Articles: trauma.
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Anesthesia and analgesia · Aug 2005
Review Meta AnalysisRevising a dogma: ketamine for patients with neurological injury?
We evaluated reports of randomized clinical trials in the perioperative and intensive care setting concerning ketamine's effects on the brain in patients with, or at risk for, neurological injury. We also reviewed other studies in humans on the drug's effects on the brain, and reports that examined ketamine in experimental brain injury. In the clinical setting, level II evidence indicates that ketamine does not increase intracranial pressure when used under conditions of controlled ventilation, coadministration of a gamma-aminobutyric acid (GABA) receptor agonist, and without nitrous oxide. Ketamine may thus safely be used in neurologically impaired patients. Compared with other anesthetics or sedatives, level II and III evidence indicates that hemodynamic stimulation induced by ketamine may improve cerebral perfusion; this could make the drug a preferred choice in sedative regimes after brain injury. In the laboratory, ketamine has neuroprotective, and S(+)-ketamine additional neuroregenerative effects, even when administered after onset of a cerebral insult. However, improved outcomes were only reported in studies with brief recovery observation intervals. In developing animals, and in certain brain areas of adult rats without cerebral injury, neurotoxic effects were noted after large-dose ketamine. These were prevented by coadministration of GABA receptor agonists. ⋯ Ketamine can be used safely in neurologically impaired patients under conditions of controlled ventilation, coadministration of a {gamma}-aminobutyric acid receptor agonist, and avoidance of nitrous oxide. Its beneficial circulatory effects and preclinical data demonstrating neuroprotection merit further animal and patient investigation.
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Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi · Aug 2005
Review[Advances of functional electrical stimulation in treatment of peripheral nerve injuries].
To review the advances of functional electrical stimulation (FES) in treatment of peripheral nerve injuries. ⋯ FES is an effective treatment for peripheral nerve injuries.
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Today most complications of thyroid and parathyroid surgery are related to either metabolic derangements or injury to the recurrent laryngeal nerves. Other complications include superior laryngeal nerve injury, infection, airway compromise, and bleeding. Although the principal goal of thyroid and parathyroid surgery is the prevention of these complications, prompt recognition and intervention will minimize morbidity and provide the patient with the best chance of a satisfactory outcome.
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Neural injuries that occur after total hip arthroplasty (THA) can be classified as involving either the central nervous system or peripheral nerves. Central nervous system changes after THA may be attributed to increased appreciation of fat embolism syndrome associated with THA. Certain maneuvers such as impacting the acetabulum, femoral reaming, and cement pressurization can force marrow fat into the venous system. ⋯ The mechanisms of vascular injury include occlusion associated with preexisting peripheral vascular disease and vascular injury during removal of cement during screw fixation of acetabular components, cages, or structural grafts. Perioperative assessment should include vascular evaluation of patients with absent pulses, previous vascular bypass surgery, or dysvascular limbs. A CT scan should be considered when cement or components extend medially into the pelvis.