European journal of anaesthesiology
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In previous studies we have demonstrated that it is possible and safe to identify the lumbar epidural space by an acoustic and visible signal. The use of an experimental set-up constructed for this purpose, the acoustic puncture assist device, the lumbar epidural puncture procedure became both audible and visible. In the present study we have extended the use of the device to localize the thoracic epidural space. We have also evaluated whether the device can be used as a practical tool to confirm correct catheter placement. ⋯ It is possible to localize the thoracic epidural space guided by an acoustic signal. The method was shown to be safe, reliable and simple. Potential implications of this technique include better needle control, improved monitoring for training purposes and for clinical documentation of the thoracic epidural puncture as well as identifying correct catheter placement.
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To evaluate the feasibility of an abbreviated focus assessed transthoracic echocardiographic protocol, consisting of four standardized acoustic views for cardiopulmonary screening and monitoring. ⋯ By means of an abbreviated, focus assessed transthoracic echo protocol it is feasible to visualize the haemodynamic determinants for assessment and optimization. One or more useful images are obtainable in 97% of critically ill patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Continuous spinal analgesia or opioid-added continuous epidural analgesia for postoperative pain control after hip replacement.
Continuous spinal anaesthesia and continuous epidural anaesthesia are both able to provide adequate postoperative pain relief. Combining local anaesthetics and opioids results in synergistic effects. The purpose of this randomized, prospective study was to compare quality of analgesia, side-effects and patient's satisfaction between spinal bupivacaine alone and epidural bupivacaine with sufentanil postoperatively. ⋯ Continuous spinal analgesia with bupivacaine alone and continuous epidural analgesia with bupivacaine/sufentanil are both effective for postoperative pain relief after hip replacement. Those patients in the epidural group reported better analgesia but had a higher rate of postoperative nausea and vomiting. Efficacy of pain therapy did not correlate with patient satisfaction.
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Randomized Controlled Trial Comparative Study Clinical Trial
Pain control with low-dose alfentanil in children undergoing minor abdominal and genito-urinary surgery.
The aim of this study was to investigate the quality of intra- and postoperative analgesia obtained by alfentanil compared to that produced by peripheral blockade in children. ⋯ It was concluded that a low-dose, intravenous bolus of alfentanil may be an efficient alternative to peripheral nerve blockade in controlling pain during and after minor abdominal and genito-urinary surgery.
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Isoflurane has been shown experimentally to protect the myocardium against infarction but the clinical relevance of these findings is not yet well established. We therefore evaluated the effects of isoflurane administration before cardiopulmonary bypass (CPB) on postoperative cardiac troponin I (cTnI) release and clinical outcome in a large group of adult patients scheduled for cardiac surgery. ⋯ No significant effect was observed on postoperative cTnI release and in-hospital outcome when isoflurane was added to standardized intravenous anaesthesia before CPB in adult patients undergoing cardiac surgery.