Canadian journal of anaesthesia = Journal canadien d'anesthésie
-
Randomized Controlled Trial
Esmolol versus ketamine-remifentanil combination for early postoperative analgesia after laparoscopic cholecystectomy: a randomized controlled trial.
Controversy surrounds the optimal technique to moderate pain after laparoscopic cholecystectomy (LC). Opioid analgesics, sympatholytic drugs, and adjuvants, such as ketamine, have all been used. We compared esmolol with a combination of remifentanil plus ketamine in patients undergoing LC to determine the impact of these drugs on morphine requirements and pain control. ⋯ Intraoperative esmolol infusion reduces morphine requirements and provides more effective analgesia compared with a combination of remifentanil-ketamine given by infusion in patients undergoing LC.
-
Multicenter Study
Retrospective analysis of perioperative ketorolac and postoperative bleeding in reduction mammoplasty.
We conducted a retrospective review following concerns involving a suspected increase in the requirement for surgical re-exploration for hematoma evacuation when ketorolac was administered perioperatively in patients undergoing reduction mammoplasty. ⋯ A single perioperative intravenous dose of ketorolac was associated with a greater than three-fold increase in the likelihood of requirement for surgical hematoma evacuation. Our data suggest that it may be prudent to consider carefully whether the potential risks associated with the use of ketorolac outweigh the potential benefits of using ketorolac in patients undergoing reduction mammoplasty.
-
Since certain surgical procedures still require a sitting or reverse Trendelenburg position, it remains important to evaluate the risk for paradoxical embolization. Intracardiac shunting, the most common cause being a patent foramen ovale, can be excluded by contrast-enhanced transesophageal echocardiography. There are, however, less described cases which result from patency of intrapulmonary functional arteriovenous anastomoses and lead to extra-cardiac paradoxical air embolism during anesthesia. We report a unique case to increase awareness of this real and potentially dangerous complication. ⋯ In the presence of massive venous air emboli, intrapulmonary right-to-left paradoxical air emboli can occur while intraoperatively transitioning a patient from the sitting to the supine position.
-
Randomized Controlled Trial Comparative Study
Double-lumen tube placement with the patient in the supine position without a headrest minimizes displacement during lateral positioning.
The correct position of double-lumen tubes (DLTs) is customarily confirmed after tracheal intubation by bronchoscopy with the patient supine on a headrest. However, displacement of DLTs usually occurs during lateral positioning because of neck extension. This study was undertaken to determine whether displacement of DLTs could be minimized during lateral positioning if DLTs were positioned without a headrest. ⋯ Displacement of DLTs during lateral positioning appears to be caused primarily by extension of the neck. Correct adjustment of DLT position without a headrest in the supine position is an easy and effective method to minimize DLT displacement during lateral positioning.