Anesthesiology and pain medicine
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Premedication is required for reducing anxiety and child's struggling against mask acceptance on anesthesia in pediatric surgery for congenital heart disease. Midazolam has been widely used for this purpose, but because of its side effects, finding an effective replacement with less complication is necessary. ⋯ It appears reasonable to apply oral premedication with dexmedetomidine 45 minutes before transferring the patient to the operating room when he or she is more prone to resist inhalation anesthesia induction.
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Nerve damage after regional anesthesia has been of great concern to anesthetists. Various modalities have been suggested to recognize and prevent its incidence. An understudied area is the measurement of intraneural pressure during peripheral nerve blockade. Previous investigations have produced contradicting results with only one study being conducted on human cadavers. ⋯ Obtained results demonstrate significant differences between intraneural and perineural injection pressures in the median, ulnar, and radial nerves. Intraneural injection pressures show low specificity but high sensitivity suggesting that pressure monitoring might be a valuable tool in improving the safety and efficacy of peripheral nerve blockade in regional anesthesia. Peripheral nerves "pressure mapping" hypothetically might show difference amongst various nerves depending on anatomic location, histologic structure, and ultrasonographic appearance.
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Arthroscopic knee surgery is commonly performed as an outpatient procedure and is often associated with postoperative pain. ⋯ Intra-articular levobupivacaine-tenoxicam-morphine combination provides effective pain relief, longer analgesic duration, and less analgesic requirement when compared with intra-articular levobupivacaine-tenoxicam-tramadol combination and saline after knee arthroscopic surgery.
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Spinal anesthesia is widely used for caesarean section. Addition of intrathecal magnesium sulfate to local anesthetics seems to improve the quality of block and prolong the duration of analgesia. ⋯ This study showed that the addition of intrathecal magnesium sulfate to bupivacaine is not desirable in patients undergoing cesarean section due to the delay in the onset of sensory blockade and the lack of significant effects of magnesium on post-operative pain.