British journal of anaesthesia
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Randomized Controlled Trial Comparative Study
Randomized comparison of sugammadex and neostigmine for reversal of rocuronium-induced muscle relaxation in morbidly obese undergoing general anaesthesia.
Complete and fast recovery of neuromuscular function is very important in morbidly obese patients because of the possible influence of postoperative residual curarization (PORC) on respiratory function in the postoperative period. Recent reports underline incidences of the residual influence of neuromuscular blocking agents. ⋯ Administration of sugammadex provides fast recovery of neuromuscular function and prevents PORC in the morbidly obese, however neostigmine does not.
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Randomized Controlled Trial Comparative Study
Comparison between local anaesthesia with remifentanil and total intravenous anaesthesia for operative hysteroscopic procedures in day surgery.
This study aimed at comparing total i.v. anaesthesia (TIVA) with monitored anaesthesia care (MAC) during day-surgery operative hysteroscopy regarding: operation time, time to mobilization and discharge, and patient satisfaction. ⋯ Paracervical local anaesthesia combined with remifentanil is suitable for operative hysteroscopy in day surgery.
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Randomized Controlled Trial
Effect of remote ischaemic preconditioning on ischaemic-reperfusion injury in pulmonary hypertensive infants receiving ventricular septal defect repair.
Remote ischaemic preconditioning (RIPC) can reduce ischaemic-reperfusion injury in distant organs. The myocardial and pulmonary protective effect of RIPC in infants with pulmonary hypertension remains unclear. We conducted a randomized controlled trial to evaluate the effect of RIPC in infants receiving ventricular septal defect (VSD) repair. ⋯ RIPC does not reduce the postoperative TnI release after VSD repair in infants with pulmonary hypertension. Additionally, it is difficult to find significant clinical benefits of RIPC in this population. The effect of RIPC varies according to clinical situation and patient condition. Clinical trial registration: ClinicalTrials.gov, NCT01313832.
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Relief of acute pain during the immediate postoperative period is an important task for anaesthetists. Morphine is widely used to control moderate-to-severe postoperative pain and the use of small i.v. boluses of morphine in the post-anaesthesia care unit allows a rapid titration of the dose needed for adequate pain relief. The essential principle of a titration regimen must be to adapt the morphine dose to the pain level. ⋯ The incidence of ventilatory depression is very low when the criteria to limit the dose of i.v. morphine are enforced. Morphine titration can be used with caution in elderly patients, in children, or in obese patients. In practice, i.v. morphine titration allows the physician to meet the needs of individual patients rapidly and limits the risk of overdose making this method the first step in postoperative pain management.
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Comparative Study
Accuracy of respiratory rate monitoring by capnometry using the Capnomask(R) in extubated patients receiving supplemental oxygen after surgery.
Respiratory monitoring is standard after anaesthesia and surgery. Abnormal respiratory rate is a sensitive indicator of respiratory problems, even in patients receiving supplemental oxygen, but the best method for its continuous measurement in spontaneously breathing patients is unclear. This study compared respiratory rate assessment by capnometry using a new oxygen mask with a carbon dioxide sampling port (Capnomask(®)) and thoracic impedance pneumography with clinical measurement (used as a reference method) in extubated patients receiving supplemental oxygen. ⋯ In extubated patients, continuous assessment of respiratory rate with the Capnomask(®) is more accurate than by thoracic impedance pneumography even when supplemental oxygen is delivered at a high flow rate.