Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial Clinical Trial
Propofol offers no advantage over isoflurane anesthesia for cerebral protection during cardiopulmonary bypass: a preliminary study of S-100beta protein levels.
Despite advances in anesthesia, cardiopulmonary bypass (CPB) and surgical techniques, cerebral injury remains a major source of morbidity after cardiac surgery. We compared the effects of two different anesthetic techniques, isoflurane vs propofol on neurological outcome by serum S-100beta protein and neuropsychological tests after coronary artery bypass grafting (CABG). ⋯ Despite reports about the neuroprotective effects of propofol, S-100beta protein levels were significantly elevated in group P. Although there was no deterioration in neuropsychological outcome, propofol appeared to offer no advantage over isoflurane for cerebral protection during CPB in this preliminary study of 20 patients.
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Randomized Controlled Trial Clinical Trial
Caudal neostigmine with bupivacaine produces a dose-independent analgesic effect in children.
To evaluate the analgesic efficacy and duration of varying doses of caudal neostigmine with plain bupivacaine and its side effects in children undergoing genito-urinary surgery. ⋯ Caudal neostigmine (2, 3 and 4 microg.kg(-1)) with bupivacaine produces a dose-independent analgesic effect ( approximately 16-17 hr) in children as compared to those receiving caudal bupivacaine alone (approximately five hours) and a reduction in postoperative rescue analgesic consumption without increasing the incidence of adverse effects.
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The goal of this study was to analyze the effect of positive end-expiratory pressure (PEEP), with and without a lung recruitment maneuver, on dead space. ⋯ Lung recruitment improved the efficiency of ventilation in anesthetized patients.
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Randomized Controlled Trial Clinical Trial
Intrathecal clonidine prolongs labour analgesia but worsens fetal outcome: a pilot study.
Intrathecal clonidine prolongs total duration of spinal bupivacaine analgesia. However, there are contradictory reports about its effect on maternal blood pressure and only limited data are available on fetal and neonatal outcome. In this study, we evaluated the efficacy of spinal clonidine combined with ropivacaine and sufentanil and its effects on maternal and fetal outcome. ⋯ Intrathecal clonidine prolongs spinal analgesia with ropivacaine and sufentanil at the expense of maternal hypotension, worse fetal well being and worse neonatal umbilical artery pH. We do not recommend routine administration of spinal clonidine 30 microg to sufentanil and ropivacaine for labour pain relief.
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Case Reports
Airway management of a patient with tracheal stenosis for surgery in the prone position.
When tracheal intubation is required in a patient with an uncollapsible tracheal stenosis, the tip of the tube is usually positioned proximal to the stenosis. Only the tip of the tube may be in the trachea and the tube can be dislodged. We report the successful airway management of a patient with an uncollapsible tracheal stenosis who underwent cranial surgery in the prone position. ⋯ The laryngeal mask and an airway exchange catheter were used as backups to tracheal intubation in this patient with tracheal stenosis in the prone position. Should the trachea be extubated accidentally, it may be re-intubated through the laryngeal mask and ventilation may be possible through the laryngeal mask or the exchange catheter.