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Paediatric anaesthesia · Jul 2015
Review Meta AnalysisDoes a prophylactic dose of propofol reduce emergence agitation in children receiving anesthesia? A systematic review and meta-analysis.
Emergence agitation (EA) is common after sevoflurane anesthesia in children, and can lead to distressing inconsolability, agitation, crying, and injury. Use of a single dose of the short-acting sedative-hypnotic agent propofol at the end of a procedure has shown promise for preventing EA, but evidence evaluating the efficacy and safety of this approach has not been formally summarized. ⋯ Based on high quality evidence, prophylactic propofol appears to be effective for reducing the incidence and severity of EA in children emerging from general anesthesia.
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The use of opioids may seem to be a double-edged sword; they provide straight analgesic and antihyperalgesic effects initially, but subsequently are associated with the expression of acute opioid tolerance (AOT) and opioid-induced hyperalgesia (OIH) that have been reported in experimental studies and clinical observations. It has been suggested that opioids can induce an acute tolerance and hyperalgesia in dose- and/or time-dependent manners even when used within the clinically accepted doses. Recently, remifentanil has been used for pain management in clinical anesthesia and in the intensive care units because of its rapid onset and offset. ⋯ Twenty-four experimental and clinical studies were identified using electronic searches of MEDLINE (PubMed, Ovid, Springer, and Elsevier). However, the development of AOT and OIH by remifentanil administration remains controversial. There is no sufficient evidence to support or refute the existence of OIH in humans.
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Phenylephrine is currently recommended as the consensus choice for managing hypotension during spinal anaesthesia for Caesarean section. Ephedrine should only be used when mild hypotension is associated with bradycardia.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial.
Magnesium sulphate halves the risk of eclampsia in pre-eclamptic pregnant women without significant adverse effect.
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Anesthesia and analgesia · Sep 2004
Multicenter StudyThe incidence of awareness during anesthesia: a multicenter United States study.
The incidence of awareness-with-recall under general anesthesia in the United States is 1-2 cases per 1,000 patients.
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