Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Adherence to simple and effective measures reduces the incidence of ventilator-associated pneumonia.
Several modalities have been shown to be individually effective in reducing the incidence (and hence associated morbidity, mortality, and costs) of ventilator-associated pneumonia, but their implementation into clinical practice is inconsistent. We introduced an intensive care unit protocol and measured its effect on ventilator-associated pneumonia. ⋯ Adherence to simple and effective measures can reduce the incidence of ventilator-associated pneumonia. The protocol described was inexpensive and effective, and estimated savings are large. Implementation and maintenance of gains require a multidisciplinary approach, with buy-in from all team members, and ongoing monitoring, education, and feedback to the participants.
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Although nonsteroidal anti-inflammatory drugs (NSAIDs) provide benefit to patients following spinal fusion surgery, their routine administration has remained controversial due to concerns about possible deleterious effects on bone healing. The goal of this retrospective study was to assess the incidence of non-union following the perioperative administration of ketorolac, celecoxib, or rofecoxib. ⋯ This study revealed that the short-term perioperative administration of celecoxib, rofecoxib, or low-dose ketorolac (< or = 110 mg.day(-1)) had no significant deleterious effect on non-union. In contrast, higher doses of ketorolac (120-240 mg.day(-1)), history of smoking, and two level vertebral fusions resulted in a significant increase in the incidence of non-union following spinal fusion surgery.
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Systemic ketamine suppresses several types of chronic pain. Although ketamine is used as a general anesthetic agent, the analgesic effect of systemic ketamine for early-stage postoperative pain is not clear. We investigated the efficacy and mechanism of systemic ketamine in a rat model of postoperative pain. ⋯ The results suggest that systemic administration of ketamine perioperatively suppresses early-stage postoperative pain via monoaminergic descending inhibitory pathways.
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Letter Comparative Study
The prevention of pain from injection of propofol by dexmedetomidine and comparison with lidocaine.
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Editorial Comment
Ropivacaine cardiac toxicity--not as troublesome as bupivacaine.