The Journal of international medical research
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Randomized Controlled Trial
Effect of continuous cuff pressure regulator in general anaesthesia with laryngeal mask airway.
Postoperative pharyngolaryngeal complications (PPLC) occur during anaesthesia due to increased cuff pressure following the insertion of laryngeal mask airways. The use of a pressure regulator to prevent PPLC was evaluated in a prospective, randomized study. Sixty patients scheduled to receive general anaesthesia were randomly assigned to two equal groups of 30, either with or without the regulator. ⋯ The combined mean ± SD JSCP of both groups was 20.3 ± 3.2 mmHg. In the group with the regulator, cuff pressure was maintained at a constant level during anaesthesia. This study demonstrated that the regulator is a simple, functional device that can reduce the incidence of PST significantly at 1 h postoperatively, following general anaesthesia.
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Total intravenous anaesthesia (TIVA) can reduce the risk of postoperative nausea and vomiting (PONV) almost as much as a single antiemetic. This study compared TIVA (using propofol and remifentanil) with prophylactic palonosetron (a 5-hydroxytryptamine type 3 receptor antagonist) combined with inhalation anaesthesia using sevoflurane in 50% nitrous oxide, for the prevention of PONV. ⋯ The incidence of PONV was around 50% in both groups and the severity of nausea was similar in both groups. Prophylactic palonosetron with inhalational anaesthesia using sevoflurane in 50% nitrous oxide reduced the incidence of PONV after gynaecological laparoscopic surgery almost as much as TIVA using propofol and remifentanil.
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Randomized Controlled Trial
Effects of a priming dose of fentanyl during anaesthesia on the incidence and severity of fentanyl-induced cough in current, former and non-smokers.
Fentanyl is commonly used during anaesthesia and can cause fentanyl-induced cough (FIC). This study investigated whether a priming dose of fentanyl reduced FIC, and determined the factors associated with increased risk of FIC. Subjects undergoing elective surgery under general anaesthesia (n = 800) were randomized into four groups: group 1 received 2 μg/kg fentanyl bolus; groups 2, 3 and 4 received a priming dose of fentanyl 0.5 μg/kg followed by 1.5 μg/kg after 1, 2 or 3 min, respectively. ⋯ Former smokers were 2.91 times more likely than current smokers to experience cough. A fentanyl priming dose did not reduce the incidence and severity of FIC. Former smokers were hyper-reactive to fentanyl compared with current smokers.
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Randomized Controlled Trial
Effects of predistention with normal saline containing adrenaline on blood-vessel injury during epidural catheter placement.
This study investigated the effects of predistention with normal saline containing adrenaline on vascular plexus injury during epidural catheter placement. Three hundred parturients undergoing caesarean sections were randomly divided into three groups. Group I (n = 102) received an epidural injection with 5 ml normal saline; group II (n = 93) received 5 ml normal saline containing adrenaline (5 μg/ml); group III (n = 100) received direct epidural catheter placement. ⋯ The incidence of bloody fluid in the epidural needle was significantly lower in groups I and II compared with group III (eight [7.8%] and seven [7.5%] versus 17 [17.0%], respectively). There were no significant differences in the incidence of bloody fluid in the epidural catheter or in the incidence of intravascular epidural catheter placement between the three groups. Predistention with 5 ml normal saline before catheter insertion reduced the incidence of blood-vessel injury during epidural catheter placement, but adrenaline provided no additional protective effects.
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The findings of an expert panel convened to review critically how best to apply evidence-based guidelines for the treatment of acute pain in the Middle East region are presented. The panel recommended a three-step treatment protocol. Patients with mild-to-moderate levels of acute pain should be treated with paracetamol (step 1). ⋯ Patients reporting severe pain should be referred to a pain clinic or specialist for opioid analgesic treatment. Measures of pain and functioning that have been validated in Arabic, with culturally appropriate and easy to understand descriptors, should be used. Early and aggressive acute pain management is important to reduce the risk of pain becoming chronic, especially in the presence of neuropathic features.