Anesthesia and analgesia
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Anesthesia and analgesia · Apr 1997
Randomized Controlled Trial Clinical TrialIntravenous oxytocin in patients undergoing elective cesarean section.
The objective of this study was to compare four different doses of oxytocin to determine its minimal effective dose during elective cesarean section. A prospective, double-blind, randomized study was undertaken in 40 healthy term parturients presenting for elective cesarean section under regional anesthesia. Subjects were assigned to one of four groups. ⋯ There were no differences in the uterine tone in the four groups at any of the four intervals. EBL and delta Hct were similar in all four groups. There appears to be no benefit in terms of degree of uterine contraction and amount of blood loss to administering more than 5 IU of intravenous oxytocin to term parturients undergoing elective cesarean section with a neuraxial block.
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Anesthesia and analgesia · Apr 1997
Randomized Controlled Trial Clinical TrialTranexamic acid radically decreases blood loss and transfusions associated with total knee arthroplasty.
The application of a pneumatic tourniquet in orthopedic procedures enhances local fibrinolysis. Consequently, a short-term antifibrinolytic therapy may be indicated in this clinical situation to reduce postoperative blood loss. The purpose of this prospective double-blind study was to investigate the effect of tranexamic acid (TA) on blood loss associated with total knee arthroplasty (TKA). ⋯ Twenty-two patients in the TA group and four patients in the NS group were treated without transfusion (P < 0.00003). Two patients in the TA group and three in the NS group had a deep venous thrombosis, including a fatal case of pulmonary embolism in the NS group. We conclude that short-term TA therapy significantly reduces TKA-associated blood loss and transfusion requirements without increasing thromboembolic complications.
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Anesthesia and analgesia · Apr 1997
Randomized Controlled Trial Clinical TrialThe effect of tourniquet release time on the analgesic efficacy of intraarticular morphine after arthroscopic knee surgery.
A randomized, controlled study was conducted in patients undergoing elective arthroscopic knee surgery to assess the effects of tourniquet release time on analgesia after intraarticular (I. A.) injection of morphine. Standardized general anesthetic and surgical techniques were used for all patients, including a thigh tourniquet inflated at pressures between 300 and 350 mm Hg. ⋯ These low pain scores were associated with lower requirements of supplementary analgesics. We conclude that, as compared with releasing the tourniquet immediately after I. A. injection of morphine, maintaining the tourniquet inflated for 10 min provides superior analgesia and decreases the need for supplemental analgesics.
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Anesthesia and analgesia · Apr 1997
Comparative StudyPostoperative nausea and vomiting: a comparative survey of the attitudes, perceptions, and practice of Swiss anesthesiologists and surgeons.
Managing postoperative nausea and vomiting (PONV) depends on awareness of the problem, the therapeutic measures available, and effective implementation control systems. We mailed 616 PONV questionnaires to all 129 Swiss hospitals with anesthesiological and surgical departments. The responses [192 (31%) completed questionnaires from 87 (67%) hospitals] are representative of Swiss hospital anesthesiologists and surgeons. ⋯ The limited therapeutic efficacy of antiemetics is a concern. PONV management needs standardization, organization, consensus, and research. Better audits and visibility in patients' charts could further improve the quality of PONV management.
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Anesthesia and analgesia · Apr 1997
Patient and surgeon satisfaction with extremity blockade for surgery in remote locations.
In a practice that may be unique to military health care, extremity nerve blocks are established by anesthesiologists before transporting the patient to a remote clinic for surgery without further monitoring by anesthesia personnel. The safety and acceptance of this practice was assessed through a prospective survey of the surgeons and their patients. Six hundred seventy-seven blocks were performed in a 1-yr period with no adverse events related to this practice. ⋯ Of the responding patients, 78% stated that they would be willing to undergo a repeat block. The surgeons were satisfied with the operating conditions in 96% of the cases. This study supports the safety and efficacy of this practice.