Nitrous oxide: are we still in equipoise? A qualitative review of current controversies

Vasconcellos, Kim de; Sneyd, J. R.

doi:10.1093/bja/aet215

Cited by 49 publications

(27 citation statements)

References 104 publications

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“…These stakeholders include the trial designers, recruiters, patient and public representatives and participants, as well as health care staff who are not directly involved in the trial but will use the evidence produced by it. A lack of equipoise amongst stakeholders may lead to poor recruitment practices, low recruitment rates or a lack of utility of the evidence in the real world [29]. Consideration of the question of equipoise at the feasibility phase can offer opportunities to address this, for example through education, increasing awareness and enabling open discussion of the issues, or highlight the option of not progressing to an expensive full trial [30, 31].…”

Section: Reviewmentioning

confidence: 99%

Maximising the impact of qualitative research in feasibility studies for randomised controlled trials: guidance for researchers

O’Cathain

Hoddinott

Lewin

et al. 2015

Pilot Feasibility Stud

282

276

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Feasibility studies are increasingly undertaken in preparation for randomised controlled trials in order to explore uncertainties and enable trialists to optimise the intervention or the conduct of the trial. Qualitative research can be used to examine and address key uncertainties prior to a full trial. We present guidance that researchers, research funders and reviewers may wish to consider when assessing or undertaking qualitative research within feasibility studies for randomised controlled trials. The guidance consists of 16 items within five domains: research questions, data collection, analysis, teamwork and reporting. Appropriate and well conducted qualitative research can make an important contribution to feasibility studies for randomised controlled trials. This guidance may help researchers to consider the full range of contributions that qualitative research can make in relation to their particular trial. The guidance may also help researchers and others to reflect on the utility of such qualitative research in practice, so that trial teams can decide when and how best to use these approaches in future studies.

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Section: Reviewmentioning

confidence: 99%

Maximising the impact of qualitative research in feasibility studies for randomised controlled trials: guidance for researchers

O’Cathain

Hoddinott

Lewin

et al. 2015

Pilot Feasibility Stud

282

276

View full text Add to dashboard Cite

show abstract

“…Therefore, we used both 50% N 2 O and 0.7% sevoflurane for the purpose of reducing the latter dosage while preserving the amnestic effect during the final hour of the operation. N 2 O administration to prevent anesthetic awareness is controversial 7 ; however, N 2 O would be effective for maintenance of anesthesia during minimally invasive operations and is not associated with the risk of developing MS. 8 Concerning body temperature, the possibility of development of hyperthermia should be considered. 1,[4][5][6] Heat exposure blocks conduction in demyelinated axons and can trigger recurrence of MS, and body temperature should be closely monitored and controlled during the perioperative period.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic Management of a Patient With Multiple Sclerosis

Ohshita

Gamoh

Kanazumi

et al. 2017

Anesthesia Progress

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A 54-year-old woman diagnosed with multiple sclerosis (MS) at the age of 19 years was scheduled to undergo temporomandibular joint mobilization. She was currently in a remission phase from her MS but with persistent sequelae, including impaired eyesight and muscle weakness of the limbs. In addition, the blood vessels in her upper limbs were compromised by the formation of internal shunts secondary to vascular prosthesis replacements for plasma exchange therapy in MS. After a previous joint mobilization surgery, her temporomandibular joint developed adhesions with resultant trismus. One of the adverse effects of general anesthesia can be exacerbations of MS symptoms. Minimizing mental and physical stress caused by surgical and anesthetic procedures and maintenance of stable body temperature are important considerations. Awake intubation was performed under sedation with midazolam and fentanyl. After intubation, anesthesia was induced with propofol, remifentanil, and rocuronium. Maintenance of anesthesia was achieved with oxygen-N 2 O-sevoflurane, remifentanil, fentanyl, and rocuronium. In this case, no adverse events occurred intraoperatively. However, the patient experienced lingering weakness of the limbs in the postoperative period, and activities of daily living of the patient were affected.Key Words: Multiple sclerosis; Demyelinating encephalomyelitis; Trismus.M ultiple sclerosis (MS) is a demyelinating disease of the central nervous system characterized by varying initial symptoms such as visual impairment, bowel/bladder dysfunction, trigeminal neuralgia, cognitive problems, gait disorder, and motor paralysis. We report a case of a patient with MS who underwent temporomandibular joint (TMJ) mobilization under general anesthesia. CASE REPORTA 54-year-old woman (height, 155 cm; weight, 45 kg) with MS was scheduled for TMJ mobilization under general anesthesia. The patient was diagnosed with MS at the age of 19 years, and reportedly was in remission since the age of 35 years, after multiple episodes of remissions and exacerbations. The MS was treated mainly with steroidpulse, immunoglobulin, and plasma exchange therapy. Although the MS was in a remission phase, she had persisting after-effects, including impaired eyesight due to steroid-induced glaucoma and cataract, and muscle weakness of limbs. She used to walk with the help of a cane, but her activities of daily living had since decreased. In addition, the blood vessels of both upper extremities and the left lower extremity were compromised as a result of formation of internal shunts secondary to vascular prosthesis replacement for plasma exchange therapy and steroid pulse therapy. Her arms and legs appeared edematous. Other medical history included gastroesophageal reflux and history of hypotension. The gastroesophageal reflux was treated with sulpiride (a dopamine antagonist antipsychotic), lansoprazole (a proton pump inhibitor), mosapride citrate (a 5-HT 4 gastroprokinetic), and polaprezinc (a mucosal protective agent), and hypotension was treated with a...

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“…5 Anaesthetic opinion has been divided as to whether it should still be used. 6 It may not be an effective analgesic for women in labour -in one (small but widely quoted) trial of analgesia in early labour, compressed air was of similar efficacy. 7 The gas has adverse effects and undesirable properties; but it has advantages, 8 too, such as rapid onset of action, 9 and little overall effect on heart rate and blood pressure.…”

Section: Historymentioning

confidence: 99%