European journal of anaesthesiology
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Randomized Controlled Trial
Fluid preload before spinal anaesthesia in Caesarean section: the effect on neonatal acid-base status.
We evaluated the effect of two different preload solutions: (i) Ringer's lactate (compound sodium lactate intravenous infusion BP) and (ii) 0.9% sodium chloride solution on the neonatal acid-base status of the newborn infants. The two standard regimens were compared to detect a possible difference. ⋯ The choice of Ringer's lactate or saline for fluid preload does not have any effect on neonatal well-being.
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The 'wet vs. dry' philosophy in patients undergoing abdominal surgery is a subject of substantial debate. It has been suggested that restricting fluid input would significantly reduce complications and improve outcome following abdominal surgery. Keeping the patients dry may be a two-edged sword because the resulting hypovolaemia may result in compromised organ perfusion and poor tissue oxygenation. ⋯ Current evidence indicates that using crystalloids exclusively may cause overloading of the interstitial compartment with considerable negative sequelae, whereas using colloids may improve microperfusion and tissue oxygenation. This review shows that the meagre literature on a restricted volume replacement strategy in abdominal surgery patients cannot clearly support the 'dry' approach. Further well-performed studies are necessary to elucidate the ideal amount and type of fluid replacement and determine how to guide fluid therapy.
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Randomized Controlled Trial
The effect of fentanyl and remifentanil, with or without ketoprofen, on pain after thyroid surgery: a randomized-controlled trial.
This study was designed to quantify the additional postoperative analgesic efficacy of a single dose of ketoprofen in patients undergoing thyroid surgery using two different intraoperative analgesic regimens. ⋯ After thyroid surgery, patients receiving intraoperative fentanyl had lower pain scores and needed less rescue analgesia compared with patients receiving intraoperative remifentanil. The adjunction of ketoprofen further improved analgesia in patients who received intraoperative fentanyl only.
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Randomized Controlled Trial
The effect of ephedrine and phenylephrine on BIS values during propofol anaesthesia.
The purpose of this study was to evaluate the effect of ephedrine and phenylephrine on propofol concentrations and bispectral index during propofol anesthesia. ⋯ Ephedrine increases bispectral index values without decreasing propofol concentrations during general anesthesia.
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Intensive insulin therapy reduced mortality in patients admitted to an intensive care unit following mainly cardiac surgery. The aim of this prospective study was to evaluate, if intensive insulin therapy could reduce mortality in medical and non-cardiac surgical patients admitted to a multidisciplinary intensive care unit. ⋯ Following intensive insulin therapy there was a trend towards reduced mortality in medical and non-cardiac surgical patients but less pronounced as in cardiac surgical patients. Intensive insulin therapy increased the frequency of hypoglycaemia. Around 4400 patients would have to be included in any future randomized study to reach significance.