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Thank you for choosing Leander Veterinary Clinic to provide your pet’s dental care. In preparation for your visit, we would like to go over some basic information so you will be better informed about your pet’s needs.\nFirst, a little background. Periodontal therapy is typically composed of 2-4 stages.\n- Dental Prophylaxis. This is what most people are referring to with a dental cleaning, or a “dental”. It involves scaling and polishing the teeth, a complete oral exam and charting of the teeth.\n- Periodontal Surgery. This is needed for patients with dental disease that has advanced below the gum line and is affecting the deeper tissue.\n- Extraction. This may be necessary for teeth that are fractured, dead, or so diseased that it is impossible to resolve the pain and infection otherwise.\n- Home Care. As with people, pets require some form of regular dental care at home to maintain good dental health. We will discuss this with you upon discharge of your pet.\nAll of these steps, except home care require general anesthesia. It simply is not possible to clean under the gum line safely or thoroughly without anesthesia. While there is some inherent risk with anesthesia, there are also risks of delaying dental care. It is for this reason that a great deal of effort is made and precautions taken to make anesthesia as safe as possible for your pet.\nNext, a little information about the schedule for the day. We ask that you bring your pet in between 7:30 and 8:30 a.m. the morning of the procedure. Unless specifically instructed to do so by your veterinarian, do not give you pet anything to eat the morning of the dental. Water is OK, though. If your pet has eaten, please let us know.\nWe will do a physical exam and any preanesthetic lab work before your pet’s procedure. If any problems are found, we will call you to discuss them before deciding whether to proceed with the dental. Once your pet is anesthetized, we will clean and polish the teeth and examine the mouth for any problems. At this point dental x-rays may be taken to further evaluate for disease beneath the gum line. If any problems are identified, we may need to speak with you, either in person or over the phone, about what treatment is necessary. While we try to anticipate any problems requiring treatment prior to the dental cleaning, it simply is not possible to see everything until you pet is anesthetized and the teeth fully cleaned. Please understand that it is very common to identify further problems that may not have been previously apparent.\nIf additional work is required we will either revise the estimate you were given before your visit, or prepare you another estimate to address the problems at another date. If we are not completing all of the dental work on the first procedure, it is critical to schedule the next step soon so disease is not allowed to progress further. Our primary concern when formulating a treatment plan for your pet is what is safest and most comfortable for them. We also structure the price of dentistry such that there is usually not a significant difference in cost whether the work is done all at the same time or completed on a follow-up procedure.\nAfter your pet is awake from anesthesia, we will call you to inform you of how your pet is doing. Generally, we discharge our dental patients between 3:30 and 5:30 p.m. Upon pickup, please allow a few minutes to discuss what was done, go over any medications and schedule any follow-up appointments that may be needed. It is typical for your pet to be a little groggy the evening after their procedure. If you pet is not back to normal by the next morning, or is experiencing any adverse symptoms, please let us know right away. We want you to understand your pet’s dental needs and what is being done to help them, so please ASK QUESTIONS.\nThank you and we look forward to seeing you and your pet very soon! |
