Acta anaesthesiologica Belgica
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Randomized Controlled Trial Comparative Study
Propofol vs Sevoflurane anaesthesia on postoperative cognitive dysfunction in the elderly. A randomized controlled trial.
Postoperative cognitive dysfunction is a topic of special importance in the geriatric surgical population which primarily resolves within the short term postoperative period, but it can become a long term disorder with significant impact on patient's quality of life. This study was designed to compare the short and long term postoperative cognitive function after propofol and sevoflurane anaesthesia in the elderly and to evaluate the role of the inflammatory process. ⋯ According to the neuropsychological test evaluation of cognition, there is a negative influence of sevoflurane anaesthesia on the early and late postoperative state. As far as the inflammatory markers are concerned, they don't relate to the patient's cognitive status.
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Randomized Controlled Trial
Opioid-free anesthesia: what about patient comfort? A prospective, randomized, controlled trial.
We investigated the effect of a pern-operative opioid-free approach on postoperative patient comfort in patients undergoing breast cancer surgery. ⋯ This randomized controlled trial shows, for the first time, equal comfort during the immediate postoperative period in patients having received opioid-free and conventional anesthesia for their breast cancer surgery. Opioid-free anesthesia in this indication appears safe, and may be associated with slightly reduced pain during the first 24 postoperative hours.
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Randomized Controlled Trial Comparative Study
Use of second generation supra-glottic airway devices during laparoscopic cholecystectomy: a prospective, randomized comparison of LMA Proseal™, LMA SupremeTM and igel™.
Supra-glottic airway devices (SADs) with an inbuilt drain channel, such as the LMA Proseal™ (LMA-P), LMA SupremeTM (LMA-S) and i-gel™ (i-gel), have been used for laparoscopic cholecystectomy. We compared safety, efficacy, and ease of use, as well as the incidence of adverse events between these devices. ⋯ Among SAD's, LMA-S is the easiest to insert (including the drain tube), LMA-P achieved the best leak pressure, and i-gel fastest to insert, although associated with the worst POPD scoring.
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Oxygenation using High Flow Nasal Cannula (HFNC) was initially described in neonatal medicine, but, gradually, its use has extended to adult patients. The efficacy of the device has been linked to higher flows of oxygen delivered to the patients, air tract humidification, alveolar recruitment through a positive end-expiratory pressure (PEEP) effect, prevention of nasopharyngeal collapse, and dead-space washout. Beside the fact that HFNC is a non-invasive way of delivering oxygen to ICU patients, and is well tolerated, results from various clinical trials tend to show positive outcomes for patients presenting with acute hypoxemic respiratory failure (AHRF), during intubation, or during the post-extubation period. However, controversy arose from recent publications, and larger trials are still required to clarify the position of HFNC in the ICU, and help define the subgroups of patients presenting with AHRF that are most likely to benefit from HFNC therapy.
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Adenotonsillectomy is a frequently performed procedure in pediatric day-case surgery causing significant pain for which adequate analgesia is required. Our aim was to investigate if the intraoperative administration of IV tramadol decreases the need for postoperative pain medication in children. Because tramadol has well-known pro-emetic effects, we also assessed the incidence of postoperative nausea and vomiting (PONV). ⋯ The results of this retrospective study indicate that intraoperative tramadol administration in combination with prophylactic antiemetic therapy decreases the need for piritramide in the immediate postoperative period without increasing the incidence of PONV after tonsillectomy in children.