Journal of clinical anesthesia
-
Randomized Controlled Trial Clinical Trial
Balanced analgesia with intravenous ketorolac and patient-controlled morphine following lower abdominal surgery.
To investigate the efficacy, opioid-sparing effects and any reduction in adverse events of a continuous intravenous (i.v.) infusion of ketorolac following lower abdominal surgery. ⋯ Intravenous infusion of ketorolac combined with morphine delivered via a PCA device would appear to be a valuable method of providing balanced analgesia following lower abdominal surgery.
-
Randomized Controlled Trial Clinical Trial
Hypoxemia during outpatient gastrointestinal endoscopy: the effects of sedation and supplemental oxygen.
To compare the effects on oxygen saturation as measured by pulse oximetry (SpO2) and ECG changes of endoscopy alone, sedation followed by endoscopy, and sedation followed by endoscopy with supplemental oxygen (O2) during upper gastrointestinal (GI) endoscopy. ⋯ The use of hypnotic doses of benzodiazepines is the primary factor responsible for the reduced oxygenation seen during endoscopy. Neither the presence of the endoscope alone nor the use of midazolam with supplemental O2 caused a decreased oxygenation. This study also suggests that the routine use of benzodiazepines is unnecessary when the endoscopy is of short duration, and the endoscopist employs good topicalization of the oropharynx. In patients who require sedation for endoscopy, O2 administration prevents hypoxemia.
-
In the last decade, anesthesiologists have become increasingly involved in administering regional eye blocks, while providing care for patients undergoing ophthalmic surgery. This article describes the two major approaches to regional eye block, namely retrobulbar and peribulbar, with special consideration given to relevant orbital anatomy and technical guidelines. Potential complications, ocular and systemic, with their risk factors, are reviewed. Anesthesiologists wishing to acquire skill in administering safe regional blockade are encouraged to familiarize themselves with regional anatomy and specific guidelines suggested herein.
-
Randomized Controlled Trial Clinical Trial
The efficacy of routine central venous monitoring in major head and neck surgery: a retrospective review.
To further define the efficacy of routine central venous catheter placement for major head and neck surgery from the standpoint of fluid and blood administration, and various other parameters of perioperative management. ⋯ The study raises doubt about the efficacy of routine central venous catheter placement as a necessary guide for fluid and blood administration for these procedures, or as a necessary adjunct for several other parameters of perioperative management. It suggests the need for a randomized, prospective evaluation.
-
Clinical Trial
Postoperative myocardial ischemia: etiology of cardiac morbidity or manifestation of underlying disease?
To determine the relationship between postoperative ST segment changes and clinically apparent cardiac morbidity in noncardiac surgery patients. ⋯ These observations suggest that clinically apparent cardiac events are associated with prolonged ST segment changes detected on ambulatory ECG recorders. The cardiac ischemia leading to prolonged postoperative ST segment changes may itself result in cardiac morbidity, or it may be a reflection of underlying pathophysiology.