Anesthesia and analgesia
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Hypnosis has been defined as the induction of a subjective state in which alterations of perception or memory can be elicited by suggestion. Ever since the first public demonstrations of "animal magnetism" by Mesmer in the 18th century, the use of this psychological tool has fascinated the medical community and public alike. The application of hypnosis to alter pain perception and memory dates back centuries. ⋯ Contemporary clinical investigators claim that the combination of analgesia and hypnosis is superior to conventional pharmacologic anesthesia for minor surgical cases, with patients and surgeons responding favorably. Simultaneously, basic research of pain pathways involving the nociceptive flexion reflex and positron emission tomography has yielded objective data regarding the physiologic correlates of hypnosis. In this article I review the history, basic scientific and clinical studies, and modern practical considerations of one of the oldest therapeutical tools: the power of suggestion.
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Anesthesia and analgesia · May 2007
Randomized Controlled Trial Comparative StudyEpidural clonidine for postoperative pain after total knee arthroplasty: a dose-response study.
Combinations of epidural clonidine, local anesthetics, and opioids have improved postoperative analgesia after total knee arthroplasty. In this study we sought to determine the optimal epidural bolus dose of clonidine, which provides the best analgesia and fewest side effects. ⋯ The optimal amount of epidural clonidine in a solution of morphine and ropivacaine for postoperative pain management is 1.0 microg/mL.
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Anesthesia and analgesia · May 2007
ReviewUltrasound-guided regional anesthesia: current concepts and future trends.
The scope of ultrasound imaging guidance for regional anesthesia is growing rapidly. Preliminary data, although limited, suggest that ultrasound can improve block success rate and decrease complications. In this review, we describe the basic principles of ultrasound scanning and needling techniques for nerve blocks, highlight some of the data on clinical outcome, discuss specific limitations of ultrasound for regional anesthesia, and speculate on the future direction for physician training and competency assessment with this technology.
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Anesthesia and analgesia · May 2007
Comparative StudyPreexisting cognitive impairment in patients scheduled for elective coronary artery bypass graft surgery.
An accurate assessment of the prevalence of cognitive impairment in patients scheduled for coronary artery bypass graft (CABG) surgery is necessary if valid assumptions regarding cognitive change are to be made. Such an assessment requires the use of a healthy control group free of cardiovascular disease. ⋯ Cognitive impairment is prevalent in patients presenting for CABG surgery. Impaired cognition before surgery must be considered when assessing the effects of CABG surgery on cognitive performance.
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Anesthesia and analgesia · May 2007
Randomized Controlled Trial Multicenter Study Comparative StudyA randomized, double-blind comparison of the NK1 antagonist, aprepitant, versus ondansetron for the prevention of postoperative nausea and vomiting.
Antiemetics currently in use are not totally effective. Neurokinin-1 receptor antagonists are a new class of antiemetic that have shown promise for chemotherapy-induced nausea and vomiting. This is the first study evaluating the efficacy and tolerability of the neurokinin-1 receptor antagonist, aprepitant, for the prevention of postoperative nausea and vomiting. ⋯ Aprepitant was superior to ondansetron for prevention of vomiting in the first 24 and 48 h, but no significant differences were observed between aprepitant and ondansetron for nausea control, use of rescue, or complete response.