Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial Clinical Trial
Pre- and intraoperative epidural ropivacaine have no early preemptive analgesic effect in major gynecological tumour surgery.
Thoracic epidural analgesia (TEA) is an established technique for postoperative pain relief after major abdominal surgery. However it is still under discussion whether pre-incisional TEA can reduce postoperative pain perception or postoperative analgesic consumption. ⋯ Intraoperative TEA with ropivacaine 0.375% did not significantly reduce the amount of analgesics required after major abdominal gynecological tumour surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intrathecal morphine provides better postoperative analgesia than psoas compartment block after primary hip arthroplasty.
Intrathecal morphine and psoas compartment block represent two accepted techniques to provide postoperative analgesia after hip arthroplasty. We designed a prospective, randomized, single-blinded study to compare these two techniques. ⋯ 0.1 mg intrathecal morphine administration provides better postoperative analgesia than single-shot psoas compartment block after primary hip arthroplasty.
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Case Reports
Dexmedetomidine and low-dose ketamine provide adequate sedation for awake fibreoptic intubation.
We report the use of the alpha2 agonist, dexmedetomidine, with low-dose ketamine as a safe and effective treatment strategy to provide adequate comfort and sedation for a patient who fulfilled criteria of a difficult airway and required awake fibreoptic intubation (AFOI). ⋯ Dexmedetomidine and concurrent low-dose ketamine provided sedation and comfort to this patient who required an AFOI.
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To describe the clinical use of a new videolaryngoscope in a patient who had repeatedly been difficult or impossible to intubate by conventional direct laryngoscopy. This device provided excellent glottic visualization and permitted easy endotracheal intubation. ⋯ This new videolaryngoscope provided excellent laryngeal exposure in a patient whom multiple experienced anesthesiologists had repeatedly found to be difficult or impossible to intubate using direct laryngoscopy. The clinical role of this device awaits confirmation in a large series of difficult airways.
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To report a case where failure to provide adequate one-lung ventilation during transbronchial intubation resulted in a potentially fatal mishap. ⋯ Displacement of the double-lumen endobronchial tube and flooding with clotted blood will result in potentially fatal ventilation difficulties. Repositioning and cleaning of the tube must be prompt to reduce the risk of hypoxemia. Where emergency single-lung ventilation is required, we suggest the utilization of a modified single-lumen endotracheal tube with a shortened cuff-tip length to ensure an adequate margin of safety for mainstem bronchus intubation.