Journal of clinical anesthesia
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When intrathecal and epidural opioids are administered, pruritus occurs as an unwanted and troublesome side effect. The reported incidence varies between 30% and 100%. The exact mechanisms of neuraxial opioid-induced pruritus remain unclear. ⋯ The treatment of intrathecal opioid-induced pruritus remains a challenge. Many pharmacological therapies, including antihistamines, 5-HT(3)-receptor antagonists, opiate-antagonists, propofol, nonsteroid antiinflammatory drugs, and droperidol, have been studied. In this review, we will summarize pathophysiological and pharmacological advances that will improve understanding and ultimately the management of this troublesome problem.
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Randomized Controlled Trial Comparative Study Clinical Trial
Local anesthesia and midazolam versus spinal anesthesia in ambulatory pilonidal surgery.
To evaluate two anesthetic techniques, namely, local anesthesia with sedation, and spinal anesthesia, with respect to recovery times, postoperative side effects, pain scores, patient satisfaction, and hospital costs for ambulatory pilonidal disease surgery. ⋯ The use of local anesthesia-sedation for ambulatory anorectal surgery resulted in a shorter hospital time, lower hospital costs, and no side effects compared with spinal anesthesia.
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Randomized Controlled Trial Clinical Trial
Interleukin balance and early recovery from anesthesia in elderly surgical patients exposed to beta-adrenergic antagonism.
To determine whether proinflammatory and antiinflammatory cytokines, as measured in blood specimens, would correlate with improved SF-36 physical composite scores observed in elderly surgical patients who were administered perioperative atenolol. ⋯ Perioperative administration of atenolol to elderly surgical patients markedly improves physical sense of well-being, which coincides with improved postoperative pain control and decreased analgesic requirements. This improvement experienced by patients receiving atenolol is not related to alterations in perioperative cytokine response.
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Oxygen-carrying hemoglobin (Hb) solutions are under intense investigation as an alternative to allogeneic red cell transfusion during surgery, with or without acute normovolemic hemodilution. We present a case in which an investigational Hb solution was used as an adjunct to acute normovolemic hemodilution, and as a replacement for surgical blood loss in a patient undergoing complex aortic reconstruction with a large blood loss.
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Moving the last case of the day from one operating room (OR) to another OR can increase OR efficiency. However, there is a penalty cost for moving a case. The goal of the study was to measure perceptions of the minimum time that needs to be saved for it to be worthwhile to move a case from a late-running OR to another OR. ⋯ Members of the AACD perceive the penalty cost for moving a case to be 1 hour.