Articles: treatment.
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The present overview will try to summarize the most important recent studies performed on spinal analgesia for labor pain treatment and spinal anesthesia for Cesarean section. ⋯ The new local anesthetics have established their position in obstetric regional anesthesia, but it remains difficult to demonstrate a superior outcome as compared with bupivacaine. The same is true for combined spinal-epidural and ambulation. Phenylephrine seems to have become the vasopressor of choice in the treatment of hypotension following spinal anesthesia. A more appropriate treatment of hypotension combined with a low-dose technique may enhance the safety of spinal anesthesia in preeclamptic patients or cases of severe cardiac disease.
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Chronic hip pain is often a debilitating problem and many patients are not good surgical candidates. Furthermore, hip replacement surgery has significant associated risks. We offer a conservative approach to hip replacement using radiofrequency lesioning. ⋯ Percutaneous radiofrequency lesioning of the sensory branches of the obturator and femoral nerves appears to be a safe alternative to hip replacement, especially in those patients where surgery is not an option. Further studies are needed to confirm our results.
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Naproxen and naproxen sodium are non-steroidal anti-inflammatory drugs used in a variety of painful conditions, including the treatment of postoperative pain. This review aims to assess the efficacy, safety and duration of action of a single oral dose of naproxen/naproxen sodium for moderate to severe acute postoperative pain in adults, compared with placebo. ⋯ A single oral dose of naproxen sodium 550 mg is an effective analgesic in the treatment of acute postoperative pain. A low incidence of adverse events was found, although these were not reported consistently.
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Curr Treat Option Ne · Sep 2003
Potential Role of Neuroprotective Agents in the Treatment of Patients with Acute Ischemic Stroke.
Currently, intravenous recombinant tissue plasminogen activator is the only US Food and Drug Administration-approved therapy for acute ischemic stroke. Although efficacious, its usefulness is limited, mainly because of the very limited time window for its administration. Neuroprotective treatments are therapies that block the cellular, biochemical, and metabolic elaboration of injury during or after exposure to ischemia, and have a potential role in ameliorating brain injury in patients with acute ischemic stroke. ⋯ Recent innovations in strategies of preclinical drug development and clinical trial design that rectify past defects hold great promise for neuroprotective investigation, including novel approaches to accelerating time to initiation of experimental treatment, use of outcome measures sensitive to treatment effects, and trial testing of combination therapies rather than single agents alone. Although no neuroprotective agent is of proven benefit for focal ischemic stroke, several currently available interventions have shown promising results in preliminary trials and may be considered for cautious, off-label use in acute stroke, including hypothermia, magnesium sulfate, citicoline, albumin, and erythropoietin. Overall, the prospects for safe and effective neuroprotective therapies to improve stroke outcome remain promising.
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To review the human nutrition in the critically ill patient in a three-part presentation. ⋯ Nutritional requirements for the critically ill patient should be delivered enterally in patients who have a normally functioning gastrointestinal system. A standard formulation is usually prescribed and instilled into the stomach using a fine bore tube. If gastric emptying is delayed prokinetic agents are tried before a transpyloric tube or enterostomy tube feeding is considered. Diarrhoea caused by enteral pathogens may require specific treatment. If pathogens are excluded then fibre and probiotics may be considered. Motility reducing agents (e.g. opiates) may cause abdominal bloating.