Canadian journal of anaesthesia = Journal canadien d'anesthésie
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To show the use of the short acting opioid remifentanil for labour analgesia when epidural analgesia is considered to be contraindicated. ⋯ Remifentanil PCIA combining low continuous background infusion and small bolus doses is an alternative when epidural analgesia in labour is contraindicated. Under careful anesthesia monitoring, the technique seems to be safe for both mother and baby, at least when delivery occurs at or near the normal term of pregnancy.
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Randomized Controlled Trial Clinical Trial
Dextromethorphan attenuation of postoperative pain and primary and secondary thermal hyperalgesia.
To determine the effect of 90 mg dextromethorphan (DM) p.o. vs placebo 90 min preoperatively, on the immediate and delayed postoperative course. ⋯ Compared with placebo, DM enabled reduction of postoperative analgesics consumption, improved well-being, and reduced sedation, pain intensity and primary and secondary thermal hyperalgesia.
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Veno-arterial and regional differences of the partial pressure in CO2 (deltaPCO2), may be used as index to evaluate the adequacy of the cardiac output to the oxygen consumption. To determine the incidence of elevated deltaPCO2 and its relationship with difficult separation from bypass (DSB) in patients undergoing cardiac surgery, we conducted a prospective observational cohort study. ⋯ Elevated deltaPCO2 is frequently observed during cardiac surgery and values obtained before bypass were associated with DSB. The deltaPCO2 gradients could be used as marker of the adequacy of tissue perfusion during cardiac surgery.
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Clinical Trial
High concentrations of isoflurane do not block the sympathetic nervous system activation from desflurane.
The volatile anesthetic desflurane has been associated with neurocirculatory responses that have been relatively refractory to adjuvant treatment. We have employed desflurane to evaluate the integrity of the sympathetic nerve recording after establishment of the anesthetized state with another anesthetic agent. This retrospective evaluation of data from volunteers determined if higher concentrations of isoflurane that were sufficient to block the neurocirculatory response to laryngeal and tracheal stimulation would abolish the neurocirculatory response to desflurane. ⋯ In healthy volunteers receiving 1.5 MAC isoflurane, which was sufficient to block the neurocirculatory response to laryngoscopy and tracheal stimulation, there were striking increases in sympathetic outflow, HR and BP when 11% desflurane was substituted for isoflurane.