Journal of clinical anesthesia
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Randomized Controlled Trial Clinical Trial
Combined intrathecal fentanyl and neostigmine: therapy for postoperative abdominal hysterectomy pain relief.
To evaluate the analgesic action of spinal neostigmine as part of a multimodal analgesic therapy approach including spinal neostigmine and spinal fentanyl for postoperative pain relief ⋯ The combination of 25 microg neostigmine with 25 microg fentanyl given intrathecally with 15 mg of hyperbaric bupivacaine delayed postoperative pain and lowered the number of rescue analgesics. Because the better quality of analgesia was obtained with an increased (although not statistically significant difference) incidence of untoward side effects, larger samples should be studied before its routine use is recommended.
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Clinical Trial Controlled Clinical Trial
Fluid resuscitation, nutritional support, and cholesterol in critically ill postsurgical patients.
To determine how and why cholesterol concentrations decrease after surgery, and the effect of the administration of nutritional support. ⋯ Serum cholesterol concentrations, like those of serum albumin and total protein, are markedly reduced immediately following major abdominal surgery, often to levels reported in malnutrition. Dilution by IV fluid and redistribution into an expanded extracellular fluid space are likely the major causes of these decreases. Serum cholesterol concentrations are therefore not useful in the nutritional assessment of patients in the immediate postoperative period.
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To measure the distances from the skin to the epidural space (DSES) of the lower cervical and upper thoracic intervertebral spaces. ⋯ In the cervical spine, DSES varies from space to space. In obese individuals, the fat pad may increase DSES at the lower cervical intervertebral spaces. The longest mean distances from the ligamentum flavum to the dural sac and to the spinal cord were found at the T1-2 and T2-3 levels, precisely where DSES is shorter. All things being equal, the upper thoracic intervertebral spaces appeared to provide a greater margin of safety for insertion of epidural catheters to treat cervicobrachial radiculopathies.
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Case Reports
Mucoid impaction following nasal intubation in a child with an upper respiratory infection.
We describe a case of mucoid impaction following nasotracheal intubation in a child with an upper respiratory infection that was successfully treated with a fiberoptic bronchoscope too large to pass through the endotracheal tube lumen. To the best of our knowledge, it is the first report in the anesthesia literature in which the placement of a nasal tracheal tube is implicated as the cause of the mucous obstruction. The physiologic changes that occur with anesthesia and that place patients at increased risk for this phenomenon, as well as the differential diagnosis, treatment, and prevention of this entity, are discussed.