The Mount Sinai journal of medicine, New York
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Nonnarcotic analgesics and tricyclic antidepressants for the treatment of chronic nonmalignant pain.
Chronic nonmalignant pain is often characterized by multiple treatment failures, a pattern of maladaptive behavior, and depression. Often there is a history of inappropriate and excessive use of medications for pain. Prior and ongoing use of narcotics and sedatives acts to compound and aggravate the chronic pain syndrome. ⋯ Nonnarcotic analgesics, TCAs, and NSAIDs are seldom effective by themselves in resolving the pain and distress of patients with chronic nonmalignant pain. This is particularly true when maladaptive behavior coexists. A comprehensive multimodal pain management program encompassing additional pain-relieving strategies and behavior-modifying techniques should be considered and utilized in conjunction with medication.
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We have attempted to acquaint the internist with some aspects of anesthesiology that need to be kept in mind when performing perioperative consultation. Communication among and between the entire operative team will reduce risk and untoward reactions and will enhance the likelihood of successful outcome and rapid recovery.
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Air embolism occurred in a 25-year-old patient undergoing surgery for reconstruction of the subclavian vein. Air embolism probably occurred twice, the second time at about an hour after closure of the vein. The cause of this delayed air embolism is discussed. We conclude that capnographic monitoring for air embolism is advisable whenever surgery is performed on a patient in the half-sitting position, and that inserting a central venous catheter to facilitate removal of the air in the event of massive air embolism may be wise.
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I report on 25 asthmatic patients in whom airways obstruction was not detectable by conventional spirometric indices, but was suggested by a reduced or negative forced expiratory reserve volume (FERV), that is, the ERV measured from the forced vital capacity (FVC) maneuver and preceding tidal breaths. Patients with known causes for reduced ERV were excluded. ⋯ The FERV is easily measured in a physician's office or clinic. If this simple test is to provide a clue to the presence of airways obstruction that is otherwise not demonstrable spirometrically, the FVC maneuver must be maximal and reproducible and the preceding tidal breaths, as well as the FVC, must be graphically recorded.