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
A comparison between the GlideScope Video Laryngoscope and direct laryngoscope in paediatric patients with difficult airways - a pilot study.
The GlideScope Video Laryngoscope may improve the view seen at laryngoscopy in adults who have a difficult airway. Manikin studies and case reports suggest it may also be useful in children, although prospective studies are limited in number. We hypothesised that the paediatric GlideScope will result in an improved view seen at laryngoscopy in children with a known difficult airway, compared to direct laryngoscopy. ⋯ The GlideScope yielded a significantly improved laryngoscopic view, both with (p = 0.003) and without (p = 0.004) laryngeal pressure. The mean (SD) time taken to achieve the optimal view was 20 (8)s using conventional laryngoscopy and 26 (22)s using the GlideScope (p = 0.5). The GlideScope significantly improves the laryngoscopic view obtained in children with a difficult airway.
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The advances in regional techniques for blocks of the lower limb have been driven primarily by the need to produce effective analgesia in the postoperative period and beyond. These techniques are commonly performed before or after central neuraxial blockade when this technique is used to provide anaesthesia and analgesia for the surgical procedure. Increasingly, modern practice demands a shorter hospital stay, improved patient expectations and early mobilisation. This article describes the current methods and reasons for performing specific blocks to the lower limb and the management of these blocks particularly in the postoperative period.