The Ochsner journal
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The Ochsner journal · Jan 2011
Initial experience with implanted peripheral nerve stimulation for the treatment of refractory cephalgia.
To report 4 cases of improved pain control and function in patients with chronic cephalgia secondary to chronic headaches and/or trigeminal neuralgia. ⋯ Initial experience suggests that refractory pain secondary to chronic migraines and trigeminal neuralgia may respond to peripheral nerve stimulation. Further studies are indicated to evaluate efficacy over the long term and to elucidate the optimal array and implantation technique.
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α(2)-Agonists are a novel class of drugs with mechanisms of action that differ from other commonly used anesthetic drugs. They have neuroprotective, cardioprotective, and sedative effects. These unique characteristics make them potentially useful during neuroanesthesia and intensive care. We review the effects of dexmedetomidine on cerebral blood flow and cerebral metabolism, along with recent advances in using α(2)-agonists in neuroanesthesia and neurointensive care.
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The Ochsner journal · Jan 2011
Epidural Anesthesia for Cesarean Delivery in a Patient With Severe Pulmonary Artery Hypertension and a Right-to-Left Shunt.
A 38-year-old woman with severe pulmonary artery hypertension and a right-to-left shunt of unknown etiology presented at 32 weeks' gestational age. Determination of the cause of her pulmonary hypertension by transesophageal echocardiography was delayed until after delivery secondary to anesthetic risk. ⋯ Transesophageal echocardiography after delivery revealed a patent foramen ovale, indicating a diagnosis of idiopathic pulmonary artery hypertension and a very poor prognosis. Differentiating between Eisenmenger syndrome and idiopathic pulmonary artery hypertension may not be important for determining the optimal anesthetic management of patients with pulmonary hypertension but is important in assessing long-term prognosis.
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The Ochsner journal · Jan 2011
Comparison of extended-release epidural morphine with femoral nerve block to patient-controlled epidural analgesia for postoperative pain control of total knee arthroplasty: a case-controlled study.
Because newer anticoagulation strategies for total knee replacement present potentially increased risk of neuraxial analgesia, there is movement away from using patient-controlled epidural analgesia (PCEA) for pain control. This concern opens the door for other regional modalities in postoperative analgesia, including the use of extended-release epidural morphine (EREM) combined with a femoral nerve block (FNB). ⋯ The VAS scores at 24 and 48 hours indicate that EREM and FNB provide comparable analgesia to PCEA. The trend toward shorter PACU times represents an opportunity for cost-identification analysis. The study data are limited by their observational nature and the small number of patients involved; nevertheless, this study demonstrates a therapeutic equivalence to PCEA that may be more cost effective.
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To examine the history of pediatric endotracheal intubation and the issues surrounding the change from uncuffed endotracheal tubes to cuffed endotracheal tubes, including pediatric airway anatomy, endotracheal tube design, complications, and safety concerns. ⋯ Although the use of cuffed endotracheal tubes in infants and children remains a topic of debate, the literature supports this change in practice. Meticulous attention must be given to intracuff pressure. Cuffed endotracheal tubes designed especially for the pediatric patient may increase the margin of safety.