Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial Comparative Study Clinical Trial
The A-line ARX index may be a more sensitive detector of arousal than the bispectral index during propofol-fentanyl-nitrous oxide anesthesia: a preliminary investigation.
To compare changes in the A-line ARX index (AAI) by the Alaris AEP monitor(TM) with those of the bispectral index (BIS) during propofol-fentanyl-nitrous oxide anesthesia. ⋯ During propofol-fentanyl-nitrous oxide anesthesia, the AAI responded to LMA insertion or surgical incision, but not the BIS, and the AAI had smaller variations. The AAI recovered faster from the disturbance by electrocautery than the BIS. Thus, the AAI may be a more sensitive and useful detector of arousal than the BIS.
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Multicenter Study Clinical Trial
Most critically ill patients are perceived to die in comfort during withdrawal of life support: a Canadian multicentre study.
Most deaths in intensive care units (ICUs) follow a withdrawal of life support (LS). Evaluation of this process including the related perspectives of grieving family members is integral to improvement of palliation in the ICU. ⋯ Most patients were perceived by family members to die in comfort during a withdrawal of LS. Perceptions of patient comfort and drug use in the hours before death were not associated with the mode or sequence of withdrawal of LS, or the time to death.
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Randomized Controlled Trial Comparative Study Clinical Trial
Automated intermittent epidural boluses improve analgesia induced by intrathecal fentanyl during labour.
We compared the efficacy of epidural continual intermittent boluses (CIB) with a continuous epidural infusion (CEI) in prolonging labour analgesia induced by the combined spinal epidural (CSE) technique. ⋯ CIB prolonged the duration and improved the quality of analgesia. CIB could have resulted in an improved spread of analgesics in the epidural space or encouraged a direct passage of infusate into the IT space. This could have also rendered a higher sensory block to cold in the CIB group. CIB is a good alternative to CEI for the maintenance of epidural analgesia after CSE.
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Comparative Study
Simple changes can improve conduct of end-of-life care in the intensive care unit.
To describe changes to the conduct of withdrawal of life support (WOLS) in two teaching hospital tertiary care medical surgical intensive care units (ICUs) in a single centre over two distinct time periods. ⋯ Simple changes to the process of WOLS can improve conduct of end-of-life care in the ICU.
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Comparative Study
Contemporary anesthesia ventilators incur a significant "oxygen cost".
Anesthesia ventilators use oxygen or oxygen/air mixtures to drive the bellows during controlled ventilation. As a practitioner may find himself in a situation that the only available oxygen source is a compressed oxygen cylinder, it is important to know the oxygen consumption of anesthesia ventilators during controlled ventilation. ⋯ Machine-driven mechanical ventilation incurs a significant "oxygen cost." We show that the amount of oxygen consumed by mechanical ventilation with contemporary anesthesia ventilators is influenced by patient-dependent factors and may greatly exceed the amount of oxygen delivered to the patient.