Canadian journal of anaesthesia = Journal canadien d'anesthésie
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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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To review the perioperative management of antithrombotic therapy in cardiac surgery, including the management of cardiopulmonary bypass (CPB) and off-pump surgery. ⋯ Antithrombotic therapy is an essential component of cardiac surgery. Yet, with the exception of antiplatelet agents in CABG patients, antithrombotic therapy is often based on the clinical experience of medical teams more than on an evidence-based assessment of the literature.
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Randomized Controlled Trial
The effect of epidural needle type on postdural puncture headache: a randomized trial.
A prospective, randomized trial in labouring parturients was undertaken to assess whether the 18G Special Sprotte epidural needle is associated with a lower incidence of accidental dural puncture (ADP) in comparison with the 17G Tuohy needle. A secondary purpose was to determine if the incidence of postdural puncture headache (PDPH ) differed between groups when ADP occurred. ⋯ The incidence of ADP was not reduced with the Special Sprotte epidural needle in comparison with the Tuohy needle, but PDPH after ADP occurred less frequently in the Sprotte group.
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To review the efficacy, effectiveness and safety of hemostatic drugs to reduce surgical blood loss. ⋯ Aprotinin and tranexamic acid are valuable pharmacologic options for reducing surgical bleeding. The expected benefit of these drugs is highly dependent on the actual blood usage for a given procedure at the institutional level. More studies using clinically significant endpoints are necessary to assess the relative efficacy and optimal dosing of these drugs.