Articles: postoperative.
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Rev Bras Anestesiol · Aug 2004
[Epidural clonidine or dexmedetomidine for post-cholecystectomy analgesia and sedation.].
Clonidine and dexmedetomidine are alpha2-adrenergic agonists with analgesic proprieties which potentiate local anesthetic effects when epidurally administered. The goal of this study was to evaluate the analgesia and sedation promoted by clonidine or dexmedetomidine associated to epidural ropivacaine, in the postoperative period of subcostal cholecystectomy. ⋯ Our results allowed to conclude that the association of clonidine or dexmedetomidine to 0.75% ropivacaine induces analgesia and sedation in 2 and 6 hours after anesthetic recovery in patients submitted to subcostal cholecystectomy and that clonidine promotes more prolonged analgesia.
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Rev Bras Anestesiol · Aug 2004
[Epidural caudal block: evaluation of length of analgesia with the association of lidocaine, fentanyl and clonidine.].
The association of different substances to local anesthetics aims to improve the blockade quality and prolonging analgesia. The aims of this study were to compare the effectiveness of the association of clonidine, clonidine and fentanyl, and fentanyl, to lidocaine for postoperative analgesia. ⋯ Clonidine, associated or not to fentanyl, has prolonged postoperative analgesia after epidural caudal blockade with lidocaine.
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The literature on the appropriate dose of local anaesthetic and combinations with opioids for spinal anaesthesia for caesarean section in patients without comorbid conditions is reviewed. The controversial issue of spinal anaesthesia in severe preeclampsia is also addressed. ⋯ Low-dose spinal anaesthesia has been advocated in the interests of improving cardiovascular stability. However, current sophistication of knowledge concerning spinal anaesthetic technique makes cardiovascular instability easy to prevent. Therefore this review emphasizes the importance of adequate surgical anaesthesia during caesarean section, and makes suggestions as to the optimal pharmacological agents for intraoperative anaesthesia and postoperative analgesia. Spinal anaesthesia is safe in severe preeclampsia, provided there are no contraindications to regional anaesthesia.
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Rev Bras Anestesiol · Aug 2004
[Bilateral pleural block: analgesia and pulmonary functions in postoperative of median laparotomies.].
Notwithstanding pleural block having become almost an analgesic panacea, contradictory results have been published. This study aimed at observing analgesic and spirometric behavior of pulmonary function in the immediate postoperative period of 21 patients submitted to urgency median laparotomies under bilateral pleural block. ⋯ In our study, postoperative pain control with bilateral pleural block after urgency median laparotomies was null with saline. With bupivacaine, however, analgesia was not considered fully effective in all patients during movements on bed and deep breathing. Pleural block does not seem to have the same analgesic outcome for all patients.
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The next couple of decades will be characterized by an increase in life expectancy, leading to an older population. As the incidence of Alzheimer's dementia and vascular dementia is rising with age, the future anaesthesiologist will be increasingly confronted with perioperative care of patients with impaired cognitive function. This paper tries to highlight some topics specifically related to demented patients. ⋯ Anaesthesia in the demented patient may be complicated by a number of potential problems, including the comorbid pathology, the concomitant anticholinesterase activity, the need for normoventilation, monitoring of anaesthesia depth and the evaluation of postoperative pain. Anaesthesia in variant Creutzfeldt-Jakob disease is aimed at preventing the spread of the causing prion. There is a broad consensus that early return to the preoperative level of cognition is to be pursued, with the help of short-acting drugs and loco-regional anaesthesia.