Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial Comparative Study
Magnesium added to bupivacaine prolongs the duration of analgesia after interscalene nerve block.
Local anesthetic adjuvants have been studied previously in an attempt to prolong the duration of analgesia after peripheral nerve blockade. Magnesium has been shown to have an antinociceptive effect in animal and human pain models. We evaluated the effects of adding magnesium sulphate to long-acting local anesthetics for interscalene nerve block to prolong the duration of analgesia and improve the analgesic quality. ⋯ The addition of magnesium sulphate to a bupivacaine-epinephrine mixture for interscalene nerve block prolongs the duration of analgesia and reduces postoperative pain.
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Randomized Controlled Trial Comparative Study
Use of a novel technique, solid phase microextraction, to measure tranexamic acid in patients undergoing cardiac surgery.
Solid phase microextraction (SPME) is a technique widely used and accepted in the field of food technology and in environmental and biological analyses. Despite its numerous advantages over older analytical methods, it has not been studied extensively in the medical sciences. Tranexamic acid (TXA) is currently the sole antifibrinolytic agent used during cardiac surgery involving the use of cardiopulmonary bypass (CPB). The current standard method of measuring TXA in plasma is based on plasma protein precipitation (PPP), but this analytical approach is time-consuming and not practical for routine use. The aim of the current study was to compare plasma TXA levels measured with the PPP method vs those acquired with the novel, highly efficient SPME technique. We also investigated the use of automated SPME with the aim of improving the technique so it could be used efficiently for measuring plasma TXA levels. ⋯ Solid phase microextraction is a relatively simple, rapid extraction technique that can facilitate future pharmacokinetic studies analyzing TXA drug concentrations and drug dosing in various clinical settings.
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Case Reports
Alternative site for median nerve blockade allowing early functional rehabilitation after hand surgery.
In this report we describe an alternative approach to catheter placement for continuous selective median nerve blockade. It spared the finger movements and therefore allowed early postoperative rehabilitation in a patient who underwent surgical repair of the index finger flexor tendon. ⋯ Placement of a catheter for continuous median nerve blockade in the proximal one-third of the forearm for effective postoperative pain-free rehabilitation after hand surgery should be considered in cases in which the surgical incision extends toward the patient's wrist. The block site can be readily identified by a combined use of ultrasonography and neurostimulation guidance.
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Case Reports
Extubation of a difficult airway after thyroidectomy: use of a flexible bronchoscope via the LMA-Classic™.
We report an extubation strategy for a patient scheduled for thyroidectomy who had several factors indicating that it would be a difficult extubation. ⋯ We describe a viable extubation strategy used in a patient after complex thyroid surgery involving tracheal resection. By using the LMA-Classic™ as a bridging device and to facilitate bronchoscopic examination, we were able to address the above concerns and safely manage the extubation phase in this patient.