Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Meta Analysis
Examining the evidence in anesthesia literature: a survey and evaluation of obstetrical postdural puncture headache reports.
To describe a bibliographic database on the literature of postdural puncture headache (PDPH) in the obstetrical population, to describe the research architecture in this field, and to evaluate the quality of case-control studies, cohort studies, and controlled clinical trials on PDPH. ⋯ Although the amount of research on PDPH in parturients is increasing, use of optimal study designs and improvement in methodology is needed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Lidocaine with fentanyl, compared to morphine, marginally improves postoperative epidural analgesia in children.
To compare the epidural administration of fentanyl (1 microg/mL) combined with lidocaine 0.4% to preservative-free morphine for postoperative analgesia and side effects in children undergoing major orthopedic surgery. ⋯ Postoperative epidural fentanyl with lidocaine infusion provides slightly better analgesia than conventional bolus administration of epidural morphine. Side-effects or risk of systemic toxicity were not augmented by the addition of lidocaine to epidural opioids.
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Randomized Controlled Trial Clinical Trial
Titration of isoflurane using BIS index improves early recovery of elderly patients undergoing orthopedic surgeries.
This study was designed to investigate the effect of bispectral index (BIS) monitoring on the recovery profiles, level of postoperative cognitive dysfunction, and anesthetic drug requirements of elderly patients undergoing elective orthopedic surgery with general anesthesia. ⋯ There was no difference in the level of postoperative cognitive dysfunction between the two groups. However, titration of isoflurane using the BIS index decreased utilization of isoflurane and contributed to faster emergence of elderly patients undergoing elective knee or hip replacement surgery.
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Randomized Controlled Trial Clinical Trial
Continuous epidural infusion of racemic methadone results in effective postoperative analgesia and low plasma concentrations.
To compare two protocols of epidural administration of racemic methadone for postoperative analgesia (continuous infusion and intermittent bolus), focussing on plasma concentration, analgesic efficacy and side effects. ⋯ Plasma methadone concentrations were significantly lower with continuous infusion. Plasma methadone accumulation, which is considered the main disadvantage for its purported influence on the incidence of side effects, did not occur at the doses used over the three days of treatment that we report.
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To review the use of adjuncts to intravenous regional anesthesia (IVRA) for surgical procedures in terms of their intraoperative effects (efficacy of block and tourniquet pain) and postoperative analgesia. ⋯ Using NSAIDs or clonidine as adjuncts to IVRA improves postoperative analgesia and muscle relaxant improves motor block.