Anesthesiology
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Randomized Controlled Trial Comparative Study
Fentanyl-sparing effect of acetaminophen as a mixture of fentanyl in intravenous parent-/nurse-controlled analgesia after pediatric ureteroneocystostomy.
Although acetaminophen has been used widely and is well tolerated in children, its efficacy and safety have not been clarified when combined with an opioid in intravenous parent-/nurse-controlled postoperative analgesia. ⋯ Acetaminophen has significant fentanyl-sparing effects and reduces side effects when combined with fentanyl in intravenous parent-/nurse-controlled analgesia for postoperative pediatric pain management.
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Randomized Controlled Trial Comparative Study
Effects of preoxygenation on desaturation time during hemorrhagic shock in pigs.
Patients in hemorrhagic shock often require emergent airway management. Clinical experience suggests that oxygen desaturation occurs rapidly in these patients; however, data are scant. The hypothesis of this study was that increasing levels of hemorrhagic shock, varying levels of fraction of inspired oxygen (Fio2) for preoxygenation, and fluid resuscitation significantly affect the duration until critical desaturation occurs. ⋯ Findings from this swine hemorrhagic shock model confirm that Fio2 and the level of hemorrhagic shock, but not fluid resuscitation, influence the rate of apneic desaturation. A five-fold increase in time until critical oxygen desaturation occurs can be achieved when preoxygenating with 100% oxygen compared with room air, underscoring the importance of adequate preoxygenation before emergent airway management.
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Complex regional pain syndrome (CRPS) is a neuropathic pain disorder with significant autonomic features. Few treatments have proven effective, in part, because of a historically poor understanding of the mechanisms underlying the disorder. CRPS research largely conducted during the past decade has substantially increased knowledge regarding its pathophysiologic mechanisms, indicating that they are multifactorial. ⋯ These include peripheral and central sensitization, inflammation, altered sympathetic and catecholaminergic function, altered somatosensory representation in the brain, genetic factors, and psychophysiologic interactions. Relative contributions of the mechanisms underlying CRPS may differ across patients and even within a patient over time, particularly in the transition from "warm CRPS" (acute) to "cold CRPS" (chronic). Enhanced knowledge regarding the pathophysiology of CRPS increases the possibility of eventually achieving the goal of mechanism-based CRPS diagnosis and treatment.
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Biography Historical Article
Joseph Adrian Jeevendra Martyn, M.D., F.R.C.A., F.C.C.M., recipient of the 2010 Excellence in Research Award.