Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Numerous postoperative analgesic therapies are continuing to develop as interest increases in the control of acute pain, particularly within the specialty of anaesthesia. Further progress will be made in the near future in relation to preemptive analgesia and reduction of postoperative pain by controlling spinal cord plasticity.(41,42) The concept of multimodal or balanced analgesia(43) in which the combined use of specific agents blocking specific segments of the pain pathway is another area which may provide improvements in postoperative analgesia.
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Comparative Study
Tongue oximetry in children with extensive thermal injury: comparison with peripheral oximetry.
We undertook a prospective study of standard peripheral pulse oximetry versus a modified pulse oximeter probe applied to the tongue in order to determine the efficacy of this alternative monitoring site in children with thermal injuries. Ten patients with a mean age (+/- SD) of 7.5 +/- 4.5 yr were studied on 15 occasions. The mean weight (+/- SD) was 31.4 +/- 13.7 kg and percent surface area burn (+/- SD) was 56 +/- 21%. ⋯ The tongue oximeter provided 563 min more monitoring time than the peripheral sites. The tongue oximeter also functioned in children with peripheral vasoconstriction when the peripheral sensor failed and was less susceptible to electrocautery interference. The tongue oximeter is a reasonable adjunct but not a substitute for peripheral oximetry since its application is limited to paralyzed, intubated patients.
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Unanticipated difficulties continue to occur in airway management. While newer systems of evaluation show some promise, the problem of poor predictive value limits their usefulness. ⋯ The anaesthetist should have a clear "fall back" plan of which of these techniques to use in emergency or urgent situations. Published algorithms may aid in the selection of appropriate techniques, but the anaesthetist must also develop dexterity with the particular technique chosen.