Articles: cations.
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Arterial blood gas analysis is the 'gold standard' method to measure the arterial partial pressure of carbon dioxide (PaCO2). However, arterial sampling including arterial catheterization is invasive and expensive. Cutaneous carbon dioxide tension (PcCO2) measurement is used as a noninvasive surrogate measure of PaCO2, which is used to either estimate PaCO2 or determine trend changes in the measurement. There has been considerable progress in the technical aspects of PcCO2 monitoring in the last few years. In this article, we evaluate recent developments and the renewed interest in the subject of PcCO2 monitoring in adults and discuss the technical aspects, clinical applications and the future outlook for this technique in the clinical setting. ⋯ The clinical settings in which PcCO2 monitoring can be applied include patient monitoring during and after anaesthesia, patients receiving noninvasive ventilation, post extubation, endoscopy under sedation, the sleep laboratory and the lung function laboratory. Although there is an overlap of the clinical indications when both PcCO2 and end-tidal carbon dioxide monitoring may be used, it is our opinion that both these methods have independent indications and are sometimes also complementary to each other in patient care.
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Aesthetic surgery journal · Nov 2004
Pain management in augmentation mammaplasty: a randomized, comparative study of the use of a continuous infusion versus self-administration intermittent bolus of a local anesthetic.
Indwelling catheters for pain control after augmentation mammaplasty appear to be safe and effective. However, little is known regarding the comparison of continuous flow to intermittent bolus anesthetics. ⋯ After augmentation mammaplasty, both indwelling catheters using continuous flow and intermittent bolus anesthesia as needed are effective in controlling postoperative pain. Continuous flow maintains a steady state of pain control without patient intervention. Self-administration allows patients to have a more active role if they have pain and is an effective low-cost alternative to a commercial pain pump. These conclusions are supported by a review of the literature and by our own experience with more than 380 consecutive patients.
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Interventional pain management has been growing by leaps and bounds with the introduction of an array of new CPT codes, the expansion of interventional techniques, and utilization. Interventional pain management dates back to the origin of neural blockade and regional analgesia, in 1884. Over the years, pain medicine and interventional pain management have taken many approaches, including biological, biopsychosocial, and psychosocial. ⋯ Overall, the utilization of various nerve blocks (excluding epidurals, disc injections, and facet joint blocks) in Medicare recipients from 1998 to 2003 were performed approximately 50% of the time by non-pain physicians. Interventional pain management is growing rapidly, under the watchful eye of the government, and third party payors. Establishing an algorithmic approach and following guidelines may improve compliance and quality of care without implications of abuse.
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Epidural steroid injections (ESI) are commonly used in managing radicular pain. The risk of complications with epidural steroids is small, with the majority of complications being non-specific. Flushing is a known side effect of corticosteroid administration. The occurrence of flushing after epidural steroids has not been studied prospectively. ⋯ Flushing reaction appears to be more widespread than previously assumed, with an overall incidence of 11%. There was no significant difference in self-reported flushing reactions following lumbar epidural steroid injections using either betamethasone or methylprednisolone.
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Two major portals are available for delivery of medication into the cervical epidural space: interlaminar and transforaminal. The choice of which approach to use is commonly made by assessing the patient's structural pathology, one's skill in performing each procedure, and then weighing the advantages versus the risk associated with the particular technique. Over the past several years, a growing number of cases involving serious complications following cervical transforaminal epidural steroid injections have led some to question the safety of the procedure and to preferentially perform interlaminar epidural injections. ⋯ When performed by experienced interventionalists, major complications are probably rare and it could take years for a significant complication to occur. We must however all be aware that these complications can occur.