Articles: post-operative.
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Intrathecal patient-controlled analgesia (IT-PCA) through implanted intrathecal infusion pumps has been increasingly utilized for severe cancer and chronic noncancer pain management. However, its application for acute postoperative pain management has not been reported to date. ⋯ The IT-PCA functionality of her intrathecal pump was successfully integrated into her postoperative multimodal pain regimen. Hence, IT-PCA can be safely incorporated into acute postoperative pain management with vigilant monitoring and close multidisciplinary collaboration.
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Anesthesia and analgesia · Jun 2018
Achieving Milestones as a Prerequisite for Proceeding With a Clinical Trial.
Although the National Institutes of Health (NIH) invests $30 billion in research annually, many funded studies fail to generate results that can inform practice. The National Institutes of Health introduced a phased funding mechanism as one potential solution. Study-specific milestones are established for an initial pilot phase. We assess the utility of this phased approach through the ongoing Electroencephalography (EEG) Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) pragmatic clinical trial. The hypothesis of the trial is that EEG guidance of general anesthesia, through prevention of EEG suppression, can decrease postoperative delirium and its downstream negative sequelae. ⋯ With the ENGAGES trial, we demonstrated that key milestones can be identified and progressively assessed during a pilot phase. Success in attaining appropriate milestones hypothetically predicts meaningful completion of a study, and can provide justification for proceeding beyond a pilot phase. The impact of this phased approach on return on investment and scientific yield requires additional study.
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Randomized Controlled Trial Multicenter Study
Amisulpride Prevents Postoperative Nausea and Vomiting in Patients at High Risk: A Randomized, Double-blind, Placebo-controlled Trial.
Postoperative nausea and vomiting causes distress for patients and can prolong care requirements. Consensus guidelines recommend use of multiple antiemetics from different mechanistic classes as prophylaxis in patients at high risk of postoperative nausea and vomiting. The prophylactic efficacy of the dopamine D2/D3 antagonist amisulpride in combination with other antiemetics was investigated. ⋯ An online visual overview is available for this article at http://links.lww.com/ALN/B727.
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Sudden postoperative hearing loss is rare, and thought to be caused by a variety of mechanisms. Here we report on a patient with Crouzon syndrome who experienced multiple episodes of postoperative hearing loss, with persistent hearing loss occurring after she received nitrous oxide as part of a general anesthetic. ⋯ Patients with craniofacial syndromes may have acoustic nerve compression from skull base and cartilage anomalies that cause narrowing of the internal acoustic meatus. These anatomic variations may make patients more susceptible to increased middle ear pressure secondary to nitrous oxide, increasing their risk for hearing loss.