Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial Comparative Study Clinical Trial
Dexmedetomidine in combination with morphine PCA provides superior analgesia for shockwave lithotripsy.
To compare the analgesic effects of dexmedetomidine/morphine with those of tramadol/midazolam in patients undergoing extracorporeal shockwave lithotripsy (ESWL) for urinary calculi. ⋯ Dexmedetomidine in combination with morphine PCA provided better analgesia for ESWL and was associated with higher patients' and urologist's satisfaction when compared with a tramadol/midazolam PCA combination.
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Randomized Controlled Trial Comparative Study Clinical Trial
The radial nerve should be blocked before the ulnar nerve during a brachial plexus block at the humeral canal.
The brachial plexus block through the humeral canal as described by Dupré is indicated in hand and forearm surgery. This block requires a multi-stimulation technique that emphasizes the necessity of a rigorous and safe technique. Nerve injury associated with regional anesthesia can entail significant morbidity for patients. Thus, we investigated the brachial block sequence in terms of unintended nerve stimulation as a surrogate of potential nerve injury. ⋯ Our results indicate that the radial nerve should be blocked before the ulnar nerve when performing a brachial plexus block at the humeral canal.
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To provide evidence-based guidelines for the prophylaxis and treatment of postoperative nausea and vomiting (PONV). ⋯ PONV are common after anesthesia and surgery. We provided evidence-based guidelines for the management of this problem based on the available literature.
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Review
Massive transfusion and coagulopathy: pathophysiology and implications for clinical management.
To review the pathophysiology of coagulopathy in massively transfused, adult and previously hemostatically competent patients in both elective surgical and trauma settings, and to recommend the most appropriate treatment strategies. ⋯ Coagulopathy associated with massive transfusion remains an important clinical problem. It is an intricate, multifactorial and multicellular event. Treatment strategies include the maintenance of adequate tissue perfusion, the correction of hypothermia and anemia, and the use of hemostatic blood products to correct microvascular bleeding.
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Randomized Controlled Trial Clinical Trial
Low alfentanil target-concentrations improve hemodynamic and intubating conditions during induction with sevoflurane.
To investigate the effects of different alfentanil target-concentrations on hemodynamics, respiration and conditions of tracheal intubation during an inhalation induction with 8% sevoflurane. ⋯ Adding alfentanil at a 75 ng*mL(-1) target-concentration during an inhalation induction with 8% sevoflurane in 50% nitrous oxide allows intubation slightly earlier and provides stable hemodynamic conditions but the incidence of apnea during induction is higher. Lower concentrations are of little clinical interest.