Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial
Nasotracheal intubation under curve-tipped suction catheter guidance reduces epistaxis.
Nasotracheal intubation (NTI) has greater potential for trauma of nasopharyngeal mucosa than orotracheal intubation. The present study investigated the success rate of NTI and frequency of nasal bleeding using a curve-tipped suction catheter (CTSC) to guide nasotracheal tube advancement. ⋯ Nasotracheal intubation under CTSC guidance increases the success rate of airway instrumentation, and also reduces the incidence and severity of epistaxis.
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The Canadian Anesthesiologists' Society (CAS), the Ontario Preoperative Task Force (OPTF) and The Ottawa Hospital (TOH) have published guidelines detailing the indications for preoperative testing. The purpose of this study was to: (a) document compliance of testing practice at TOH-Civic Campus with published guidelines; and (b) determine the impact of preoperative testing on clinical management. ⋯ The majority of elective surgical patients undergo preoperative testing. Non-compliance with guidelines ranged from 5 to 98%. The results of most tests were normal and influenced management in only 2.6% of cases.
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Epidural hematoma is a rare but serious complication of epidural anesthesia. We report a case of epidural hematoma, occurring in an obstetric patient after the epidural catheter had been withdrawn accidentally after an episode of hemorrhagic shock leading to a hypocoagulable state. ⋯ In the presence of an epidural hematoma, surgery for emergency cord decompression is usually required. Another option that receives increasing attention is to monitor neurological function, but the indications for this expectant treatment are not well defined.
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Meta Analysis Comparative Study
A meta-analysis of noninvasive weaning to facilitate liberation from mechanical ventilation.
To summarize the evidence comparing noninvasive positive pressure ventilation (NPPV) and invasive positive pressure ventilation (IPPV) weaning on mortality, ventilator associated pneumonia and the total duration of mechanical ventilation among invasively ventilated adults with respiratory failure. ⋯ In the absence of a large randomized controlled trial, this meta-analysis demonstrated a consistent positive effect of noninvasive weaning on mortality. Notwithstanding, the use of NPPV to facilitate weaning, in mechanically ventilated patients, with predominantly chronic obstructive pulmonary disease, is associated with promising, but insufficient, evidence of net clinical benefit at present.
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Randomized Controlled Trial
Preemptive gabapentin reduces postoperative pain and opioid demand following thyroid surgery.
Gabapentin is reported to possess antihyperalgesic and antiallodynia properties. Recently, reports have indicated that gabapentin may have a place in the treatment of postoperative pain. In this study, we sought to determine whether preemptive use of gabapentin reduced postoperative pain and morphine demand following thyroidectomy. ⋯ Preoperative gabapentin decreased pain scores and postoperative morphine consumption in patients following thyroid surgery.