Anaesthesia
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Randomized Controlled Trial
Optimal effect-site concentration of remifentanil for preventing cough during emergence from sevoflurane-remifentanil anaesthesia.
This randomised, double-blinded, controlled trial was designed to identify the optimal dose of remifentanil for cough suppression without adverse effects during emergence from sevoflurane-remifentanil anaesthesia for thyroidectomy. One hundred and four patients were randomly assigned to maintain target effect-site concentrations of remifentanil at 0 (control group), 1.0 (remifentail 1 group), or 1.5 ng.ml(-1) (remifentanil 1.5 group) during emergence. The incidence of coughing was lower in the remifentanil 1.5 group (31%) than in the control group (74%) or remifentanil 1 group (63%) (p = 0.0004). ⋯ Haemodynamic changes were reduced, but emergence time and stay in the post-anaesthesia care unit was prolonged in the remifentanil 1.5 group. Maintaining the remifentanil effect-site concentration at 1.5 ng.ml(-1) during emergence from sevoflurane-remifentanil anaesthesia reduces the incidence and severity of coughing without serious adverse events and may provide haemodynamic stability in patients undergoing thyroidectomy. However, awakening may be delayed.
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Randomized Controlled Trial Comparative Study
A randomised single blinded study of the administration of pre-warmed fluid vs active fluid warming on the incidence of peri-operative hypothermia in short surgical procedures.
We compared the effect of delivering fluid warmed using two methods in 76 adult patients having short duration surgery. All patients received a litre of crystalloid delivered either at room temperature, warmed using an in-line warming device or pre-warmed in a warming cabinet for at least 8 h. ⋯ The administration of 1 l warmed fluid to patients having short duration general anaesthesia results in higher postoperative temperatures. Pre-warmed fluid, administered within 30 min of its removal from a warming cabinet, is as efficient at preventing peri-operative hypothermia as that delivered through an in-line warming system.
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Transforaminal epidural injection is an effective method for treating spinal pain but can cause devastating complications that result from accidental vascular uptake of the injectate or a direct vascular injury. We prospectively evaluated the patient factors that might be associated with intravascular uptake during transforaminal epidural injections. A total of 2145 injections were performed on 1088 patients under contrast-enhanced real-time fluoroscopic guidance. ⋯ The highest incidence was at the cervical level (28/136; 20.6%), followed by the sacral level (111/673; 16.5%), the thoracic level (23/280; 8.2%) and the lumbar level (64/1056; 6.1%). The difference was significant for the cervical and sacral level compared with the lumbar and thoracic levels (p < 0.001). Intravascular injection was not associated with the other patient characteristics studied.