Canadian journal of anaesthesia = Journal canadien d'anesthésie
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A new postgraduate anesthesiology residency program has been founded as a North-South partnership between the United Kingdom (UK) and Zambia. The project aims to train physician anesthesiologists in Lusaka in an attempt to address the high perioperative mortality associated with anesthesia as well as to provide better professional support for clinical officer anesthesiologists. ⋯ On reflection, some of the lessons learned were very specific to local circumstances and could have been appreciated only after starting the program - flexibility and responsiveness early in the program have been very necessary. Nonetheless, our findings enhance existing knowledge about establishing and conducting global health partnerships in anesthesia.
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Carcinoid crises are rare life-threatening events involving cardiac instability when carcinoid tumours release vasoactive peptides. Such events can occur in the perioperative setting. Octreotide, a somatostatin analogue, is administered as a bolus dose of 100-500 μg iv or by infusion to treat carcinoid crises. Due to the apparent low risk-to-benefit profile, a much higher dose is sometimes used in urgent situations. The purpose of this study was to assess the evidence for administering doses or hourly infusions of octreotide that exceeded 1,500 μg iv to treat carcinoid crises. We also sought to identify which patients may require large doses and to describe the adverse effects of such doses. ⋯ In the included case reports, carcinoid crises were managed effectively using octreotide 25-500 μg iv. Previous exposure to octreotide and carcinoid heart disease may warrant the need for higher doses. In addition to the low quality of the articles and the small sample size, inconsistent use of the term "carcinoid crisis" and paucity of reported outcomes were also limitations of this systematic review. These findings highlight the need for further investigation into dose-response relationships of octreotide for the treatment of carcinoid crisis.
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Randomized Controlled Trial
Gabapentin does not improve multimodal analgesia outcomes for total knee arthroplasty: a randomized controlled trial.
This study assessed whether gabapentin given preoperatively and for two days postoperatively (in addition to patient-controlled analgesia [PCA] morphine, acetaminophen, and ketorolac) is effective in reducing morphine requirements and moderating pain scores when compared with placebo for primary total knee arthroplasty. ⋯ Gabapentin 600 mg po given preoperatively followed by 200 mg po every eight hours for two days has no effect on postoperative morphine consumption, pain scores, patient satisfaction, or length of hospital stay. This trial is registered at ClinicalTrials.gov NCT01307202.