Journal of clinical anesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative pain control with methadone following lower abdominal surgery.
To describe a technique for the use of methadone during and following lower abdominal surgery that integrates its pharmacokinetic and pharmacodynamic properties with the objective of postoperative analgesia; to compare methadone with morphine for postoperative pain control. ⋯ Sustained analgesia with methadone is predicted by its pharmacokinetics. Patients who received 22 +/- 2.9 mg of IV methadone (combined intraoperative and recovery room doses) reported less pain and required minimal additional analgesic over the next 72 hours than did patients who received morphine. This is consistent with sustained therapeutic plasma levels due to methadone's long plasma half-life (54 +/- 20 hours). Use of methadone in this manner is an effective therapy for postoperative pain control and is not associated with toxicity or notable side effects.
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To determine the level of care available to obstetric patients during the immediate postanesthesia period. ⋯ In many obstetric PACUs, the level of expertise of personnel needs to be upgraded to ensure the safety of patients recovering from general or major regional anesthesia and to comply with existing care standards.
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Comparative Study
Secondary polycythemia does not increase the risk of perioperative hemorrhagic or thrombotic complications.
To determine the effects of secondary polycythemia on perioperative hemorrhagic and thrombotic complications. ⋯ Secondary polycythemia does not impart any added perioperative risk.
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A case is presented of a 34-month-old child who developed hyperthermia with a temperature of 40 degrees C while undergoing a suboccipital craniotomy for resection of a medulloblastoma. The presentation is followed by a discussion of the differential diagnosis of hyperthermia during anesthesia. Malignant hyperthermia, septicemia, thyroid storm, neuroleptic malignant syndrome, transfusion reaction, and exogenous causes of fever are discussed. The case serves as an illustration of the association between neurosurgical manipulation, intraventricular hemorrhage, and fever that may result from hypothalamic irritation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Anesthesia for craniotomy: total intravenous anesthesia with propofol and alfentanil compared to anesthesia with thiopental sodium, isoflurane, fentanyl, and nitrous oxide.
To compare a total intravenous (IV) anesthetic technique based on propofol and alfentanil with a commonly used anesthetic technique for craniotomy. ⋯ A total IV anesthetic technique with propofol and alfentanil is a valuable alternative to a more commonly used technique based on thiopental sodium, N2O, fentanyl, and isoflurane.