Current medical research and opinion
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Neurosurgery often requires skull immobilization with a Mayfield clamp, which often causes brief intense nociceptive stimulation, hypertension and tachycardia. Blunting this response may help prevent increased intracranial pressure, cerebral aneurysm or vascular malformation rupture, and/or myocardial stress. While various interventions have been described to blunt this response, no reports have compared administration of a propofol versus a remifentanil bolus. ⋯ Thus, a remifentanil bolus is more effective than a propofol bolus in blunting hemodynamic responses to Mayfield placement, and possibly for other short, intense nociceptive stimuli.
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This survey assessed the impact of symptoms of COPD on patients' ability to perform activities throughout the day and the extent to which physicians provided advice including how medications may help maintain quality of life. ⋯ Morning symptoms of COPD can severely compromise patients' ability to perform tasks throughout the day. Despite this, physicians are unlikely to discuss with patients how their ability to perform tasks might be improved.