Journal of clinical anesthesia
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To evaluate the consequences of opioid use for postoperative pain management and the degree to which these consequences may be reduced or minimized with opioid-sparing or opioid-replacement techniques. ⋯ Opioids will likely remain an integral part of postoperative pain management, but side effects increase the costs of care. The challenge is to identify situations where opioid-sparing techniques improve surrogate economic measurements and decrease overall hospital costs.
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Spontaneous rupture of the uterus is a life-threatening obstetrical emergency. Diagnosis may be delayed because of the bizarre presentation or absence of significant pain and tenderness, which could have been masked by the analgesic medications used during labor. We present a case of spontaneous rupture in a multigravid female who was undergoing oxytocin-augmented labor while receiving epidural analgesia. ⋯ At emergent cesarean section, a uterine rupture was noted. The uterine rupture extended down to the left vaginal angle, was not reparable and a hysterectomy was performed. The fetus survived.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of effects of lidocaine hydrochloride, buffered lidocaine, diphenhydramine, and normal saline after intradermal injection.
To evaluate pain and the spread of analgesia when local anesthetics are given as an intradermal injection into the dorsal aspect of the hand. ⋯ There is a reduction of infiltration pain using buffered lidocaine as opposed to lidocaine and diphenhydramine. Although lidocaine injection resulted in a slightly faster spread of analgesic diameter, buffered lidocaine was equivalent to lidocaine from minute 2 until minute 30. Therefore, to obtain optimal anesthetic conditions, we recommend that buffered lidocaine be given 2 minutes before performing catheterization, whereas diphenhydramine should be given 5 minutes before catheterization, but only when buffered lidocaine cannot be used.
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Randomized Controlled Trial Clinical Trial
Effects of combining midazolam and barbiturate on the response to tracheal intubation: changes in autonomic nervous system.
To investigate the effects on the autonomic nervous system of anesthesia induction with a combination of midazolam and barbiturate using plasma catecholamine concentration and heart rate (HR) variability in comparison with the induction with barbiturate alone. ⋯ Anesthesia induction with a combination of midazolam-thiopental was effective in reducing hemodynamic and cardiac autonomic nervous system responses to tracheal intubation in comparison with the conventional induction with thiopental alone.
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To determine the influence of head and neck elevation beyond the "sniffing position" during difficult direct laryngoscopy. ⋯ Elevation of the head and neck beyond the sniffing position may improve visualization of glottic structures in cases of difficult direct laryngoscopy, leading to better intubation performance.