The Ochsner journal
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Degenerative lumbar stenosis associated with spondylolisthesis is common in elderly patients. The most common symptoms are those of neurogenic claudication with leg pain. Surgery is indicated for those who fail conservative management. The generally accepted recommendation is to perform a laminectomy and a fusion at the involved level. ⋯ Minimally invasive decompression alone can be a reasonable alternative to decompression and fusion for patients with spondylolisthetic lumbar stenosis and neurogenic claudication with leg pain. Decompression without fusion should be considered for older patients and for patients who are not ideal fusion candidates.
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The Ochsner journal · Jan 2014
ReviewFuture management of carotid stenosis: role of urgent carotid interventions in the acutely symptomatic carotid patient and best medical therapy for asymptomatic carotid disease.
Stroke is the fourth leading cause of death in the United States, leading to devastating disability. Most strokes are ischemic, and nearly one-third of these are caused by carotid disease. The primary mechanism of carotid-related stroke is an atheroembolic event from an unstable atherosclerotic plaque rupture. In the 1990s, randomized trials demonstrated the benefit of carotid endarterectomy (CEA) in reducing the risk of stroke in both symptomatic and asymptomatic carotid disease. ⋯ CAS has an increasingly higher risk of stroke with advancing age. Patients treated with CAS have a 1.76-fold increased risk of stroke (95% CI, 1.35-2.31) with each 10-year increase in age. No such age effect is seen in patients treated with CEA. Age is a critical variable in making informed choices regarding treatment of severe carotid artery stenosis.
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The Ochsner journal · Jan 2014
Ultrasound imaging for endotracheal tube repositioning during percutaneous tracheostomy in a cadaver model: a potential teaching modality.
Percutaneous tracheostomy (PCT) is a widely accepted method for the insertion of a tracheostomy tube in a critically ill patient. Because a patient's preexisting endotracheal tube is manipulated during the procedure, premature extubation with potential catastrophic loss of airway control is a risk. As portable ultrasound imaging becomes increasingly useful in the critical care setting, investigations continue to determine the safety of PCT with the technology. ⋯ Ultrasound can be used to identify an endotracheal tube cuff during a PCT, and repositioning the endotracheal tube under ultrasound guidance could decrease the risk of accidental extubation. This approach to PCT may be used in a cadaveric model to teach anatomy and procedural skills to learners and possibly further adopted in real patients to improve the overall safety profile of the PCT procedure.
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The Ochsner journal · Jan 2014
Analgesic efficacy and technique of ultrasound-guided suprascapular nerve catheters after shoulder arthroscopy.
Conventional approaches to brachial plexus blocks may not cover the suprascapular nerve. Accordingly, after shoulder arthroscopy, sensation from the posterior part of the shoulder is commonly spared. Most previous research involving suprascapular nerve blocks described single-injection techniques. However, with the widespread availability and fairly reasonable cost of disposable infusion pumps, continuous catheter techniques provide a more appealing method of prolonging postoperative analgesia. ⋯ Continuous suprascapular catheter techniques provide good pain relief and improve postoperative analgesia after shoulder arthroscopy.
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The Ochsner journal · Jan 2014
ReviewEffect of opiates, anesthetic techniques, and other perioperative factors on surgical cancer patients.
Opioid pharmacotherapy is often used to treat cancer pain. However, morphine and other opioid-like substance use in patients with cancer may have significant adverse consequences, including the suppression of both innate and acquired immune responses. Although studies have examined the possibility that regional anesthesia attenuates the immunosuppressive response of surgery, the effects of morphine and other opioid-related substances on tumor progression remain unknown. ⋯ Immune responses from all components of the immune system, including both the humoral and cell-mediated components, appear to be suppressed by anesthetics and analgesics. The clinical anesthesiologist should consider these factors in the application of technique, especially in cancer surgery.