European journal of anaesthesiology
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Randomized Controlled Trial Comparative Study
Efficacy of low-dose caudal clonidine in reduction of sevoflurane-induced agitation in children undergoing urogenital and lower limb surgery: a prospective randomised double-blind study.
Sevoflurane is commonly used as an inhalational induction agent in paediatric patients. Emergence agitation is a common post-operative problem in young children who have received sevoflurane. Clonidine has proven to be effective in reducing the incidence of post-operative agitation at a higher dose (3 and 2 μg kg⁻¹). It has some dose-dependent disadvantages, prominently bradycardia, hypotension and respiratory impairment. ⋯ Caudal clonidine at a lower dose (1 μg kg⁻¹) could be effective in reducing the incidence of sevoflurane-induced emergence agitation in children undergoing urogenital and lower limb surgery without any significant adverse effects.
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Randomized Controlled Trial
The effect of sub-Tenon lidocaine injection on emergence agitation after general anaesthesia in paediatric strabismus surgery.
Sevoflurane is widely used for paediatric anaesthesia. However, many cases of emergence agitation after sevoflurane anaesthesia have been reported and pain was suggested as a major contributing factor. The purpose of this study was to evaluate the effect of sub-Tenon lidocaine injection on emergence agitation in children receiving sevoflurane or propofol-remifentanil anaesthesia. ⋯ The frequency of emergence agitation is significantly reduced by sub-Tenon lidocaine injection regardless of the modality of anaesthesia used.
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The management of a patient with severe sepsis is first to diagnose the infection, to collect samples immediately after diagnosis and to initiate promptly broad-spectrum antibiotic treatment. The choice of empirical antimicrobial therapy should be based on host characteristics, site of infection, local ecology and the pharmacokinetics and pharmacodynamics of the antibiotics. ⋯ This is associated with optimal costs, decreased incidence of superinfection and reduced development of antimicrobial resistance. All these steps should be based on written protocols, and compliance to these protocols should be monitored continuously in order to detect violations and implement corrective procedures.
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Randomized Controlled Trial
Increased apparatus dead space and tidal volume increase blood concentrations of oxygen and sevoflurane in overweight patients: a randomised controlled clinical study.
General anaesthesia impairs respiratory function in overweight patients. We wanted to determine whether increased tidal volume (V(T)), with unchanged end-tidal carbon dioxide partial pressure (P(ET)CO₂), affects blood concentrations of oxygen and sevoflurane in overweight patients. ⋯ Ventilation with larger tidal volumes with isocapnia maintained with added apparatus dead space increases the tension of oxygen and sevoflurane in arterial blood in overweight patients.