Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial Comparative Study Clinical Trial
Propofol patient-controlled sedation during hip or knee arthroplasty in elderly patients.
Little information is available regarding the use of patient-controlled sedation (PCS) among the elderly. This study evaluated the safety and efficacy of propofol PCS among elderly patients undergoing hip or knee arthroplasty. ⋯ Propofol PCS provides effective sedation. Using a propofol dose of 0.3 mg.kg-1, transient episodes of deeper sedation were noted more frequently among patients receiving PCS. These episodes did not require intervention but, suggest that this propofol PCS dose approaches the limit of safety and should be further reduced for some elderly patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Haemodynamic changes induced by two I:E ratios: a transoesophageal echocardiographic study.
To assess the effects of controlled ventilation with two I:E ratios on haemodynamic and left ventricular function in mechanically ventilated patients with moderate to severe respiratory disease, using fluctuation of the arterial pressure waveform and the changes in left ventricular areas obtained by transoesophageal echocardiography. ⋯ In this setting, EDA and SBPV allow beat-to-beat evaluation of left ventricular preload during change of I:E ratio. Switch from I:E 1:3 to 1:1 may be used as a rapid, safe and reversible test to estimate intravascular volume status assessed by changes in SBPV or EDA.
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Review Case Reports
Oxygen venous embolism after the use of hydrogen peroxide during lumbar discectomy.
The knee-prone position is commonly used for patients undergoing spinal surgery. Venous air embolism in such a position may be produced by the negative venous pressure gradient between the ambient air and the venous plexuses of the spinous process. When hydrogen peroxide is used to cleanse the wound, oxygen is produced. We report a case of suspected oxygen venous embolism during lumbar discectomy in the knee-prone position after use of H2O2. ⋯ Although hydrogen peroxide has an innocuous reputation, cases of accidental ingestion or massive gas embolism after wound irrigation leading to death have been reported. A review of the literature suggests that many of the clinical and physiopathological features of air and oxygen emboli are similar. For both, measures of prevention and treatment of complications are similar. We argue that the use of hydrogen peroxide should be avoided during procedures where the position of the patient (sitting, knee-prone) increases the risk of gas embolism and that hydrogen peroxide is a potentially dangerous solution.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of three regional anaesthesia techniques for outpatient knee arthroscopy.
The purpose of this study was to compare intraoperative conditions and postoperative pain control of three peripheral regional anaesthesia techniques for outpatient knee arthroscopic procedures. ⋯ Any of the three anaesthetic techniques tested provide reliable intraoperative patient and surgical conditions for outpatient knee arthroscopy. Patient discomfort postoperatively was considerable in all groups and requires further investigation.