The Mount Sinai journal of medicine, New York
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Selected orthopedic surgical procedures, such as total joint arthroplasty and spinal instrumentation, have some of the highest perioperative transfusion rates of all surgical procedures. Blood transfusions carry the risk of complications, including the transmission of disease, immunomodulation, and hemolytic and non-hemolytic reactions. Strategies that reduce or remove the risk of allogeneic transfusion include preoperative autologous donation, acute normovolemic hemodilution, perioperative cell salvage techniques, deliberate hypotension, and pharmacologic interventions. This paper will review the current status of these therapies in the orthopedic surgical patient.
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New trends in pediatric anesthesia for ambulatory surgery will be described. Preoperative preparation as well as care of pediatric patients requiring sedation outside of the operating room are emphasized.
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Historical Article
The evolution of intraoperative transesophageal echocardiography.
In this article, the development of intraoperative transesophageal echocardiography (TEE) is reviewed. It took two decades to develop the present clinical applications of TEE. This modality will continue to serve as a monitor and diagnostic tool to ensure better care of patients in the operating room and the intensive care units.
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Randomized Controlled Trial Clinical Trial
Preemptive epidural analgesia for thoracic surgery.
The purpose of this study was to determine if preemptive epidural analgesia performed before thoracotomy incision and during the operation reduces postoperative pain. Patients in the treatment group received 8 mL of 0.25% bupivacaine and 2 mL of fentanyl (50 microg/mL) via the epidural route prior to skin incision, followed by an infusion of bupivacaine 0.1% and fentanyl 10 microg/mL at 6 mL/hr. ⋯ The patients in the treatment group required less isoflurane intraoperatively and had lower maximum pain scores in the first 6 hours postoperatively. No significant differences were noted after the first 6 hours.
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Approximately two-thirds of all women in the United States receive analgesia for labor and delivery. The ideal labor analgesic technique would confer complete pain relief without side effects to either the mother or the neonate. ⋯ Modern obstetric analgesia techniques and medications come close to achieving these goals. The following article will review current labor analgesia techniques and medications used during labor and delivery.