Articles: patients.
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Critical care medicine · Apr 1988
Comparative StudyPatient selection for intensive care: a comparison of New Zealand and United States hospitals.
To examine how the use of intensive care varies, we compared 5,030 adult ICU admissions in 13 U. S. hospitals with 1,005 patients in two New Zealand (N. Z.) hospitals. ⋯ Additional outcome comparisons between acutely ill patients treated in the U. S. and N. Z. could help refine ICU selection criteria and improve the precision of clinical decision-making.
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Patients operated because of lumbar disc herniations (104 patients) were included in a randomized double-blind study analyzing the influence of dexamethasone versus placebo on postoperative drug requirements and the pain score on the visual analogue scale. High doses of dexamethasone had been administered: 40 mg i.v. on the night before the operation; 8 mg intraoperatively topical perineural application; 8 mg i.v. in the evening of the day of operation; 2x8 mg i.m. on days 1 and 2 postoperatively; 2x4 mg i.m. on days 3 and 4; 4 mg po on day 5 and 6 postoperatively. A significant decrease in the requirement for analgesics was found in the drug-treated group, particularly male patients, and also an impressive reduction in the lumbar pain score. In conclusion, there was good alleviation of sciatic pain in the dexamethasone-treated group of females during the 1st week after operation, but we found no evidence that the agent tested had an influence on the clinical outcome 1 month following the operation.
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We evaluated the efficiency of sublingual buprenorphine (Temgesic((R)) sublingual, Boehringer Mannheim GmbH) in a controlled study over a minimum of 4 weeks in 15 patients with extreme cancer pain. The tumors included 8 locoregional carcinoma recurrences in the head and neck region, 4 distant metastases of primary squamous cell carcinoma in the oral and maxillo-facial region, 1 tumor after irradiation, 1 non-Hodgkin's lymphoma, and 1 primarily non-operable carcinoma. Pain intensity was continually documented by means of a visual analogue scale (VAS) by the patients themselves. In 14 of 15 the patients it was possible to reduce pain rapidly to one fifth the original intensity with a comparatively low dosage of 0.60 mg buprenorphine (median) daily.
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The relationship between the age and the spread of analgesia from different epidural anesthetic doses was examined by studying analgesic dose responses in cervical epidural analgesia. Two different anesthetic doses (5 ml or 10 ml) of 2% mepivacaine were injected into the cervical epidural space at a constant pressure (80 mmHg) using an intravenous apparatus, and the spread of analgesia to pinprick was assessed. The significant correlation was found between the patient's age and the number of spinal segments blocked (5 ml : r = 0.8498, P < 0.01, 10 ml : r = 0.5988, P < 0.01). ⋯ The analgesic dose-response relation in patients over 60 years of age differed from that in patients under 39 years of age and doubling the epidural dose did not double the number of spinal segments blocked. Progressively more extensive analgesia was obtained from a given dose of local anesthetic with advancing age. It was difficult to limit the extent of analgesia by injecting a smaller dose of local anaesthetic in the elderly.