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
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
Long-term quality of sleep after remifentanil-based anaesthesia: a randomized controlled trial.
Clinical and pre-clinical data agree that opioids disrupt sleep architecture. Recently, remifentanil has been suggested to cause possible long-term disturbances of sleep quality. This randomized controlled clinical trial was designed to substantiate or refute a possible long-term effect of remifentanil on the quality of sleep. ⋯ The intraoperative use of remifentanil in a general patient population does not significantly alter the quality of sleep in the postoperative period. However, it may result in a significant reduction in the quality of sleep in patients before operation considered good sleepers. These changes were not observed in the group of patients receiving fentanyl. The relevance of these findings in terms of patient recovery and quality-of-life warrants further investigation. Trial Registration. ACTRN12610000362099.
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Randomized Controlled Trial
Intraoperative tissue oxygenation and postoperative outcomes after major non-cardiac surgery: an observational study.
The relationship between tissue oxygen saturation (StO(2)) and serious postoperative complications remains unclear. We tested the hypothesis that perioperative in patients undergoing major non-cardiac surgery is inversely related to serious surgical outcomes. ⋯ Minimum perioperative peripheral tissue oxygenation predicted a composite of major complications and mortality from major non-cardiac surgery. This is an observational association and whether clinical interventions to augment tissue oxygenation will improve outcomes remains to be determined.
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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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