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
Randomized Controlled Trial Multicenter StudyNitrous oxide and serious morbidity and mortality in the POISE trial.
Nitrous oxide exposure was not associated with 30-day MI, stroke, death or hypotension in an observational analysis of POISE subjects.
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Anesthesia and analgesia · May 2013
Randomized Controlled TrialAn alternative distal approach for the lumbar medial branch radiofrequency denervation: a prospective randomized comparative study.
An alternative technique involving a "distal approach" can be used for lumbar medial branch radiofrequency denervation (LMBRFD). We described and assessed this technique by comparing it with a conventional tunnel vision approach in a prospective randomized trial. ⋯ Patients who underwent LMBRFD by the tunnel vision or distal approaches showed significant pain relief at the 6-month follow-up. Less periprocedural pain was reported in the distal approach group. We consider that the distal approach provides an improved option for LMBRFD.
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Anesthesia and analgesia · May 2013
Review Comparative StudyEstimating surgical case durations and making comparisons among facilities: identifying facilities with lower anesthesia professional fees.
Consumer-driven health care relies on transparency in cost estimates for surgery, including anesthesia professional fees. Using systematic narrative review, we show that providing anesthesia costs requires that each facility (anesthesia group) estimate statistics, reasonably the mean and the 90% upper prediction limit of case durations by procedure. The prediction limits need to be calculated, for many procedures, using Bayesian methods based on the log-normal distribution. ⋯ Such comparisons of durations among facilities should be performed with correction for the effects of the multiple comparisons. Our review also has direct implications to the potentially more important issue of how to study the association between anesthetic durations and patient morbidity and mortality. When pooling duration data among facilities, both the large heterogeneity in the means and coefficients of variation of durations among facilities need to be considered (e.g., using "multilevel" or "hierarchical" models).