Articles: general-anesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of ketorolac and morphine as adjuvants during pediatric surgery.
The intraoperative use of opioid analgesics decreases the volatile anesthetic requirement and provides for pain relief in the early postoperative period. In a randomized double-blind, placebo-controlled study involving 95 ASA physical status 1 or 2 children (ages 5-15 yr) undergoing general anesthesia for elective operations, we compared postoperative analgesia following the intraoperative intravenous (iv) administration of ketorolac, a nonsteroidal antiinflammatory drug or morphine, an opioid analgesic. After induction of general anesthesia and before the start of the surgical procedure, children received equal volumes of saline, morphine (0.1 mg.kg-1, iv) or ketorolac (0.9 mg.kg-1, iv). ⋯ The placebo group had a significantly higher VAS and OPS score and required earlier and more frequent analgesic therapy in the PACU compared to the two analgesic groups. Patients receiving ketorolac had less postoperative emesis than those receiving morphine. We conclude that ketorolac (0.9 mg.kg-1) is an effective alternative to morphine (0.1 mg.kg-1) as an iv adjuvant during general anesthesia, and in the dose used in this study, is associated with less postoperative nausea and vomiting in children.
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Whatever induces general anesthesia, i.e. cerebral arrest, tends to cause respiratory and cardiac arrest also. However, general anesthesia does not necessarily exclude nor block all other mechanisms which can provoke one or more of these three phenomena. Amongst many such more or less equipotent factors are intracranial, intrapleural, intra-abdominal and intratracheal pressures. These mechanical factors occurring but unrecognized in surgical patients cause puzzling complications including, insomnia, coma and unexpected sudden death.
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Claims against anesthesiologists for eye injuries were analyzed as part of the ASA Closed Claims Project. Eye injury occurred in 3% of all claims in the database (71 of 2,046). The payment frequency for eye injury claims was higher than that for non-eye injury claims (70% vs. 56%; P less than or equal to 0.05). ⋯ The median payment for claim involving movement was 10 times greater than for non-movement claims ($90,000 vs. $9,000; P less than or equal to 0.01). Anesthesiologist reviewers deemed the care rendered in the general anesthesia "movement" claims as meeting standards in only 19% of claims. From the perspective of patient safety, as well as risk management, these data suggest two specific needs: research directed at better understanding of the etiology of corneal abrasion and clinical strategies designed to assure patient immobility during ophthalmic surgery.