Anaesthesia
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We propose recommendations to reduce the risk of haemorrhagic events associated with regional anaesthesia in patients treated with newer anticoagulants after orthopaedic surgery. The risk/benefit ratio should be individualised for each patient according to the type and dose of anticoagulant, the type of regional anaesthesia and patient risk factors. ⋯ After removing a catheter or after a haemorrhagic puncture, the timing of the next anticoagulant injection should be based on the time required for an anticoagulant dose to reach maximum activity. Vigilance remains paramount during the initial days after removal of a neuraxial catheter.
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Clinical Trial
The effect of time of day on the duration of neuromuscular blockade elicited by rocuronium.
In a prospective, observational trial, we investigated the influence of time of day on the duration of neuromuscular blockade (NMB) elicited by rocuronium. Forty-nine patients scheduled for surgery between 08:00 and 02:00 were enrolled after giving written informed consent. Time to neuromuscular recovery was measured following three doses: (1) a fat-free-mass (FFM) related induction dose (0.6 mg x kg(-1): n = 47); (2) a maintenance dose (20% of the induction dose: n = 42); and (3) a standard 10-mg dose (n = 35). ⋯ The maximum effect of 50 min (95% CI 41-59 min) was elicited between 08:00 and 11:00 and the minimum duration of 29 min (95% CI 23-35 min) between 14:00 and 17:00 (p = 0.005). A similar pattern was observed for the maintenance dose. The duration of action of rocuronium is influenced by time of day and this effect is of potential clinical significance and practical relevance to research.
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Randomized Controlled Trial Comparative Study
A comparison of the disposable vs the reusable laryngeal tube in paralysed adult patients.
A disposable laryngeal tube (LT-D) with dimensions identical to, but physical properties different from (stiffer tube/thicker cuff), the reusable laryngeal tube (LT-R) has recently become available. We performed a randomised, single blind trial among 100 anaesthetised and paralysed patients to compare these devices in terms of ease of insertion, airway sealing pressure, position assessed fibreoptically and postoperative throat complications. Anaesthesia was administered with midazolam, fentanyl, propofol, atracurium, oxygen and isoflurane. ⋯ There were no differences in airway sealing pressure, fibreoptic position or post operative sore throat and dysphagia. The intra cuff pressure remained stable for the LT-R but decreased slightly for the LT-D. In paralysed, anaesthetised patients, the single use and reusable laryngeal tubes are similar in clinical performance.
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Randomized Controlled Trial
A comparison of dexmedetomidine and midazolam for sedation in third molar surgery.
This randomised, double-blind study compared dexmedetomidine and midazolam for intravenous sedation during third molar surgery under local anaesthesia. Sixty patients received either dexmedetomidine (up to 1 microg x kg(-1)) or midazolam (up to 5 mg), which was infused until the Ramsay Sedation Score was four or the maximum dose limit was reached. Intra-operative vital signs, postoperative pain scores and analgesic consumption, amnesia, and satisfaction scores for patients and surgeons, were recorded. ⋯ There was no significant difference in satisfaction or pain scores. Midazolam was associated with greater amnesia. Dexmedetomidine produces comparable sedation to midazolam.