British journal of anaesthesia
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Randomized Controlled Trial Multicenter Study Clinical Trial
Parecoxib sodium has opioid-sparing effects in patients undergoing total knee arthroplasty under spinal anaesthesia.
This multicentre, double-blind, placebo-controlled study compared the opioid-sparing effectiveness and clinical safety of parecoxib sodium over 48 h, in 195 postoperative patients after routine total knee replacement surgery. ⋯ Parecoxib sodium provides opioid-sparing analgesic effects in postoperative patients.
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There is an increasing trend towards performing craniotomy awake. The challenge for the anaesthetist is to provide adequate analgesia and sedation, haemodynamic stability, and a safe airway, with an awake, cooperative patient for neurological testing. ⋯ We have developed a technique for craniotomy, which facilitates awake neurological testing, is safe, and has good patient satisfaction.
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Randomized Controlled Trial Clinical Trial
Dolasetron prophylaxis reduces nausea and postanaesthesia recovery time after remifentanil infusion during monitored anaesthesia care for extracorporeal shock wave lithotripsy.
Remifentanil is used as an analgesic for different procedures performed during monitored anaesthesia care. Opioid-induced nausea and vomiting can be troublesome. ⋯ Patient characteristics, baseline values, duration of ESWL, and total dose of remifentanil did not differ between groups. The frequency (Group 1/Group 2; 20/55%; P<0.05) and mean (SD) maximal intensity [15 (9)/45 (14) mm; P<0.05] of nausea during 24 h was significantly reduced after dolasetron and discharge times in Group 1 were less than Group 2 [22 (14)/45 (28) min; P<0.05].
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We describe a case of pulmonary oedema occurring at 37 weeks gestation, following the attempted removal of a cervical suture under general anaesthesia. The use of an ultrasound technique to demonstrate the patient's fluid status is described. Signs of amniotic fluid embolism and how it exerts its influence on the circulation are discussed.
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We present a case of neurogenic pulmonary oedema (NPO) due to subarachnoid haemorrhage that resulted in hypoxia refractory to conventional mechanical ventilation. Prone positioning was employed, resulting in rapid and sustained improvement in oxygenation. ⋯ Prone ventilation may be of value in the management of NPO, both in treating life-threatening hypoxia and in optimizing neurological recovery. Further data are required on its effect on intracranial pressure after subarachnoid haemorrhage.