Anesthesia and analgesia
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Hypnosis has been defined as the induction of a subjective state in which alterations of perception or memory can be elicited by suggestion. Ever since the first public demonstrations of "animal magnetism" by Mesmer in the 18th century, the use of this psychological tool has fascinated the medical community and public alike. The application of hypnosis to alter pain perception and memory dates back centuries. ⋯ Contemporary clinical investigators claim that the combination of analgesia and hypnosis is superior to conventional pharmacologic anesthesia for minor surgical cases, with patients and surgeons responding favorably. Simultaneously, basic research of pain pathways involving the nociceptive flexion reflex and positron emission tomography has yielded objective data regarding the physiologic correlates of hypnosis. In this article I review the history, basic scientific and clinical studies, and modern practical considerations of one of the oldest therapeutical tools: the power of suggestion.
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Anesthesia and analgesia · May 2007
Randomized Controlled Trial Multicenter Study Comparative StudyA randomized, double-blind comparison of the NK1 antagonist, aprepitant, versus ondansetron for the prevention of postoperative nausea and vomiting.
Antiemetics currently in use are not totally effective. Neurokinin-1 receptor antagonists are a new class of antiemetic that have shown promise for chemotherapy-induced nausea and vomiting. This is the first study evaluating the efficacy and tolerability of the neurokinin-1 receptor antagonist, aprepitant, for the prevention of postoperative nausea and vomiting. ⋯ Aprepitant was superior to ondansetron for prevention of vomiting in the first 24 and 48 h, but no significant differences were observed between aprepitant and ondansetron for nausea control, use of rescue, or complete response.
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Anesthesia and analgesia · May 2007
Randomized Controlled Trial Comparative StudyThere is no dose-escalation response to dexamethasone (0.0625-1.0 mg/kg) in pediatric tonsillectomy or adenotonsillectomy patients for preventing vomiting, reducing pain, shortening time to first liquid intake, or the incidence of voice change.
Tonsillectomy is associated with postoperative nausea and vomiting (PONV) if no prophylaxis is administered. Previous studies have shown that a single dose of dexamethasone decreases the incidence of PONV. The most effective dose of dexamethasone to affect clinical outcome is yet to be defined. ⋯ We conclude that the lowest dose of dexamethasone (0.0625 mg/kg) was as effective as the highest dose of dexamethasone (1.0 mg/kg) for preventing PONV or reducing the incidence of other secondary outcomes following tonsillectomy or adenotonsillectomy. There is no justification for the use of high-dose dexamethasone for the prevention of PONV in this cohort of children.
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Anesthesia and analgesia · May 2007
ReviewUltrasound-guided regional anesthesia: current concepts and future trends.
The scope of ultrasound imaging guidance for regional anesthesia is growing rapidly. Preliminary data, although limited, suggest that ultrasound can improve block success rate and decrease complications. In this review, we describe the basic principles of ultrasound scanning and needling techniques for nerve blocks, highlight some of the data on clinical outcome, discuss specific limitations of ultrasound for regional anesthesia, and speculate on the future direction for physician training and competency assessment with this technology.
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Anesthesia and analgesia · May 2007
Comparative StudyCricoid pressure impedes insertion of, and ventilation through, the ProSeal laryngeal mask airway in anesthetized, paralyzed patients.
We designed this prospective self-controlled study to assess whether cricoid pressure hampers placement of and ventilation through the ProSeal laryngeal mask airway (ProSeal LMA) in anesthetized, paralyzed adult patients. ⋯ Cricoid pressure applied before insertion hampered proper placement of the ProSeal LMA. Temporary cricoid pressure release during insertion allowed the device to be advanced to the proper position. After correct placement of the ProSeal LMA, application of cricoid pressure did not change tidal volume, but produced a significant increase in peak inspiratory pressure.