Anesthesia and analgesia
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Anesthesia and analgesia · May 2013
Historical ArticleContributions of Medieval Islamic physicians to the history of tracheostomy.
Tracheostomy was first described by Greco-Roman physicians, including Paulus of Aegina. Medieval Islamic clinicians extended the Greco-Roman ideas with substantial contributions to the field of surgery, including tracheostomy. Although Al-Zahrawi (936-1013 CE) stated that he had not heard or read of any Islamic physicians having performed tracheostomy, there is evidence that many prominent Islamic surgeons did practice this lifesaving procedure during medieval times. Throughout the Islamic Golden Age, Muslim physicians advanced the practice of tracheostomy with many modifications of the procedure, instrumentation, and adjuvant medicinal prescriptions.
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Anesthesia and analgesia · May 2013
ReviewNonsteroidal anti-inflammatory drugs during pregnancy and the initiation of lactation.
Nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin, which are available as "over-the counter" medications in most countries, are widely used by both pregnant and lactating women. They are popular non-opioid analgesics for the treatment of pain after vaginal and operative delivery. In addition, NSAIDs are used for tocolysis in premature labor, and low-dose aspirin has a role in the prevention of preeclampsia and recurrent miscarriage in antiphospholipid syndrome. ⋯ In the second trimester their use is considered reasonably safe, but has been associated with fetal cryptorchism. In the third trimester, NSAIDs and aspirin are usually avoided because of significant fetal risks such as renal injury, oligohydramnios, constriction of the ductus arteriosus (with potential for persistent pulmonary hypertension in the newborn), necrotizing enterocolitis, and intracranial hemorrhage. Maternal administration or ingestion of most NSAIDs results in low infant exposure via breastmilk, such that both cyclooxygenase-1 and cyclooxygenase-2 inhibitors are generally considered safe, and preferable to aspirin, when breastfeeding.
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Anesthesia and analgesia · May 2013
Altered arterial compliance in hypertensive pregnant women is associated with preeclampsia.
Vascular alterations are present in pregnant women affected by preeclampsia. In this study, we assessed arterial compliance in women affected by hypertensive disorders of pregnancy. We hypothesized that arterial compliance is reduced in women affected by preeclampsia. ⋯ The noninvasive assessment of arterial elasticity may contribute toward characterization of the nature of the pathophysiology in pregnancy-induced hypertensive disorders. The vascular alterations of the small arteries, as assessed by C2, may reflect the extent of vascular alterations present with preeclampsia.
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Anesthesia and analgesia · May 2013
Ryanodine receptor type 1 gene variants in the malignant hyperthermia-susceptible population of the United States.
Mutations in the ryanodine receptor type 1 gene (RYR1) that encodes the skeletal muscle-specific intracellular calcium (Ca(2+)) release channel are a cause of malignant hyperthermia (MH). In this study, we examined RYR1 mutations in a large number of North American MH-susceptible (MHS) subjects without prior genetic diagnosis. ⋯ The identification of novel RYR1 variants and previously observed RYR1 variants of uncertain significance in independent MHS families is necessary for demonstrating the significance of these variants for MH susceptibility and supports the need for functional studies of these variants. Continued reporting of the clinical phenotypes of MH is necessary for interpretation of genetic findings, especially because the pathogenicity of most of these genetic variants associated with MHS remains to be elucidated.
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Anesthesia and analgesia · May 2013
Review Meta AnalysisPreventive analgesia by local anesthetics: the reduction of postoperative pain by peripheral nerve blocks and intravenous drugs.
Barreveld et al. show that LA administered either IV or via block; before, during or after surgery, significantly reduces postoperative pain and opioid consumption.
Specifically in:
- Total knee arthroplasty (femoral, sciatic and lumbar plexus b., single-shot or continuous)
- Total hip arthroplasty (continuous lumbar plexus; intra-articular LA)
- Knee arthroscopy (single-shot lumbar plexus; IA LA; single-shot femoral nerve ± sciatic).
- Arthroscopic shoulder surgery - interscalene b., single-shot or continuous. IA is not beneficial.
- Hand & forearm surgery - axillary b. offers analgesic benefits only on day of surgery.
- TAP block is beneficial for laparoscopic, open appendectomy, abdominal surgery, cesarean section, and TAH.