European journal of anaesthesiology
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Comparative Study
A secure and rapid method for orotracheal intubation of laboratory rats utilising handy instruments.
Tracheal intubation of anaesthetised rats for laboratory experiments remains an essential yet challenging procedure. ⋯ Tracheal intubation for laboratory rats can be securely and safely completed with the modified method employing a short learning curve and easily available devices.
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Randomized Controlled Trial Comparative Study
Optimal remifentanil dose for lightwand intubation without muscle relaxants in healthy patients with thiopental coadministration: a prospective randomised study.
Muscle relaxants used to facilitate tracheal intubation have disadvantages. ⋯ Our results suggest that remifentanil 2 or 3 μg kg(-1) combined with thiopental 5 mg kg provides acceptable conditions for lightwand intubation without muscle relaxants. Spontaneous ventilation returns more rapidly following remifentanil 2 μg kg(-1) than with remifentanil 3 μg kg(-1).
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Etomidate is used to induce anaesthesia in critically ill patients in many environments, including pre-hospital care, in the emergency and critical care departments and in the operating theatre. It has a favourable cardiovascular profile, but its use has courted controversy because it suppresses adrenal function which some believe is associated with worse outcome, particularly in patients with sepsis. Because there is much evidence of harm associated with hypotension in critically ill patients, it is important to use an anaesthetic induction drug which is less likely to cause hypotension. ⋯ There is no convincing or consistent evidence that etomidate is associated with harm, particularly if adjustment is made for pre-existing severity of illness. The etomidate debate is currently in clinical equipoise in which there is genuine uncertainty within the expert medical community. We review briefly the arguments in favour of continuing to use etomidate in critically ill patients.
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Randomized Controlled Trial Comparative Study
Comparison between systemic analgesia, continuous wound catheter analgesia and continuous thoracic paravertebral block: a randomised, controlled trial of postthoracotomy pain management.
Thoracotomy is the surgical procedure that creates the greatest demand for postoperative analgesia. ⋯ Our results support the efficacy of TPVB for pain management after thoracotomy, at rest and after coughing. These results confirm the preference for TPVB over epidural analgesia in postthoracotomy pain care. CWC failed to decrease pain and morphine consumption and performed no better than placebo.
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Etomidate is an imidazole-derived hypnotic agent preferentially used for rapid sequence induction of anaesthesia because of its favourable haemodynamic profile. However, 11β-hydroxylase inhibition causes adrenal insufficiency with potentially fatal consequences in specific populations. We review the arguments against the liberal administration of etomidate in critically ill, and especially septic, patients. ⋯ Based on these randomised controlled trials, the use of etomidate should be avoided in unstable trauma patients. Midazolam and ketamine are two valid alternatives with similar intubation and haemodynamic conditions as etomidate but without its adverse effects. Therefore, for safety reasons, etomidate should be avoided in the critical conditions of sepsis and trauma.