European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study
Patient-controlled analgesia with lornoxicam vs. dipyrone for acute postoperative pain relief after septorhinoplasty: a prospective, randomized, double-blind, placebo-controlled study.
We compared the efficacy of intravenous lornoxicam vs. dipyrone in patient-controlled analgesia for postoperative analgesia. ⋯ Lornoxicam has better tolerability and is a more effective analgesic than dipyrone when administered by patient-controlled analgesia for postoperative analgesia after septorhinoplasty.
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Randomized Controlled Trial
Co-induction of anaesthesia with 0.75 mg kg propofol followed by sevoflurane: a randomized trial in the elderly with cardiovascular risk factors.
The induction of general anaesthesia is associated with the greatest cardiovascular changes in elderly patients. Induction can be performed either intravenously or with gaseous induction. Sevoflurane has advantages over propofol for induction of anaesthesia in the elderly, since the lower reduction in mean arterial pressure with sevoflurane is both statistically and clinically significant. This prospective randomized controlled trial investigated the cardiovascular benefits of co-induction of anaesthesia with 0.75 mg kg(-1) propofol and 8% sevoflurane, when compared with 8% sevoflurane alone in patients requiring surgery for fractured neck of femur. ⋯ We concluded that 0.75 mg kg(-1) of propofol followed by sevoflurane induction is an acceptable alternative to sevoflurane induction. It is associated with similar haemodynamic variables, faster induction times and is very well tolerated.
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Comparative Study
Cardiac output measurements with electrical velocimetry in patients undergoing CABG surgery: a comparison with intermittent thermodilution.
The purpose was to study the agreement between cardiac output measurements with electrical velocimetry vs. intermittent thermodilution before and after coronary artery bypass graft surgery. ⋯ The agreement between cardiac output measurements with electrical velocimetry and intermittent thermodilution was clinically acceptable only before skin incision in coronary artery bypass graft surgery. The mean error was unacceptably high immediately after skin closure and was at a borderline level in the intensive care unit. Thus, the overall accuracy of cardiac output measurements with the electrical velocimetry technique during coronary artery bypass graft surgery is not clinically unacceptable.
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During off-pump coronary bypass grafting, surgical manipulation and dislocation of the heart may cause cardiovascular instability. Monitoring of cardiac output facilitates intraoperative haemodynamic management but pulmonary artery catheters are often considered too invasive. Pulse contour analysis and transoesophageal echocardiography could serve as alternatives, but there is controversy about their accuracies. We validated pulse contour analysis using a standard radial arterial catheter (PulseCO) and aortic Doppler flowmetry with transoesophageal echocardiography in patients undergoing off-pump coronary bypass surgery. Pulmonary arterial thermodilution served as the reference technique. ⋯ Calibrated pulse contour analysis using the PulseCO system is an acceptable technique to measure cardiac output non-invasively in off-pump coronary bypass patients. Doppler echocardiography performs less well and is not always feasible with transoesophageal echocardiography when the heart is displaced.
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Although the PROWESS trial demonstrated a mortality benefit, subsequent studies in different patient populations have not reproduced the effect. As a result, concerns have been expressed about the clinical effectiveness of drotrecogin alfa (activated). Therefore the aim of this audit was to review the clinical impact of drotrecogin alfa (activated) when used outside clinical trials. ⋯ Expected mortality derived from both the APACHE II score and organ dysfunctions suggests that drotrecogin alfa (activated) does reduce mortality. Serious adverse incidents occurred in 5.1% patients; however, the direct contributing effect of drotrecogin alfa (activated) cannot be established from this type of audit.