Canadian journal of anaesthesia = Journal canadien d'anesthésie
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The objective of this systematic review was to assess the effectiveness and safety of ephedrine compared with control when given prophylactically to prevent hypotension during spinal anesthesia for Cesarean delivery. ⋯ Prophylactic ephedrine is more effective than control for preventing hypotension during spinal anesthesia for elective Cesarean delivery but a clinically relevant positive effect on neonatal outcome was not observed. Therefore, the routine use of prophylactic ephedrine to prevent any adverse effects of maternal hypotension following spinal anesthesia for Cesarean delivery is not supported by the current systematic review.
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Randomized Controlled Trial Clinical Trial
Epidural bolus injection with alkalinized lidocaine improves blockade of the first sacral segment--a brief report.
It has been reported that the addition of epinephrine and/or bicarbonate to local anesthetic enhances the depth of epidural blockade and that initial partial bolus injection results in greater caudal spread. We evaluated the anesthetic effects of lidocaine with epinephrine and/or bicarbonate injected into the epidural space by bolus or catheter injection. ⋯ Epidural bolus injection of lidocaine-bicarbonate with epinephrine improves the pain threshold and speeds the onset of the blockade of the first sacral region.
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Clinical Trial
Loss of intrathecal morphine analgesia in terminal cancer patients is associated with high levels of excitatory amino acids in the CSF.
To examine excitatory amino acid (EAA) levels in the cerebrospinal fluid (CSF) of patients on long-term morphine treatment for terminal cancer pain relief and to correlate these with morphine's analgesic effect. ⋯ Long-term IT morphine administration was accompanied by an increase of EAA level in the CSF that was associated with a loss of morphine's analgesic effect.
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Randomized Controlled Trial Comparative Study Clinical Trial
Acupressure and ondansetron for postoperative nausea and vomiting after laparoscopic cholecystectomy.
To compare the efficacy of acupressure wrist bands and ondansetron for the prevention of postoperative nausea and vomiting (PONV). ⋯ Acupressure at P6 causes a significant reduction in the incidence of PONV and the requirement for rescue medication in the first six hours following laparoscopic cholecystectomy, similar to that of ondansetron 4 mg iv.
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Reversal of pharmacologic anticoagulation is an issue that arises when an anticoagulated patient has major bleeding or when a patient on chronic anticoagulant therapy requires urgent reversal of anticoagulation, for example, for surgery. ⋯ Newer anticoagulant agents generally lack specific antidotes. Thus, careful choice of an anticoagulant agent and laboratory monitoring where appropriate are needed to minimize risk of bleeding complications.