Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial
Carbetocin at Cesarean delivery for labour arrest: a sequential allocation trial to determine the effective dose.
The aim of this study was to estimate the effective dose 90% (ED90) of carbetocin to provide adequate uterine tone at Cesarean delivery (CD) for labour arrest. ⋯ The ED90 of carbetocin at CD for labour arrest, as determined in our study, should be interpreted with caution since it may be underestimated. This dose is higher than the currently recommended dose of 100 µg at elective CD and should not be used routinely given the uncertainty regarding its efficacy and the high incidence of arrhythmias at higher doses. This trial was registered at ClinicalTrials.gov, number: NCT01725243.
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Review Meta Analysis
Postoperative recovery after anesthesia in morbidly obese patients: a systematic review and meta-analysis of randomized controlled trials.
Obese patients present a challenge to safe general anesthesia because of impaired cardiopulmonary physiology and increased risks of aspiration and acute upper airway obstruction. Since studies are lacking regarding the postoperative effects on recovery from general anesthesia in morbidly obese patients, we conducted a systematic review and meta-analysis of recovery outcomes in morbidly obese patients who had undergone general anesthesia. ⋯ Postoperative recovery was significantly faster after desflurane than after sevoflurane, isoflurane, or propofol anesthesia in obese patients. No clinically relevant differences were observed regarding PACU discharge time, incidence of PONV, or postoperative pain scores. The systematic review was registered with PROSPERO (CRD42014009480).
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Randomized Controlled Trial
Effect of superficial cervical plexus block on postoperative quality of recovery after anterior cervical discectomy and fusion: a randomized controlled trial.
Spine surgeries are increasingly being performed as a day or short-stay surgery programs. Peripheral nerve block provide site-specific pain relief with few side effects, thereby reducing surgical stress and enhancing quality of recovery. The aim of our study was to determine the effect of a superficial cervical plexus block (SCPB) on postoperative quality of recovery and analgesia in patients undergoing elective anterior cervical discectomy and fusion (ACDF). ⋯ We showed that preoperative SCPB is an effective strategy for improving the early quality of recovery in patients undergoing single- or two-level ACDF. Nevertheless, there was no impact on opioid consumption or discharge times. This trial was registered at www.clinicaltrials.gov (NCT01662219).
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Editorial Comment
The "Friday effect": Can epidemiology tell us when to operate?
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Randomized Controlled Trial
A naloxone admixture to prevent opioid-induced pruritus in children: a randomized controlled trial.
Morphine administered by continuous opioid infusion (COI) or by patient-controlled analgesia (PCA) is associated with opioid-induced pruritus (OIP). Intravenous naloxone administered separately to the morphine infusion at a dose of 0.25-1.65 μg·kg(-1)·hr(-1) can provide effective prevention from OIP. Nevertheless, this strategy requires a dedicated intravenous line and an additional infusion pump. The purpose of this study was to determine whether an admixture of naloxone with morphine in normal saline administered via COI or PCA would also prevent OIP in children without attenuation of analgesia or increased opioid utilization. ⋯ This admixture of naloxone and morphine in normal saline did not decrease the incidence or severity of OIP in this sample. Separate administration of naloxone may be the more effective strategy for prevention of OIP. This trial was registered at ClinicalTrials.gov (NCT01071057).