Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Apr 2012
Randomized Controlled TrialDexamethasone does not reduce pain or analgesic consumption after thyroid surgery; a prospective, randomized trial.
Post-operative analgesic effect of a perioperative fixed dose glucocorticoid has been demonstrated in studies on different surgical procedures. The aim of this study was to look for analgesic and opioid sparing effect after thyroid surgery with a weight-adjusted medium dose of dexamethasone compared with placebo or a higher dose. Further, to register other effects and side effects of dexamethasone in the 0–30 days postoperative period. ⋯ Dexamethasone had no analgesic or opioid sparing effect in our set-up after thyroid surgery. Dexamethasone reduced the incidence of PONV and led to a modest increase in blood sugar. A medium dose seems as effective as a higher dose.
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Acta Anaesthesiol Scand · Apr 2012
Randomized Controlled TrialElevated BIS and Entropy values after sugammadex or neostigmine: an electroencephalographic or electromyographic phenomenon?
Sugammadex is designed to antagonize neuromuscular blockade (NMB) induced by rocuronium or vecuronium. In clinical practice, we have noticed a rise in the numerical values of bispectral index (BIS) and Entropy, two electroencephalogram (EEG) - based depth of anesthesia monitors, during the reversal of the NMB with sugammadex. The aim of this prospective, randomized, double-blind study was to test this impression and to compare the effects of sugammadex and neostigmine on the BIS and Entropy values during the reversal of the NMB. ⋯ The EMG contamination of EEG causes BIS and Entropy values to rise during reversal of rocuronium-induced NMB in light propofol-remifentanil anesthesia.
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Acta Anaesthesiol Scand · Apr 2012
Case ReportsContinuous interscalene block: the good, the bad and the refined spread.
Continuous interscalene block is popular for shoulder surgery, but there are several challenges when performing this continuous block. The interscalene catheter is susceptible to incidental dislodgement and migration due to movement of the head and neck. ⋯ We present two cases: firstly, a case demonstrating an interscalene catheter insertion approach that provides an effective spread of local anaesthetic perineurally within the interscalene groove, with the additional benefit of preventing catheter dislodgement. Secondly, we present a case in which ultrasound-guided interscalene catheter insertion resulted in phrenic nerve palsy in an asthmatic patient, where dilution or 'wash-off' of local anaesthetic with normal saline and repositioning of the catheter under ultrasound guidance resulted in rapid recovery of respiratory function and adequate pain control.
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Acta Anaesthesiol Scand · Apr 2012
ReviewDesflurane: a clinical update of a third-generation inhaled anaesthetic.
Available volatile anaesthetics are safe and efficacious; however, their varying pharmacology provides small but potentially clinically important differences. Desflurane is one of the third-generation inhaled anaesthetics. It is the halogenated inhaled anaesthetic with the lowest blood and tissue solubilities, which promotes its rapid equilibration and its rapid elimination following cessation of administration at the end of anaesthesia. ⋯ In addition, the use of desflurane promotes early and predictable extubation, and the ability to rapidly transfer patients from the operating theatre to the recovery area, which has a positive impact on patient turnover. Desflurane also increases the likelihood of patients, including obese patients, recovering their protective airway reflexes and awakening to a degree sufficient to minimise the stay in the high dependency recovery area. The potential impact of the rapid early recovery from desflurane anaesthesia on intermediate and late recovery and resumption of activities of daily living requires further study.