Anaesthesia
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Review Meta Analysis
Association between nitrous oxide and the incidence of postoperative nausea and vomiting in adults: a systematic review and meta-analysis.
Some, but not all studies have suggested intra-operative use of nitrous oxide is correlated with postoperative nausea and vomiting. We performed a meta-analysis of randomised controlled trials to compare the incidence of nausea and vomiting in adults following general anaesthesia with or without nitrous oxide. We retrieved 30 studies (incorporating 33 separate trials) that investigated a 'nitrous oxide group' (total 2297 patients) vs a 'no-nitrous oxide group' (2301 patients). ⋯ In subgroup analysis, the maximal risk reduction was obtained in female patients (pooled relative risk 0.76, 95% CI 0.60-0.96). When nitrous oxide was used in combination with propofol, the antiemetic effect of the latter appeared to compensate the emetogenic effect of nitrous oxide (pooled relative risk 0.94, 95% CI 0.77-1.15). We conclude that avoiding nitrous oxide does reduce the risk of postoperative nausea and vomiting, especially in women, but the overall impact is modest.
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Randomized Controlled Trial Comparative Study
Effect of suxamethonium vs rocuronium on onset of oxygen desaturation during apnoea following rapid sequence induction.
This study investigates the effect of suxamethonium vs rocuronium on the onset of haemoglobin desaturation during apnoea, following rapid sequence induction of anaesthesia. Sixty patients were randomly allocated to one of three groups. Anaesthesia was induced with lidocaine 1.5 mg.kg(-1), fentanyl 2 microg.kg(-1) and propofol 2 mg.kg(-1), followed by either rocuronium 1 mg.kg(-1) (Group R) or suxamethonium 1.5 mg.kg(-1) (Group S). ⋯ The median (IQR [range]) time to reach S(p)O(2) of 95% was significantly shorter in Group S (358 (311-373 [245-430]) s) [corrected] than in Group R (378 (370-393 [366-420]) s; p = 0.003), and shorter in Group SO (242 (225-258 [189-270]) s) [corrected] than in both Group R (p < 0.001) and Group S (p < 0.001). When suxamethonium is administered for rapid sequence induction of anaesthesia, a faster onset of oxygen desaturation is observed during the subsequent apnoea compared with rocuronium. However, time to desaturation is prolonged whenever lidocaine and fentanyl precede suxamethonium.
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The goals for ambulatory surgery are rapid recovery with minimal side effects, adequate postoperative pain control, rapid patient discharge and overall cost containment. The addition of regional anaesthetic techniques has been shown to decrease nausea, postoperative pain scores and the need for post-anaesthesia care unit monitoring. The use of regional anaesthesia is increasing as studies confirm the goals for ambulatory anaesthesia can be met with a combination of regional anaesthesia and a multimodal pain management regimen.
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Randomized Controlled Trial
Determination of the optimal stylet strategy for the C-MAC videolaryngoscope.
The C-MAC videolaryngoscope is a novel intubation device that incorporates a camera system at the end of its blade, thereby facilitating obtaining a view of the glottis without alignment of the oral, pharyngeal and tracheal axes. It retains the traditional Macintosh blade shape and can be used as a direct or indirect laryngoscope. We wished to determine the optimal stylet strategy for use with the C-MAC. ⋯ The use of a stylet alone does not confer benefit in the setting of easy laryngoscopy. However, in more difficult laryngoscopy scenarios, the C-MAC videolaryngoscope performs best when used with a stylet that angulates the distal tracheal tube. The hockey-stick stylet configuration performed best in the scenarios tested.
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In this review, we discuss the central non-neuraxial regional anaesthesia blocks of the abdomen, including intercostal and intrapleural blocks, rectus sheath and ilioinguinal-iliohypogastric blocks, transversus abdominis plane blocks and paravertebral blocks.