Canadian journal of anaesthesia = Journal canadien d'anesthésie
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The purpose of this structured, evidence-based, clinical update was to identify the best evidence comparing general and regional anesthesia and their influence on delirium or cognitive dysfunction (POCD) in the postoperative period. ⋯ Available randomized controlled trials suggest that there is no significant difference in the incidence of delirium or POCD when general anesthesia and regional anesthesia are compared.
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Comparative Study
Laboratory investigation: effects of propofol on the systemic inflammatory response during aortic surgery.
A laboratory investigation was undertaken to assess the effects of propofol on renal function, through modulation of the systemic inflammatory response, in an in vivo experimental model of aortic surgery in comparison with sevoflurane. ⋯ In an experimental model of aortic reconstructive surgery, and compared with sevoflurane, propofol anesthesia is associated with less neutrophil infiltration, lower plasma proinflammatory cytokine levels, lower production of oxygen free radicals, less lipid peroxidation, and reduced inducible nitric oxide synthase activity. These observations suggest a possible renal protective effect of propofol in this surgical setting.
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Randomized Controlled Trial Comparative Study
Pain relief and functional status after vaginal hysterectomy: intrathecal versus general anesthesia.
We tested the hypothesis that the use of subarachnoid block (SAB) for vaginal hysterectomy produces superior postoperative analgesia and improves functional status at 12 weeks postoperatively. ⋯ A significantly better immediate postoperative analgesia was present in the SAB group, and the duration was consistent with the expected action of intrathecally administered drugs. Two weeks after surgery a higher percentage of the patients in the SAB group reported no pain. However, SAB had no effect on either length of hospitalization or patients' postoperative functional status.
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Randomized Controlled Trial
Intraoperative infusion of dexmedetomidine reduces perioperative analgesic requirements.
This prospective, randomized, double-blind study was designed to assess whether intraoperative infusion of dexmedetomidine provides effective postoperative analgesia. Postoperative pain scores and morphine consumption were compared in a treated group and a placebo group, both of which received patient-controlled morphine after total abdominal hysterectomy. ⋯ Continuous iv dexmedetomidine during abdominal surgery provides effective postoperative analgesia, and reduces postoperative morphine requirements without increasing the incidence of side effects.
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Randomized Controlled Trial
Poor inter-rater reliability on mock anesthesia oral examinations.
Inter-rater reliability (IRR) and communication skills are both important factors that have been shown to affect oral examination scores. This study was designed to test: 1) IRR of a group of American Board of Anesthesiology (ABA) and the Royal College of Physicians and Surgeons of Canada (RCPSC) graders who graded in true isolation; 2) the effect of teaching residents examination techniques. ⋯ Inter-rater reliability may be poor when graders score an oral examination in true isolation. Teaching candidates an oral examination communication and presentation technique did not appear to improve performance. Oral examination practice may be of value in training for future examinations.