Anesthesiology and pain medicine
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Postoperative sore throat is a common complication of endotracheal intubation and can lead to dissatisfaction after surgery. Airway management has the strongest influence on the incidence of sore throat and improving endotracheal intubating conditions can reduce this complaint. Type of induction agent used during anesthesia can contribute to variances in the degree of post-operative sore throat. ⋯ Use of high dose Cisatracurium for induction during rapid sequence intubation carries a lower chance of developing sore throat compared to Succinylcholine. Studies comparing other adverse effects of these two agents are required to guide physician's choice of induction agent.
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Postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy (LC) has multifactorial etiology. Pain and use of opioids are among the important factors. ⋯ Intraperitoneal bupivacaine administration at the beginning and end of laparoscopic cholecystectomy reduced only visceral and shoulder pains at the 4th postoperative hour, but had no effect on reducing neither PONV, nor opioid demand, during the first four postoperative hours.
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There have been many concerns about alteration in hemodynamic parameters within and shortly after endotracheal intubation (ETI) in patients scheduled for elective coronary artery bypass grafting (CABG). ⋯ Lidocaine induced hemodynamic instability but premedication of magnesium sulfate maintained hemodynamic stability after intubation. Therefore, in patients undergoing CABG who received high-dose intravenous analgesic for general anesthesia, the administration of magnesium sulfate might result in maintaining hemodynamic stability after ETI in comparison with lidocaine.
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Case Reports
Caudal Epidural of Pulsed Radiofrequency in Post Herpetic Neuralgia (PHN); Report of Three Cases.
Postherpetic neuralgia (PHN) is a frequently occurring neuropathic pain, its pathophysiology is not fully understood. There are only few evidence based therapeutic options; sympathetic nerve block can be considered for patients with PHN refractory to conservative treatment, but long-term effects are poor. Application of pulsed radiofrequency was effective to treat a variety of pain syndromes without neurological complications or other sequelae. ⋯ The mode of action of PRF is far from being completely elucidated. The high frequency current induces an electric field that in turn seems to influence the immunity, the inflammation and other pain conducting mechanisms. Our findings suggest an effect distal from the application of the current. It reaches targets that are difficultly attainable by any other means of current application. The observations of pain relief in the difficult to treat patients with PHN justifies further investigation.