Journal of clinical anesthesia
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The efficacy of the erector spinae plane block (ESPB) has been demonstrated in several meta-analyses and it is increasingly being used in clinical practice. However, its mechanism of action is still not fully elucidated. Although initial anatomical studies have suggested the spread of the injectate into the paravertebral space as the main mechanism of action, more recent studies have not consistently demonstrated this. This systematic review was conducted to determine the overall proportion and extent of injectate spread following a thoracic ESPB. ⋯ Based on this study, the thoracic ESPB consistently led to injectate spread into the ESP compartment but less reliable spread into the PVS, ES and ICS compartments. There is also preliminary evidence that an increased time to assessment may be associated with an increased spread of injectate into the PVS.
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We tested the hypothesis that pre-existing chronic pain is associated with prolonged time to reach sustained acceptable pain scores after major surgery. ⋯ Patients with chronic pain sustain more surgical pain than those without, and the pain takes longer to resolve. Clinicians providing postoperative pain management should consider the special needs of chronic pain patients.
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Randomized Controlled Trial
The effect of driving pressure-guided versus conventional mechanical ventilation strategy on pulmonary complications following on-pump cardiac surgery: A randomized clinical trial.
Postoperative pulmonary complications occur frequently and are associated with worse postoperative outcomes in cardiac surgical patients. The advantage of driving pressure-guided ventilation strategy in decreasing pulmonary complications remains to be definitively established. We aimed to investigate the effect of intraoperative driving pressure-guided ventilation strategy compared with conventional lung-protective ventilation on pulmonary complications following on-pump cardiac surgery. ⋯ Among patients who underwent on-pump cardiac surgery, the use of driving pressure-guided ventilation strategy did not reduce the risk of postoperative pulmonary complications when compared with conventional lung-protective ventilation strategy.
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Randomized Controlled Trial
Nasal continuous positive pressure versus simple face mask oxygenation for adult obese and obstructive sleep apnea patients undergoing colonoscopy under propofol-based general anesthesia without tracheal intubation: A randomized controlled trial.
To determine if a nasal positive airway pressure (nasal CPAP) mask would decrease the number of hypoxemic events in obese and obstructive sleep apnea patients undergoing colonoscopy. ⋯ A nasal CPAP did not prevent hypoxemia and should not be used routinely for colonoscopy in obese or OSA patients if a simple face mask is an alternative therapy. However, potential advantages of its use include fewer airway maneuvers or interventions, which may be desirable in certain clinical settings.
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Observational Study
Association between maternal labour epidural analgesia and autistic traits in offspring.
Studies investigating associations between maternal epidural analgesia (MEA) and autism spectrum disorder (ASD) in the offspring are conflicting and lack prospective neurobehavioral follow-up assessments for autistic traits. We aim to prospectively investigate associations between MEA and autistic traits in the offspring. ⋯ MEA is not significantly associated with the development of ASD and autistic traits in offspring, assessed over 7 years. Results should be taken into perspective given our wide confidence intervals and small cohort size.