Pharmacotherapy
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Coronary artery bypass surgery is an accepted treatment for patients with coronary artery disease. Perioperative morbidity includes development of supraventricular arrhythmias. To prevent this, prophylactic administration of drugs such as calcium channel blockers, digoxin, and beta-blockers have been advised.
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A 69-year-old woman was admitted for control of intractable rectal pain caused by a 4-cm malignant mass. She was treated successfully with EMLA (eutectic mixture of local anesthetics) cream applied every 8 hours and covered with a Xeroform dressing. ⋯ We believe topical EMLA may be effective in managing such lesions. Close patient monitoring is necessary, however, and long-term, controlled studies must be conducted to determine its safety and efficacy in this setting.
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Randomized Controlled Trial Comparative Study Clinical Trial
The effects of sevoflurane and isoflurane on recovery from outpatient surgery.
This randomized, open-label study compared the investigational inhalational anesthetic sevoflurane with isoflurane in 47 healthy women undergoing elective ambulatory surgery. The women were randomized to receive either sevoflurane or isoflurane in 60% nitrous oxide-oxygen. Induction with thiopental 3-6 mg/kg was followed by vecuronium 0.1 mg/kg and fentanyl 0-200 micrograms. ⋯ The emergence, length of stay, and discharge times after discontinuation of sevoflurane were 9.7 +/- 0.7, 120.6 +/- 8.0, and 244 +/- 15 minutes, respectively, and for isoflurane were 11.9 +/- 1.4, 106.8 +/- 7.1, and 282 +/- 24 minutes, respectively (NS). The isoflurane group had a higher frequency of postoperative cough. At the end of surgery, the sevoflurane group received a deeper level of anesthesia (minimum alveolar concentration 1.5 vs 1.3), however, these patients were oriented earlier (13.6 +/- 1.1 min vs 17.0 +/- 1.5 min isoflurane; p = 0.02) after discontinuation of anesthesia, although this difference is of little clinical significance.
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Acute encephalopathy attributable to 5-fluorouracil (5-FU) is rare. A patient experienced this reaction associated with a continuous 5-FU infusion. The etiology of the event remains uncertain, but it is generally reversible and does not preclude retreatment with 5-FU at reduced dosages. Steroids and thiamine may expedite neurologic recovery.
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Comparative Study
QT interval prolongation and torsades de pointes due to erythromycin lactobionate.
To discern the frequency of torsades de pointes and QT prolongation in patients receiving intravenous erythromycin lactobionate; to examine the degree of QT prolongation and QT dispersion due to intravenous erythromycin in a typical clinical setting; and to identify any concurrent factors that might predispose patients to excessive QT prolongation or torsades de pointes while receiving intravenous erythromycin. ⋯ Erythromycin lactobionate-induced torsades de pointes is rare, although QT prolongation is common. Some patients may be at risk for suffering torsades de pointes due to this agent, particularly if heart disease or other factors that may further delay ventricular repolarization are present.