Anesthesiology
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Randomized Controlled Trial
The Analgesic Effects of Proximal, Distal, or No Sciatic Nerve Block on Posterior Knee Pain after Total Knee Arthroplasty: A Double-blind Placebo-controlled Randomized Trial.
Either proximal or distal sciatic nerve block reduces pain in the first 6 hours after total knee arthroplasty. Distal (popliteal) may be superior.
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Tracheal intubation compromises mucus clearance and secretions accumulate inside the tracheal tube (TT). The aim of this study was to evaluate with a novel methodology TT luminal obstruction in critically ill patients. ⋯ TT luminal narrowing is a common finding and correlates with increased airflow resistance. The authors propose high-resolution CT as a novel technique to visualize and quantify secretions collected within the TT lumen.
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Randomized Controlled Trial
Anesthesia and Increased Hypercarbic Drive Impair the Coordination between Breathing and Swallowing.
Coordination between breathing and swallowing helps prevent aspiration of foreign material into the respiratory tract. The authors examined the effects of anesthesia and hypercapnia on swallowing-breathing coordination. ⋯ Anesthesia impaired the coordination between swallowing and respiration. Mild hypercapnia increased the frequency of swallowing during anesthesia and the likelihood of pathological swallowing. During anesthesia, the risk for aspiration may be further increased when ventilatory drive is stimulated.
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Biography Historical Article
The Chloroform Still of Dr. Samuel Guthrie, Jr.
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Diverting attention away from noxious stimulation (i.e., distraction) is a common pain-coping strategy. Its effects are variable across individuals, however, and the authors hypothesized that chronic pain patients who reported higher levels of pain catastrophizing would derive less pain-reducing benefit from distraction. ⋯ Distraction produced greater analgesia among chronic pain patients with higher catastrophizing, suggesting that catastrophizing's pain-amplifying effects may be due in part to greater attention to pain, and these patients may benefit from distraction-based pain management approaches. Furthermore, these data suggest that distraction analgesia and conditioned pain modulation may involve separate underlying mechanisms.