Articles: surgery.
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In the past the view has often been expressed that children are less sensitive to pain than adults as a result of the assumption that their nervous system is not as well developed. According to this theory, newborns were not supposed to feel pain at all, and for this reason minor surgery was often performed with inadequate anesthesia. Evidence in the more recent literature and the regular choice of "pain in children" as a topic for congresses exemplify the more and more widespread belief that children of all ages can feel pain and, relative to their developmental stage, suffer accordingly. ⋯ As cognition develops further, the patient's own concept of health and sickness changes, as does the ability to express feelings of pain. In the pathogenesis of pain in children, the dominant types are nociceptor pain (e.g., as a result of trauma or infection) and pain resulting from malfunction (e.g., physical malposition, migraine), whereas nervous pain occurs less frequently. Pediatricians should pay particular attention to the treatment of acute and chronic pain in children.
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J Dermatol Surg Oncol · Jun 1989
Anesthesia for outpatient dermatologic cosmetic surgery: midazolam--low-dosage ketamine anesthesia.
Cardiovascular, respiratory, CNS, and postoperative effects of using low-dose ketamine and midazolam combined with local anesthesia during 40 outpatient cosmetic procedures are reviewed. This method of anesthesia is safe, effective, and well-tolerated by patients.
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Aust N Z J Obstet Gynaecol · May 1989
Abruptio placentae at the University of Nigeria Teaching Hospital, Enugu: a 3-year study.
A total of 81 cases of abruptio placentae treated in a 3-year period at the University of Nigeria Teaching Hospital, Enugu is reported. The incidence of 0.44% found in the study is low when compared to reports from Europe. ⋯ Management was by rapid and adequate resuscitation by blood transfusion and delivery as soon as the diagnosis was made. The absence of maternal mortality amongst mothers who received antenatal care at the University Teaching Hospital emphasizes the need for adequate antenatal and intrapartum care in order to eliminate the complications of this obstetrical enigma.
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J Neurosurg Anesthesiol · Mar 1989
Hypocapnia prevents the decrease in regional cerebral metabolism during isoflurane-induced hypotension.
In neurologic surgery, induced hypotension is often used while the patient is hypocapnic. We investigated, by tissue biopsy methods and scintillation counting, the regional cerebral glucose utilization (rCMRglc) and blood flow (rCBF) in rats subjected to hypocapnia alone and in combination with hypotension. Anesthesia was maintained with 1.0% isoflurane in nitrous oxide/oxygen. ⋯ During hypocapnia/hypotension, rCBF was unaltered in cortical areas, while increases were seen in all subcortical areas compared to hypocapnia. Regional values of the ratio of rCBF/rCMRglc indicated that during hypocapnia and hypotension induced by isoflurane in nitrous oxide/oxygen, the individual brain areas were perfused according to their metabolic needs. It is suggested that hypocapnia may prevent the decrease in rCMRglc, which is usually observed during deep isoflurane anesthesia.
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Handchir Mikrochir Plast Chir · Mar 1989
Case Reports[Autologous injection of fatty tissue following liposuction--not a method for breast augmentation].
In recent years autologous fat transplantation employing liposuction has become an established method for correction of small soft tissue defects and irregularities of skin contour. Only a small amount of fat may be used because fat cells will be nourished by perifusion alone until neovascularisation occurs. Transplantation of a large amount of fat will result in fat necrosis. The inappropriate use of fat for breast augmentation after liposuction is described in a case report.