Journal of clinical anesthesia
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Postoperative pain relief has improved in recent years with the development of new analgesics, additional routes of administration and the appearance of the hypothesis of preemptive as well as balanced analgesia (Kehlet H; Postoperative pain relief-what is the issue? Br J Anaesth 1994;72:375-8). Many initial improvements simply involved the administration of opioid analgesics in new ways, such as continuous or on demand intravenous (i.v.) or epidural infusion. These methods allow lower total opioid dosages, provide a more stable concentration of opioid at the receptor and correspondingly better analgesic effects, and also fewer unwanted side effects. ⋯ Thus, the recent emphasis on ambulatory surgery and accelerated surgical stay programs, both with a focus on early recovery of organ function and provision of functional analgesia [i.e., pain relief that allows normal function (Kehlet H: Postoperative pain relief-what is the issue? Br J Anaesth 1994;72:375-8)] provide an opportunity for a reappraisal of opioid use in these settings. For this debate, controlled clinical studies on the opioid-sparing effect of different analgesic techniques are mentioned, and preferably studies with multiple dosing of analgesics and/or a reasonably large patient sample size. These data do not allow a proper meta-analysis to be performed because of the large variability in surgical procedures, dosing regimens, assessment criteria, among others.
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To evaluate the effectiveness of a behavioral preparation program on reducing anxiety in children and their parents prior to elective surgery. ⋯ The results highlight the complexities in assuming that a behavior-based preoperative preparation program is effective for all pediatric outpatients. The effects of such an intervention vary with the child's age, the timing of the intervention, and a history of previous hospitalization.
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Until 1952, the administration of inhaled volatile anesthetics was inexact because vaporizers in general use were not calibrated for either concentration or volume of vapor produced. These devices diverted a variable portion of fresh gas flow either through or over the liquid to be vaporized, but they lacked vernier or fine control. Therefore, changes in the concentration of the anesthetic vapor were not easily controlled. ⋯ Morris standardized the administration of volatile anesthetics with his invention of the Copper Kettle, which produced known volumes of saturated vapor, then diluted to calculated concentrations necessary for anesthesia. To achieve this, modifications had to be made in the liquid container, circuit design, and vaporizing surfaces in use at the time. Morris' design incorporated a separately metered flow of carrier gas through the vaporizer to produce known volumes of saturated vapor for introduction into the fresh gas flow delivery.
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Venous air embolism is a potentially fatal complication. In a patient undergoing extensive debridement of an open perineal wound, hemodynamically significant air embolization occurred during use of a pulsatile saline irrigation device. We describe another intraoperative setting in which venous air embolism is a risk.
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Comparative Study Clinical Trial
Comparison of esophageal, tympanic, and forehead skin temperatures in adult patients.
To compare esophageal, tympanic membrane, and forehead skin temperatures in patients undergoing elective surgeries. ⋯ There was a lack of precision between the clinically accepted measurements (lower esophageal and tympanic membranes and the skin temperature measurement. The data suggest that forehead skin temperature is not interchangeable with standard core temperature measurements, and that sole reliance on the forehead skin measurement in the perioperative setting could adversely affect patient care.