Articles: outcome.
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Int J Obstet Anesth · Oct 1998
Anaesthesia for caesarean section in a patient with systemic amyloidosis secondary to familial Mediterranean fever.
The anaesthetic management of a 33-year-old primigravid woman at 29 + 5 weeks' gestation with familial Mediterranean fever (FMF), secondary amyloidosis, renal allograft with deteriorating renal function and cardiac impairment for emergency caesarean section is described. Pathophysiology and management options are discussed. Cautious induction of epidural anaesthesia together with continuous invasive monitoring produced a good outcome for mother and baby.
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Objective. This study examines, in a retrospective fashion, the effects of intraspinal infusion therapy in 36 patients with pain of non-cancer origin. In those cases where pain was recalcitrant to the infused opiate and/or had a neuropathic component, a local anesthetic, tetracaine, was added. ⋯ Conclusion. The results support the potential utility of infusion therapy in the treatment of non-cancer pain. This treatment, however, is not without problems and should be applied judiciously and in the context of evolving guidelines.
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Cerebral vasospasm is increasingly recognized as contributing to ischaemia after head injury. The reported incidence of post-traumatic vasospasm (PTV) varies between 10% and 90%, probably largely because of differences in patient selection, in definitions of vasospasm and in methods of detecting spasm. In severe head injury, based on studies with similar criteria, the incidence is approximately 40%. ⋯ There is evidence that calcium antagonists improve outcome in patients with head injury and tSAH; aminosteroids may also be effective here. Other strategies such as maintaining normocapnia and control of blood volume and pressure may also be useful. Further investigation of large cohorts is required to clarify fully the significance of PTV, its relationship with tSAH and outcome and possible treatment modalities.
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To compare thiopental, fentanyl, and midazolam for rapid-sequence induction and intubation (RSI). ⋯ Fentanyl provided the most neutral hemodynamic profile during RSI, although factors other than choice of sedative can play a more significant role in determining hemodynamic re sponse. Depth of sedation may influence the speed of RSI. [Sivilotti MLA, Ducharme J: Randomized, double-blind study on sedatives and hemodynamics during rapid-sequence intubation in the emergency department: The SHRED study. Ann Emerg Med March 1998;31;313-324.].
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This article provides information supporting the need for new outcome measures in emergency care. It also addresses the use of outcome measures in emergency care, the impact of emergency care, identification of at-risk groups, new approaches to measuring patient satisfaction, quality of life and cost-effectiveness, and the unique related implications for emergency medicine. [Cairns CB, Garrison HG, Hedges JR, Schriger DL, Valenzuela TD: Development of new methods to assess the outcomes of emergency care. Ann Emerg Med February 1998;31:166-171.].