British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Intra-atrial ECG is not a reliable method for positioning left internal jugular vein catheters.
ECG guidance is widely used for positioning central venous catheters (CVCs) in the superior vena cava. We noticed a higher incidence of a more perpendicular angle between the catheter tip and the vessel wall after left-sided ECG-guided catheter positioning. To investigate the value of left-sided ECG guidance, we performed this prospective study. ⋯ Intra-atrial ECG does not detect the junction between the superior vena cava and right atrium. It is not a reliable method for confirming position of left-sided CVCs. Post-procedural CXRs are recommended for left-sided, but not right-sided CVCs.
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Randomized Controlled Trial Clinical Trial
Influence of thoracic epidural analgesia on cardiovascular autonomic control after thoracic surgery.
Thoracic epidural analgesia (TEA) is effective in alleviating pain after major thoracoabdominal surgery and may also reduce postoperative mortality and morbidity. This study investigated cardiovascular autonomic control in patients undergoing elective thoracic surgery and its modulation by continuous TEA. ⋯ In contrast with PCA management, TEA using low concentrations of bupivacaine and fentanyl blunted cardiac sympathetic neural drive, resulting in vagal predominance, while HRV variables were better restored after surgery.
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Randomized Controlled Trial Clinical Trial
Effect of intrathecal tramadol administration on postoperative pain after transurethral resection of prostate.
Tramadol administered epidurally has been demonstrated to decrease postoperative analgesic requirements. However, its effect on postoperative analgesia after intrathecal administration has not yet been studied. In this double-blind, placebo-controlled study, the effect of intrathecal tramadol administration on pain control after transurethral resection of the prostate (TURP) was studied. ⋯ Intrathecal tramadol was not different from saline in its effect on postoperative morphine requirements after TURP.