Articles: postoperative.
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Acta neurologica Belgica · Mar 2015
Randomized Controlled TrialEffect of dexamethasone on the incidence of post-dural puncture headache after spinal anesthesia: a randomized, double-blind, placebo-controlled trial and a meta-analysis.
The effect of dexamethasone on post-dural puncture headache (PDPH) after spinal anesthesia has not been well elucidated. This randomized, double-blind, placebo-controlled trial was carried out in patients undergoing a cesarean at the Qilu Hospital, Shandong University. The subjects were randomly divided into a placebo and a dexamethasone group. ⋯ The results indicated that prophylactic administration of 8 mg dexamethasone did not have any protective effect against PDPH (31 vs. 18, P = 0.054) and even increased the incidence of PDPH in the first 24 h in parturient patients (25 vs. 11, P = 0.016). Furthermore, the meta-analysis also showed that dexamethasone did not prevent the incidence of PDPH in the postoperative follow-up days (RR 1.05; 95 % CI 0.46-2.38; P = 0.91) and may even have increased the trend in the first 24 h. Prophylactic administration of 8 mg dexamethasone does not have any protective effect against PDPH and may even increase the incidence of PDPH in the first 24 h in patients with spinal anesthesia.
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Randomized Controlled Trial Multicenter Study Comparative Study
Comparison of vestipitant with ondansetron for the treatment of breakthrough postoperative nausea and vomiting after failed prophylaxis with ondansetron.
Postoperative nausea and vomiting (PONV) is common; ondansetron is often used as prophylaxis or for breakthrough episodes. Vestipitant is a neurokinin 1 (NK-1) receptor antagonist that is effective for prophylaxis, but its efficacy for treating established PONV is unknown. This study was performed to evaluate the efficacy and safety of vestipitant, compared with ondansetron for the treatment of breakthrough PONV in patients who had already received prophylactic ondansetron before surgery. ⋯ NCT01507194.
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Anesthesia and analgesia · Mar 2015
Perioperative neurotoxicity in the elderly: summary of the 4th international workshop.
To learn the latest developments in the various forms of postoperative cognitive dysfunction, a group of scientists and physicians met in Stockholm for a full day of presentations and interactive discussions. This article summarizes the discussion; highlighting progress, challenges, and new directions in the area of perioperative neurotoxicity in our aging population.
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Postoperative opioid-induced respiratory depression (RD) is a significant cause of death and brain damage in the perioperative period. The authors examined anesthesia closed malpractice claims associated with RD to determine whether patterns of injuries could guide preventative strategies. ⋯ This claims review supports a growing consensus that opioid-related adverse events are multifactorial and potentially preventable with improvements in assessment of sedation level, monitoring of oxygenation and ventilation, and early response and intervention, particularly within the first 24 h postoperatively.
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Cardiac surgery with cardiopulmonary bypass has a major impact on the congenital immune response, in which Toll-like receptors (TLRs) are the first line of defence. Decreased surface expression of TLRs and impaired monocyte responsiveness to TLR ligands occur following surgery. However, the clinical implications of this altered immune response are not clear. ⋯ Clinicaltrials.gov identifier: NCT00356746.