Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Sep 2008
Review Meta AnalysisNosocomial infections and infection control in regional anesthesia.
Although rare, infectious complications from regional anesthesia and analgesia can be devastating. The literature on this topic consists primarily of surveys, case reports, case series, and studies in which used supplies were cultured. We derived infection control recommendations from the existing literature and compared these recommendations with existing guidelines. ⋯ Studies using more robust methods are necessary to define the rates of infection after different regional anesthesia procedures and to identify risk factors for infections. Data on risk factors would allow anesthesiologists to develop evidence-based guidelines for placement and care of catheters used for regional anesthesia. A multicenter surveillance system may help anesthesiologists address some of the unanswered questions and to develop evidence-based infection control recommendations.
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Acta Anaesthesiol Scand · Aug 2007
Review Meta AnalysisImpact of the intubation model on the efficacy of rocuronium during rapid sequence intubation: systematic review of randomized trials.
Propofol-rocuronium is thought to be superior to thiopental-rocuronium for rapid sequence intubation (RSI). The role of the intubation model per se has never been investigated. ⋯ The efficacy of rocuronium for RSI is influenced by both, the induction agent and the intubation model. To test the clinical usefulness of alternatives to succinylcholine for RSI, a true RSI model should be used.
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Acta Anaesthesiol Scand · Jan 2006
Meta AnalysisA qualitative systematic review of peri-operative dextromethorphan in post-operative pain.
The N-methyl-D-aspartate (NMDA) receptor antagonist, dextromethorphan (DM), has received interest as an adjunctive agent in post-operative pain management. Clinical trials have been contradictory. This systematic review aims to evaluate the available literature examining the analgesic efficacy of DM in post-operative patients. ⋯ Based on the studies available, DM has the potential to be a safe adjunctive agent to opioid analgesia in post-operative pain management, but the consistency of the potential opioid-sparing and pain-reducing effect must be questioned. Consequently, it is not possible to recommend dose regimens or routine clinical use of DM in post-operative pain. The route of administration may be important for the beneficial effect.
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Acta Anaesthesiol Scand · Nov 2005
Review Meta AnalysisPeri-operative ketamine for acute post-operative pain: a quantitative and qualitative systematic review (Cochrane review).
Post-operative pain management is usually limited by adverse effects such as nausea and vomiting. Adjuvant treatment with an inexpensive opioid-sparing drug such as ketamine may be of value in giving better analgesia with fewer adverse effects. The objective of this systematic review was to evaluate the effectiveness and tolerability of ketamine administered peri-operatively in the treatment of acute post-operative pain in adults. ⋯ In the first 24 h after surgery, ketamine reduces morphine requirements. Ketamine also reduces PONV. Adverse effects are mild or absent. These data should be interpreted with caution as the retrieved studies were heterogenous and the result of the meta-analysis can not be translated into any specific administration regimen with ketamine.
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Acta Anaesthesiol Scand · May 2005
Review Meta Analysis Comparative StudyEffect of preoperative Cox-II-selective NSAIDs (coxibs) on postoperative outcomes: a systematic review of randomized studies.
Preoperative use of coxibs has been claimed to reduce postoperative pain and analgesic consumption, and to affect other postoperative outcomes. ⋯ Preoperative coxibs had clear benefits in terms of reduced postoperative pain, analgesic consumption and patient satisfaction compared with placebo. Effects on postoperative nausea and vomiting remain uncertain, as do those on recovery from surgery or economic benefit. Future trials should be larger and more pragmatic in nature.