Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial
Up-down determination of the ED(90) of oxytocin infusions for the prevention of postpartum uterine atony in parturients undergoing Cesarean delivery.
Use of the lowest effective dose of oxytocin may reduce side effects. This study was designed to determine the effective dose (ED)(90) of oxytocin infusion for an elective Cesarean delivery (CD) to prevent uterine atony. ⋯ In this study, we found the ED(90) of oxytocin required to prevent uterine atony and postpartum hemorrhage after an elective CD to be 0.29 IU.min(-1)-approximately 15 IU of oxytocin in 1 L of intravenous fluid administered over a one-hour period-(95% CI 0.15-0.43 IU.min(-1)). This oxytocin infusion dose is 30% less than the clinical infusions currently in use. It remains to be seen whether this dosing will be required for higher risk individuals or for labouring parturients undergoing non-elective CD. (Clinical Trial gov. NCT00785395).
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To provide an evidence-based overview and update on the use of the Fastrach Intubating Laryngeal Mask Airway (FT-LMA) when used within operative and non-operative settings. ⋯ The FT-LMA has proven to be a useful difficult airway device both within and outside of the operating room. Effective ventilation is established in nearly all cases, and blind ETI is possible in the vast majority of cases if the optimal techniques described are used. Serious complications are uncommon.
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In diabetics, elevated preoperative hemoglobin A1c (HbA1c) levels are associated with increased complication rates after cardiac surgery. While many non-diabetics also have elevated HbA1c, the relationship with outcome in these patients is not well understood. Therefore, in a cohort of non-diabetic patients, we tested the hypothesis that preoperative HbA1c is associated with early mortality risk after cardiac surgery. ⋯ In non-diabetics, an elevated preoperative HbA1c level (>6.0%) is independently associated with significantly greater early mortality risk after elective cardiac surgery. Our findings suggest that HbA1c may have value as a screening tool to identify high-risk non-diabetic cardiac surgery patients.
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Controlled Clinical Trial
No change in impedance upon intravascular injection of D5W.
Electrical impedance increases following test injections of non-conducting solutions around nerves; however, this increase should diminish rapidly with intravascular needle placement, wherein the systemic circulation will dissipate the solution. For this observational study, we hypothesized that the impedance increases significantly at the perineural space after an injection of 5% dextrose in water (D5W), but that it does not increase correspondingly at the intravascular location ⋯ The absence of a significant increase in impedance upon injection of D5W prior to injection of local anesthetic may provide useful information to warn of intravascular injection.