Anesthesiology
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Meta Analysis Comparative Study
Effects of nonsteroidal antiinflammatory drugs on patient-controlled analgesia morphine side effects: meta-analysis of randomized controlled trials.
Nonsteroidal antiinflammatory drugs (NSAIDs) are commonly combined with intravenous morphine patient-controlled analgesia to relieve postoperative pain. NSAIDs have a documented 30-50% sparing effect on morphine consumption. However, most of the studies have not demonstrated a decrease in morphine adverse effects. ⋯ NSAIDs decreased significantly postoperative nausea and vomiting by 30%, nausea alone by 12%, vomiting alone by 32% and sedation by 29%. A regression analysis yielded findings indicating that morphine consumption was positively correlated with the incidence of nausea and vomiting. Pruritus, urinary retention, and respiratory depression were not significantly decreased by NSAIDs.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of nicotine replacement therapy on stress and smoking behavior in surgical patients.
Many surgical patients are dependent on nicotine. Smoke-free policies in healthcare facilities mandate abstinence from smoking, which could contribute to psychological stress in the perioperative period. The authors tested the hypothesis that nicotine replacement therapy decreases psychological stress in cigarette smokers scheduled to undergo elective surgery and determined whether nicotine replacement therapy affects postoperative smoking behavior, even when not specifically prescribed to promote abstinence. ⋯ Routine nicotine replacement therapy is not indicated in smokers undergoing surgery for the purposes of managing nicotine withdrawal and stress but can modify some aspects of postoperative smoking behavior.
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Comparative Study
Severe pulmonary hypertension during pregnancy: mode of delivery and anesthetic management of 15 consecutive cases.
Available literature on pregnant women with severe pulmonary hypertension (PH) relies mainly on anecdotal case reports and two series only. ⋯ Despite the most modern treatment efforts, the maternal mortality was 36%. Scheduled cesarean delivery during combined spinal-epidural anesthesia seemed to be an attractive approach, but there was no evidence of actual benefit. Therefore, pregnancy must still be discouraged in patients with severe PH.
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Comparative Study
Painful nerve injury decreases resting cytosolic calcium concentrations in sensory neurons of rats.
Neuropathic pain is difficult to treat and poorly understood at the cellular level. Although cytoplasmic calcium ([Ca]c) critically regulates neuronal function, the effects of peripheral nerve injury on resting sensory neuronal [Ca]c are unknown. ⋯ Painful SNL nerve injury depresses resting [Ca]c in sensory neurons. This is most marked in axotomized neurons, especially the large and capsaicin-insensitive neurons presumed to transmit non-nociceptive sensory information.