European journal of anaesthesiology
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Letter Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
The analgesic efficacy and tolerance of ketoprofen (100 mg) combined with morphine in patient-controlled analgesia after orthopaedic surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Lidocaine 10% in the endotracheal tube cuff: blood concentrations, haemodynamic and clinical effects.
The purpose of this study was to evaluate the effects (common haemodynamic variables, peak cuff pressures, the incidence of reaction ('bucking') during extubation and the incidence of sore throat after operation) of lidocaine 10% instilled into the endotracheal tube cuff in intubated patients. Plasma concentrations of lidocaine were assayed. Seventy ASA class I-II patients scheduled for plastic surgery were studied. ⋯ Plasma lidocaine concentrations did not reach toxic values. Lidocaine 10%, compared with saline, in the endotracheal tube cuff was associated with less disturbance of haemodynamic responses and less incidence of bucking during tracheal extubation. Lidocaine was also effective in reducing of incidence and severity of sore throat after operation.
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The efficacy of an integrated autotransfusion regimen, including pre-donation and perioperative salvage of autologous blood, was prospectively evaluated in 2884 patients undergoing total hip (n = 2016) or knee arthroplasty (n = 480), and hip revision (n = 388) with either balanced general, regional, or integrated epidural/general anaesthesia. Allogenic concentrated red blood cells were transfused in the presence of symptomatic anaemia or when haemoglobin concentration was < 6 g dL-1 (10 g dL-1 in patients affected by cerebrovascular or coronary artery disease) after all salvaged and pre-donated autologous blood had been transfused. ⋯ The incidence of perioperative complications, including wound infection and haematoma, as well as myocardial ischaemia, respiratory failure and thromboembolic complications, was higher in those patients requiring allogenic blood transfusion (29.8%) than that observed in patients receiving only autologous blood (6.6%) (P = 0.0005); while the mean time duration from surgical procedure to patient discharge from the orthopaedic ward was shorter in those patients not receiving allogenic blood transfusion (12 days; 25-75th percentiles: 8-14 days) than in those patients who required perioperative transfusion with allogenic blood (15 days; 25-75th percentiles: 10-17 days) (P = 0.0005). In conclusion, this prospective study highlighted the clinical relevance of applying an extensive and integrated autotransfusion regimen in order to reduce allogenic blood transfusion and associated complications in patients undergoing major joint replacement.