Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2007
Randomized Controlled Trial Comparative StudySpinal perianal block: a prospective, randomized, double-blind comparison with spinal saddle block.
In this prospective, randomized, double-blind study, we evaluated whether a very low dose of spinal bupivacaine could be sufficient for safe performance of short perianal surgery. ⋯ The use of 1.5 mg spinal bupivacaine can be successful for short perianal surgery.
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Anesthesia and analgesia · Jun 2007
Randomized Controlled Trial Comparative StudyGranisetron versus ondansetron treatment for breakthrough postoperative nausea and vomiting after prophylactic ondansetron failure: a pilot study.
Patients with an increased risk of postoperative nausea and vomiting (PONV) are frequently given prophylactic doses of a selective 5-hydroxytryptamine-3 antagonist (5HT3). In chemotherapy patients, it has been demonstrated that after unsuccessful treatment with one 5HT3 administering a different 5HT3 alleviated symptoms. We hypothesized that we could define a benefit of a 5HT3, cross-over in a pilot study of PONV. Two-hundred-fifty female patients received prophylactic ondansetron 4 mg at the end of a surgical procedure requiring general anesthesia and were then followed postoperatively for 4 h. ⋯ Unlike patients with chemotherapy-induced nausea and vomiting, perioperative patients who failed ondansetron prophylaxis did not have a significant response to cross-over dosing with granisetron.
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Anesthesia and analgesia · Jun 2007
Randomized Controlled Trial Comparative StudyEpidural anesthesia and analgesia decrease the postoperative incidence of insulin resistance in preoperative insulin-resistant subjects only.
Insulin resistance (IR) is a feature of the endocrine stress response to surgery. It is not known whether a preoperative state of IR would affect the postoperative endocrine response. We sought to characterize the preoperative state of IR in a group of patients undergoing elective hip and knee arthroplasty, and to determine to what extent perioperative epidural analgesia modifies the postoperative state of IR in those who are and are not insulin-resistant before surgery. ⋯ Epidural anesthesia and analgesia compared to general anesthesia followed by patient-controlled analgesia decreased the incidence of IR soon after surgery and 48 h after surgery only in patients who were insulin-resistant before surgery.
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Anesthesia and analgesia · Jun 2007
Case ReportsSignificant hypoglycemia secondary to icodextrin peritoneal dialysate in a diabetic patient.
Icodextrin, a peritoneal dialysate commonly used in the renal failure patient with diabetes, may lead to an overestimation of blood glucose levels as determined by bedside glucometers. This spurious hyperglycemia can lead to significant morbidity if unrecognized. We describe a case of severe hypoglycemia caused by an unappreciated overestimation of blood glucose in a diabetic patient with concomitant chronic renal failure requiring peritoneal dialysis with icodextrin.
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Anesthesia and analgesia · Jun 2007
Case Reports Comparative StudyTen consecutive cases of complex regional pain syndrome of less than 12 months duration in active duty United States military personnel treated with spinal cord stimulation.
Complex regional pain syndrome describes a constellation of symptoms that may involve the sympathetic nervous system. Emerging consensus recommends early intervention with spinal cord stimulation to facilitate physical therapy. Isolated case reports suggest this may be an effective treatment. ⋯ Six received injuries directly as a result of service in Iraq or Afghanistan. These patients also had posttraumatic stress disorder, but it did not interfere with successful pain control. Additionally, 6 of 10 patients continued on active duty.