Cancer isn't just a human disease, but veterinarians are turning to human treatment options to save our furry friends.\n“Pets at home or our zoo animals, they are as close to us as a family member,” said Angela Comedy, carnivore collection manager for the Phoenix Zoo.\nAnd when that family member is diagnosed with cancer, you’ll do anything to save them.\n“This particular procedure saved her leg,” said Comedy.\nThe her is Caipora, a 12-year-old jaguar at the Phoenix Zoo.\nDoctors during a routine yearly exam found a deadly form of cancer on Caipora's leg.\n“We just noticed a small lump on her right thigh,” Comedy described.\nIn years past, Caipora most likely would have faced invasive surgery or even amputation. But a new treatment option gave her a second chance, and it works for your pets too.\nMore than 12 million cancer cases are diagnosed in dogs and cats every year, but a Gilbert veterinarian clinic is now using technology once only used on humans to save their lives.\n“We’re always looking for new treatment options just like the human side,” said Dr. Eric Boshoven of PetCure Oncology.\nDr. Boshoven says animal cancers like Caipora’s are difficult to surgically remove.\n“They grow with little fingers and it's those little fingers that get left behind,” said Dr. Boshoven.\nThey’ve now turned to a radiation therapy treatment that uses 3d mapping to precisely target the tumor from all angles, and adjust the amount of radiation automatically.\n“The great news now is we can do it much faster, many fewer treatments which means much less anesthesia,” said Dr. Boshoven.\nWhich means your dog or cat, like Caipora, can be back on their feet in no time. |
Gov. Sonny Perdue announced Wednesday that the state of Georgia will seek a court order this week requiring the U.S. Army Corps of Engineers to restrict water flows from Lake Lanier and Georgia's federal reservoirs.\nThe developer of Seasons on Lanier is not having a good financial season, according to information released by the firm's parent corporation. The news apparently has brought activity at the Gainesville development to a halt and left the company's future in doubt.\nOn March 30, 1842, Crawford W. Long performed the first surgical operation using ether for general anesthesia. The patient, James Venable, felt no pain when he regained consciousness. Long's fee for the groundbreaking surgery was $2. |
Nurse testifies Jackson asked for anesthetic\nLOS ANGELES (AP) -- A nurse who treated Michael Jackson has testified the singer asked her to help him get the powerful anesthetic propofol.\nNurse practioner Cherilyn Lee told jurors Tuesday that Jackson complained he could not sleep and asked her for the drug two months before he died.\nLee says she initially didn't know about the drug, but after speaking with a doctor told the singer it was unsafe to use in his home.\nLee was called to testify by defense attorneys for Dr. Conrad Murray, who has pleaded not guilty to involuntary manslaughter. Authorities say he provided the singer with the fatal dose of the drug.\nLee says Jackson told her he had received propofol during surgery but didn't mention any doctors who were involved.\nShe says Jackson told her propofol was the only drug that would help him sleep.\nTHIS IS A BREAKING NEWS UPDATE. Check back soon for further information. AP's earlier story is below.\nThe judge hearing the involuntary manslaughter trial of Michael Jackson's doctor blocked defense lawyers from asking about the singer's multimillion-dollar contract for his final concert series.\nDefense attorneys for Dr. Conrad Murray had wanted to introduce Jackson's contract with concert giant AEG Live to show that he would be heavily indebted to the promoter if the concerts were canceled. They said Jackson would be desperate to make sure the shows continued.\nSuperior Court Judge Michael Pastor said allowing testimony about the contract might confuse jurors, who are considering whether Murray's actions caused Jackson's June 2009 death.\n"This is not a contractual dispute. This is a homicide case," Pastor said.\nDefense attorney Ed Chernoff told Pastor that Jackson would have been indebted to AEG Live for nearly $40 million if the shows were canceled. Chernoff contends that led Jackson to give himself a dose of the anesthetic propofol in a desperate attempt to sleep.\nProsecutors contend Murray, who has pleaded not guilty, gave the fatal dose.\nAlthough Pastor blocked the AEG contract testimony, he will allow some testimony from Randy Phillips, the company's president and CEO. The judge said Chernoff could ask Phillips about putting together the shows, titled "This Is It," the singer's conduct during a March 2009 press conference and any issues that may have occurred with Jackson's performance of rehearsals.\nPhillips is expected to testify later Tuesday, after jurors hear from Cherilyn Lee, a nurse practitioner who has said Jackson repeatedly asked her for propofol to help him sleep, but she refused.