British journal of anaesthesia
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Review Meta Analysis
Regional anaesthesia to prevent chronic pain after surgery: a Cochrane systematic review and meta-analysis.
Epidural anesthesia may reduce post-thoracotomy chronic pain (OR 0.33) and paravertebral block reduce that following breast ca surgery (OR 0.37).
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Randomized Controlled Trial Comparative Study
Postoperative pain relief after total hip arthroplasty: a randomized, double-blind comparison between intrathecal morphine and local infiltration analgesia.
Periarticular infiltration with ropivacaine and ketorolac provides equivalent and likely superior post-op analgesia to intrathecal morphine after THA.
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Comparative Study
Minimally invasive intraoperative estimation of left-ventricular end-systolic elastance with phenylephrine as loading intervention.
Left-ventricular end-systolic elastance (Ees) is an index of cardiac contractility, but the invasive nature of its assessment has limited perioperative application. We explored the feasibility of a minimally invasive method of Ees estimation for perioperative assessment of cardiac function and evaluated the suitability of phenylephrine as a loading intervention. ⋯ It is feasible to determine Ees combining continuous non-invasive arterial pressure measurements and left-ventricular volume determinations with TOE. However, administration of phenylephrine cannot substitute IVCC as a loading intervention, indicating that estimation of Ees in the intraoperative setting remains a challenge.
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Comparative Study
Comparison of an automated respiratory systolic variation test with dynamic preload indicators to predict fluid responsiveness after major surgery.
Predicting the response of cardiac output to volume administration remains an ongoing clinical challenge. The objective of our study was to compare the ability to predict volume responsiveness of various functional measures of cardiac preload. These included pulse pressure variation (PPV), stroke volume variation (SVV), and the recently launched automated respiratory systolic variation test (RSVT) in patients after major surgery. ⋯ In predicting fluid responsiveness the new automated RSVT appears to be as accurate as established dynamic indicators of preload PPV and SVV in patients after major surgery. The automated RSVT is clinically easy to use and may be useful in guiding fluid therapy in ventilated patients.