Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Randomized Controlled Trial
Dexmedetomidine during total knee arthroplasty performed under spinal anesthesia decreases opioid use: a randomized-controlled trial.
It remains unclear whether the opioid-sparing effects of dexmedetomidine seen in patients undergoing general anesthesia are reproducible in patients undergoing spinal anesthesia. We hypothesized that the administration of intravenous dexmedetomidine for sedation during total knee arthroplasty under spinal anesthesia would decrease postoperative morphine consumption in the first 24 hr following surgery. ⋯ Dexmedetomidine was associated with a significant decrease in morphine use in the first 24 hr following total knee arthroplasty. Our study shows that an intraoperative infusion of dexmedetomidine for sedation in patients receiving spinal anesthesia can produce postoperative analgesic effects. This offers another potential adjunct in the multimodal pain management of these patients. This trial was registered at ClinicalTrials.gov (identifier NCT02026141).
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Randomized Controlled Trial Comparative Study
The effect of sevoflurane versus desflurane on postoperative catheter-related bladder discomfort in patients undergoing transurethral excision of a bladder tumour: a randomized controlled trial.
Catheter-related bladder discomfort (CRBD) due to an indwelling urinary catheter can cause postoperative distress, and the mechanism underlying CRBD is linked to the activation of muscarinic receptors. Inhalation of anesthetic agents, such as sevoflurane and desflurane, has differential inhibitory effects on muscarinic receptors. We aimed to compare the effect of intraoperative sevoflurane vs desflurane inhalation on postoperative CRBD. ⋯ As a maintenance agent of general anesthesia, sevoflurane reduced the incidence of early postoperative CRBD in patients undergoing TURBT when compared with desflurane. The protocol for this clinical trial was registered at ClinicalTrials.gov (NCT02096224).
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Postoperative epidural analgesia for major upper abdominal and thoracic surgery can provide significant benefits, including superior analgesia and reduced pulmonary dysfunction. Nevertheless, epidural analgesia may also be associated with decreased muscle strength, sympathetic tone, and proprioception that could possibly contribute to falls. The purpose of this retrospective case-control study was to search a large national database in order to investigate the possible relationship between postoperative epidural analgesia and the rate of inpatient falls. ⋯ Our study suggests that postoperative epidural analgesia for patients undergoing major upper abdominal and thoracic surgery is not associated with an increased risk of inpatient falls.
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Case Reports
Failed caudal block due to physiologic changes associated with a cerebrospinal fluid leak: a case report.
The sum of the volumes of brain tissue, cerebrospinal fluid (CSF), and intracranial blood remain constant. This tenet of the Monroe-Kellie hypothesis is most often considered in the setting of intracranial hypertension, but it can also be applied in the setting of CSF volume depletion. We used this hypothesis to explain a case of failed caudal block in a patient with an iatrogenic CSF leak. ⋯ The possible mechanism of this failed caudal block was high systemic absorption of anesthetic given the epidural venous plexus engorgement thus leaving less anesthetic acting within the CSF and on the exiting spinal nerves. Decreased CSF flow in the thecal sac might also have contributed, as might dilution of the remaining local anesthetic caused by large amounts of leaking CSF within the epidural space.