European journal of anaesthesiology
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Randomized Controlled Trial
Effects of a continuous low-dose clonidine epidural regimen on pain, satisfaction and adverse events during labour: a randomized, double-blind, placebo-controlled trial.
Epidural clonidine has been proposed as an adjunct for anaesthetic mixtures during labour. Administered as a bolus, clonidine may have side effects such as sedation and hypotension; its continuous infusion could be attractive in this respect. We, therefore, conducted a randomized, double-blind trial using patient-controlled epidural analgesia with a background infusion using a low dose of clonidine during labour. ⋯ The addition of clonidine to epidural levobupivacaine and sufentanil for patient-controlled epidural analgesia in labour improved analgesia, reduced the supplementation rate and reduced pruritus without improvement in maternal satisfaction. Blood pressure was significantly lower in the clonidine group over time but without clinical consequence.
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The management of patients with recent coronary artery stents presenting for noncardiac surgery has become a major topic of interest and concern for all perioperative care givers. The present review will update recent reports and particularly new guidelines as well as recommendations. Based on the available literature, all experts recommend avoiding premature discontinuation of antiplatelet drug therapy if possible except for a few surgical procedures. Drug-eluting stents obviously carry more risks than bare-metal stents.
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Patients undergoing oncologic neck dissection may have many of the risk factors for carotid artery stenosis, thus predisposing them to perioperative cerebral ischaemic events. The present study was designed to investigate development of postoperative neurocognitive dysfunction in these patients. ⋯ POCD was detectable only after neck dissection in the early postoperative period accompanied by increased incidence of microembolism and protein S100beta levels, but not 12 months after surgery.
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To study the characteristics of patients dying in the ICU, dying after ICU treatment during the same hospitalization period in general wards and post-ICU hospital survivors. In addition, causes of death and post-ICU mortality (PICUM) predictors were addressed. ⋯ Causes of deaths were equally distributed among study groups, except for sepsis. Sepsis was more frequently encountered among ICU deaths. Five PICUM predictors were found: age, Acute Physiology and Chronic Health Evaluation II score, length of ICU stay, do-not-resuscitate code and comorbidities. A do-not-resuscitate code during the first 24 h after admission was the most important predictor of PICUM. Prospective research is warranted to evaluate the applicability of PICUM prediction models in individual ICU patients.
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Randomized Controlled Trial Multicenter Study Comparative Study
Efficacy and safety of fentanyl HCl iontophoretic transdermal system compared with morphine intravenous patient-controlled analgesia for postoperative pain management for patient subgroups.
Inadequate postoperative pain control remains a problem for many patients undergoing surgery. This study presents subgroup analyses from a large, randomized, multicentre, European study comparing the efficacy and safety of the fentanyl HCl iontophoretic transdermal system and morphine intravenous patient-controlled analgesia for postoperative pain management. ⋯ The fentanyl iontophoretic transdermal system and morphine intravenous patient-controlled analgesia are comparably well tolerated and effective methods of pain control, regardless of sex, American Society of Anesthesiologists physical status or the type of anaesthesia used for surgery, and following most surgery types.