Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2007
Comparative StudyNeedlestick distal nerve injury in rats models symptoms of complex regional pain syndrome.
Complex Regional Pain Syndrome (CRPS)-I consists of chronic limb pain and dysautonomia triggered by traumas that sometime seem too trivial to be causative. Several pathological studies have identified minor distal nerve injuries (DNIs) in CRPS-I patients, but retrospective studies cannot establish causality. Therefore, we, prospectively investigated whether DNIs are sufficient to cause CRPS-like abnormalities in animals. We used needlestick, a cause of human CRPS, to evaluate lesion-size effects. ⋯ Needlestick DNI models several clinical and pathological features of human CRPS and provides direct prospective evidence that even minor DNI can cause CRPS-like abnormalities in rats.
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Anesthesia and analgesia · Dec 2007
Development of a standardized method for motion testing in pulse oximeters.
Pulse oximeter performance in the presence of motion varies among devices and manufacturers because of variations in hardware, software, testing, and calibration. Compounding these differences is a lack of uniform characterization of motion, and the consequential effects of motion upon the wide range of normal and abnormal human physiology. Traditional motion testing attempts to standardize motion into a reproducible form by using a mechanical jig to produce passive motion of a known amplitude and frequency. This type of motion challenge fails to account for the physiologic changes induced by active movement. ⋯ We have set the stage for a feasibility demonstration using a novel form of testing. With sufficient subjects and proper statistical evaluation, a robust test method for assessing the performance of pulse oximeters in the presence of motion may be at hand.
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Anesthesia and analgesia · Dec 2007
GuidelineSociety for Ambulatory Anesthesia guidelines for the management of postoperative nausea and vomiting.
The present guidelines were compiled by a multidisciplinary international panel of individuals with interest and expertise in postoperative nausea and vomiting (PONV) under the auspices of The Society of Ambulatory Anesthesia. The panel critically evaluated the current medical literature on PONV to provide an evidence-based reference tool for the management of adults and children who are undergoing surgery and are at increased risk for PONV. In brief, these guidelines identify risk factors for PONV in adults and children; recommend approaches for reducing baseline risks for PONV; identify the most effective antiemetic monotherapy and combination therapy regimens for PONV prophylaxis; recommend approaches for treatment of PONV when it occurs; and provide an algorithm for the management of individuals at increased risk for PONV.
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Anesthesia and analgesia · Dec 2007
Multicenter Study Comparative Study Clinical TrialThe safety and efficacy of extended thromboprophylaxis with fondaparinux after major orthopedic surgery of the lower limb with or without a neuraxial or deep peripheral nerve catheter: the EXPERT Study.
The benefit-risk ratio of extended fondaparinux therapy has not been assessed in patients undergoing major lower limb joint arthroplasty. Few data on the concomitant use of fondaparinux and continuous neuraxial or deep peripheral nerve blockade are available. We performed a prospective intervention study in patients undergoing major orthopedic surgery primarily designed to assess the efficacy of fondaparinux when drug administration was withheld for 48 h to permit removal of a neuraxial or deep peripheral nerve catheter. The safety and efficacy of extended fondaparinux therapy for the prevention of venous thromboembolism were also evaluated. ⋯ Once-daily subcutaneous injection of 2.5 mg fondaparinux given for 3 to 5 wk was effective and safe for prevention of venous thromboembolism after major orthopedic surgery. Temporary discontinuation of fondaparinux for 48 h permitted safe removal of a neuraxial or deep peripheral nerve catheter without decreasing thromboprophylatic efficacy.
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Anesthesia and analgesia · Dec 2007
Randomized Controlled Trial Comparative StudyThoracic paravertebral block for breast cancer surgery: a randomized double-blind study.
We examined in this randomized, double-blind study whether a multilevel paravertebral block performed before general anesthesia with propofol and a laryngeal mask enhances postoperative analgesia after breast cancer surgery. ⋯ A multilevel paravertebral block provides good analgesia for breast surgery, but the duration of analgesia is briefer than described in previous studies.