Anesthesiology and pain medicine
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Colonoscopy is performed without preparing sedation in many countries. However, according to the current literature patients are more satisfied when appropriate sedation is prepared for them. ⋯ IV bolus injection of propofol-ketamine can lead to more patients' satisfaction than the other protocols during colonoscopy.
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Pain is a major problem in patients after cesarean and medication such as aromatherapy which is a complementary therapy, in which the essences of the plants oils are used to reduce such undesirable conditions. ⋯ The inhaled Lavender essence may be used as a part of the multidisciplinary treatment of pain after cesarean section, but it is not recommended as the sole pain management.
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Placement of a Blalock-Taussig (BT) shunt is frequently performed for palliation of cyanotic congenital heart disease (CCHD). ⋯ Use of inhalational anesthesia has increased in adult cardiac surgery and has proved to reduce duration of elective ventilation, decrease ICU and hospital LOS, and mortality. Inhalational anesthetics are less well-studied in CCHD. In the current study, desflurane was chosen because of its low solubility, decreased recovery time and lack of metabolism or organ system toxicities. Although it is a popular belief that desflurane is associated with tachycardia and airway irritation, findings of the current study are consistent with those of the previous works demonstrating a lack of these side effects below 1 MAC3. No hemodynamic instability was encountered and there was no evidence that desflurane exerted a negative inotropic effect. Markers of cardio protection were not examined, although desflurane may have had a renal protective effect compared to narcotic technique. In the current study, a desflurane anesthetic for BT shunt decreased the duration of mechanical ventilation and ICU and hospital LOS by nearly three days, with no difference in perioperative morbidity or mortality. Larger studies are required to determine whether these changes result in overall decreased complication rate and morbidity/mortality and whether desflurane has a cardio or renal protective effect in the patient population.
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Various attempts have been made to reduce the incidence of fentanyl-induced cough during anesthesia induction. We hypothesized that an appropriate dose of propofol might suppress fentanyl-induced cough. ⋯ Priming dose of propofol (20mg) one minute prior to fentanyl injection was effective in suppressing a fentanyl-induced cough.
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Although opioids are the main choice for acute postoperative pain control, many side effects have been reported for them. NSAIDs and paracetamol have been used extensively as alternatives, and it seems that they are more effective for minor to moderate pain control postoperatively when have been used alone or in combination with opioids. As laparoscopic cholecystectomy poses moderate pain postoperatively, this study was planned to assess whether paracetamol is able to provide effective analgesia as a sole analgesic at least in the first few hours post operatively. ⋯ Although paracetamol (1gr) has caused a better pain relief quality but it is not a suitable analgesic for moderate pain control in acute phase after surgery alone.