Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial
Continuous positive airway pressure does not improve lung function after cardiac surgery.
Despite the well-documented impairment of pulmonary function after cardiopulmonary bypass, effective precautions and ideal management strategies for this problem are still under debate. This study aimed to evaluate the effects of continuous positive airway pressure (CPAP) applied during cardiopulmonary bypass on respiratory and hemodynamic variables. ⋯ Continuous positive airway pressure administered during cardiopulmonary bypass decreased shunt fraction and alveolar-arterial oxygen partial pressure difference during surgery, but had no sustained effect on either variable postoperatively. We conclude that, in patients with normal preoperative pulmonary function, application of 10 cm H2O CPAP does not improve lung function after cardiac surgery.
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Randomized Controlled Trial
Epidural dexamethasone reduces postoperative pain and analgesic requirements.
Epidural steroids may have potential advantages for providing postoperative analgesia. We therefore undertook a study to evaluate the efficacy of epidurally administered dexamethasone in reducing postoperative morphine requirements, as a measure of analgesia following laparoscopic cholecystectomy. ⋯ Preoperative epidural administration of dexamethasone 5 mg, with or without bupivacaine, reduces postoperative pain and morphine consumption following laparoscopic cholecystectomy.
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Not all bone cancer pain can be effectively treated with current therapies. In the present study, the effects of ip administration of alpha-2 agonists (dexmedetomidine and clonidine), N-methyl-D-aspartate (NMDA) antagonists (MK-801 and ketamine), an N-acetylaspartylglutamate peptidase inhibitor (ZJ-43), and morphine were examined in a mouse bone cancer pain model. ⋯ These data suggest that alpha-2 agonists produce an analgesic effect only at a sedative dose and that ketamine, but not MK-801, is associated with an analgesic response without overt side effects. The effect of ZJ-43 is mediated by activating group II mGluRs.
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Preparation of the Dräger Primus anesthetic machine for malignant hyperthermia-susceptible patients.
Preparation of anesthesia machines for patients who are susceptible to malignant hyperthermia includes flushing the machine with vapour-free fresh gas to washout residual anesthetic agents. To establish guidelines for the preparation of the Dräger Primus machine, we compared the washout profiles for isoflurane and sevoflurane in the Dräger Primus and Ohmeda Excel 210 anesthesia machines. ⋯ We conclude that the Primus must be flushed for at least 70 min to decrease the anesthetic concentration to 5 ppm when using a FGF of 10 L.min(-1). We recommend maintaining a FGF of 10 L.min(-1) for the duration of anesthesia in order to prevent the rebound increase in anesthetic concentration in the FGF.
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Meta Analysis
The effects of volatile anesthetics on cardiac ischemic complications and mortality in CABG: a meta-analysis.
Coronary artery bypass graft surgery (CABG) is associated with cardiac complications, including ischemia, acute myocardial infarction (AMI), and death. Volatile anesthetics have been shown to have a preconditioning-like effect. This systematic review assesses the effects of volatile anesthetics on cardiac ischemic complications and morbidity after CABG. ⋯ This meta-analysis demonstrates sevoflurane and desflurane reduce the postoperative rise in cTnI. Sevoflurane-mediated reduction in cardiac troponin was associated with improved long-term outcomes in one study. This meta-analysis was not able to show that these positive effects on troponin were translated into improved clinical outcomes. Well-designed large randomized control trials are needed to further elucidate the differential cardio-protective effects of volatile anesthetics.