European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study
Esomeprazole for the prevention of postoperative nausea and vomiting. A randomized, placebo-controlled trial.
Postoperative nausea and vomiting still represents a major problem after surgery. Although risk factors for postoperative nausea and vomiting and procedures to reduce postoperative nausea and vomiting have been described, the incidence of postoperative nausea and vomiting remains high. The aim of the present study was to investigate the potential role of the proton pump inhibitor esomeprazole to reduce postoperative nausea and vomiting after elective surgery. ⋯ There is no evidence that prophylactic esomeprazole reduces the incidence of postoperative nausea and vomiting or the degree of postoperative nausea.
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Comparative Study Clinical Trial
The correlation between the Richmond agitation-sedation scale and bispectral index during dexmedetomidine sedation.
The primary objective of sedation in the critically ill patient is to achieve security and comfort. The routine use of standardized and validated sedation scales and monitors are needed. The Richmond agitation sedation scale has been used but some patients cannot be evaluated with subjective assessment tools such as the Richmond agitation sedation scale because they lack motor responsiveness due to therapeutic paralysis or because they are receiving deep sedation. We aimed to assess the correlation of bispectral index with Richmond agitation sedation scale during dexmedetomidine sedation and evaluate the use of the bispectral index in monitoring the levels of sedation in intensive care patients. ⋯ Richmond agitation sedation scale levels significantly correlated with bispectral index values during dexmedetomidine sedation in critically ill patients requiring mechanical ventilation in the intensive care unit.
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Comparative Study
The effect of a remifentanil bolus on the bispectral index of the EEG (BIS) in anaesthetized patients independently from intubation and surgical stimuli.
Remifentanil boluses are used in different clinical situations and the effects on bispectral index monitoring are unclear. We analysed the effect of a remifentanil bolus on the bispectral index of the electroencephalogram (bispectral index) under total intravenous anaesthesia with propofol and remifentanil. ⋯ There was a significant reduction in the areas under the curve between 90-120 s following the bolus. Heart rate and blood pressure also showed significant reductions. Thus, remifentanil bolus given under total intravenous anaesthesia with propofol and remifentanil decreases bispectral index, an effect independent of intubation and surgical stimuli.
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To assess the knowledge, beliefs and attitudes of anaesthesia providers on the patients' possible intraoperative visual experiences during cataract surgery under local anaesthesia. ⋯ The majority of anaesthesia providers in the USA, UK and Singapore are aware that patients may experience a variety of visual sensations during cataract surgery under regional or topical anaesthesia. Those who have previously managed patients undergoing cataract surgery under topical anaesthesia are more likely to believe this compared to those who have not.
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Comparative Study
Inter-patient variability upon induction with sevoflurane estimated by the time to reach predefined end-points of depth of anaesthesia.
A difficult issue in anaesthesia is its titration for an individual patient to avoid over- and underdosage. Common practice is to use an initial dose and increase it subsequently if the defined end-point is not reached. This assumes that the end-point is reached after a similar interval of time in all patients given a similar dose. In order to test this hypothesis we measured the time to reach end-points such as loss of consciousness (LOC), a bispectral index (BIS) value of 60, the minimal BIS and the minimal mean arterial pressure (MAP) values. ⋯ These results demonstrate large inter-patient variability for the time necessary to reach defined end-points of depth of anaesthesia when a similar dose of anaesthetic is given. Measuring the time to reach a predefined BIS value would allow application of nociceptive stimuli only at adequate levels of hypnosis and would facilitate titration.