Articles: postoperative.
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Anesthesia and analgesia · Nov 2015
Anesthetic Management of Patients with Congenital Insensitivity to Pain with Anhidrosis: A Retrospective Analysis of 358 Procedures Performed Under General Anesthesia.
Congenital insensitivity to pain with anhidrosis (CIPA) is a rare autosomal recessive disorder characterized by recurrent episodic fevers, anhidrosis, absent reaction to noxious stimuli, self-mutilating behavior, and mental retardation. The anesthetic management of patients with CIPA is challenging. Autonomic nervous system abnormalities are common, and patients are at increased risk for perioperative complications. ⋯ Regurgitation, hyperthermia, and aspiration were uncommon, but the incidence of bradycardia was higher than has been reported in previous studies. CIPA remains a challenge for anesthesiologists. Because of the rare nature of this disorder, the risk of various complications is difficult to predict.
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Management of cardiovascular implantable electronic devices (CIEDs), including pacemakers and implantable cardioverter defibrillators, for surgical procedures is challenging due to the increasing number of patients with CIEDs and limited availability of trained providers. At the authors' institution, a small group of anesthesiologists were trained to interrogate CIEDs, devise a management plan, and perform preoperative and postoperative programming and device testing whenever necessary. ⋯ An ADS can provide safe CIED management for surgery, but it requires specialized provider training and strong support from the EPCS. Due to the complexity of CIED management, an ADS will likely only be feasible in high-volume settings.
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The optic nerve sheath diameter has been verified by various clinical studies as a non-invasive indicator of intracranial hypertension. The aim of this study was to compare the optic nerve sheath diameter before and immediately after ventriculo-peritoneal shunt surgery in children with hydrocephalus. ⋯ The mean (SD) optic nerve sheath diameters were 5.4 (0.6) mm (right) and 5.3 (0.7) mm (left) before surgery and 4.4 (0.5) mm (right) and 4.5 (0.7) mm (left) after surgery (p < 0.0001 for before and after comparisons for both eyes). The technique allows rapid and non-invasive assessment of intracranial pressure to guide appropriate postoperative management.
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Abrupt cessation of intrathecal baclofen can lead to a serious withdrawal syndrome. The anesthesiologist must be prepared to avoid intraoperative interruption of baclofen delivery before starting spinal surgery and to recognize and treat the symptoms of baclofen withdrawal in the immediate postoperative period.
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Interact Cardiovasc Thorac Surg · Nov 2015
Randomized Controlled TrialDouble edge closure: a novel technique for reducing post-thoracotomy pain. A randomized control study.
Thoracic surgeons being doctors, spend much effort not only to manage pathologies but also to make their procedures painless. Many surgical manoeuvres have been evolved to reduce post-thoracotomy pain with its associated morbidities. This trial aimed to study the impact of double edge closure technique on post-thoracotomy pain. ⋯ Double edge technique for thoracotomy closure is easy, rapid, safe and effective in decreasing post-thoracotomy pain with subsequent earlier ambulation and lesser use of analgesics.