Anesthesiology
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Melatonin possesses sedative, hypnotic, analgesic, antiinflammatory, antioxidative, and chronobiotic properties that distinguish it as an attractive alternative premedicant. A qualitative systematic review of the literature concerning the perioperative use of melatonin as an anxiolytic or analgesic in adult patients was carried out using the recommended guidelines provided by the Cochrane Handbook for Systematic Reviews of Interventions. ⋯ Thus, melatonin premedication is effective in ameliorating preoperative anxiety in adults, but its analgesic effects remain controversial in the perioperative period. Additional well designed randomized controlled trials are necessary to compare melatonin premedication with other pharmacological interventions, investigate its effect on more varied surgical populations, and to delineate its optimal dosing regimen.
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Randomized Controlled Trial
A two-handed jaw-thrust technique is superior to the one-handed "EC-clamp" technique for mask ventilation in the apneic unconscious person.
Mask ventilation is considered a "basic" skill for airway management. A one-handed "EC-clamp" technique is most often used after induction of anesthesia with a two-handed jaw-thrust technique reserved for difficult cases. Our aim was to directly compare both techniques with the primary outcome of air exchange in the lungs. ⋯ A two-handed jaw-thrust mask technique improves upper airway patency as measured by greater tidal volumes during pressure-controlled ventilation than a one-handed "EC-clamp" technique in the unconscious apneic person.
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Randomized Controlled Trial
Neurally adjusted ventilatory assist in critically ill postoperative patients: a crossover randomized study.
Neurally adjusted ventilatory assist (NAVA) is a new mode of mechanical ventilation that delivers ventilatory assist in proportion to the electrical activity of the diaphragm. This study aimed to compare the ventilatory and gas exchange effects between NAVA and pressure support ventilation (PSV) during the weaning phase of critically ill patients who required mechanical ventilation subsequent to surgery. ⋯ Compared with PSV, respiratory parameter variability was greater with NAVA, probably leading in part to the significant improvement in patient oxygenation.
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Good postoperative recovery is increasingly recognized as an important outcome after surgery. The authors created a new Post-operative Quality Recovery Scale (PQRS) that tracks multiple domains of recovery from immediate to long-term time periods in patients of varying ages, languages, and cultures. ⋯ The scores on the PQRS demonstrated an improvement over time, consistent with an expected recovery after surgery and anesthesia, and an ability to discriminate between individuals. Many patients had incomplete recovery by the third postoperative day.
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Cigarette smoke, which serves as a nicotine delivery vehicle in humans, produces profound changes in physiology. Experimental studies suggest that nicotine has analgesic properties. ⋯ This review will examine current knowledge regarding how acute and chronic exposure to nicotine and cigarette smoke affects acute and chronic painful conditions. It will cover the relevant pharmacology of nicotine and other ligands at the nicotinic acetylcholine receptor as related to pain, explore the association of cigarette smoking with chronic painful conditions and potential mechanisms to explain this association, and examine clinical implications for the care of smokers with pain.