Canadian journal of anaesthesia = Journal canadien d'anesthésie
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To review the literature on airway and respiratory management following non-lethal (suicidal) hanging and to describe the anatomy, injury and pathophysiological sequelae and their impact on patient care. ⋯ Airway injuries severe enough to interfere with airway management are uncommon after attempted suicide by hanging. Irrespective of the initial neurological assessment, aggressive and early resuscitation to optimize cerebral oxygenation is recommended.
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Randomized Controlled Trial Comparative Study Clinical Trial
Propofol patient-controlled sedation during hip or knee arthroplasty in elderly patients.
Little information is available regarding the use of patient-controlled sedation (PCS) among the elderly. This study evaluated the safety and efficacy of propofol PCS among elderly patients undergoing hip or knee arthroplasty. ⋯ Propofol PCS provides effective sedation. Using a propofol dose of 0.3 mg.kg-1, transient episodes of deeper sedation were noted more frequently among patients receiving PCS. These episodes did not require intervention but, suggest that this propofol PCS dose approaches the limit of safety and should be further reduced for some elderly patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of three regional anaesthesia techniques for outpatient knee arthroscopy.
The purpose of this study was to compare intraoperative conditions and postoperative pain control of three peripheral regional anaesthesia techniques for outpatient knee arthroscopic procedures. ⋯ Any of the three anaesthetic techniques tested provide reliable intraoperative patient and surgical conditions for outpatient knee arthroscopy. Patient discomfort postoperatively was considerable in all groups and requires further investigation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Transdermal fentanyl system plus im ketorolac for the treatment of postoperative pain.
To assess the safety and efficacy of transdermal fentanyl plus im ketorolac vs im ketorolac alone in the treatment of postoperative pain. ⋯ The transdermal fentanyl delivery system plus ketorolac im was more effective in controlling post-operative pain than ketorolac im alone. The two treatment modalities were comparable in safety with no difference in serious adverse events.
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Review Case Reports
Oxygen venous embolism after the use of hydrogen peroxide during lumbar discectomy.
The knee-prone position is commonly used for patients undergoing spinal surgery. Venous air embolism in such a position may be produced by the negative venous pressure gradient between the ambient air and the venous plexuses of the spinous process. When hydrogen peroxide is used to cleanse the wound, oxygen is produced. We report a case of suspected oxygen venous embolism during lumbar discectomy in the knee-prone position after use of H2O2. ⋯ Although hydrogen peroxide has an innocuous reputation, cases of accidental ingestion or massive gas embolism after wound irrigation leading to death have been reported. A review of the literature suggests that many of the clinical and physiopathological features of air and oxygen emboli are similar. For both, measures of prevention and treatment of complications are similar. We argue that the use of hydrogen peroxide should be avoided during procedures where the position of the patient (sitting, knee-prone) increases the risk of gas embolism and that hydrogen peroxide is a potentially dangerous solution.