Articles: postoperative.
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Although several potential risk factors have been discussed, risk factors associated with bacterial colonization or even infection of catheters used for regional anaesthesia are not very well investigated. ⋯ Colonization of peripheral and epidural nerve catheter can only in part be predicted at the time of catheter insertion since two out of three relevant variables that significantly influence the risk can only be recorded postoperatively. Catheter localisation in the groin, removal of the dressing and omission of postoperative antibiotics were associated with, but were not necessarily causal for bacterial colonization. These factors might help to identify patients who are at increased risk for catheter colonization.
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This review presents a brief overview of the non-analgetic effects of thoracic epidural anaesthesia. It covers the cardiac, pulmonary and gastrointestinal effects of thoracic epidural anaesthesia. The results of newer studies are of particular importance regarding mortality and major morbidity after thoracic epidural anaesthesia. ⋯ Despite this controversy, the numerous positive effects and advantages of thoracic epidural anaesthesia are the reasons for its increasing popularity. However, the advantages of thoracic epidural anaesthesia must be incorporated into a multimodal treatment management aimed at improving outcomes after surgery.
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Rev Bras Anestesiol · Feb 2005
[Preemptive analgesia with epidural bupivacaine and S(+)ketamine in abdominal hysterectomy.].
This study investigates the ability of epidural S(+)ketamine, NMDA receptor antagonist, plus local anesthetic (bupivacaine) injection to promote preemptive analgesia in patients undergoing total abdominal hysterectomy, when this solution is administered before surgical incision. ⋯ This study failed to demonstrate a preemptive effect of epidural administration of bupivacaine and S(+)ketamine in the doses tested for abdominal hysterectomy.
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Preoperative pediatric anxiety is characterized by stress, worry, nervosism and concern and may be expressed in different ways. Postoperative behavior changes, such as nocturnal enuresis, dietary problems, apathy, insomnia, nightmares and agitated sleep may be results of this anxiety. In some children, these changes persist for one year. This study aimed at evaluating anxiety-related aspects affecting children and parents in the preoperative period, as well as pharmacological or non-pharmacological interventions to minimize them. ⋯ The preoperative period is accompanied of an emotional overload for the whole family, especially the child. For many children, a turbulent preoperative period may translate into several behavior changes lasting for long periods of time. The presence of parents during anesthetic induction and the preoperative preparation of children and parents may be useful for selected cases, taking into account age, temperament and previous hospital experience. Preanesthetic medication with benzodiazepines, especially midazolam, is clearly the most effective method to decrease postoperative anxiety in children and their related behavior changes.
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Intraoperative neurophysiologic monitoring provides useful information on the functional status of the nervous system. This review focuses on recently published data concerning the impact of monitoring on patient outcome. ⋯ Brain monitoring facilitates anesthetic drug administration. An increasing number of neurosurgical procedures will require some form of intraoperative neurophysiologic monitoring to achieve higher degrees of safety and accuracy. In many instances, the data derived from monitoring will guide and influence surgical decisions. In this context, neurophysiologic monitoring should be regarded as interventional.