Articles: postoperative.
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Hemophilia A and hemophilia B are X chromosome-linked congenital bleeding disorders caused by a deficiency or absence of activity of coagulation factor VIII (hemophilia A) or factor IX (hemophilia B), which are graded in different degrees of severity (mild, moderate, severe). Depending on the severity patients may experience spontaneous bleeding episodes or will develop excessive bleeding in the context of injuries or surgery. Hemophilia should not be a contraindication for an invasive procedure; however, a number of conditions are required to provide successful surgery and an uncomplicated and safe postoperative course. This review provides an overview of hemophilia and the key biochemical laboratory and clinical aspects as well as possible specific and non-specific treatment options and addresses the special needs for the perioperative care of these patients.
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To review left ventricular assist device physiology, initial postoperative management, common complications, trouble shooting and management of hypotension, and other common ICU problems. ⋯ Intensivists are increasingly likely to encounter patients requiring mechanical circulatory support with left ventricular assist devices at various points in the trajectory of their disease, from the immediate postimplant period to subsequent admissions for complications, and at end of life. A basic understanding of left ventricular assist device physiology is essential to the safe and effective care of these patients.
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Review Meta Analysis Comparative Study
Comparison between continuous thoracic epidural and paravertebral blocks for postoperative analgesia in patients undergoing thoracotomy: Systematic review.
Thoracotomy is a procedure associated with postoperative severe pain. Epidural block (EB) is considered the gold standard for its control. Paravertebral block (PVB) is an option for the management of postoperative pain. The aim of this study was to evaluate by meta-analyses the effectiveness of continuous thoracic epidural and paravertebral blocks for pain management after thoracotomy and the incidence of adverse effects. ⋯ There were no statistically significant differences in pain relief after thoracotomy between EB and PVB. PVB showed a lower incidence of side effects with reduced frequency of urinary retention and hypotension.
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Front Public Health · Jan 2013
ReviewThe utility of intravenous acetaminophen in the perioperative period.
Intravenous acetaminophen (IVA) has rapid and effective analgesic properties. Recent studies have shown several benefits of using IVA perioperatively. However, due to its relatively high cost and limited clinical data concerning its efficacy compared with other agents, physicians are hesitant to use IVA in the perioperative period. This brief review examines the utility of this medication in the perioperative period and highlights future areas of clinical and epidemiological research regarding its use.
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Good pain control after surgery is important to prevent negative outcomes such as tachycardia, hypertension, myocardial ischemia, decrease in alveolar ventilation, and poor wound healing. Exacerbations of acute pain can lead to neural sensitization and release of mediators both peripherally and centrally. ⋯ The new pharmacological products to treat postoperative pain include extended-release epidural morphine and analgesic adjuvants such as capsaicin, ketamine, gabapentin, pregabalin dexmetomidine, and tapentadol. Newer postoperative patient-controlled analgesia (PCA) in modes such as intranasal, regional, transdermal, and pulmonary presents another interesting avenue of development.