Canadian journal of anaesthesia = Journal canadien d'anesthésie
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The purpose of this structured, evidence-based, clinical update was to determine if rapid sequence induction is a safe or effective technique to decrease the risk of aspiration or other complications of airway management. ⋯ An absence of evidence from RCTs suggests that the decision to use RSI during management can neither be supported nor discouraged on the basis of quality evidence.
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Randomized Controlled Trial
Chronobiological characteristics of postoperative pain: diurnal variation of both static and dynamic pain and effects of analgesic therapy.
Previous postoperative investigations report morning peaks in analgesic administration. However, few studies have examined diurnal variation of both pain and analgesic consumption and little is known about dynamic pain in this context. ⋯ Based on data from our post-hysterectomy analgesic clinical trial, static and dynamic pain in the morning appears to be more intense than pain later in the day. This pattern was observed in the presence of substantial nocturnal morphine use. Based on these and other previous observations, specifically designed investigations are needed to better characterize the clinical, neurohormonal and neurophysiological features of postoperative circadian pain variation - including pain during sleeping hours. If the above observations are replicated, future study of nocturnal sustained-release opioids as well as time-shifting the administration of non-opioid co-analgesic drugs to the very early morning may be warranted.
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Case Reports
Noninvasive bilevel positive airway pressure for preoxygenation of the critically ill morbidly obese patient.
We describe the use of noninvasive bilevel positive airway pressure (BiPAP) in a critically ill, hypoxemic and morbidly obese patient for preoxygenation prior to rapid sequence induction of anesthesia. ⋯ Prior to rapid sequence induction of anesthesia in patients with respiratory compromise secondary to factors which reduce FRC, noninvasive BiPAP in combination with supplemental oxygen may be indicated whenever traditional preoxygenation does not provide adequate oxyhemoglobin saturation. Improved oxygenation is most likely attributable to improved ventilation and alveolar recruitment.