Canadian journal of anaesthesia = Journal canadien d'anesthésie
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To review end of life care issues in the intensive care unit (ICU) and how practice variation might affect the ultimate outcome of acute brain injury. ⋯ Provision of compassionate high quality end of life care should be standard of practice for brain injured and all other critically ill patients who cannot survive. Inconsistencies in end of life care may affect where, when and how patients die, the quality of their death and whether or not they are considered for organ and tissue donation.
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Comparative Study
Identification of independent risk factors for fentanyl-induced cough.
To determine how the probability of fentanyl-induced cough is affected by patient characteristics and/or anesthetic technique. ⋯ Fentanyl-induced cough may be suppressed by aging, cigarette smoking, prior epidural injection of lidocaine, or a priming dose of vecuronium. These findings may allow insights into the mechanism of this phenomenon, thereby leading to its prevention.
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Randomized Controlled Trial Comparative Study
Effects of nabilone, a synthetic cannabinoid, on postoperative pain.
Cannabinoids have been shown to have analgesic properties in animal studies, but a potential role for these drugs in acute pain management has not been established. It was hypothesized that nabilone, an oral cannabinoid synthetic tetrahydrocannabinol analogue, decreases morphine consumption, pain scores, nausea and vomiting following major surgery. ⋯ Contrary to the main hypothesis, high dose nabilone in the presence of morphine patient controlled analgesia is associated with an increase in pain scores in patients undergoing major surgery.
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Comparative Study
Off-pump coronary bypass surgery: risk of ischemic brain lesions in patients with atheromatous thoracic aorta.
The purpose of this study was to determine if there is an association between the proximal thoracic aortic (ascending aorta and aortic arch) atheroma and ischemic brain lesions on diffusion-weighted magnetic resonance imaging (DW-MRI) after on-pump (ONCAB) and off-pump (OPCAB) coronary artery bypass surgery. ⋯ Patients with aortic atheroma > 2 mm may have a lower risk of new ischemic brain lesions as identified by DWMRI after OPCAB surgery. Patient stratification based upon aortic atheroma burden should be addressed in future trials designed to tailor treatment strategies to improve short- and long-term neurological outcomes in patients undergoing cardiac surgery.