Journal of clinical anesthesia
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Comparative Study
Pain assessment following general anesthesia using the Toddler Preschooler Postoperative Pain Scale: a comparative study.
To evaluate the reliability of the Toddler Preschooler Postoperative Pain Scale (TPPS) following general anesthesia as a guide to analgesic administration, and to compare the validity of this scale with other observational measures of pain in children. ⋯ Following procedures that are likely to produce pain, TPPS, FLACC, and the COMFORT scale, modified as a purely behavioral tool, can be recommended for postoperative assessment of patients aged 1 to 5 years. The TPPS may be preferred for the discrimination between painful and nonpainful states.
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To evaluate the effect of carbon dioxide (CO(2)) pneumoperitoneum and retropneumoperitoneum insufflation on CO(2) excretion. ⋯ This study may focus attention on the need for continuous ventilatory adjustments during transperitoneal endoscopic surgery.
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Comparative Study
The association of intraoperative neuraxial anesthesia on anticipated admission to the intensive care unit.
To determine whether use of intraoperative neuraxial anesthesia would decrease the frequency of ICU admission postoperatively in orthopedic patients. ⋯ Intraoperative neuraxial anesthesia in higher-risk patients undergoing elective hip or knee replacement surgery is associated with a decrease in anticipated ICU admission postoperatively. A causal relationship cannot be determined with this type of study and further research is needed to better understand this association.
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Comparative Study
Orthotopic liver transplant patients require less postoperative morphine than do patients undergoing hepatic resection.
To compare postoperative morphine use, analgesic efficacy, and side effect profiles in patients following orthotopic liver transplantation (OLTx) and liver resection (LR). ⋯ Orthotopic liver transplant patients experienced less pain and used less morphine postoperatively than did liver resection patients.
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Heparin-induced thrombocytopenia (HIT) is a common complication of heparin therapy. There are three types of HIT. In the majority of patients, thrombocytopenia is modest and resolves without sequelae (HIT I). ⋯ It is advisable that heparin not be administered in any form to patients with documented or suspected HIT II or HITT. This situation, of course, poses a problem for those patients requiring cardiopulmonary bypass (CPB) surgery. In this report, we summarize our experience with Lepirudin (Hoechst, Frankfurt Ammain, Germany), which is a recombinant hirudin (r-hirudin), as an alternative to heparin for systemic anticoagulation, as well as the use of the ecarine clotting time (ECT) for monitoring anticoagulation status during CPB.