Articles: general-anesthesia.
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Randomized Controlled Trial
The effects of dexamethasone, light anesthesia, and tight glucose control on postoperative fatigue and quality of life after major noncardiac surgery: A randomized trial.
Why is this important?
Post-operative fatigue (POF) is common and has significant effects on post-operative recovery and quality of life.
Past studies have linked post-operative fatigue to the pro-inflammatory effects of surgery and anesthesia. Other studies have suggested anti-inflammatory benefits of steroids, tight glucose control and avoiding deep anesthesia.
What did they do?
Abdelmalak and team randomized 381 patients using a 3-factorial design for the three interventions. 306 patients were analysed for POF outcome.
Surgical interventions covered a wide range of major non-cardiac procedures, with mean surgical length just under 5 hours and 75% of patients being ASA 3 or 4.
And they found?
No difference for any of the interventions for either fatigue or quality of life.
Hang on...
While it may be that post-operative inflammation is not the causative factor for POF, more likely the study interventions had insufficient impact on inflammation to change fatigue outcomes.
For minor and moderate surgery of shorter duration in lower-acuity patients (ASA 1 & 2) who have experienced significant POF previously, these simple interventions may still be beneficial.
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Anesthesia and analgesia · Aug 2019
Randomized Controlled TrialMidazolam Premedication Facilitates Mask Ventilation During Induction of General Anesthesia: A Randomized Clinical Trial.
During induction of general anesthesia, proper mask ventilation is crucial for supplying sufficient oxygen to unconscious patients. Midazolam has a relaxing effect on airway muscles. We hypothesized that sedative premedication with midazolam would facilitate mask ventilation during anesthetic induction. ⋯ This randomized clinical trial demonstrated that midazolam premedication enhanced mask ventilation during induction of general anesthesia.
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Randomized Controlled Trial
Comparison of volume-controlled ventilation mode and pressure-controlled ventilation with volume-guaranteed mode in the prone position during lumbar spine surgery.
During lumbar spine surgery, patients are placed in the prone position for surgical access. The prone position has various effects on cardiac and pulmonary function, including a decreased cardiac index (CI), decreased dynamic lung compliance (Cdyn), and increased peak inspiratory pressure (Ppeak). In this study, we compared the volume-controlled ventilation mode (VCV) and pressure-controlled ventilation with volume guaranteed mode (PCV-VG) based on hemodynamic and pulmonary variables in the prone position during lumbar spine surgery. ⋯ PCV-VG led to lower Ppeak and improved Cdyn values compared with VCV, showing that it may be a favorable alternative mode of mechanical ventilation for patients in the prone position during lumbar spine surgery.
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Randomized Controlled Trial
A prospective, randomized comparison of the LMA-protector™ and i-gel™ in paralyzed, anesthetized patients.
In the present study, we compare the LMA-Protector™ and the i-gel™ in terms of adequacy of the airway seal, insertion time, ease and accuracy of insertion, and the incidence of postoperative sore throat. ⋯ The LMA-Protector™ provided a better airway sealing effect than the i-gel™. However, it required a longer insertion time, provided a worse fiberoptic view of the vocal cords, and caused more mucosal injury compared to the i-gel™.
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J Bone Joint Surg Am · Jul 2019
Randomized Controlled TrialRegional or General Anesthesia in the Surgical Treatment of Distal Radial Fractures: A Randomized Clinical Trial.
Most patients undergoing surgery for the treatment of a distal radial fracture are treated in a day-surgery setting and are given either general anesthesia (GA) or regional anesthesia (RA). The main purpose of this study was to investigate the impact of the anesthesia method on patients' postoperative opioid consumption during the first 3 days following surgery. ⋯ Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.