Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial
Locked out and still knocking: predictors of excessive demands for postoperative intravenous patient-controlled analgesia.
Psychosocial factors governing the use of postoperative, intravenous patient-controlled analgesia (PCA) have received little attention in spite of the fact that PCA is the most common modality for managing pain after surgery. The motivation behind requests for analgesia during lockout periods is not known. Unrelieved pain and need for pain medication are obvious reasons but other factors may be involved. The aim of the present study was to predict PCA lockout interval demands based on preoperative psychosocial factors. ⋯ Excessive demands for postoperative intravenous- PCA morphine during lockout intervals appear to reflect, in part, poor preoperative adaptation to surgery involving intrusive thoughts and avoidant behaviours about the upcoming surgery.
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Comparative Study
Ultrasound imaging in cadavers: training in imaging for regional blockade at the trunk.
The unique strategy of using cadaveric models for teaching ultrasound-guided blocks has been described for blocks of the upper and lower extremities. This report considers the parallels between cadaveric and live imaging relevant to scanning of the trunk. The inter-individual variation between subjects (particularly for epidural blocks) is also considered, for practicing ultrasound-guided or supported trunk and central neuraxial techniques. ⋯ Cadavers may provide viable training options for practicing ultrasound imaging and real-time ultrasound needle guidance for nerve blocks at the trunk and epidural space. The training can be performed in a stress-free pre-clinical environment without time constraints and the potential for patient discomfort.
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Review
Transcranial Doppler monitoring in subarachnoid hemorrhage: a critical tool in critical care.
To review the literature regarding the use of transcranial Doppler ultrasonography (TCD) for monitoring cerebral vasospasm following subarachnoid hemorrhage (SAH). ⋯ Vasospasm following SAH is a very important source of morbidity and mortality. Too often, the first sign is a neurologic deficit, which may be too late to reverse. Transcranial Doppler ultrasonography assists in the clinical decision-making regarding further diagnostic evaluation and therapeutic interventions. When performed in isolation, the contribution of TCD to improving patient outcome has not been established. Nevertheless, TCD has become a regularly employed tool in neurocritical care and perioperative settings.
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Randomized Controlled Trial
Fibreoptic airway training: correlation of simulator performance and clinical skill.
Simulation centres, where trainees can practise technical procedures on models of varying fidelity, provide a training option that allows them to acquire skills in a controlled environment prior to clinical performance. It has been proposed that the time to complete a simulator task may translate to proficiency in the clinical setting. The objective of this study was to determine whether time to complete a simulator task translates to clinical fibreoptic manipulation (FOM) performance. ⋯ These results suggest that simulator-based, task-orientated time measurement may not be a good indicator of FOI performance in the clinical setting.