Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jan 2012
Review Meta AnalysisNeuromuscular blocking agents for electroconvulsive therapy: a systematic review.
Electroconvulsive therapy (ECT) is the transcutaneous application of small electrical stimuli to the brain to induce generalised seizures for the treatment of selected psychiatric disorders. The clinical indications for ECT as an effective therapeutic modality have been considerably expanded since its introduction. Anaesthesia and neuromuscular blocking agents (NMBAs) are required to ensure patients' safety during ECT. ⋯ Slight residual motor convulsive activity is helpful in ascertaining that a seizure has occurred, while total paralysis prolongs the procedure unnecessarily. Suxamethonium is commonly used, but nondepolarising NMBAs are indicated in patients with certain comorbidities. In this review, we summarise current concepts of NMBA management for ECT.
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Acta Anaesthesiol Scand · Jan 2012
Randomized Controlled Trial Comparative StudyShort stay and less pain after ambulatory anterior cruciate ligament (ACL) repair: COX-2 inhibitor versus glucocorticoid versus both combined.
Many studies have demonstrated that either COX-2 antagonists or glucocorticoids are efficient analgesics after orthopaedic surgery. We wanted to evaluate if the combination of these two drugs was better than one drug alone when added to paracetamol, local anaesthesia, and cryo-cuff for outpatient anterior crucial ligament (ACL) surgery. ⋯ The combination of a COX-2 inhibitor and dexamethasone results in better pain relief 24 h after surgery in patients undergoing outpatient ACL surgery, compared to COX-2 inhibitor alone or dexamethasone alone. With a dedicated multimodal pain regime, most ACL patients may be discharged within 3 h.
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Acta Anaesthesiol Scand · Jan 2012
Randomized Controlled TrialProtection by remote ischemic preconditioning during coronary artery bypass graft surgery with isoflurane but not propofol - a clinical trial.
Remote ischemic preconditioning (RIPC) of the myocardium by limb ischemia/reperfusion may mitigate cardiac damage, but its interaction with the anesthetic regimen is unknown. We tested whether RIPC is associated with differential effects depending on background anesthesia. Specifically, we hypothesized that RIPC during isoflurane anesthesia attenuates myocardial injury in patients undergoing coronary artery bypass graft (CABG) surgery, and that effects may be different during propofol anesthesia. ⋯ Thus, RIPC during isoflurane but not during propofol anesthesia decreased myocardial damage in patients undergoing CABG surgery. Accordingly, effects of RIPC evoked by upper limb ischemia/reperfusion depend on background anesthesia, with combined RIPC/isoflurane exerting greater beneficial effects under conditions studied.
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Acta Anaesthesiol Scand · Jan 2012
Randomized Controlled TrialLow dose intrathecal morphine effects on post-hysterectomy pain: a randomized placebo-controlled study.
Spinal anesthesia with different doses of intrathecal morphine has been shown to relieve post-operative pain. We studied in a prospective randomized, double-blind fashion the effects of morphine 0, 100, 200, or 300 μg added to intrathecal bupivacaine on first post-operative 24 h patient-controlled analgesia morphine (PCA-morphine) consumption after abdominal hysterectomy under general anesthesia. ⋯ Intrathecal morphine supplementation to bupivacaine reduces first 24 h PCA-morphine consumption after abdominal hysterectomy under general anesthesia, and we found no benefit from increasing the dose over 200 μg.
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Acta Anaesthesiol Scand · Jan 2012
Heart rate limitation and cardiac unloading in sevoflurane post-conditioning.
Sevoflurane post-conditioning (SePost) has been found to alleviate ischemic myocardial reperfusion injury through the activation of prosurvival kinases. Lowered myocardial oxygen demand from reduced cardiac work may also contribute to cardioprotection, and is much less well-studied. Our aim was to examine the simultaneous effects of SePost on cardiac work (here, rate-pressure product, RPP) and myocardial infarct size in a porcine model. ⋯ SePost (1.5-3%) reduced infarct size after regional myocardial ischemia in vivo and reduced cardiac work was significantly correlated to myocardial salvage.