Journal of clinical anesthesia
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Randomized Controlled Trial Clinical Trial
Combined intrathecal fentanyl and neostigmine: therapy for postoperative abdominal hysterectomy pain relief.
To evaluate the analgesic action of spinal neostigmine as part of a multimodal analgesic therapy approach including spinal neostigmine and spinal fentanyl for postoperative pain relief ⋯ The combination of 25 microg neostigmine with 25 microg fentanyl given intrathecally with 15 mg of hyperbaric bupivacaine delayed postoperative pain and lowered the number of rescue analgesics. Because the better quality of analgesia was obtained with an increased (although not statistically significant difference) incidence of untoward side effects, larger samples should be studied before its routine use is recommended.
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To measure the distances from the skin to the epidural space (DSES) of the lower cervical and upper thoracic intervertebral spaces. ⋯ In the cervical spine, DSES varies from space to space. In obese individuals, the fat pad may increase DSES at the lower cervical intervertebral spaces. The longest mean distances from the ligamentum flavum to the dural sac and to the spinal cord were found at the T1-2 and T2-3 levels, precisely where DSES is shorter. All things being equal, the upper thoracic intervertebral spaces appeared to provide a greater margin of safety for insertion of epidural catheters to treat cervicobrachial radiculopathies.
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Case Reports
Mucoid impaction following nasal intubation in a child with an upper respiratory infection.
We describe a case of mucoid impaction following nasotracheal intubation in a child with an upper respiratory infection that was successfully treated with a fiberoptic bronchoscope too large to pass through the endotracheal tube lumen. To the best of our knowledge, it is the first report in the anesthesia literature in which the placement of a nasal tracheal tube is implicated as the cause of the mucous obstruction. The physiologic changes that occur with anesthesia and that place patients at increased risk for this phenomenon, as well as the differential diagnosis, treatment, and prevention of this entity, are discussed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Carbon dioxide dynamics during apneic oxygenation: the effects of preceding hypocapnia.
To compare the rate of increase of arterial carbon dioxide tension (PaCO2) during apneic oxygenation preceded by acute respiratory hypocapnia with that during apnea preceded by respiratory eucapnia. ⋯ Acute hypocapnia compared with eucapnia prior to apneic oxygenation is associated with a greater rise in PaCO2 in the anesthetized patient. This finding may be due in part to widening of the venoarterial gradient of pCO2.
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Randomized Controlled Trial Comparative Study Clinical Trial
Evaluation of anxiolysis and pain associated with combined peri- and retrobulbar eye block for cataract surgery.
To evaluate five different preoperative anxiolytic regimens in cataract surgery performed under regional anesthesia; to quantify the pain associated with combined peri- and retrobulbar injection (PRBI) of local anesthetic drugs; and to describe a technique of painless eye block. ⋯ 1. There was interpersonal variation in the level of preoperative anxiety. 2. In patients who were anxious, the anxiolytic drugs and placebo decreasedanxiety although the level of anxiety did not differ between the anxiolytic drugs or between placebo and the anxiolytic drugs. The only difference was in Group 1 patients (3 mg promazepam), who reported slightly increased anxiety before and during PRBB administration (p < 0.05). 3. Placement of the PRBB is less painful than the insertion of a 20 g i.v. cannula.