Journal of clinical anesthesia
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Clinical Trial Controlled Clinical Trial
Hemodynamic effects of intrathecal fentanyl in nonlaboring term parturients.
To determine the effect of intrathecal fentanyl on maternal hemodynamics. ⋯ Intrathecal administration of fentanyl 25 micrograms in nonlaboring term parturients does not produce clinically important maternal hemodynamic changes.
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Comparative Study Clinical Trial
Quantitative improvement in laryngoscopic view by optimal external laryngeal manipulation.
To determine the improvement in laryngoscopic view obtained using both the Macintosh and Miller blades by applying optimal external laryngeal manipulation (OELM). ⋯ We conclude that OELM can improve the laryngoscopic view by at least one whole grade, that the best way to determine OELM for an individual patient is on an empirical basis by manipulation of the larynx with the laryngoscopist's right hand, and that OELM should be an instinctive and reflex response to any "A" of 2, 3, or 4.
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Case Reports Clinical Trial
Respiratory depression: an adverse outcome during patient controlled analgesia therapy.
Patient-controlled analgesia (PCA) is one of the more popular means of controlling postoperative pain. However, there is very little in the literature concerning the adverse outcome of respiratory depression in PCA. ⋯ The respiratory depressions were associated with drug interactions, continuous narcotic infusion, nurse- or physician-controlled analgesia and inappropriate use of PCA by patients. This report identified the common precipitating factors in PCA-associated respiratory depression and its prevention.
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Clinical Trial
The effect of laparoscopic cholecystectomy on respiratory compliance as determined by continuous spirometry.
To evaluate the effect of pneumoperitoneum on dynamic compliance during laparoscopic cholecystectomy with continuous spirometry. ⋯ Increased intraabdominal pressure during laparoscopic cholecystectomy causes a significant, but fully reversible, decrease in dynamic compliance. On-line spirometry with a graphic display of the pressure-volume loop facilitates the immediate discovery of these alterations.
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We present 12 case reports from patients treated with more than 600 mg of morphine per day. We found no "opioid-nonresponsive pain" under treatment with a combination of morphine and nonopioids, supplemented with coanalgesics where appropriate. ⋯ Serious adverse effects were not observed. Episodes of break-through pain, dysphagia, and dyspnea caused by far advanced cancer disease were seen frequently.