British journal of anaesthesia
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Randomized Controlled Trial Comparative Study
Comparison of propofol and fentanyl administered at the end of anaesthesia for prevention of emergence agitation after sevoflurane anaesthesia in children.
Propofol 1 mg/kg reduces emergence delirium in children, without increasing nausea, vomiting or length of PACU stay, unlike fentanyl 1 mcg/kg.
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Review Meta Analysis
Impact of perioperative dexamethasone on postoperative analgesia and side-effects: systematic review and meta-analysis.
Intraoperative dexamethasone produces a small, though clinically insignificant post-operative analgesic benefit.
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Review Meta Analysis
Opioid-induced respiratory depression in paediatrics: a review of case reports.
Opioids remain the cornerstone of modern-day pain treatment, also in the paediatric population. Opioid treatment is potentially life-threatening, although there are no numbers available on the incidence of opioid-induced respiratory depression (OIRD) in paediatrics. To get an indication of specific patterns in the development/causes of OIRD, we searched PubMed (May 2012) for all available case reports on OIRD in paediatrics, including patients 12 yr of age or younger who developed OIRD from an opioid given to them for a medical indication or due to transfer of an opioid from their mother in the perinatal setting, requiring naloxone, tracheal intubation, and/or resuscitation. ⋯ In eight cases, OIRD was due to an iatrogenic overdose. Three distinct patterns in the remaining data set specifically related to OIRD include: (i) morphine administration in patients with renal impairment, causing accumulation of the active metabolite of morphine; (ii) codeine use in patients with CYP2D6 gene polymorphism associated with the ultra-rapid metabolizer phenotype, causing enhanced production of the morphine; and (iii) opioid use in patients after adenotonsillectomy for recurrent tonsillitis and/or obstructive sleep apnoea, where OIRD may be related to hypoxia-induced enhancement of OIRD. Despite the restrictions of this approach, our analysis does yield an important insight in the development of OIRD, with specific risk factors clearly present in the data.
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Randomized Controlled Trial Comparative Study
Balanced crystalloid compared with balanced colloid solution using a goal-directed haemodynamic algorithm.
Controversy exists regarding the optimal i.v. fluids for use with a goal-directed haemodynamic algorithm. ⋯ Using a goal-directed haemodynamic algorithm to optimize stroke volume, a balanced HES solution is associated with better haemodynamic stability and reduced need for fresh-frozen plasma. There were no signs of renal impairment by colloid solutions when fluid administration is targeted to optimize cardiac preload.
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Randomized Controlled Trial Comparative Study
A double-blinded randomized evaluation of alfentanil and morphine vs fentanyl: analgesia and sleep trial (DREAMFAST).
Patients using fentanyl patient-controlled analgesia (PCA), the standard first-line choice in our hospitals, commonly complain of postoperative sleep disruption due to pain. The aim of this study was to determine whether the PCA combination of alfentanil and morphine, which provides longer analgesia without compromising onset speed, would improve postoperative pain-related sleep interference. ⋯ Despite better early postoperative analgesia, pain-related sleep interference was not improved by the PCA combination of alfentanil and morphine. AUSTRALIAN NEW ZEALAND CLINICAL TRIALS REGISTRY: Ref: ACTRN12608000118303.