Anaesthesia and intensive care
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Anaesth Intensive Care · Jul 2014
Letter Randomized Controlled TrialPharmacist prescribing of venous thromboembolism prophylaxis in a surgical pre-admission clinic.
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Anaesth Intensive Care · May 2014
Randomized Controlled Trial Comparative StudyComparison of the effect of propofol and sevoflurane anaesthesia on acute and chronic postoperative pain after hysterectomy.
There is some evidence that propofol may reduce acute postoperative pain; however, the results are inconsistent. Furthermore, there is a paucity of information about the type of anaesthesia and chronic pain. This study was designed to evaluate the hypothesis that propofol reduces acute and chronic postoperative pain compared with sevoflurane. ⋯ Persistent surgical pain was observed less frequently (7 out of 40 patients in the propofol group and 21 out of 40 in the sevoflurane group at three months post-surgery, P <0.01) and pain scores were lower at one and three months in the propofol group (0.78±0.55 versus 2.23±0.73 for the sevoflurane group at three months post-surgery, P <0.01). Anxiety and depression scores were significantly lower in the propofol group at three months. In this study, general anaesthesia with propofol was associated with reduced early acute postoperative and persistent pain, compared to sevoflurane-based anaesthesia, among patients undergoing open abdominal hysterectomy.
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Anaesth Intensive Care · May 2014
Randomized Controlled TrialCerebral oximetry to reduce perioperative morbidity.
The use of cerebral oximetry to guide intraoperative management has been shown to improve patient outcomes in cardiac surgery. This pilot trial assessed the feasibility of performing a similar study of outcome in patients over the age of 70 years undergoing non-cardiac surgery. Patients over the age of 70 years undergoing total knee or hip arthroplasty or bowel resection surgery were randomly assigned to have cerebral oximetry values monitored (intervention group) or not monitored (control) while under general anaesthesia. ⋯ Maintenance of cerebral oximetry values appeared to be closer to baseline in the intervention group than in the control group but this difference was not significant (P=0.15). Our results indicated that complications occurred frequently in the study population but did not appear to be associated with cerebral desaturation events. These findings do not support a larger intervention study using the current study population.
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Anaesth Intensive Care · May 2014
Randomized Controlled TrialEffect of statins on insulin requirements during non-cardiac surgery.
Statins are thought to potentially impair glucose metabolism, increasing plasma glucose concentration. The effect of prolonged statin use on glucose metabolism among outpatients is thus well established. However, the impact of statin use on glucose concentrations and insulin requirements during surgery remains poorly characterised and may very well differ considering the substantial hyperglycaemic stress response to surgery. ⋯ While the total amount of intraoperative insulin used was not statistically different between the statin users and non-users, we observed a potentially important trend toward insulin resistance intraoperatively among statin users during major non-cardiac surgery. This result is consistent with non-operative settings and cardiac surgery. Further investigation is essential to determine whether this effect is real and, if so, determine which specific statins are more associated with insulin resistance.
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Anaesth Intensive Care · Mar 2014
Randomized Controlled TrialLow-dose epidural dexmedetomidine improves thoracic epidural anaesthesia for nephrectomy.
Thoracic epidural anaesthesia alone is an applied technique of anaesthesia for nephrectomy which has both advantages and limitations. Dexmedetomidine is a highly selective alpha2-adrenoreceptor agonist which has both central and peripheral analgesic properties. Forty patients undergoing nephrectomy were enrolled in this clinical trial and allocated randomly to two groups, a control group (C group) and a dexmedetomidine group (D group). ⋯ Compared with the C group, pain scores were significantly lower in the first four postoperative hours in the D group (two hours rest P=0.038; two hours activity P=0.009; four hours rest P=0.044; four hours activity P=0.003). The total amount of flurbiprofen analgesic was significantly lower in the D group compared with the C group (P=0.03). Epidural dexmedetomidine 0.5 µg/kg appears to intensify thoracic epidural anaesthesia with levobupivacaine.