British journal of anaesthesia
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One major risk factor of the sitting position for neurosurgery is air embolism, especially in patients with persistent foramen ovale (PFO). The first aim of this prospective study was to evaluate a bedside method for detecting PFO using transcranial Doppler sonography (TCD) with contrast medium. A second aim was to address intraoperative monitoring, patient positioning and the occurrence and clinical relevance of air embolism. ⋯ To address the risk of a paradoxical air embolism, especially in patients undergoing surgery in sitting position, preoperative detection of PFO is advisable. If surgery is performed in seated PFO patients, additional monitoring and special care are warranted.
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Randomized Controlled Trial
Magnesium moderately decreases remifentanil dosage required for pain management after cardiac surgery.
Magnesium is a calcium and an NMDA-receptor antagonist and can modify important mechanisms of nociception. We evaluated the co-analgesic effect of magnesium in the postoperative setting after on-pump cardiac surgery. ⋯ Magnesium gluconate moderately reduced the remifentanil consumption without serious side-effects. The opioid-sparing effect of magnesium may be greater at higher pain intensities and with increased dosages.
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Randomized Controlled Trial Comparative Study
A comparison of patient-controlled subacromial and i.v. analgesia after open acromioplasty surgery.
The aim of this study was to compare three patient-controlled analgesia (PCA) techniques for pain relief after acromioplasty. These techniques included use of subacromial ropivacaine, subacromial fentanyl or i.v. fentanyl. ⋯ The PCA techniques using subacromial ropivacaine or fentanyl i.v. provided similar and adequate pain relief and minimal side-effects after open acromioplasty surgery. The PCA using subacromial fentanyl was not as effective as either subacromial ropivacaine or i.v. fentanyl.
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The laryngeal mask airway CTrach (CTrach) is a variant of the intubating laryngeal mask airway. It provides visualization of the larynx during intubation and is designed to increase the success rates of ventilation and tracheal intubation. ⋯ In 60 patients with normal airways, the CTrach was used successfully for ventilation, with successful tracheal intubation in 59 patients. Tracheal intubation can be successful despite grade III or IV views.
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Acute surgical admission during weekends, with reduced staffing levels, has been associated with increased risk of mortality, but the effect of longer vacation/holiday periods has not been studied. We therefore examined early postoperative mortality in hip fracture patients admitted during weekends and holiday periods, compared with normal weekdays. ⋯ Staff reduction during holiday periods in units that care for acute surgical patients may adversely influence postoperative outcome. This may have important consequences both for outcome analysis of interventions and the planning of resource management in surgical units.