British journal of anaesthesia
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Optimal treatment for acute pain is a function of an individual's willingness to make trade-offs between treatment side effects and pain control. The objective was to investigate the degree to which patients are willing to make these trade-offs. ⋯ We conclude that people have different relative preferences for different side effects and are willing to trade-off pain relief for less upsetting and/or less severe side effects but to different degrees. Thus, physicians should consider offering pain medications with fewer side effects than narcotics as a first choice. Our study indicates the need to balance analgesia and side effects in order for patients to achieve optimal pain control.
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Randomized Controlled Trial Clinical Trial
Optimal concentration of epidural fentanyl in bupivacaine 0.1% after thoracotomy.
The aim of this prospective, double-blind, randomized controlled trial was to investigate the analgesic and adverse effects of three commonly used concentrations of thoracic epidural fentanyl with bupivacaine in patients undergoing thoracotomy for lung resection. ⋯ We conclude that thoracic epidural fentanyl 5 microg ml(-1) with bupivacaine 0.1% provides the optimum balance between pain relief and side effects following thoracotomy.
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We have investigated the effect of propofol on language processing using event-related functional magnetic resonance imaging (MRI). ⋯ Our findings suggest sequential effects of propofol on auditory language processing networks. Brain activation firstly declines in the frontal lobe before it disappears in the temporal lobe.
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Ventilation in the prone position is used in patients with acute respiratory distress syndrome (ARDS), although data supporting this strategy are limited, and benefit for patients with other conditions is unclear. The patient in this report had severe hypoxaemia from diffuse alveolar haemorrhage caused by vasculitis with positive antineutrophil cytoplasmic antibodies (ANCA). Ventilation in the prone position improved oxygenation dramatically. ⋯ Prone ventilation was used on three consecutive days for 10, 14 and 15 h, respectively. Prone ventilation could improve oxygenation by better ventilation-perfusion (V/Q) matching and improved drainage of blood from the dorsal lung. The improved oxygenation in this patient should encourage the use of prone ventilation in other patients with pulmonary haemorrhage and severe hypoxia.