Canadian journal of anaesthesia = Journal canadien d'anesthésie
-
Randomized Controlled Trial
Efficacy of a single dose of dexmedetomidine for cough suppression during anesthetic emergence: a randomized controlled trial.
Maintenance of a remifentanil infusion during anesthetic emergence has been reported to decrease the incidence of coughing and thereby help to ensure a smooth emergence. It may, however, cause respiratory depression and possibly delay emergence. The purpose of this study was to investigate the effect of a single dose of dexmedetomidine combined with a low-dose remifentanil infusion on cough suppression during emergence from general anesthesia. ⋯ Compared with an infusion of low-dose remifentanil alone, the addition of a single dose (0.5 μg·kg(-1)) of dexmedetomidine during emergence from sevoflurane-remifentanil anesthesia was effective in attenuating coughing and hemodynamic changes and did not exacerbate respiratory depression after thyroid surgery. This trial was registered at Clinicaltrial.gov, identifier: NCT01774305.
-
Comparative Study
Neuraxial anesthesia improves long-term survival after total joint replacement: a retrospective nationwide population-based study in Taiwan.
This study explored the effects of general (GA) and neuraxial (NA) anesthesia on the outcomes of primary total joint replacement (TJR) in terms of postoperative mortality, length of stay (LOS), and hospital treatment costs. ⋯ Our results support the use of NA for primary TJR. The improvements in hospital costs persist even when anesthesia costs are removed. The mechanism underlying the association between NA and long-term survival is unknown.
-
Lumbar plexus (LP) block is a common and useful regional anesthesia technique. Surface landmarks used to identify the LP in patients with healthy spines have been previously described, with the distance from the spinous process (SP) to the skin overlying the LP being approximately two-thirds the distance from the SP to the posterior superior iliac spine (PSIS) (SP-LP:SP-PSIS ratio). In scoliotic patients, rotation of the central neuraxis may make these surface landmarks unreliable, possibly leading to an increased block failure rate and an increased incidence of complications. The objective of the present study was to describe these surface landmarks of the LP in patients with scoliosis. ⋯ In patients with scoliotic disease of the spine, there is wide variability in the bony surface landmarks. The location of the LP is generally more medial than expected when compared with both modified and traditional landmarks. A review of the imaging studies and the pre-procedural ultrasound assessment of the anatomy should be considered prior to needle puncture.