\nLee began her testimony Monday, the sixth witness that Murray's attorneys called to try to shift the blame for Jackson's death to the singer himself. Lee's testimony was briefly delayed Tuesday after she appeared flustered on the witness stand and said she had become dizzy.\nMurray's team plans Tuesday to call other witnesses who they think may support that theory, including Phillips and Jackson's makeup artist and hairstylist, Karen Faye. They will also call several expert witnesses who will try to rebut the testimony of prosecution experts who said Murray was reckless and at fault in Jackson's unexpected death on June 25, 2009.\nIn a court filing Monday, Murray's attorneys expect Faye will testify that Jackson was distraught about completing the comeback shows.\nOne of the initial defense witnesses, Dr. Allan Metzger, supported prosecutors' contentions that Murray acted recklessly by giving Jackson propofol as a sleep aid and that the singer was looking forward to the show.\n"He was excited," Metzger said of Jackson's demeanor during conversations and a house call in the months before the singer's death. "He was talking to me about some creative things that he was thinking about. He spoke to me about his excitement and his fear about the tour."\nMetzger said Jackson felt the shows were a big obligation and he wanted to deliver stellar performances.\nThe doctor, who knew and treated Jackson for more than 15 years, testified the pop superstar asked him about IV medications during his house call.\nOn cross-examination, Metzger said he told Jackson that using any IV drugs or anesthetics to sleep was unsafe.\n"You explained to him that it that was dangerous, life-threatening and should not be done outside of a hospital, correct," prosecutor David Walgren asked the doctor.\n"That's correct," he replied.\n"Was there any amount of money that would have convinced you to give him intravenous propofol in his house?" Walgren asked.\n"Absolutely not," Metger said.\nLee was similarly against Jackson taking propofol to help him sleep. She told The Associated Press in 2009 that the singer repeatedly asked for the drug while she was treating him for nutrition and sleep issues.\n"I said, `Michael, the only problem with you taking this medication' — and I had a chill in my body and tears in my eyes three months ago — `the only problem is you're going to take it and you're not going to wake up,'" she recalled telling Jackson.\nLee kept detailed notes of her treatments on Jackson, which she flipped through repeatedly while testifying Monday.\nAccording to prosecutors, Murray kept no notes on his treatments on Jackson after signing on as his personal physician for the London shows.\nDefense attorneys expect to conclude their case Thursday. Even if they do, jurors won't begin deliberations until next week. A judge told attorneys that he would give them the weekend to craft their closing arguments and finalize jury instructions.\nAP Special Correspondent Linda Deutsch contributed to this report.\nMcCartney can be reached at http://twitter.com/mccartneyAP\nSelena Gomez, Zoe Saldana, and Maggie Gyllenhaal all get an F on this week's Fashion Offenders.Watch Video »\nFind out which stars attended Jennifer Lopez's birthday celebration on today's Celebs Gone Social.Watch Video »\nGet the scoop on Naya Rivera's wacky wedding on Replay hosted by Wonderwall's Kirby Kristen.Watch Video »\nCameron Diaz, Rumer Willis, and Ellie Goulding all get an F on this week's Fashion Offenders.Watch Video »\nLet's check out some of Eva's tactics behind her baby bump secret on Replay hosted by Wonderwall's Kirby Kristen.Watch Video »\nSexy Marky Mark\nTake a look back at Mark Wahlberg's best shirtless looks over the yearsWatch Video »\nLike us on Facebook?\nUP NEXTSexy Sweeties\nFrom Crowd Ignite |
Chuck Reese, CRNA, Ph.D.\nChuck Reese, CRNA, Ph.D.\nAssociate Professor, Department of Anesthesiology and Associate Professor, Department of Obstetrics and Gynecology Medical College of Virginia Physicians/Virginia Commonwealth University Medical Center\n, Richmond, VA.\nChuck holds a BS degree in Nursing from the University of Oklahoma, a BS in Nurse Anesthesia from the George Washington University, a MBA in Health Services Management from National University, a Ph.D. in Health Services Administration from California Pacific University and a second Ph.D. in Adult Education from Virginia Commonwealth University.\nresearch interests center on clinical applications of regional anesthesia.