British journal of anaesthesia
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Comparative Study
Prediction of the haemodynamic response to tracheal intubation: comparison of laser-Doppler skin vasomotor reflex and pulse wave reflex.
The laser-Doppler skin vasomotor reflex (SVmR) caused by tetanic stimulation of the ulnar nerve may be a test that can predict the haemodynamic response to tracheal intubation. A decrease in pulse wave amplitude (pulse wave reflex, PWR) may be an alternative index of this response. We compared the abilities of PWR and SVmR to predict the haemodynamic response to tracheal intubation and studied how alfentanil, muscle relaxation, stimulation site and stimulation pattern affected the two reflexes. ⋯ An absent SVmR does not predict a blunted arterial pressure or heart rate response to tracheal intubation. The PWR may be a better predictor.
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The commercial propofol preparation in an intralipid solution causes marked vasodilatation. Both propofol and its solvent seem to stimulate the nitric oxide (NO) pathway. The role of intralipid in cardiac and regional haemodynamic changes induced by propofol and their respective interactions with the NO pathway was assessed. ⋯ Except for the coronary and carotid circulations, intralipid modulates the NO pathway in cardiac and regional blood flow.
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Randomized Controlled Trial Clinical Trial
Management of post-strabismus nausea and vomiting in children using ondansetron: a value-based comparison of outcomes.
This study evaluated the clinical efficacy and cost-effectiveness of prophylactic ondansetron versus early ondansetron treatment in the management of postoperative nausea and vomiting (PONV) in children undergoing strabismus repair using clinically meaningful outcomes and value-based principles. ⋯ Compared with early symptomatic treatment with ondansetron, prophylactic ondansetron shortened fast-tracking time and duration of PACU stay and improved parental satisfaction and therapeutic outcomes at a lower direct cost.
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Review Meta Analysis
Effectiveness of acute postoperative pain management: I. Evidence from published data.
This review examines the evidence from published data concerning the incidence of moderate-severe and of severe pain after major surgery, with three analgesic techniques; intramuscular (i.m.) analgesia, patient controlled analgesia (PCA), and epidural analgesia. ⋯ These results suggest that the UK Audit Commission (1997) proposed standards of care might be unachievable using current analgesic techniques. The data may be useful in setting standards of care for Acute Pain Services.
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Review Case Reports
Maternal deaths from anaesthesia. An extract from Why mothers die 1997-1999, the Confidential Enquiries into Maternal Deaths in the United Kingdom.
This article is reprinted from Why Mothers Die 1997-1999, the fifth report of the Confidential Enquiries into Maternal Deaths in the United Kingdom.