Canadian journal of anaesthesia = Journal canadien d'anesthésie
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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.
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This article is a review of the efficacy and safety of the Laryngeal Mask Airway (LMA) Supreme™ as a stand-alone supraglottic airway during general anesthesia and as a conduit for tracheal intubation. Relevant articles were obtained using MEDLINE (1948-July 2011) and EMBASE (1980-July 2011). Only original studies with adult human patients and published in English were selected. ⋯ The LMA Supreme has been shown to be a safe and efficacious device as a stand-alone supraglottic airway and may also be used as a conduit for tracheal intubation. Further trials are needed to determine the efficacy of the LMA Supreme compared with other supraglottic airways in both elective and emergent airway management situations.
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Case Reports
Continuous spinal anesthesia for Cesarean hysterectomy and massive hemorrhage in a parturient with placenta increta.
We present anesthetic management using a continuous spinal anesthesia (CSA) technique in a patient with placenta increta who underwent elective Cesarean hysterectomy with massive postpartum hemorrhage. ⋯ A CSA technique may be a viable option in the event of inadvertent dural puncture during planned CSE or epidural placement in patients with a reassuring airway undergoing Cesarean delivery. Although a catheter-based neuraxial technique is appropriate for Cesarean hysterectomy for abnormal placentation, conversion to general anesthesia may be required in the event of massive perioperative hemorrhage and fluid resuscitation.
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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.