Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Review Meta Analysis
Effect of epidural analgesia in patients with traumatic rib fractures: a systematic review and meta-analysis of randomized controlled trials.
A consensus group recently proposed epidural analgesia as the optimal analgesic modality for patients with multiple traumatic rib fractures. However, its beneficial effects are not consistently recognized in the literature. We performed a systematic review and a meta-analysis of randomized controlled trials (RCT) of epidural analgesia in adult patients with traumatic rib fractures. ⋯ No significant benefit of epidural analgesia on mortality, ICU and hospital LOS was observed compared to other analgesic modalities in adult patients with traumatic rib fractures. However, there may be a benefit on the duration of mechanical ventilation with the use of thoracic epidural analgesia with local anesthetics. Further research is required to evaluate the benefits and harms of epidural analgesia in this population before being considered as a standard of care therapy.
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Randomized Controlled Trial
Sympathectomy-mediated vasodilatation: a randomized concentration ranging study of epidural bupivacaine.
We tested the hypothesis that the development of sympathectomy-mediated vasodilatation is dependent on the concentration rather than the dose of epidural local anesthetic administered. ⋯ Our observations suggest that drug concentration is more important than drug dose in determining the degree of sympathectomy following lumbar epidural local anesthesia.
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Metabolic acid-base disorders are common in critically ill patients. Clinicians may have difficulty recognizing their presence when multiple metabolic acid-base derangements are present in a single patient. Clinicians should be able to identify the components of complex metabolic acid-base disorders since metabolic acidoses due to unmeasured anions are associated with increased mortality in critically ill patients. This review presents the derivation of three commonly used methods of acid-base analysis, which include the anion gap, Stewart physiochemical, and modified base excess. Clinical examples are also provided to demonstrate the subtleties of the different methods and to demonstrate their application to real patient data. ⋯ While all three methods correctly identify metabolic acidosis due to unmeasured anions, which is a predictor of mortality, it remains unclear if further delineation of complex metabolic acid-base disorders using the Stewart physiochemical or the modified base excess methods is clinically beneficial.
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Clinical prediction models estimate the risk of having or developing a particular outcome or disease. Researchers often develop a new model when a previously developed model is validated and the performance is poor. However, the model can be adjusted (updated) using the new data. The updated model is then based on both the development and validation data. We show how a simple updating method may suffice to update a clinical prediction model. ⋯ When a clinical prediction model in new patients does not show adequate performance, an alternative to developing a new model is to update the prediction model with new data. The updated model will be based on more patient data, and may yield better risk estimates.
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Case Reports
Helium insufflation with sevoflurane general anesthesia and spontaneous ventilation during airway surgery.
The therapeutic benefits and clinical applications of helium-oxygen gas mixtures were first reported over 70 years ago. Since then, helium has been used in the treatment of obstructive processes of both the upper and lower airways. We report a unique case regarding helium insufflation with sevoflurane anesthesia and spontaneous ventilation for airway surgery. ⋯ The addition of helium improves gas exchange with spontaneous ventilation during general anesthesia for airway surgery.