Anesthesiology
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of intraoperative fluid management on outcome after intraabdominal surgery.
The debate over the correct perioperative fluid management is unresolved. ⋯ In patients undergoing elective intraabdominal surgery, intraoperative use of restrictive fluid management may be advantageous because it reduces postoperative morbidity and shortens hospital stay.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Remifentanil-induced postoperative hyperalgesia and its prevention with small-dose ketamine.
Remifentanil-induced secondary hyperalgesia has been documented experimentally in both animals and healthy human volunteers, but never clinically. This study tested the hypotheses that increased pain sensitivity assessed by periincisional allodynia and hyperalgesia can occur after relatively large-dose intraoperative remifentanil and that small-dose ketamine prevents this hyperalgesia. ⋯ A relatively large dose of intraoperative remifentanil triggers postoperative secondary hyperalgesia. Remifentanil-induced hyperalgesia was prevented by small-dose ketamine, implicating an N-methyl-d-aspartate pain-facilitator process.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparative study of sequential epidural bolus technique and continuous epidural infusion.
In this randomized, double-blind study, the authors compared the effectiveness of a sequential epidural bolus (SEB) technique versus a standard continuous epidural infusion (CEI) technique of local anesthetic delivery. Both techniques used the same hourly dose of local anesthetic. ⋯ The SEB technique with ropivacaine provides superior epidural block compared with an identical hourly dose administered as a continuous infusion.
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Comparative Study
Sex- and age-related differences in morphine requirements for postoperative pain relief.
Sex-related differences in the perception of pain and susceptibility to opioids remain a matter of debate. Intravenous morphine titration used to obtain pain relief in the immediate postoperative period is a unique clinical model for assessing the effect of sex on reported pain. Because of the wide variation in dose requirements for pain management, the authors conducted a prospective study in a large population and also assessed the effect of aging. ⋯ Women experienced more severe postoperative pain and required a greater dose (+11%) of morphine than men in the immediate postoperative period. This sex-related difference disappeared in elderly patients.