Articles: adult.
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Until a short time ago, the view prevailed worldwide that children were less sensitive to pain than adults, and such operations as circumcision were performed in babies without adequate anesthesia or analgesia. This view is now considered a misconception, as psychophysiological and behavioral studies show that even neonates have a well-functioning nociceptive system. Nociception generally refers to the neural and sensory aspects of pain, which do not necessarily include conscious experience. ⋯ Thus, a considerable range of sensorimotor function, including memory, develops during fetal life. Anatomical, physiological and behavioral data suggest that the nociceptive system is included in this development. Although we cannot be sure at present whether the fetus consciously experiences pain, beyond the protective nociceptive behavioral responses, anesthesia should be used for invasive procedures to protect the fetus and its nervous systems.
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In children and young adults migraine attacks can be triggered by mild head injury. The literature on this syndrome was surveyed and 50 case reports found to meet the latest criteria of classification requiring at least two similar attacks for diagnosis of migraine (except for common migraine which was excluded from review). 33 subjects had at least one trauma-triggered attack and one identical or similar spontaneous attack, 17 cases at least two similar or identical trauma triggered attacks. An analysis of all cases showed the following features: The symptoms of migraine mostly start with a latency between one and thirty minutes after the injury and dissolve within one day. ⋯ Trauma-triggered migraine attacks are well documented for familial hemiplegic migraine, migraine attacks with hemispheric symptoms and attacks with disturbances of consciousness, while the view that posttraumatic transient cortical blindness and transient global amnesia are migraine attacks is insufficiently supported. A hereditary predisposition for a traumatic trigger mechanism seems to be present at least in familial hemiplegic migraine. Nosologic relations to syndromes of secondary neurological deterioration after mild head injury in childhood are discussed.
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Journal of anesthesia · Apr 1991
Clinical Trial Controlled Clinical TrialEvaluation of alkalinized lidocaine solution in brachial plexus blockade.
The effect of alkalinization of lidocaine solution in brachial plexus blockade was evaluated in a double blind study. Commercial 1.5% lidocaine with epinephrine 1 : 200,000 (pH 5.72) was compared with an alkalinized solution of lidocaine (pH 7.12). 10 mg.kg(-1) of each solution was administrated by the axillary perivascular technique in 34 adult patients scheduled for elective surgery. The onset and spread of sensory blockade and the intensity of motor blockade were determined. ⋯ Also the analgesic onset in the radial and musculocutaneous nerves was significantly faster than the other two nerves ( P < 0.05 and P < 0.01). Furthermore, the intensity of motor blockade was greatly potentiated when alkalinized lidocaine solution was employed. There was no significant increase in plasma concentration of lidocaine in patients who were given alkalinized solution.