AANA journal
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Acute postoperative pain can cause detrimental effects on multiple organ systems. To treat pain effectively, a thorough knowledge of the anatomy and physiology of pain and its transmission is necessary. Painful stimuli, like that produced by a surgical incision, can lead to a hyperexcitable state in the spinal cord. ⋯ Once the hyperexcitable state has been established, a larger dose of analgesic drug is needed than if hyperexcitability had been prevented. When an analgesic is administered before the bombardment of painful stimuli that occurs with surgical incision, postoperative pain can be greatly diminished. Epidural, intravenous, and intramuscular opioids have been shown to reduce the severity of postoperative pain to a greater extent when administered before surgical stimuli rather than following it.
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Review Case Reports
Anesthetic implications in epidermolysis bullosa dystrophica.
Epidermolysis bullosa is a genetic mechanobullous disease of the stratified squamous keratinizing epithelium that affects the skin and mucous membranes. Its primary feature is the formation of blisters after minor shearing trauma to the skin or mucous membranes that can result in debilitating, even life-threatening scarring. ⋯ The challenge is to maintain patency of the airway and use monitoring technology without damaging epithelial surfaces, which could result in permanent scarring. Successful anesthetic management of a patient with epidermolysis bullosa is possible if precautions with anesthetic instrumentation are observed.
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Clinical Trial Controlled Clinical Trial
The addition of interscalene block to general anesthesia for patients undergoing open shoulder procedures.
Several studies have demonstrated that interscalene brachial plexus anesthesia alone decreases postoperative pain, nausea, vomiting, urinary retention, and unplanned hospital admissions compared with general anesthesia alone. Anecdotal evidence suggests that an interscalene block combined with general anesthesia decreases unwanted effects of general anesthesia following open shoulder surgery. We compared the effect of combined interscalene block and general anesthesia with general anesthesia alone on Aldrete scores, length of postanesthesia care unit (PACU) stay, verbal rating scale (VRS) pain scores, incidence of postoperative narcotic administration and nausea, and patient satisfaction in a convenience sample of 52 men and women, ASA physical status I, II, or III. ⋯ Group 2 had significantly lower VRS scores than group 1 while in the PACU, on the day of surgery, and on postoperative days 1 and 2. Overall satisfaction with the anesthetic technique was higher in the group 2 than in group 1. Results suggest that adding an interscalene block to general anesthesia can be of value in today's outpatient-dominated surgery schedule.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of motor block between ropivacaine and bupivacaine for continuous labor epidural analgesia.
The aim of the present study was to compare the amount of motor block produced by different loading doses of ropivacaine and bupivacaine when delivered in a dilute solution with added opioid. Sixty-eight healthy term primigravid parturients were randomized to receive an initial bolus dose of 10 mL of 1 of the following: 0.25% bupivacaine (high bupivacaine), 0.25% ropivacaine (high ropivacaine), 0.125% bupivacaine (low bupivacaine), or 0.125% ropivacaine (low ropivacaine). Each loading dose had 10 micrograms of sufentanil added to it. ⋯ A statistically significant greater percentage of parturients receiving bupivacaine had motor block than those who received ropivacaine, with a marked decrease in the occurrence of motor block in the low ropivacaine group. The pain relief seemed to be less satisfactory in the ropivacaine groups, but the difference was not statistically significant. Ropivacaine produced significantly less motor block than bupivacaine in the 0.25% and the 0.125% loading doses, with the greatest difference seen in the lower concentration loading dose of ropivacaine.
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Randomized Controlled Trial Clinical Trial
Reducing anxiety in parents before and during pediatric anesthesia induction.
Fear and anxiety in a child undergoing surgery are correlated positively with the parent's level of anxiety, and interventions to decrease the parent's anxiety are appropriate. The purpose of this study was to determine whether viewing a video of an actual pediatric inhalation induction would reduce the level of parental anxiety. Eighty patients requiring an inhalation anesthetic induction were selected and randomized to 2 groups. ⋯ The level of anxiety postoperatively of children and parents in group 1 was significantly lower than that of children and parents in group 2 (P < .05). Viewing a preoperative video seems to be beneficial. Decreasing the parent's level of anxiety preoperatively may have a positive effect on the child's level of anxiety expressed postoperatively.