Articles: postoperative.
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Dexmedetomidine is an alpha(2) -adrenergic agonist with sedative and analgesic properties. This study aimed to investigate if the use of a continuous dexmedetomidine infusion with i.v. morphine patient-controlled analgesia (PCA) could improve postoperative analgesia while reducing opioid consumption and opioid-related side effects. ⋯ Continuous dexmedetomidine infusion may be a useful analgesic adjuvant for patients susceptible to opioid-induced respiratory depression.
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Dexmedetomidine, an alpha₂-adrenoceptor agonist, has been evaluated as an adjunct to anesthesia and for the delivery of sedation and perioperative hemodynamic stability. It provokes dose-dependent and centrally-mediated sympatholysis. Coronary artery bypass grafting (CABG) with extracorporeal circulation is a stressful procedure increasing sympathetic nervous system activity which could attenuate renal function due the interrelation of sympathetic nervous system, hemodynamics and renal function. We tested the hypothesis that dexmetomidine would improve kidney function in patients undergoing elective CABG during the first two postoperative days. ⋯ Use of intravenous dexmedetomidine did not alter renal function in this cohort of relatively low-risk elective CABG patients but was associated with an increase in urinary output.This study was carried out in 1994-1997 and was thus not registered.
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There is a growing concern of the potential injurious role of ventilatory over-distention in patients without lung injury. No formal guidelines exist for intraoperative ventilation settings, but the use of tidal volumes (VT) under 10 mL/kg predicted body weight (PBW) has been recommended in healthy patients. We explored the incidence and risk factors for receiving large tidal volumes (VT > 10 mL/kg PBW). ⋯ Ventilation with VT > 10 mL/kg PBW is still common, although poor correlation with PBW suggests it may be unintentional. BMI ≥ 30, female gender and height < 165 cm may predispose to receive large tidal volumes during general anesthesia. Further awareness of patients' height and PBW is needed to improve intraoperative ventilation practices. The impact on clinical outcome needs confirmation.
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The effect of local infiltration after breast surgery is controversial. This prospective double blind randomized study sought to document the analgesic effect of local anaesthetic infiltration after breast cancer surgery. ⋯ Single shot infiltration with ropivacaine transiently improves postoperative pain control after breast cancer surgery.