Medical science monitor : international medical journal of experimental and clinical research
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Randomized Controlled Trial
Combined spinal epidural analgesia for labor with and without 3 ml of 1.5% epidural lidocaine.
Lidocaine is used as a 'test dose' to detect misplacement of epidural catheters. When administered immediately after the initiation of a combined spinal epidural for labor analgesia, it was found to interfere with motor function. The authors hypothesized that an epidural test dose of 3 ml of 1.5% lidocaine injected immediately after the initiation of combined spinal epidural analgesia and followed by a continuous epidural infusion would prolong the duration of analgesia and decrease the incidence of breakthrough pain. ⋯ The administration of epidural lidocaine and saline immediately after intrathecal levobupivacaine 2.5 mg and fentanyl 25 microg did not reduce the incidence of breakthrough pain in combined spinal epidural labor.
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The current view holds that gastric emptying is effected by the force of the antral peristaltic wave squeezing food particles through pyloric sphincter resistance. Whether this is accomplished by a reflex action was investigated. ⋯ Pyloric sphincter relaxation upon antral distension implies a reflex relationship the authors call the "antro-sphincteric inhibitory reflex". Pyloric sphincter distension effected antral contraction, which is suggested to be a reflex in nature and which they term the "sphinctero-antral excitatory reflex". It is postulated that these two reflexes act to churn and transport gastric contents to the duodenum.
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Randomized Controlled Trial
Total intravenous anesthesia with propofol and remifentanil is associated with a nearly twofold higher incidence in postanesthetic shivering than desflurane-fentanyl anesthesia.
Postanesthetic shivering (PAS) is a frequent side effect of general anesthesia. Previous reports on the incidence of PAS of propofol for the induction or maintenance of anesthesia have been controversial, but have not been studied in detail. The aim of the present study was to evaluate the incidence and severity of PAS in total intravenous anesthesia (TIVA) with propofol and remifentanil compared with an inhalative anesthesia. ⋯ Postanesthetic shivering appears significantly more frequently and intensively after TIVA with propofol and remifentanil compared with an inhalative anesthesia with fentanyl and desflurane.
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The syndrome of mitral valve prolapse (MVP) is the most common form of valvular heart disease. ⋯ A young female patient with combined mitral valve prolapse, atrial flutter, and syncope is presented.
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Randomized Controlled Trial Comparative Study
Effects of posterior pericardiotomy on the incidence of pericardial effusion and atrial fibrillation after coronary revascularization.
The aim of this prospective, randomized study was to assess the efficacy of posterior pericardiotomy in decreasing the prevalence of pericardial effusion and postoperative atrial fibrillation (AF). ⋯ These findings suggest that posterior pericardiotomy reduces the prevalence of early pericardial effusion and related AF by improving pericardial drainage in patients undergoing coronary artery bypass surgery.