British journal of anaesthesia
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Randomized Controlled Trial Clinical Trial
Efficacy of intravenous magnesium in neuropathic pain.
Postherpetic neuralgia is a complication of acute herpes zoster characterized by severe pain and paraesthesia in the skin area affected by the initial infection. There is evidence that the N-methyl-D-aspartate receptor is involved in the development of hypersensitivity states and it is known that magnesium blocks the N-methyl-D-aspartate receptor. ⋯ The present study supports the concept that the N-methyl-D-aspartate receptor is involved in the control of postherpetic neuralgia.
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Randomized Controlled Trial Clinical Trial
Effects of a new modified, balanced hydroxyethyl starch preparation (Hextend) on measures of coagulation.
Hydroxyethyl starch (HES) may affect blood coagulation. We studied the effects of a modified, balanced, high-molecular weight [mean molecular weight (MW) 550 kDa], high-substituted [degree of substitution (DS) 0.7] HES preparation (Hextend) on coagulation in patients undergoing major abdominal surgery. ⋯ A modified, balanced high-molecular weight HES with a high degree of substitution (Hextend) adversely affected measures of coagulation in patients undergoing major abdominal surgery, whereas a preparation with a low MW and low DS affected these measures of haemostasis less. Large amounts of RL decreased the coagulation time.
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There is little advice on the posture to be used when intubating the trachea. Does the stance used depend on experience? ⋯ Novice anaesthetists should be given explicit instructions on correct trolley height and should be taught to intubate with a straight back.
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Randomized Controlled Trial Comparative Study Clinical Trial
The laryngeal tube compared with the laryngeal mask: insertion, gas leak pressure and gastric insufflation.
We have compared the laryngeal tube and laryngeal mask in 22 patients for the success rate of insertion, gas leak pressure and the incidence of gastric insufflation. ⋯ The laryngeal tube provides a better seal in the oropharynx than the laryngeal mask.
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The increasing number of patients with coronary artery disease undergoing major non-cardiac surgery justifies guidelines concerning preoperative evaluation, stress testing, coronary angiography, and revascularization. A review of the recent literature shows that stress testing should be limited to patients with suspicion of a myocardium at risk of ischaemia, and coronary angiography to situations where revascularization can improve long-term survival. Recent data have shown that any event in the coronary circulation, be it new ischaemia, infarction, or revascularization, induces a high-risk period of 6 weeks, and an intermediate-risk period of 3 months. ⋯ However, this delay may be too long if an urgent surgical procedure is requested, as for instance with rapidly spreading tumours, impending aneurysm rupture, infections requiring drainage, or bone fractures. It is then appropriate to use perioperative beta-block, which reduces the cardiac complication rate in patients with, or at risk of, coronary artery disease. The objective of this review is to offer a comprehensive algorithm to help clinicians in the preoperative assessment of patients undergoing non-cardiac surgery.