Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial Comparative Study
Prewarming neurosurgical patients to minimize hypotension on induction of anesthesia: a randomized trial.
Prewarming prior to surgery is effective in preventing perioperative hypothermia. There is a paucity of evidence, however, regarding the hemodynamic effects of prewarming. We hypothesized that the nadir mean arterial pressure during anesthesia induction would be higher after prewarming than after no prewarming. ⋯ Prewarming with convective forced air for one hour prior to intravenous anesthetic induction did not prevent hypotension during the induction period (Australian New Zealand Clinical Trials Registry [ANZCTR] ACTRN12615000431527).
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Randomized Controlled Trial
Dexmedetomidine during total knee arthroplasty performed under spinal anesthesia decreases opioid use: a randomized-controlled trial.
It remains unclear whether the opioid-sparing effects of dexmedetomidine seen in patients undergoing general anesthesia are reproducible in patients undergoing spinal anesthesia. We hypothesized that the administration of intravenous dexmedetomidine for sedation during total knee arthroplasty under spinal anesthesia would decrease postoperative morphine consumption in the first 24 hr following surgery. ⋯ Dexmedetomidine was associated with a significant decrease in morphine use in the first 24 hr following total knee arthroplasty. Our study shows that an intraoperative infusion of dexmedetomidine for sedation in patients receiving spinal anesthesia can produce postoperative analgesic effects. This offers another potential adjunct in the multimodal pain management of these patients. This trial was registered at ClinicalTrials.gov (identifier NCT02026141).
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New regulations are in place at the federal and provincial levels in Canada regarding the way medical cannabis is to be controlled. We present them together with guidance for the safe use of medical cannabis and recent clinical trials on cannabis and pain. ⋯ The science of medical cannabis and the need for education of healthcare professionals and patients require continued effort. Although cannabinoids work to decrease pain, there is still a need to confirm these beneficial effects clinically and to exploit them with acceptable benefit-to-risk ratios.
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The immune system plays an important role in tumour progression. Systemic opioids are immunosuppressive; thus, theoretically they may promote tumour spread. Our primary aim was to test the hypothesis that general anesthesia (GA) with spinal analgesia (SA) in patients with bladder cancer undergoing radical cystectomy (RC) will both reduce systemic opioid use and improve oncological outcomes. Since blood transfusions also induce immunosuppression, a secondary aim was to evaluate the effect of perioperative transfusions on oncological outcomes. ⋯ In patients undergoing RC, the opioid-sparing effect with SA was not associated with improved oncological outcomes, while blood transfusion was associated with increased mortality.