European journal of anaesthesiology
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Intraoperative hypoxaemia and postoperative respiratory complications remain the challenges of modern anaesthetic practice. Anaesthesia causes both depression of respiratory centres and profound changes of respiratory mechanics. ⋯ In this review, we briefly describe the mechanisms responsible for the impairment of intraoperative gas exchange and provide guidelines to prevent or manage hypoxaemia. Moreover, we discuss several aspects of mechanical ventilation that can be employed to improve patients' outcome.
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Randomized Controlled Trial
Landiolol, a new ultra-short-acting beta1-blocker, reduces anaesthetic requirement during sevoflurane/N(2)O/fentanyl anaesthesia in surgical patients.
It is known that esmolol, a short-acting beta1-blocker, reduces anaesthetic requirement. In this study, we evaluated whether a low dose of landiolol, a new ultra-short-acting beta1-blocker, can reduce the sevoflurane requirement. ⋯ The results suggest that a low dose of landiolol significantly reduces the intraoperative sevoflurane requirement during sevoflurane/N(2)O/fentanyl anaesthesia in patients undergoing hip surgery.
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Randomized Controlled Trial
Saving sevoflurane and hastening emergence from anaesthesia using an anaesthetic-conserving device.
This study compared an anaesthetic-conserving device (AnaConDa) and a conventional vaporizer in terms of sevoflurane consumption and emergence from anaesthesia using a total gas flow of 4 l min(-1), with a rebreathing circuit. ⋯ The AnaConDa could decrease sevoflurane consumption and hasten emergence from anaesthesia, but increasing sevoflurane concentration with AnaConDa at the start of anaesthesia might take longer than that with a conventional vaporizer.
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Randomized Controlled Trial
Randomised controlled trial of combined spinal epidural vs. spinal anaesthesia for elective caesarean section: vasopressor requirements and cardiovascular changes.
Combined spinal and epidural anaesthesia (CSEA) has previously been shown to result in a higher sensory block than equivalent single shot spinal anaesthesia (SSSA). In nonpregnant patients, hypotension was also more pronounced in the CSEA group. The aim of this randomized trial was to compare the haemodynamic stabilities of CSEA and SSSA during elective caesarean section when the same dose of anaesthetic was administered. This was studied directly by measuring the noninvasive arterial blood pressure (BP) and indirectly by the amount of ephedrine required to maintain baseline BP. Systemic vascular resistance index (SVRI) and cardiac index (CI) were also measured using thoracic impedance cardiography. ⋯ CSEA placement appears to offer no haemodynamic benefits compared with SSSA when the same dose of local anaesthetic is administered.
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Administering various combinations of acetaminophen, ketoprofen, nefopam and ketamine, though sometimes discussed, is expected to provide superior pain relief and reduce opioid analgesic-related side effects. However, some studies have indicated that multimodal analgesia has limited efficacy. We studied the stability of various binary combinations of these four drugs. ⋯ Physicochemical negative interaction is not likely to account for the limited clinical efficacy sometimes reported with binary combinations of these drugs. Coadministration of binary mixtures of acetaminophen, nefopam, ketoprofen and ketamine from the same bottle or infusion bag using the same venous line is demonstrated to be feasible.