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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A total of 100 patients who underwent elective lobar donor hepatectomy from 2000 to 2002 at the University of Rochester Medical Center were reviewed. Assessed clinical data were estimated blood loss, intraoperative central venous pressure (CVP), blood product and fluid administration, perioperative arterial blood gas tension and acid-base state, metabolic status, perioperative serum levels of aspartate aminotransferase, alanine aminotransferase, prothrombin time, albumin, and lactate, procedure duration, and perioperative complications. All patients survived surgery, and the average duration of surgery (from skin incision to skin closure) was 615 +/- 99.6 minutes. Mean blood loss was 549 +/- 391 mL (range, 80-2,500 mL), and only 4 patients required homologous blood transfusion. The intraoperative blood loss did not correlate with CVP values. A total of 72 patients received isotonic sodium bicarbonate solution, and their metabolic variables were superior to those of normal saline group patients (arterial pH, 7.35 +/- 0.03 vs. 7.29 +/- 0.07; base excess, -4.3 +/- 2.4 vs. 7.3 +/- 3.4; and serum bicarbonate level, 20.6 +/- 2.2 vs. 18.6 +/- 2.9). However, the better control of metabolic acidosis was not associated with serum lactate levels or other outcome measures. Maintaining the CVP < 5 mmHg was not associated with blood loss. Clinically significant anesthetic complications were severe metabolic acidosis, pneumothorax and respiratory insufficiency immediately following extubation in the operating room. In conclusion, placement of a thoracic epidural catheter delivering a local anesthetic in addition to intravenous (IV) patient-controlled analgesia with opiates provided safe and effective pain control in most patients. Further prospective studies should shed a light on the optimal care of patients undergoing liver donor hepatic resection.
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PMID:Anesthesia care for adult live donor hepatectomy: our experiences with 100 cases. 1739 51

Indwelling interscalene catheters are utilized for inpatient postoperative pain control after shoulder surgery. Improved medical equipment and advanced techniques may allow safe and efficacious outpatient use. One hundred and forty-four consecutive indwelling interscalene catheter placements were reviewed to determine adverse events, complications, and efficacy. Real-time ultrasound-guided catheter placement technique is described. Post-anesthesia care unit (PACU) narcotic consumption and last recorded pain score were reviewed to gauge efficacy. The catheter placement technique was 98% successful. There were 14 (9.7%) minor adverse events including inadequate analgesia (8), accidental catheter removal (4) of disconnection (1), and shortness of breath (1). The single complication (0.7%) was a small apical pneumothorax. The average PACU narcotic consumption in intravenous morphine equivalents was 1.7 mg. The average last recorded PACU pain score on a scale of 1 to 10 was 0.6. Catheter placement under real-time ultrasound guidance is accurate. Outpatient use of indwelling interscalene catheters is safe and efficacious.
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PMID:Indwelling interscalene catheter use in an outpatient setting for shoulder surgery: technique, efficacy, and complications. 1750 47

Fifty-seven patients were studied over a period of three years to analyse the efficacy of surgical pleurectomy for spontaneous pneumothorax. Thirty-one and 26 patients underwent open and video-assisted thoracoscopic surgery (VATS) pleurectomy, respectively. VATS was the main modality used for primary spontaneous pneumothorax (PSP) (21 vs. 8). However, secondary spontaneous pneumothorax (SSP) was mainly managed with open pleurectomy (23 vs. 5). The median operating time was significantly longer in open group (72.4 vs. 55 min; P=0.005). The amount of analgesia required in the first five days was significantly more in open group (108 mg vs. 46.9 mg; P=0.02). Chest drainage was significantly more in open group (1027.1 ml vs. 652.8 ml; P=0.04). However, chest drain duration and hospital stay had no significant difference. VATS emerged as a cost-effective modality (1770 pounds vs. 3226 pounds). The ability to return to work was significantly earlier in VATS group in PSP patients (6 weeks vs. 10 weeks; P=0.007). There were 3 (5.27%) recurrences in VATS group for patients with SSP. This experience suggests that VATS pleurectomy is an appropriate modality for PSP. However, open pleurectomy is a viable alternative to treat SSP.
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PMID:Should surgical pleurectomy for spontaneous pneumothorax be always thoracoscopic? 1840 60

