British journal of anaesthesia
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Randomized Controlled Trial Comparative Study
Randomized, double-blind comparison of patient-controlled epidural infusion vs nurse-administered epidural infusion for postoperative analgesia in patients undergoing colonic resection.
There is little published evidence of the analgesic efficacy of patient-controlled epidural analgesia (PCEA) for postoperative pain relief. The aim of this study was to compare the analgesic efficacy of epidural infusion of bupivacaine 0.125% and fentanyl 4 microg ml(-1) administered by either PCEA with a background infusion or nurse-administered continuous epidural infusion (CEI) after major intra-abdominal surgery. ⋯ PCEA provides greater analgesic efficacy than CEI for postoperative analgesia after major intra-abdominal surgery, and a decreased requirement for physician or nurse intervention.
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Randomized Controlled Trial
The coiling length of thoracic epidural catheters: the influence of epidural approach angle.
Thoracic epidural catheters are used for anaesthesia and postoperative analgesia. Usually, epidural catheters are placed without confirmation of their position despite frequent reports of complications as a result of malposition. In this study, we evaluated the threading length of thoracic epidural catheters without coiling and assessed the influence of two different epidural approach angles on the threading length without coiling. ⋯ Approaching the thoracic epidural space with an obtuse approach angle provides longer coiling length. We recommend that an obtuse approach angle should be used to maximize the chance of the catheter reaching the intended level with minimum risk of coiling.
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Randomized Controlled Trial
Hypothermia during laparotomy can be prevented by locally applied warm water and pulsating negative pressure.
Conflicting results have been obtained when using heat and constant negative pressure applied to the arm to induce re-warming in patients with mild hypothermia due to surgery. We hypothesized that pulsating negative pressure would increase skin blood flow and thus heat transfer. The purpose of this study was to compare a new method of applying heat and pulsating negative pressure to the skin with conventional forced-air warming for preventing perioperative hypothermia. ⋯ Warm water and pulsating negative pressure was significantly better at treating hypothermia during laparotomy than forced-air warming.
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Randomized Controlled Trial
Rectal acetaminophen does not reduce morphine consumption after major surgery in young infants.
The safety and value of acetaminophen (paracetamol) in addition to continuous morphine infusion has never been studied in newborns and young infants. We investigated the addition of acetaminophen to evaluate whether it decreased morphine consumption in this age group after major thoracic (non-cardiac) or abdominal surgery. ⋯ Acetaminophen, as an adjuvant to continuous morphine infusion, does not have an additional analgesic effect and should not be considered as standard of care in young infants, 0-2 months of age, after major thoracic (non-cardiac) or abdominal surgery.
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Randomized Controlled Trial
Influence of acute normovolaemic haemodilution on the dose-response relationship and time course of action of cisatracurium besylate.
Acute normovolaemic haemodilution (ANH) is an efficacious blood conservation strategy aiming at avoiding allogeneic blood transfusion. ANH was shown to increase the potency of vecuronium, atracurium, and rocuronium. The aim of our study was to investigate whether cisatracurium potency is altered with ANH. ⋯ Our results demonstrated that unlike other previously reported neuromuscular blocking drugs, ANH did not alter cisatracurium potency. Thus, cisatracurium would be the neuromuscular blocking drug of choice in patients who undergo surgery with ANH, as no dose adjustments are required.