from 1991 to 1997 inclusive, for an epidural blood patch as a treatment for headache after dural puncture. The patterns of referral and symptoms, the distributions of age and gender and the effectiveness of the blood patch were examined. Most of the referrals (n = 153) were after deliberate diagnostic dural puncture in neurology and neuroradiology, with a minority (n = 28) used for anaesthesia and obstetrics, which were mostly inadvertent. ⋯ Epidural blood patches are effective in treating headache after dural puncture, but less successful than is commonly believed, especially after inadvertent dural taps. A relapse after treatment does not always require a second patch. Specialities other than anaesthesia seemed reluctant to accept the benefits in both cost and comfort of using needles of improved design for dural puncture.
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Randomized Controlled Trial Comparative Study Clinical Trial
Anti-emetic efficacy of prophylactic granisetron compared with perphenazine for the prevention of post-operative vomiting in children.
We have compared the efficacy of granisetron with perphenazine in the prevention of vomiting after tonsillectomy with or without adenoidectomy in children. In a prospective, randomized, double-blind study, 90 paediatric patients, ASA I, aged 4-10 years, received granisetron 40 mg kg-1 or perphenazine 70 mg kg-1 (n = 45 each) intravenously immediately after an inhalation induction of anaesthesia. A standard general anaesthetic technique was employed throughout. ⋯ The corresponding incidence during the next 21 h (3-24 h) after anaesthesia was 87% and 62% (P = 0.007). No clinically serious adverse events were observed in any of the groups. We conclude that granisetron is a better anti-emetic than perphenazine for the long-term prevention of post-operative vomiting in children undergoing general anaesthesia for tonsillectomy.
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Randomized Controlled Trial Comparative Study Clinical Trial
Droperidol-supplemented anaesthesia decreases post-operative nausea and vomiting but impairs post-operative mood and well-being.
Post-operative nausea and vomiting is distressing for patients and can cause dissatisfaction and impaired well-being in the post-operative period. This study examined the question whether the reduced incidence of post-operative nausea and vomiting inevitably translates into improved clinical status and well-being. In this context high doses of droperidol were investigated. ⋯ Well-being scores returned to pre-operative base-line values and did not differ between the two groups 24 and 48 h post-operatively. The reduced incidence of post-operative nausea and vomiting achieved with high dose droperidol does not equate with increased post-operative well-being. It is an important point at issue to decide whether smaller doses of droperidol that are commonly used for anti-emetic therapy are free of these side effects.