Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Review Meta Analysis
Brief review: the role of ancillary tests in the neurological determination of death.
The acceptance of brain death by society has allowed for the discontinuation of "life support" and the transplantation of organs. In Canada we accept the clinical criteria for brain death (essentially brain stem death) when they can be legitimately applied. Ancillary tests are needed when these clinical criteria cannot be applied or when there are confounders. Ancillary tests include tests of intracranial blood circulation, electrophysiological tests, metabolic studies and tests for residual vagus nerve function. The ideal confirmatory test is one which, when positive, would be incompatible with recoverable brain function (i.e., has no false positives), is not influenced by drugs or metabolic disturbances and which can be readily applied. A critical review of the various ancillary tests used to support the neurological determination of death (brain death) was undertaken. ⋯ At present only cerebral angiography and nuclear medicine tests of perfusion are accepted by Canadian standards, but computed tomography and magnetic resonance angiography should prove to be suitable. Transcranial Doppler studies may be suitable for specific cases once appropriate guidelines are established.
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Review Meta Analysis
Review article: the role of anticonvulsant drugs in postoperative pain management: a bench-to-bedside perspective.
Anticonvulsant drugs are effective in the treatment of chronic neuropathic pain but were not, until recently, thought to be useful in more acute conditions such as postoperative pain. However, similar to nerve injury, surgical tissue injury is known to produce neuroplastic changes leading to spinal sensitization and the expression of stimulus-evoked hyperalgesia and allodynia. Pharmacological effects of anticonvulsant drugs which may be important in the modulation of these postoperative neural changes include suppression of sodium channel, calcium channel and glutamate receptor activity at peripheral, spinal and supraspinal sites. The purpose of this article is to review preclinical evidence and clinical trial data describing the efficacy and safety of anticonvulsant drugs in the setting of postoperative pain management. ⋯ Given the incomplete efficacy of currently available non-opioid analgesics, and the identified benefits of opioid sparing, anticonvulsant medications may be useful adjuncts for postoperative analgesia. Further research in this field is warranted.
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Randomized Controlled Trial Comparative Study
Lower flange modification improves performance of the Macintosh, but not the Miller laryngoscope blade.
In order to minimize the potential for dental damage and to improve laryngeal visualization during tracheal intubation, two commonly used laryngoscope blades were modified and compared in a clinical setting: the Miller laryngoscope blade and the Macintosh laryngoscope blade. Modified versions of both laryngoscope blades with a lowered heel (Callander modification) at the proximal end of the blade were compared to standard blades. ⋯ A reduction of the proximal flange of a Miller blade decreases the blade's effectiveness for laryngeal visualization, whereas a similar modification of a Macintosh blade increases blade-tooth distance, decreases the number of blade-tooth contacts and provides a better laryngeal view.
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Randomized Controlled Trial Comparative Study
Nerve stimulator guided pudendal nerve block versus general anesthesia for hemorrhoidectomy.
A randomized clinical trial was undertaken to test the hypothesis that patients receiving a nerve stimulator guided pudendal nerve block for hemorrhoidectomy would experience more effective and prolonged postoperative analgesia and shorter hospital stay compared to patients receiving general anesthesia. ⋯ Nerve stimulator guided pudendal nerve block is associated with reduced postoperative pain, shortened hospital stay, and earlier return to normal activity compared to general anesthesia for hemorrhoidectomy.