Journal of clinical anesthesia
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When intrathecal and epidural opioids are administered, pruritus occurs as an unwanted and troublesome side effect. The reported incidence varies between 30% and 100%. The exact mechanisms of neuraxial opioid-induced pruritus remain unclear. ⋯ The treatment of intrathecal opioid-induced pruritus remains a challenge. Many pharmacological therapies, including antihistamines, 5-HT(3)-receptor antagonists, opiate-antagonists, propofol, nonsteroid antiinflammatory drugs, and droperidol, have been studied. In this review, we will summarize pathophysiological and pharmacological advances that will improve understanding and ultimately the management of this troublesome problem.
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Oxygen-carrying hemoglobin (Hb) solutions are under intense investigation as an alternative to allogeneic red cell transfusion during surgery, with or without acute normovolemic hemodilution. We present a case in which an investigational Hb solution was used as an adjunct to acute normovolemic hemodilution, and as a replacement for surgical blood loss in a patient undergoing complex aortic reconstruction with a large blood loss.
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Moving the last case of the day from one operating room (OR) to another OR can increase OR efficiency. However, there is a penalty cost for moving a case. The goal of the study was to measure perceptions of the minimum time that needs to be saved for it to be worthwhile to move a case from a late-running OR to another OR. ⋯ Members of the AACD perceive the penalty cost for moving a case to be 1 hour.
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Case Reports
Recombinant factor VIIa for control of hemorrhage: early experience in critically ill trauma patients.
To examine our institutional experience with recombinant Factor VIIa (rFVIIa) as a treatment for exsanguinating hemorrhage in critically ill trauma patients. ⋯ Administration of rFVIIa shows promise in the treatment of exsanguinating hemorrhage. Prospective, controlled clinical trials of this therapy are strongly recommended.
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Randomized Controlled Trial Comparative Study Clinical Trial
Sevoflurane requirements during coloproctologic surgery: difference between two different epidural regimens.
To examine the influence of epidural morphine on the end-tidal sevoflurane concentration titrated to maintain bispectral index (BIS) values between 40 and 50. ⋯ Adding morphine to the bupivacaine epidural solution did not reduce sevoflurane requirements but did provide high-quality postoperative analgesia, mainly just after tracheal extubation.