Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial
Carbetocin at elective Cesarean delivery: a randomized controlled trial to determine the effective dose.
The primary objective of our study was to determine the minimum intravenous dose of carbetocin required to produce adequate uterine contraction in 95% of women (effective dose [ED](95)) undergoing elective Cesarean delivery (CD). ⋯ In women at low risk for PPH undergoing elective CD, carbetocin doses of 80-120 μg are similarly effective. There is a high incidence of hypotension associated with carbetocin in these doses, and further studies with doses lower than 80 μg are warranted to assess the balance of efficacy and side effects. This trial was registered at www.clinicaltrials.gov (NCT01262742).
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Postoperative complications represent a major concern for elderly patients. We report a case of a medically complex and frail 88-yr-old woman with endometrial cancer who was scheduled for a robotic-assisted total abdominal hysterectomy. In addition to her cardiac morbidity she presented with several risk factors for neurocognitive decline, including prior episodes of postoperative delirium. ⋯ This report provides suggestive evidence that a prehabilitation program optimized the health of this elderly patient and may have prevented a further episode of postoperative delirium. Prehabilitation protocols should be evaluated in clinical trials to evaluate their efficacy and the target populations who may benefit and to elucidate the underlying mechanisms responsible for enhanced recovery in the perioperative setting.
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Review Meta Analysis Comparative Study
Transversus abdominis plane block for analgesia after Cesarean delivery: a systematic review and meta-analysis.
In patients not receiving intrathecal morphine, TAP block after caesarean section reduced opioid use at 6, 12 and 24 hours, along with nausea at 12h.
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Preoperative cognitive impairment is associated with the development of postoperative delirium, a common and consequential complication of major surgery in older patients. Screening for cognitive impairment should become a routine part of the preoperative evaluation of older patients; however, its implementation is hampered by limited clinical time and resources. The objective of this review was to identify cognitive screening tools that could be easily incorporated into the evaluation of older patients before major surgery. ⋯ Incorporating a cognitive screening assessment into the preoperative evaluation of older patients is feasible. More research is needed to validate cognitive screening tools in the perioperative setting.
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The aim of this brief review is to provide an update on the theory regarding minimal fresh gas flow techniques for inhaled general anesthesia. The article also includes an update and discussion of the practical aspects associated with minimal-flow anesthesia, including the advantages, potential limitations, and safety considerations of this important anesthetic technique. ⋯ With our modern anesthesia machines, reducing the fresh gas flow of oxygen to 0.3-0.5 L·min(-1) and using third-generation inhaled anesthetics provide a reassuringly safe anesthetic technique. This environmentally friendly practice can easily be implemented for elective anesthesia; furthermore, it will facilitate cost savings and improve temperature homeostasis.