Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2011
Randomized Controlled TrialOptimum dose of ketamine for prevention of postanesthetic shivering; a randomized double-blind placebo-controlled clinical trial.
Our objective was to investigate the efficacy and the optimum dosage of ketamine for post anesthetic shivering prevention. One-hundred and twenty patients (ASA I-II) scheduled for elective orthopedic surgery were randomly allocated to receive ketamine in 3 groups ; groups A (0.125 mg/Kg), groups B (0.25 mg/Kg) and C (0.5 mg/Kg) along with those receiving 0.9% normal saline as the placebo group. Tympanic temperature was measured immediately after induction of anesthesia, 30 min after induction, before administration of the study drug and by the end of the surgery. ⋯ The frequency of shivering was significantly less in groups B (0.25 mg/Kg) and C (0.5 mg/Kg) than in groups A (0.125 mg/Kg) and D (placebo). In addition recovery, extubation time and hallucination was observed to be less in group B compared to group A. Prophylactic 0.25 and 0.5 mg/kg ketamine was found to be effective in preventing postanesthetic shivering with a better response observed with 0.25 mg/kg dosage.
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Acta Anaesthesiol Belg · Jan 2011
Randomized Controlled TrialLow-dose intravenous ketamine and clonidine for poor postoperative opioid responsiveness: a double blind randomized study.
In the immediate postoperative period, some patients present with pain that responds poorly to intravenous opioids. In a double-blind randomized study, we tested the hypothesis that administering small doses of intravenous ketamine (0.125 mg/kg) combined with clonidine (0.5 microg/kg) would enhance the speed of onset and the quality of an opioid analgesic regimen in patients who initially responded poorly to opioids. We enrolled 68 patients in the study, all physical status I to III according to the American Society of Anesthesiologists classification. ⋯ The primary endpoint of the study was to reduce by 20 minutes the time necessary to achieve an NRS < 4. There was no statistically significant difference between the two groups regarding the time required for patients to achieve an NRS < 4. It was concluded that in the immediate postoperative period, the acute administration of small combined doses of intravenous ketamine (0.125 mg/kg) and clonidine (0.5 mirog/kg) does not reduce the onset of an opioid-based analgesia in patients with an initial poor response to intravenous opioids.
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Acta Anaesthesiol Belg · Jan 2011
Randomized Controlled TrialDexamethasone in preventing post-dural puncture headache: a randomized, double-blind, placebo-controlled trial.
Spinal anesthesia is major complication is Post-Dural Puncture Headache (PDPH) which is an intense and debilitating event. We decided to assess if intravenous administration of dexamethasone can decrease the incidence and/or intensity of this kind of headache. For this purpose 178 patients, who were supposed to undergo lower extremity orthopedic surgery, were enrolled in the study. ⋯ There was no statistically significant difference between DMX and PCB groups regarding the incidence of PDPH. However, the intensity of headache differed between the two groups being less severe if IV dexamethasone had been given prophylactically. Dexamethasone can be used to decrease the severity of PDPH in patients who receive spinal anesthesia.
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Acta Anaesthesiol Belg · Jan 2011
Case ReportsFailed intubating laryngeal mask airway-guided blind endotracheal intubation in a severe postburn contractured neck patient.
Securing the airway in patients with severe post burn contracture of the neck is often challenging for attending anesthesiologists. Fiberoptic bronchoscope (FOB)-guided endotracheal intubation is considered safe and reliable in this situation. ⋯ We report a case of 30 year old female with mentosternal contracture, where the use of ILMA allowed easy ventilation but failed to enable successful ILMA-guided blind intubation despite multiple attempts, the use of recommended Chandey's maneuver and muscle relaxation. Subsequent FOB revealed marked anterior dislocation of laryngotracheal structures, leading to a slippage of the endotracheal tube back to the esophagus.