Canadian journal of anaesthesia = Journal canadien d'anesthésie
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This retrospective study was designed to assess the intensity of postoperative pain in relation to the location of craniotomy. ⋯ This study shows that the intensity of postoperative pain in neurosurgery is affected by the site of craniotomy. Frontal craniotomy patients experienced the lowest pain scores, and required significantly less opioid than patients undergoing posterior fossa interventions.
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Randomized Controlled Trial
Priming with rocuronium accelerates neuromuscular block in children: a prospective randomized study.
To determine the effects of a priming technique with respect to onset time and duration of action of rocuronium (1.5 x ED(95), 2.0 x ED(95)) in a pediatric patient population. ⋯ Priming accelerated the onset of rocuronium in children. A priming interval of one minute and a cumulative dose of rocuronium 1.5 x ED(95) resulted in an onset of neuromuscular block comparable to a single dose of rocuronium (2.0 x ED(95)).
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Recombinant activated factor VII (rFVIIa) is currently not approved by Health Canada or the Food and Drug Administration for treating excessive blood loss in nonhemophiliac patients undergoing on-pump cardiac surgery, but is increasingly being used "off-label" for this indication. A Canadian Consensus Conference was convened to generate recommendations for rFVIIa use in on-pump cardiac surgery. ⋯ In cardiac surgery, the risks and benefits of rFVIIa are unclear, but current evidence suggests that its benefits may outweigh its risks for rescue therapy in selected patients. Methodologically rigorous studies are needed to clarify its riskbenefit profile in cardiac surgery patients.
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Randomized Controlled Trial
Sitting position does not alter minimum alveolar concentration for desflurane.
Hypotension is a common complication of the sitting position during anesthesia, and is often counteracted by decreasing anesthetic depth, thereby exposing patients to the risk of being inadequately anesthetized. Baroreceptor unloading and the consequent sympathoexcitation, as during head up tilt, decreases pain threshold and arouses the central nervous system (CNS), whereas hypotension exerts a direct CNS depressant effect. We estimated the minimal alveolar concentration (MAC) of desflurane for immobility in patients undergoing surgery in the sitting position, in comparison to MAC desflurane for patients having a similar type of surgery in the supine position. ⋯ The sitting position does not change desflurane anesthetic requirements for immobility.
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Randomized Controlled Trial
Small dose spinal bupivacaine for Cesarean delivery does not reduce hypotension but accelerates motor recovery.
Maternal hypotension occurs in 60-94% of Cesarean deliveries with 10-15 mg spinal bupivacaine. Reduced doses of bupivacaine may decrease the incidence of hypotension, nausea, and vasopressor use. The primary objective of this study was to compare 4.5 mg and 12 mg doses of intrathecal bupivacaine on maternal hemodynamics. The secondary objective was to determine if anticipated reductions in side effects were reflected in increased patient satisfaction. ⋯ Intrathecal bupivacaine 4.5 and 12 mg yielded similar sensory block and side effects during Cesarean delivery. Patients receiving 4.5 mg did, however, experience significantly less motor blockade of shorter duration.