Articles: general-anesthesia.
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Randomized Controlled Trial Multicenter Study
Effects of a Hypnosis Session Before General Anesthesia on Postoperative Outcomes in Patients Who Underwent Minor Breast Cancer Surgery: The HYPNOSEIN Randomized Clinical Trial.
Hypnosis is now widespread in medical practice and is emerging as an alternative technique for pain management and anxiety. However, its effects on postoperative outcomes remain unclear. ⋯ The results of this study do not support a benefit of hypnosis on postoperative breast pain in women undergoing minor breast cancer surgery. However, other outcomes seem to be improved, which needs to be confirmed by further studies.
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Randomized Controlled Trial Multicenter Study
Emergence times and airway reactions during general anaesthesia with remifentanil and a laryngeal mask airway: A multicentre randomised controlled trial.
What did they do?
Kowark and friends randomised 343 patients across four German hospitals to receive desflurane, sevoflurane or propofol for maintenance anesthesia using a laryngeal airway for surgery expected to be up to 2 hours.
And they found?
There was no difference in airway reactions among the three groups, and the desflurane patients emerged (statistically) significantly faster.
Hang on...
But the difference in emergence times was, i) at most only 2 minutes, and ii) was a surrogate marker for what actually matters – when a patient leaves the PACU or hospital – which wasn't reported.
Additionally, the study protocol very prescriptively defined when volatiles were decreased (50% at 5 min before expected surgical finish) and ceased – the same for both Des and Sevo. Yet it is common practice to begin weaning Sevo earlier than Des if trying to achieve comparable emergence.
Could this even be applied to my patients?
Probably not. Unless you are in the habit of using remifentanil infusions (0.15 mcg/kg/min) for surgery that almost certainly does not justify its use and have access to uniquely European analgesics piritramide and metamizole.
The elephant in the room...
Why do we persist in trying to find new justifications for desflurane, given its expense and high environmental costs? (And for that matter, remifentanil?!).
This study demonstrates the well known faster pharmacokinetics of desflurane during an unnecessarily complex laryngeal mask anesthetic, and yet adds little to meaningful clinical outcomes.
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Multicenter Study Observational Study
Current Ventilator and Oxygen Management during General Anesthesia: A Multicenter, Cross-sectional Observational Study.
Intraoperative oxygen management is poorly understood. It was hypothesized that potentially preventable hyperoxemia and substantial oxygen exposure would be common during general anesthesia. ⋯ Potentially preventable hyperoxemia and substantial oxygen exposure are common during general anesthesia, especially during one-lung ventilation. Future research should explore the safety and feasibility of a more conservative approach for intraoperative oxygen therapy.
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Randomized Controlled Trial Multicenter Study
Amisulpride Prevents Postoperative Nausea and Vomiting in Patients at High Risk: A Randomized, Double-blind, Placebo-controlled Trial.
Postoperative nausea and vomiting causes distress for patients and can prolong care requirements. Consensus guidelines recommend use of multiple antiemetics from different mechanistic classes as prophylaxis in patients at high risk of postoperative nausea and vomiting. The prophylactic efficacy of the dopamine D2/D3 antagonist amisulpride in combination with other antiemetics was investigated. ⋯ An online visual overview is available for this article at http://links.lww.com/ALN/B727.