Anaesthesia
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Case Reports
Use of thromboelastography to demonstrate persistent anticoagulation after stopping enoxaparin.
Peri-operative guidelines exist for neuraxial anaesthesia and anticoagulant therapy. We describe the use of thromboelastography to assess the coagulation status of a patient with moderate renal impairment who had been receiving enoxaparin and was being managed in accordance with current recommendations. This report demonstrates that current guidelines for discontinuing treatment with enoxaparin may not allow a sufficient safety margin in all patient groups and that thromboelastography is a useful tool in such situations.
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Randomized Controlled Trial Comparative Study
A prospective randomised double blind study to evaluate the effect of peribulbar block or topical application of local anaesthesia combined with general anaesthesia on intra-operative and postoperative complications during paediatric strabismus surgery.
We studied 45 ASA I/II children aged between 2 and 13 years scheduled for elective strabismus surgery, randomly allocated to receive either a peribulbar block or topical lidocaine 2% combined with general anaesthesia, or general anaesthesia alone. The incidence and severity of the occulocardiac reflex, the requirement for atropine, the occurrence of arrhythmias and incidence of postoperative nausea and vomiting following surgery at 1, 2 and 4 h were studied. We found the incidence and severity of occulocardiac reflex intra-operatively was significantly reduced in children who received a peribulbar block. The incidence of postoperative nausea and vomiting was significantly reduced in patients receiving either peribulbar block or topical local anaesthesia combined with general anaesthesia, compared to general anaesthesia alone (p = 0.008).
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We propose recommendations to reduce the risk of haemorrhagic events associated with regional anaesthesia in patients treated with newer anticoagulants after orthopaedic surgery. The risk/benefit ratio should be individualised for each patient according to the type and dose of anticoagulant, the type of regional anaesthesia and patient risk factors. ⋯ After removing a catheter or after a haemorrhagic puncture, the timing of the next anticoagulant injection should be based on the time required for an anticoagulant dose to reach maximum activity. Vigilance remains paramount during the initial days after removal of a neuraxial catheter.
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Clinical Trial
The effect of time of day on the duration of neuromuscular blockade elicited by rocuronium.
In a prospective, observational trial, we investigated the influence of time of day on the duration of neuromuscular blockade (NMB) elicited by rocuronium. Forty-nine patients scheduled for surgery between 08:00 and 02:00 were enrolled after giving written informed consent. Time to neuromuscular recovery was measured following three doses: (1) a fat-free-mass (FFM) related induction dose (0.6 mg x kg(-1): n = 47); (2) a maintenance dose (20% of the induction dose: n = 42); and (3) a standard 10-mg dose (n = 35). ⋯ The maximum effect of 50 min (95% CI 41-59 min) was elicited between 08:00 and 11:00 and the minimum duration of 29 min (95% CI 23-35 min) between 14:00 and 17:00 (p = 0.005). A similar pattern was observed for the maintenance dose. The duration of action of rocuronium is influenced by time of day and this effect is of potential clinical significance and practical relevance to research.
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Randomized Controlled Trial Comparative Study
A comparison of the disposable vs the reusable laryngeal tube in paralysed adult patients.
A disposable laryngeal tube (LT-D) with dimensions identical to, but physical properties different from (stiffer tube/thicker cuff), the reusable laryngeal tube (LT-R) has recently become available. We performed a randomised, single blind trial among 100 anaesthetised and paralysed patients to compare these devices in terms of ease of insertion, airway sealing pressure, position assessed fibreoptically and postoperative throat complications. Anaesthesia was administered with midazolam, fentanyl, propofol, atracurium, oxygen and isoflurane. ⋯ There were no differences in airway sealing pressure, fibreoptic position or post operative sore throat and dysphagia. The intra cuff pressure remained stable for the LT-R but decreased slightly for the LT-D. In paralysed, anaesthetised patients, the single use and reusable laryngeal tubes are similar in clinical performance.