British journal of anaesthesia
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A patient developed persistent symptoms and signs suggestive of partial spinal cord infarction after an operation involving the use of the hyperlordotic position. This position involves extension at the waist, such that both the head and feet are below the level of the waist. It is employed to increase surgical access to the abdomen. Where this position is adopted for a prolonged surgical procedure, existing risk factors for spinal cord ischaemia should urge caution in the use of epidural analgesia.
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Randomized Controlled Trial Clinical Trial
Analgesic effects of parecoxib following total abdominal hysterectomy.
Forty-eight ASA I-II patients undergoing total abdominal hysterectomy (TAH) were studied in a double blind, randomized placebo controlled trial of parecoxib for postoperative analgesia. ⋯ Parecoxib 40 mg i.v. may be recommended in patients having TAH as it provides morphine-sparing analgesia.
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There has long been an appreciation that cerebral blood flow is modulated to ensure adequate cerebral oxygen delivery in the face of systemic hypoxaemia. There is increasing appreciation of the modulatory role of hyperoxia in the cerebral circulation and a consideration of the effects of such modulation on the maintenance of cerebral tissue oxygen concentration. ⋯ However, before the modulatory effects of hyperoxia can be used for diagnosis, to predict prognosis or to direct therapy, a more detailed analysis and understanding of the physiological concepts behind this modulation are required, as are the limitations of the measurement tools used to define the modulation. This overview summarizes the available information in this area and suggests some avenues for further research.
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Randomized Controlled Trial Clinical Trial
Sedation caused by clonidine in patients with spinal cord injury.
In patients with spinal cord injury, cephalad spread of intrathecal (i.t.) medication could be delayed. ⋯ A systemic effect is likely to be the main reason for sedation.