Interpleural analgesia is a method of postoperative analgesia that was developed by Kvalheim and Reiestad in 1984. The main indication is postoperative pain after unilateral thoracic and upper abdominal surgery. Many authors report good analgesic effects and better postoperative lung function following cholecystectomy. There is some controversy on the effectiveness of this method after thoracic surgery. Further indications are post-traumatic pain after multiple rib fractures and chronic pain in the upper abdomen (carcinoma of the pancreas, chronic pancreatitis). The local anaesthetic of choice is bupivacaine (in concentrations of 0.25-0.75%, injection volumes of 10-40 ml, with or without epinephrine, applied as bolus or infusion), but others, such as lidocaine or morphine, are also being tested. Risks involved in this method are pneumothorax when the catheter is placed blind and the systemic toxicity of the local anaesthetic. This review provides information on the mechanism of action, the technique, the clinical use to date and possible risks.
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PMID:[Interpleural analgesia : A topical review.]. 1841 50

This report describes a case of rectal cancer with severe interstitial pneumonia (IP) and chronic pneumothorax. Acute exacerbation of IP is a serious postoperative complication and the consequences are extremely poor. To provide less invasive surgery and to prevent acute exacerbation of the IP, the patient received chemo-radiotherapy for controlling locally advanced tumor following low anterior resection under combined spinal-epidural anesthesia. Adequate epidural analgesia during the postoperative period had been shown and the epidural catheter was removed on the 3rd postoperative day. The patient showed symptoms of intrapelvic abscess due to the anastomotic leakage at 10th postoperative day. In order to avoid complications due to spinal and epidural anesthesia (epidural abscess, meningitis), and to prevent acute exacerbation of the IP, general anesthesia was employed with minimal fraction of inspired oxygen (FIO(2)) to perform the colostomy for the anastomotic leakage. The patient recovered without any postoperative respiratory complications. We herein report the successful perioperative management of a rectal cancer patient with severe IP and chronic pneumothorax, with special attention paid to the respiratory functions.
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PMID:Perioperative management of severe interstitial pneumonia for rectal surgery: a case report. 1847 42

The objective of this pilot study was to evaluate the safety and success of early tracheal extubation (ETE) as compared to delayed tracheal extubation (DTE) in single-lung transplantation (SLT) for chronic obstructive pulmonary disease (COPD). This retrospective observational study was undertaken at a university hospital. Fifty-seven adult patients who underwent SLT for COPD (1998-2003) were enrolled. The study cohort was divided into an ETE subgroup (tracheal extubation in the operating room) or a DTE subgroup (tracheal extubation in the intensive care unit). There were no significant differences in perioperative outcomes between subgroups (in-hospital mortality; length of stay; prolonged mechanical ventilation; primary graft dysfunction; pneumonia; atrial fibrillation; renal dysfunction; and, sepsis). The anesthetic technique associated with ETE in SLT for COPD was characterized by limited systemic anesthetics and perioperative thoracic epidural analgesia. Appropriate ETE in SLT for COPD is not only safe but also results in equivalent perioperative outcome when compared to the traditional technique of DTE. Future studies should be powered to examine whether ETE reduces native lung complications such as hyperinflation, pneumonia and pneumothorax.
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PMID:Early tracheal extubation in adults undergoing single-lung transplantation for chronic obstructive pulmonary disease: pilot evaluation of perioperative outcome. 1862 42

