British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Double-blind, placebo-controlled analgesic study of ibuprofen or rofecoxib in combination with paracetamol for tonsillectomy in children.
The analgesics used for paediatric tonsillectomy may be associated with side-effects such as sedation, respiratory depression and vomiting (opioids) or increased bleeding [non-steroidal anti-inflammatory drugs (NSAIDs)]. In our institution, we employ a combination of paracetamol, NSAID and opioid, although there is no published evidence of analgesic benefit from adding NSAIDs to paracetamol in children. ⋯ This study provides evidence to support the combination of ibuprofen (but not rofecoxib) with paracetamol for perioperative analgesia in children.
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We quantified the predictive performance of our computer model of the administration of inhalation anaesthesia from a Datex-Ohmeda Modulus CD circle-absorber system. ⋯ Administration of inhalation anaesthesia can be based on version 2 of this model, but must be guided by active monitoring.
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Systemic venous air embolism is a serious complication in patients with chronic liver disease having liver surgery. Intrapulmonary arteriovenous shunting can permit air emboli to pass into the systemic circulation. We describe a case of paradoxical air embolism detected by transoesophageal echocardiography in a patient with cirrhosis who was having a hepatic resection.
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Comment Letter Case Reports
Myasthenia gravis unmasked by neuromuscular blockade.
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This review focuses on the mechanisms and sites of action underlying beta-adrenergic antagonism in perioperative medicine. A large body of knowledge has recently emerged from basic and clinical research concerning the mechanisms of the life-saving effects of beta-adrenergic antagonists (beta-AAs) in high-risk cardiac patients. This article re-emphasizes the mechanisms underlying beta-adrenergic antagonism and also illuminates novel rationales behind the use of perioperative beta-AAs from a biological point of view. ⋯ Despite overwhelming evidence of benefit, beta-AAs are currently under-utilized in the perioperative period because of concerns of potential adverse effects and toxicity. The effects of acute administration of beta-AAs on cardiac function in the compromised patient and strategies to counteract potential adverse effects will be discussed in detail. This may help to overcome barriers to the initiation of perioperative treatment with beta-AAs in a larger number of high-risk cardiac patients undergoing surgery.