International anesthesiology clinics
-
Intrathecal opioids and the combined spinal/epidural technique provide new tools for the obstetrical anesthesiologist. With intrathecal opioids, we can rapidly and safely relieve the pain of labor without maternal sedation or motor blockade. Intrathecal sufentanil 10 micrograms provides 1 to 2 hours of excellent analgesia during the first stage of labor. ⋯ Unless morphine is used, the side effects induced by intrathecal opioids are usually mild and easily treated. In our practice, combined spinal/epidural labor analgesia has rapidly gained wide acceptance by patients, nurses, obstetricians, and anesthesiologists. Continuous spinal analgesia, although theoretically appealing, requires further refinement.
-
Inadequately treated pain is a major cause of unanticipated hospital admissions after ambulatory surgery. The ability to provide adequate pain relief by simple methods that are readily available to the day-care patient in his or her home environment is one of the major challenges for providers of ambulatory surgery and anesthesia. The increasing number of extensive and painful surgical procedures (e.g., laparoscopic cholecystectomy, laminectomy, knee construction, hysterectomies) being undertaken on an ambulatory basis presents new challenges with respect to acute postoperative pain. ⋯ The aim of an analgesic technique should be not only to lower the pain scores but also to facilitate earlier mobilization and reduce perioperative complications. If future clinical investigations clarify the issues that have been raised by laboratory studies, clinicians may be able to effectively treat postoperative pain using combinations of "balanced," "preemptive," and "peripheral" analgesia. More important, improved analgesic techniques will increase patient satisfaction and enhance their perception of ambulatory anesthesia and surgery.
-
Int Anesthesiol Clin · Jan 1994
ReviewBlood, fluids, and electrolytes in the pediatric trauma patient.
Successful resuscitation of pediatric trauma patients begins with identification of the physiological abnormalities that require intervention. Health care practitioners in the prehospital, emergency room, and operating room settings must be familiar with normal physiological parameters to be able to recognize abnormalities and begin resuscitative efforts. Recognition of shock may be more subtle in the pediatric patient, because blood pressure can be maintained in the face of a marked decrease in circulating blood volume. ⋯ The area of fluid management and blood transfusion has undergone extensive change in the last decade but needs continued investigation in the pediatric trauma population. Studies targeting this population are limited, and current practices are based largely on extrapolation from adult experience and studies. The area continues to evolve, but further research is needed to improve resuscitation in the pediatric trauma patient.
-
Regional anesthesia has several distinct advantages over general anesthesia in the patient scheduled for ambulatory surgery. These include residual analgesia and a lower incidence of postoperative nausea and vomiting. With appropriate choice of regional technique and local anesthetic drug, earlier ambulation and discharge are often possible. ⋯ Regional anesthesia requires more time to administer than does general anesthesia, and ideally should be performed in an induction area. However, use of such an area, or employment of techniques with a rapid onset of analgesia (e.g., intravenous regional of spinal anesthesia) may actually reduce the total amount of time a patient spends in the ambulatory unit [16]. Selected application of regional techniques will help convince surgeons, anesthesiologists, and nurses of the advantages of regional blockade and may ultimately lead to greater patient and surgeon satisfaction.