Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2008
Randomized Controlled Trial Comparative StudyThe effective concentration 50 (EC50) for propofol with 70% xenon versus 70% nitrous oxide.
Xenon anesthesia has many favorable properties, such as pain modulation and organ protection. However, due to its MAC of 70%, it cannot be used as a sole anesthetic. We estimated the amount of propofol required to supplement xenon to produce adequate anesthesia in 50% and 95% of patients in comparison with nitrous oxide. ⋯ Xenon seems to be clinically more potent than nitrous oxide, but still requires minimal supplement of a hypnotic anesthetic to suppress noxious stimulation during and after skin incision.
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Anesthesia and analgesia · Mar 2008
Randomized Controlled Trial Comparative StudyPerioperative versus postoperative celecoxib on patient outcomes after major plastic surgery procedures.
Controversy continues to surround the use of cyclooxygenase (COX)-2 inhibitors in the perioperative period. We designed this randomized, double-blind, placebo-controlled study to examine the hypothesis that administration of celecoxib preoperatively or postoperatively and for 3 days after major plastic surgery would improve pain control and clinically important patient outcomes. Another objective of the study was to determine whether perioperative administration of celecoxib offered any advantages over postoperative administration alone. ⋯ Celecoxib (400 mg p.o.) administered on the day of surgery and for 3 days postoperatively is effective in improving postoperative pain management, as well as the speed and quality of recovery after major plastic surgery. However, perioperative administration offers no advantages over simply giving the drug after surgery.
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Anesthesia and analgesia · Mar 2008
Randomized Controlled TrialA prospective randomized double-blind study to determine the effect of thoracic epidural neostigmine on postoperative ileus after abdominal aortic surgery.
Postoperative ileus is a major gastrointestinal complication of abdominal aortic surgery leading to increased rates of morbidity and mortality, longer lengths of hospital stay, and higher costs. In this study, we evaluated the effect of epidurally administered neostigmine on postoperative ileus after abdominal aortic surgery. ⋯ Thoracic epidural neostigmine enables faster restoration of bowel sounds and shortens duration of postoperative ileus after abdominal aortic surgery.
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Anesthesia and analgesia · Mar 2008
Clinical TrialDecision support increases guideline adherence for prescribing postoperative nausea and vomiting prophylaxis.
Guidelines for postoperative nausea and vomiting (PONV) prevention are implemented widely but their effectiveness may be limited by poor adherence. We hypothesized that the use of an electronic decision support (DS) system would significantly improve guideline adherence. ⋯ Electronic DS increases guidelines adherence for the prescription of PONV prophylaxis in high-risk PONV patients.
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Anesthesia and analgesia · Mar 2008
Case ReportsCar accidents after ambulatory surgery in patients without an escort.
Occasionally, ambulatory surgical patients present without an escort for their procedure. This creates a dilemma for caregivers, and allowing patients to drive may have an impact on their safety. The Canadian Medical Protective Association is a mutual defense organization for 95% of Canadian physicians. ⋯ Both had a car accident and sustained serious injuries. Based on this we do not recommend discharge without an escort after general anesthesia, regional anesthesia, monitored anesthesia or sedation. Driving after ambulatory surgery cannot be considered safe and caregivers need to verify a safe ride home.