Journal of clinical anesthesia
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We report an unusual case of endotracheal tube obstruction secondary to alteration of the preoperative fasting period. A patient scheduled for coronary artery bypass grafting had been instructed to take nothing by mouth except scheduled medication with sips of water prior to surgery. Induction of anesthesia and tracheal intubation were accomplished without incident. ⋯ We believe that the mass of gum caused enough deviation of the endotracheal tube to impair ventilation. The safety of preoperative gum chewing and liquid ingestion is discussed. Other incidents of anesthetic problems caused by modification of the traditional preoperative fast are highlighted.
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Randomized Controlled Trial Clinical Trial
Intravenous clonidine fails to reduce postoperative meperidine requirements.
To investigate the effect of an additional postoperative intravenous (IV) clonidine infusion on meperidine requirements in the early postoperative period. ⋯ During the first 2 postoperative hours following cholecystectomy, postoperative meperidine intake could not be reduced by IV administration of clonidine 300 micrograms.
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Meta Analysis
Postoperative patient-controlled analgesia: meta-analyses of initial randomized control trials.
To compare outcomes during conventional analgesia (as-needed intramuscular dosing) and patient-controlled analgesia (PCA) in postoperative patients by analyzing data from published comparative trials. ⋯ Patient preference strongly favors PCA over conventional analgesia. Patients using PCA also obtain better pain relief than those using conventional analgesia, without an increase in side effects. Favorable effect of PCA upon analgesic usage and length of hospital stay did not in the initial trials attain statistical significance. Nonetheless, the favorable trends in the mean effect sizes for both outcomes argue that further studies of both outcomes should be performed to determine whether the favorable impact of PCA upon either may become statistically significant if larger numbers of patients are enrolled.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of dexmedetomidine and midazolam sedation and antagonism of dexmedetomidine with atipamezole.
To evaluate the effects of dexmedetomidine, an alpha-2 agonist, as an intravenous sedative drug and the effects of atipamezole, an alpha-2 antagonist, on recovery. ⋯ Atipamezole is an effective antagonist for reversing psychomotor impairment following dexmedetomidine sedation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Spinal or systemic analgesia after extensive spinal surgery: comparison between intrathecal morphine and intravenous fentanyl plus clonidine.
To compare two different methods of postoperative analgesia after extensive spinal fusion. ⋯ This study shows that there is a major risk of respiratory depression with a single intrathecal dose of morphine 0.3 mg to control postoperative pain after scoliosis surgery. Systemic clonidine-fentanyl may be a possible approach to the postoperative pain treatment of this surgery.