Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Antiallodynic effects have been demonstrated after intrathecal administration of alpha-2 adrenoceptor agonists and cholinesterase inhibitors in rats. Intrathecal carbachol also increases the activity of cholinergic receptor system at the spinal level. However, there is no study regarding the antagonism of carbachol on touch-evoked allodynia and the interaction with clonidine. This study examines the intrathecal interaction between two drugs in a rat model of nerve ligation injury. ⋯ This study indicates that carbachol, like clonidine, provides a moderate antagonism on touch-evoked allodynia at the spinal level. The results suggest that intrathecally administered carbachol is synergistic when combined with clonidine.
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Randomized Controlled Trial Clinical Trial
The addition of tramadol to lidocaine does not reduce tourniquet and postoperative pain during iv regional anesthesia.
We conducted a prospective, randomized, double-blind study to determine whether the combination of tramadol with lidocaine 0.5% had an analgesic effect on tourniquet pain during iv regional anesthesia and also on postoperative pain. ⋯ We conclude, therefore, that for carpal tunnel operation under iv regional anesthesia, the combination of tramadol and lidocaine is not more effective than lidocaine alone.
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Randomized Controlled Trial Comparative Study Clinical Trial
Central nervous system side effects are less important after iv regional anesthesia with ropivacaine 0.2% compared to lidocaine 0.5% in volunteers.
Following release of a double tourniquet for intravenous regional anesthesia (IVRA), ropivacaine was shown to have a longer duration of action and less central nervous system (CNS) side effects than lidocaine. This study examines the correlation of CNS side effects to plasma levels of lidocaine 0.5% and ropivacaine 0.2% when injected intravenously for IVRA. ⋯ We observed a lower incidence of CNS side effects with ropivacaine as compared to lidocaine. Although ropivacaine's greater lipid solubility should, theoretically, lead to more CNS side effects, this was, likely, offset by slower release from tissues and lesser percentage of unbound (free) drug.
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Hypotension is the most frequent complication of spinal anesthesia in pregnant patients. This study was designed to identify patients at risk for postspinal hypotension based on preoperative vital signs before and after an orthostatic challenge. ⋯ Baseline HR may be predictive of obstetric spinal hypotension. Higher baseline HR, possibly reflecting a higher sympathetic tone, may be a useful parameter to predict postspinal hypotension.
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Case Reports
Oral styletted intubation under video control in a patient with a large mobile glottic tumour and a difficult airway.
With fibreoptic intubation, advancement of the endotracheal tube (ETT) through the glottis is blind. Thus, in patients with a laryngeal tumour, there is a potential for damage to the tumour. Previously, we proposed the use of a fibreoptic bronchoscope (FOB)-video camera system to permit visualization of tube passage. We used this technique successfully in a patient with a known difficult airway and a large glottic tumour. ⋯ This alternative intubation technique, providing a view of the tube passage into the glottis, was a reasonable method to avoid potential damage to the glottic tumour by blind tube passage during conventional fibreoptic intubation.