Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Comparative Study Clinical Trial
Comparative efficacy of uterotonic agents: in vitro contractions in isolated myometrial strips of labouring and non-labouring women.
To compare the in vitro contractile responses to oxytocin, ergonovine, prostaglandin F2 alpha (PGF2α), and misoprostol in isolated myometrium from non-labouring and labouring pregnant women. ⋯ Oxytocin induces superior myometrial contractions compared with ergonovine, PGF2α, and misoprostol. The effect of oxytocin is reduced in myometrium of women with oxytocin-augmented labour; however, it is still superior to the other uterotonics. This trial was registered at ClinicalTrials.gov: NCT01689311.
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Hyperbaric 2% prilocaine (HP) is increasingly used for spinal anesthesia in day-case surgery. The aim of this prospective double-blind study was to determine the effective dose (ED)50 and the ED90 of HP for patients undergoing knee arthroscopy. ⋯ This study determined the ED50 of HP is 28.9 mg and suggests that a 40-mg dose of HP is adequate to provide successful spinal anesthesia for outpatient knee arthroscopy.
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Patients must receive information in a manner that promotes understanding so they can make informed decisions about anesthesia and other medical interventions. Unfortunately, history is replete with examples of the negative consequences of inadequate disclosure of information and lack of patient understanding. While obtaining consent for anesthesia poses unique challenges, the ability of the anesthesiologist to engage the patient in meaningful discussion is critical as a means to ensure that the patient is truly informed. This narrative review aims to: 1) discuss the process of informed consent as it applies to anesthesia practice; 2) describe the salient issues related to patient capacity, disclosure, understanding, decision-making, and documentation of the informed consent process; and 3) discuss current strategies to improve the presentation and understanding of consent information. ⋯ Despite the unique challenges of obtaining consent for anesthesia on the day of surgery, attention to the manner in which information for anesthesia care is provided and adoption of simple strategies to enhance understanding can go a long way to ensure that decision-makers are appropriately informed.
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Shock is defined as a situation where oxygen transport is inadequate to meet the body's oxygen demand. An understanding of the mechanism(s) of reduced cardiac output, a determinant of oxygen transport, is crucial in order to initiate appropriate therapy to manage shock. Combining the concept of venous return with the ventricular pressure-volume relationship is a useful method to appreciate the complex circulatory physiology of shock. Clues from the patient's history, physical examination, and key laboratory tests, along with the careful inspection of hemodynamic, electrocardiographic and respiratory waveforms can help with the identification of the etiology and mechanism(s) of shock. Following verification of the arterial pressure, general resuscitation can begin, and more specific treatment can be undertaken to manage shock. If the patient is unresponsive to these measures, bedside ultrasound can then be performed to ascertain more detail regarding the mechanism(s) and etiology of shock. ⋯ Not applicable.