Canadian journal of anaesthesia = Journal canadien d'anesthésie
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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 Clinical Trial
The lateral recumbent head-down position decreases the incidence of epidural venous puncture during catheter insertion in obese parturients.
The unintentional and unrecognized cannulation of an extradural vein is a potentially serious complication of an epidural anesthetic. The present study was undertaken to assess the incidence of blood vessel puncture related to epidural catheterization in three different body positions, in a cohort of morbidly obese parturients, following the completion of a similar study published in 2001 from which such parturients were excluded. ⋯ Adoption of the lateral recumbent head-down position for the performance of lumbar epidural blockade, in labour at term, reduces the incidence of lumbar epidural venous puncture in these obese parturients.
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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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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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Case Reports
Spontaneous recovery from a spinal epidural hematoma with atypical presentation in a nonagenarian.
Spinal epidural hematoma following epidural anesthesia is extraordinarily rare in association with low-dose sc heparin, and the prognosis for neurologic recovery without rapid surgical decompression poor. We report a case of spinal epidural hematoma in a nonagenarian who received low-dose sc unfractionated heparin postoperatively in accordance with standard guidelines, presented with no back pain, and made full neurologic recovery without surgical intervention. ⋯ Complete neurologic recovery from flaccid paralysis following spinal epidural hematoma occurred without surgical decompression in a nonagenarian. Low-dose sc heparin may be a greater risk factor for spinal epidural hematoma than previously assumed, and the absence of back pain does not rule out this diagnosis.