During an abdominal surgery, life-threatening events such as severe bradycardia and massive hemorrhage may occur. Reflex bradycardia may arise with surgical manipulation of abdominal contents. Anesthetic agents such as propofol or remifentanil increase the risk of bradycardia. Epidural analgesia using local anesthetics during an abdominal surgery also increases the occurrence of bradycardia and hypotension. Combination of these three factors causes severe bradycardia during the abdominal surgery. Anesthesiologist has to pay close attention to heart rate during the abdominal surgery. The surveillance of Anesthesia-Related Critical Incidents in Japan conducted by Japan Society of Anesthesiologist (JSA) shows that life-threatening events due to hemorrhage during abdominal surgery accounted for 43.9% of all perioperative life-threatening events due to hemorrhage. When we find critical hemorrhage, we have to manage the condition in accordance with "The guideline for critical intraoperative hemorrhage" published by JSA and the Japan Society of Transfusion Medicine and Cell Therapy. The pneumoperitoneum required for laparoscopy induces physiologic changes that complicate anesthetic management and could cause CO2-subcutaneous emphysema, pneumothorax, endobronchial intubation, and gas embolism. During laparoscopy, blood pressure, heart rate, electrocardiogram, end-tidal CO2, and oxygen saturation by pulse oximetry must be continuously monitored.
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PMID:[Crisis management in abdominal surgery]. 1946 94

Regional anaesthesia for bilateral upper limb surgery can be challenging, yet surgeons are becoming increasingly interested in performing bilateral procedures at the same operation. Anaesthetists have traditionally avoided bilateral brachial plexus block due to concerns about local anaesthetic toxicity, phrenic nerve block and pneumothorax. We discuss these three concerns and review whether advances in ultrasound guidance and nerve catheter techniques should make us reconsider our options. A search of Medline and EMBASE from 1966 to January 2009 was conducted using multiple search terms to identify techniques of providing anaesthesia or analgesia for bilateral upper limb surgery and potential side-effects. Ultrasound imaging and nerve catheter techniques have led to a reduction in dose requirements for effective blocks without side-effects. Effective regional anaesthesia can be performed for bilateral surgery while remaining within recommended safe dose limits. Spacing blocks apart in time can further reduce potential toxicity issues, such that peak absorption rates for each block do not coincide. Since phrenic nerve block remains an issue even with low doses of local anaesthesia, bilateral interscalene blocks are still not recommended. Peripheral nerve blocks have excellent safety profiles and are ideal for ultrasound guidance. Regional anaesthesia can be a suitable option for bilateral upper limb surgery.
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PMID:Regional anaesthesia for bilateral upper limb surgery: a review of challenges and solutions. 2071 46

The aim of this study was to determine the efficacy of bilateral intrapleural block with bupivacaine as a preemptive analgesic for postoperative pain in coronary artery bypass graft surgery. In a double-blind prospective clinical trial, 70 patients were randomly divided into a bupivacaine group (20 mL bupivacaine 0.25% and 0.5 mL adrenaline 1/200,000 each side) and a control group (20.5 mL normal saline each side). Evaluation of the severity of pain was performed using the visual analog scale at 12 and 24 h after entering the intensive care unit and again during chest tube removal. Pain scores at 12 and 24 h after intensive care unit admission were significantly lower in the bupivacaine group. There were no side-effects related to intrapleural block, such as pneumothorax or emphysema. In coronary artery bypass graft candidates, preemptive analgesia with bilateral intrapleural block using bupivacaine provided relatively less painful conditions during the first 24 h after surgery, but it did not improve the clinical outcome.
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PMID:Randomized controlled trial of bilateral intrapleural block in cardiac surgery. 2147 Dec 58

Anesthesia options for upper extremity surgery include general and regional anesthesia. Brachial plexus blockade has several advantages including decreased hemodynamic instability, avoidance of airway instrumentation, and intra-, as well as post-operative analgesia. Prior to the availability of ultrasound the risks of complications and failure of regional anesthesia made general anesthesia a more desirable option for anesthesiologists inexperienced in the practice of regional anesthesia. Ultrasonography has revolutionized the practice of regional anesthesia. By visualizing needle entry throughout the procedure, the relationship between the anatomical structures and the needle can reduce the incidence of complications. In addition, direct visualization of the spread of local anesthesia around the nerves provides instant feedback regarding the likely success of the block. This review article outlines how ultrasound has improved the safety and success of brachial plexus blocks. The advantages that ultrasound guidance provides are only as good as the experience of the anesthesiologist performing the block. For example, in experienced hands, with real time needle visualization, a supraclavicular brachial plexus block has changed from an approach with the highest risk of pneumothorax to a block with minimal risks making it the ideal choice for most upper extremity surgeries.
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PMID:Ultrasound-guided regional anesthesia for procedures of the upper extremity. 2171 34


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