Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial
Technical report: optimal quantity of saline for epidural pressure waveform analysis.
Epidural waveform analysis (EPWA) is a simple test to confirm the optimal placement of an epidural catheter. It relies on the transmission of the thecal pressure waveform through the epidural catheter. Little is known about the optimal volume of catheter injectate needed to optimize the EPWA test. ⋯ For EPWAs, S3 epidural catheters are superior to S1 catheters for determining pulsative waveform transmission at low injectate volume. The optimal initial quantity of saline for EPWA is 5 mL regardless of the catheter type used.
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Although venous air embolism is a well recognized complication within most surgical subspecialties, it has only been reported recently during eye surgery in one adult, and never before in a child. We describe the case of a 17-month-old boy who sustained a possible air embolism during repair of an open trauma of his right eye. ⋯ Although venous air embolism is a rare complication of eye surgery, it should nevertheless be considered as a possible complication during air-fluid exchange vitrectomy in children.
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To determine if deliberate hypotension decreases blood loss and transfusion requirements in patients undergoing orthopedic surgery, a systematic review of all randomized trials addressing this issue was undertaken. ⋯ This review provides some support for the use of deliberate hypotension in reducing blood loss and transfusion requirements in orthopedic surgery, but these results are tempered by the small sample sizes and poor methodological quality of published studies.
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Randomized Controlled Trial Comparative Study
Low-dose sufentanil does not potentiate intrathecal morphine for perioperative analgesia after major colorectal surgery.
Both intrathecal sufentanil (ITS) and intrathecal morphine (ITM) improve analgesia in obstetrical or cardiac procedures. From a pharmacokinetic standpoint, combining these two opioids may improve perioperative analgesia. We performed a prospective randomized double-blind study to compare the analgesic efficacy of ITM alone vs a mixture of a low dose of ITS plus ITM for perioperative pain relief in colorectal surgery. ⋯ These results do not support the addition of 10 microg ITS to 0.4 mg ITM for colorectal surgery, as low dose sufentanil does not improve intraoperative and postoperative analgesia in this setting.
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Multicenter Study
Resuscitating patients with early severe sepsis: a Canadian multicentre observational study.
Fluid resuscitation is a key factor in restoring hemodynamic stability and tissue perfusion in patients with severe sepsis. We sought to examine associations of the quantity and type of fluid administered in the first six hours after identification of severe sepsis and hospital mortality, intensive care unit (ICU) mortality, and organ failure. ⋯ An association between hospital mortality and quantity or type of fluid administered in the first six hours after the diagnosis of severe sepsis was not identifiable. These findings should be considered as hypothesis-generating and warrant confirmation or refutation by randomized controlled trials.