Journal of clinical anesthesia
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Spontaneous rupture of the uterus is a life-threatening obstetrical emergency. Diagnosis may be delayed because of the bizarre presentation or absence of significant pain and tenderness, which could have been masked by the analgesic medications used during labor. We present a case of spontaneous rupture in a multigravid female who was undergoing oxytocin-augmented labor while receiving epidural analgesia. ⋯ At emergent cesarean section, a uterine rupture was noted. The uterine rupture extended down to the left vaginal angle, was not reparable and a hysterectomy was performed. The fetus survived.
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To evaluate the consequences of opioid use for postoperative pain management and the degree to which these consequences may be reduced or minimized with opioid-sparing or opioid-replacement techniques. ⋯ Opioids will likely remain an integral part of postoperative pain management, but side effects increase the costs of care. The challenge is to identify situations where opioid-sparing techniques improve surrogate economic measurements and decrease overall hospital costs.
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Comparative Study
A comparison of Internet usage between two residency programs in the United Kingdom and the United States.
To survey the pattern of use and availability of the Internet among anesthesia residents. ⋯ If the reported survey results are representative of Internet use among anesthesia residents in the United States and UK, Internet access at work is associated with greater Internet use for medical purposes, perhaps in part because residents perceive it to be a convenient and accurate resource.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of effects of lidocaine hydrochloride, buffered lidocaine, diphenhydramine, and normal saline after intradermal injection.
To evaluate pain and the spread of analgesia when local anesthetics are given as an intradermal injection into the dorsal aspect of the hand. ⋯ There is a reduction of infiltration pain using buffered lidocaine as opposed to lidocaine and diphenhydramine. Although lidocaine injection resulted in a slightly faster spread of analgesic diameter, buffered lidocaine was equivalent to lidocaine from minute 2 until minute 30. Therefore, to obtain optimal anesthetic conditions, we recommend that buffered lidocaine be given 2 minutes before performing catheterization, whereas diphenhydramine should be given 5 minutes before catheterization, but only when buffered lidocaine cannot be used.