Journal of clinical anesthesia
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Comparative Study Clinical Trial
A comparison of three techniques for acute postoperative pain control following major abdominal surgery.
To compare the analgesic efficacy of a nonsteroidal antiinflammatory drug (NSAID) alone (basic pain treatment) with that of NSAID in conjunction with either intravenous (IV) patient-controlled analgesia (IV-PCA) or intermittent epidural morphine (epidural morphine), among patients recovering from major intraabdominal surgery; and to assess the fixed and variable costs of providing the respective acute pain treatment modalities. ⋯ Considering the respective pain profiles, complication rates, and institutional costs associated with the three analgesic regimens analyzed, the basic pain Treatment alone constitutes a useful alternative to the other two analgesic regimens assessed.
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Comparative Study Clinical Trial
Predicting recovery from deep neuromuscular block by rocuronium in the elderly.
To determine the influence of aging on the relationship between posttetanic count (PTC) and train-of-four (TOF) response during intense neuromuscular blockade caused by rocuronium. ⋯ Posttetanic twitch stimulation is a useful method of monitoring intense neuromuscular blockade caused by rocuronium in both age groups. The interval between the earliest appearance of a posttetanic response and the first response to TOF stimulation (T1) is greater in the elderly than in the young.
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To examine whether increasing mean arterial pressure (MAP) with the administration of phenylephrine would improve internal jugular venous oxygen saturation (SjvO2) during normothermic cardiopulmonary bypass (CPB) in patients with preexisting stroke. ⋯ Increasing MAP improves SjvO2 in patients with or without preexisting stroke during normothermic CPB.
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Case Reports
An initially unnoticed piece of nasal jewelry in a parturient: implications for intraoperative airway management.
The literature documenting the anesthetic implications of body piercing consists only of a few case reports that focus exclusively on interference with airway management by oral jewelry. To date, no case reports documenting anesthetic problems resulting from the presence of nasal jewelry have been reported. ⋯ This situation necessitated fiberoptic examination of the nasopharyngeal and oropharyngeal cavities and radiologic imaging studies to rule out aerodigestive tract aspiration of retained and missing piece(s) of the jewelry. Based on this experience, we now advise all laboring parturients with nasal or oral jewelry in situ to remove the hardware on admission to Labor and Delivery for safety precautions.
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Spinal cord injuries continue to be a devastating medical problem. By impairing voluntary and involuntary nervous system function, virtually every body system function is affected. However, pulmonary function alteration and respiratory complications continue to be the major causes of morbidity and mortality in patients with spinal cord injuries. The current understanding of respiratory problems faced by patients with loss of innervation from cervical spinal cord injuries are reviewed.