Journal of clinical anesthesia
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Randomized Controlled Trial Comparative Study
Is magnesium sulfate effective for pain in chronic postherpetic neuralgia patients comparing with ketamine infusion therapy?
Postherpetic neuralgia (PHN) is a frequent debilitating complication and one of the most intractable pain disorders, particularly in elderly patients. Although tricyclic antidepressants, topical capsaicin, gabapentin, and oxycodone are effective for alleviating PHN, many patients remain refractory to current therapies. Here, the analgesic effects of ketamine or magnesium for PHN were assessed in an open prospective study. ⋯ Ketamine and magnesium showed significant analgesic effects in patients with PHN.
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Review Case Reports
Valsalva hemorrhagic retinopathy presenting as a rare cause of impaired vision after a general anesthetic-a case report and review of the literature.
Postoperative visual loss from any cause is potentially catastrophic. We present a case of Valsalva hemorrhagic retinopathy (VHR) as a rare cause of impaired vision after an apparently uneventful general anesthetic. ⋯ Although VHR is considered to be rare, the events and activities with which it is associated are relatively common, both in everyday life and in the operating room. We suggest that the occurrence of VHR after anesthesia and surgery may be more frequent than previously appreciated and make recommendations for further investigations.
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Case Reports
Endocarditic sinus of valsalva fistulae to right ventricular outflow tract in adult ventricular septal defects.
Surgical repair of congenital ventricular septal defects (VSDs) in adults is quite rare. Most congenital VSDs are repaired in children. Of those adult patients diagnosed as having VSDs, many are not repaired due to irreversible pulmonary vascular disease. ⋯ This patient refused surgery until the progressive dyspnea was worsened by the endocarditis and the fistulas. At the time of surgery, his ventricular ejection fraction measured 47%, the ventricular chambers were enlarged, and the pulmonary to systemic flow ratio measured 2:1. He did well clinically after the VSD and fistulae repair.
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Remifentanil could induce opioid-induced hyperalgesia and tolerance, which would increase pain intensity after the operation. N-methyl-d-aspartate (NMDA) receptor antagonists have been used to prevent these adverse effects while the efficacy is still controversial. We evaluated the effectiveness of NMDA receptor antagonists in reducing postoperative pain and analgesic consumption after remifentanil-based anesthesia. ⋯ N-methyl-d-aspartate receptor antagonists can prevent the increase of analgesic consumption and pain intensity induced by remifentanil, and it can improve the postoperative satisfaction of patients.
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Randomized Controlled Trial Comparative Study
Addition of low-dose ketamine to midazolam-fentanyl-propofol-based sedation for colonoscopy: a randomized, double-blind, controlled trial.
To evaluate the effects of low-dose ketamine on midazolam-fentanyl-propofol-based sedation for outpatient colonoscopy. ⋯ Addition of low-dose ketamine to midazolam-fentanyl-propofol-based sedation for outpatient colonoscopy resulted in more rapid and better quality of sedation, less propofol consumption, more stable hemodynamic status, and less adverse effects with similar recovery times in adult patients.