British journal of anaesthesia
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Randomized Controlled Trial
Oral choline supplementation for postoperative pain.
Activation of nicotinic receptors with nicotine has been shown to reduce post-surgical pain in clinical and preclinical studies. Choline is a selective agonist at α7-type nicotinic receptors that does not have addictive or sympathetic activating properties. It is anti-nociceptive in animal studies. We conducted a double-blind randomized trial of oral choline supplementation with lecithin to aid in the treatment of pain after gynaecological surgery. ⋯ Oral supplementation with lecithin during the perioperative period resulted in very slow absorption and thus only a small increase in plasma choline was achieved. This concentration was inadequate to reduce TNF as has been shown in other studies. The absence of an anti-inflammatory effect was likely related to our failure to demonstrate efficacy in pain reduction.
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Randomized Controlled Trial
Efficacy of intraoperative dexmedetomidine infusion on emergence agitation and quality of recovery after nasal surgery.
Emergence agitation is common after nasal surgery. We investigated the effects of intraoperative dexmedetomidine infusion on emergence agitation and quality of recovery after nasal surgery in adult patients. ⋯ Intraoperative infusion of dexmedetomidine provided smooth and haemodynamically stable emergence. It also improved quality of recovery after nasal surgery.
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Randomized Controlled Trial
Effect of concentration of local anaesthetic solution on the ED₅₀ of bupivacaine for supraclavicular brachial plexus block.
The aim of this trial was to compare the effect of concentration of bupivacaine solution on the ED₅₀ dose required for supraclavicular brachial plexus block. ⋯ Our study demonstrates that the ED₅₀ dose of bupivacaine for supraclavicular block is not dependent on the concentration. Lowering the concentration or the strength of the local anaesthetic leads to an increase in the volume required for successful block.
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Randomized Controlled Trial
Single-cuff forearm tourniquet in intravenous regional anaesthesia results in less pain and fewer sedation requirements than upper arm tourniquet.
A limitation of Bier's block or i.v. regional anaesthesia (IVRA) is tourniquet pain. We hypothesized that tourniquet placement on the forearm vs upper arm during IVRA for distal upper extremity surgery may result in less tourniquet pain, lower the need for analgesic interventions, and decrease post-anaesthesia care unit (PACU) admission. ⋯ Our results indicate that the placement of the tourniquet on the forearm resulted in less discomfort, fewer sedation interventions, and greater likelihood of bypassing the PACU when compared with upper arm tourniquet.
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Randomized Controlled Trial
Effect of phenylephrine on the haemodynamic state and cerebral oxygen saturation during anaesthesia in the upright position.
The upright sitting or beachchair position is associated with hypotension, risk of cerebral hypoperfusion, and cerebral injury. We hypothesized that by increasing arterial pressure with phenylephrine administration, cerebral perfusion, and postoperative recovery would be improved. ⋯ Despite maintaining arterial pressure with phenylephrine, cerebral desaturation occurred with upright positioning. Cerebral oxygen saturation can provide a valuable endpoint when evaluating the effect of vasopressor therapy on cerebral perfusion.