Articles: postoperative.
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We measured pre-operative hepatic blood flow and postoperative morphine concentration in infants with or without biliary atresia. Thirty-four infants (0-3 months) with biliary atresia undergoing portoenterostomy (Kasai operation) were included and hepatic blood flow was assessed by magnetic resonance imaging before surgery in 12 of them. Sixteen subjects (0-3 months) without liver disease undergoing abdominal or pelvic surgery acted as controls and six of them had hepatic blood flow assessed. ⋯ The median (IQR [range]) morphine concentration after 24 h infusion was 5.9 (4.5-16.4 [2.9-42.2]) ng.ml(-1) and 6.4 (3.2-12.0 [1.9-48.6]) ng.ml(-1) , respectively (p = 0.460). An inverse regression relation was found between the morphine concentration and the hepatic perfusion index (R(2) = 0.519, p = 0.001). Compensatory increases in hepatic arterial blood flow maintain the total hepatic blood flow in infants with biliary atresia.
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Hand (New York, N.Y.) · Jun 2014
Targeted muscle reinnervation in the initial management of traumatic upper extremity amputation injury.
Targeted muscle reinnervation (TMR) was initially designed to provide cortical control of upper limb prostheses through a series of novel nerve transfers. Early experience has suggested that TMR may also inhibit symptomatic neuroma formation. We present the first report of TMR performed at the time of a traumatic shoulder disarticulation. ⋯ Eight months post-operatively, the patient demonstrates multiple successful nerve transfers and exhibits no evidence of neuroma pain on clinical exam. Using the Patient Reported Outcomes Measurement Information System (PROMIS), the patient demonstrates minimal pain interference or pain behavior. Targeted muscle reinnervation may be considered in the acute trauma setting to prevent neuroma pain and to prepare patients for myoelectric prostheses in the future.
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Critical care nurse · Jun 2014
Case ReportsHarlequin syndrome as a complication of epidural anesthesia.
Harlequin syndrome is a rare neurological condition that results in unilateral facial flushing and sweating. Although the syndrome is generally a benign condition with complete resolution if appropriate treatment is initiated, unilateral facial flushing can be a sign of several serious conditions and should be thoroughly investigated. ⋯ Differential diagnosis includes neurovascular disease (acute stroke), malignant neoplasm of brain or lung, Horner syndrome, idiopathic hyperhidrosis, and Frey syndrome. Harlequin syndrome is often easily treated by discontinuing the anesthetic or adjusting placement of the epidural catheter.
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The management of atrial fibrillation has seen marked changes in recent years. This is the result of better knowledge of the pathophysiology and risks factors for atrial fibrillation, better stratification for thromboembolic and bleeding risks, changing practices in anticoagulation management, and the development of new antiarrhythmic drugs. This article focuses on these new issues, with particular attention to their relevance in the perioperative period. ⋯ Better knowledge of the pathophysiology of atrial fibrillation and improved awareness of the risks associated with this frequent arrhythmia are continuing to improve the management of patients with chronic atrial fibrillation and new-onset atrial fibrillation in the perioperative period. As with most complex disease processes, treatment decisions must be individualized for each patient and clinical context.
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J Pain Palliat Care Pharmacother · Jun 2014
Case ReportsSubacute pain after total knee arthroplasty.
Acute pain during and immediately after total knee arthroplasty (TKA) can be well controlled by spinal anesthesia, local infiltration analgesia, and peripheral nerve blocks; this enables early or fast-track rehabilitation. However, about half of patients have clinically significant pain in the following weeks. ⋯ Intensive analgesic and antihyperalgesic treatment during the first few weeks after TKA surgery may reduce the risk of chronic pain after this operation, which is itself intended to remove the patient's chronic osteoarthritis pain. Spinal cord stimulation may be an effective option for patients with mainly neuropathic pain after TKA surgery.