European journal of anaesthesiology
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Randomized Controlled Trial
Multimodal analgesia with gabapentin, ketamine and dexamethasone in combination with paracetamol and ketorolac after hip arthroplasty: a preliminary study.
It has been hypothesized that combinations of analgesics with different mechanisms of action may reduce or even prevent postoperative pain. We, therefore, investigated the analgesic effect of gabapentin, dexamethasone and low-dose ketamine in combination with paracetamol and ketorolac as compared with paracetamol and ketorolac alone after hip arthroplasty. ⋯ Preoperative gabapentin, dexamethasone and ketamine combined with paracetamol and ketorolac reduced overall pain scores in patients after hip arthroplasty as compared with paracetamol and ketorolac alone. Morphine consumption was not reduced.
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The bispectral index (BIS) is derived from the EEG and therefore may be useful to diagnose intraoperative cerebral ischaemia. This study was undertaken to investigate BIS changes in awake patients with and without neurological deficits during carotid endarterectomy under regional anaesthesia. ⋯ Our results describe a relationship between BIS reductions and neurological deficits during carotid surgery in awake patients.
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Microcirculatory alterations are thought to be responsible for much of the morbidity and mortality from sepsis. The aim of the present study was to characterize the buccal microvascular response in patients with septic shock using combined laser Doppler flowmetry/visual light spectroscopy measurements. ⋯ Buccal laser Doppler flowmetry/visual light spectroscopy may be useful for tracing microvascular alterations in critically ill patients. The surgical stress response was associated with alterations in local flow with preserved microHbO2. However, in patients with septic shock, microHbO2 was reduced in the deep channel, probably muscular tissue, with no changes in microvascular flow.