Journal of clinical anesthesia
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To evaluate the success of epidural anesthesia for postpartum tubal ligation using epidural catheters placed during labor and to determine whether patient characteristics, timing of surgery, or technical factors (e.g., length of epidural catheter inserted into the epidural space) influenced the success of subsequent epidural anesthesia. ⋯ Although other factors may influence the timing of postpartum tubal ligation after delivery, the success of epidural anesthesia for tubal ligation using in situ epidural catheters is greater if surgery is performed shortly after delivery.
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Regional anesthetic techniques for children have recently enjoyed a justified resurgence in popularity. Intraoperative blockade of the neuraxis, whether by the spinal or epidural route, provides excellent analgesia with minimal physiologic alteration and, with an indwelling catheter, can provide continuous pain relief for many days postoperatively. ⋯ Although some practitioners contend that a regional block on an already anesthetized child adds to the risk of the general anesthetic itself, in experienced hands the risks are negligible and the benefits dramatic. In this review of caudal and lumbar epidural and subarachnoid blockade in infants and children, anatomy, physiologic alterations, and pharmacology pertinent to the three types of neuraxial blockade are described, with the aim of providing the practicing anesthesiologist with the foundation needed to perform these blocks with relative confidence.
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Meta Analysis
Postoperative patient-controlled analgesia: meta-analyses of initial randomized control trials.
To compare outcomes during conventional analgesia (as-needed intramuscular dosing) and patient-controlled analgesia (PCA) in postoperative patients by analyzing data from published comparative trials. ⋯ Patient preference strongly favors PCA over conventional analgesia. Patients using PCA also obtain better pain relief than those using conventional analgesia, without an increase in side effects. Favorable effect of PCA upon analgesic usage and length of hospital stay did not in the initial trials attain statistical significance. Nonetheless, the favorable trends in the mean effect sizes for both outcomes argue that further studies of both outcomes should be performed to determine whether the favorable impact of PCA upon either may become statistically significant if larger numbers of patients are enrolled.
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Randomized Controlled Trial Clinical Trial
Intravenous clonidine fails to reduce postoperative meperidine requirements.
To investigate the effect of an additional postoperative intravenous (IV) clonidine infusion on meperidine requirements in the early postoperative period. ⋯ During the first 2 postoperative hours following cholecystectomy, postoperative meperidine intake could not be reduced by IV administration of clonidine 300 micrograms.
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Historical Article
For all the world to see: anesthesia at the 1939 New York World's Fair.
The 1939 New York World's Fair presented a unique opportunity for the newly recognized specialty of anesthesiology to be presented to the general public. With funding supplied by the Winthrop Chemical Company of New York City and careful planning, a committee of physician-anesthetists was able to design a display that illustrated all aspects of the physician-anesthetist's role in health care: general "gas" anesthesia, regional techniques, pain management, resuscitation, and oxygen therapy. ⋯ Surprisingly, issues and discussions concerning the fashion in which anesthesia was to be presented at this exhibit remain germane to current presentations of the specialty to the general public. Although no record remains of the public's response to the exhibit, the World's Fair was an international showcase and an important opportunity for public recognition of anesthesiology.