\nhas had a career-long interest in teaching regional anesthesia which has resulted in the presentation of more than two-hundred professional papers at Continuing Education seminars, conventions, and workshops nationally and internationally.\nHe has published numerous professional papers and, as a member of the AANA's original Ad Hoc Committee on Regional Anesthesia, helped develop and currently serves on the core faculty of a series of post-graduate clinical workshops which offer didactic review and "hands-on" practical application of Spinal, Epidural, and Upper Extremity techniques.\nHe is the author/editor of a series of monographs for the AANA Research Foundation.\nTwo monographs (Blocks of the Upper Extremity and Spinal/Epidural Techniques) have been published to date.\nThe Spinal/Epidural manual is in its third edition.\ncompleted a 30-year career in the US Navy Nurse Corps\nwith the rank of Captain.\nWhile on active duty, he\nwas one of the original five Navy Nurses selected to participate in the Navy Healthcare Professional program which designated non-physicians to hold executive positions in the Navy Medical Department throughout the world and at sea.\nHe subsequently served as Director of Contingency Operations and Assistant Chief of Staff of the Naval Regional Medical Command, Great Lakes, Illinois and Director of Anesthesia Programs at the Uniformed Services University of the Health Sciences, Bethesda, Maryland.\nHe has served on several national-level committees of the AANA.\nAs a member of the inaugural Continuing Education Committee, he\nfacilitated development the mandatory Continuing Education program - the first such program in the nursing profession.\nWhile on the Education Committee he\nrevised and standardized clinical experience requirements and refined a tracking system for student eligibility to take the National Qualifying Examination.\nAs a member of the AANA JOURNAL Editorial Review Board he\nconceived of and initiated the first "Journal Continuing Education Course".\nauthored the inaugural offering for this program.\nDuring his affiliation with the US Navy's Nurse Anesthesia Program he established the clinical program at the Naval Hospital, San Diego and served as its first Coordinator.\nHe subsequently served as the Program's Clinical Coordinator at the Naval Hospital, Portsmouth, VA.\nwas the first CRNA\nto be stationed aboard the nuclear-powered aircraft carrier, USS NIMITZ.\ninitial tour he\nwas decorated for his\nrole in caring for more than 100 casualties of the Navy's worst peacetime aircraft flight-deck disaster.\nDuring a clinical practice spanning more than two decades, he served as staff and as Chief Anesthetist at numerous treatment facilities and foreign deployments.\nhobbies include restoration of antique automobiles. |
Welcome to Augusta Oral Surgery Specialists, PC\nOral and maxillofacial surgeons specialize in treating diseases, injuries, and defects in the head, neck, face, and jaws, as well as the hard and soft tissues of the oral (mouth) and maxillofacial (jaws and face) region. An oral surgeon must complete several additional years of medical, surgical, and anesthesia training.\nSamuel C. D’Arco, D.D.S., Oral and Maxillofacial Surgeon, practices a full scope of oral and maxillofacial surgery with expertise ranging from corrective jaw surgery to wisdom tooth removal. He performs a full range of dental implant and bone grafting procedures. Patients can choose their preferred level of pain control and receive their treatment in our specially equipped operatories using local anesthesia, nitrous oxide, IV sedation, or general anesthesia in order to make their oral surgery experience as comfortable as possible.\nAugusta Oral Surgery Specialists, PC offers in-office i-CAT scans. i-CAT techonolgy is widely regarded as the cone beam industry standard. i-CAT and its treatment planning software continue to revolutionize the landscape of 3D dental and maxillofacial radiography with ultimate efficiency and flexibility for maximum clinical control.\nOPT-IN FOR TEXT REMINDERS\nSign up for text messages! Receive appointment reminders on your cell phone. Give us your cell phone number. Text Augusta2 to 622622.\nWebsite Exclusive Offer\nMention that you saw this offer on augustaoralsurgery.com and receive a Free Panoramic X-ray with your Wisdom Tooth Consultation or a Free i-CAT Scan with your Implant Consultation. (up to a $400.00 value)\nReady to Improve Your Smile?\nCall us with any questions or to make an appointment Dr. Samuel C. D'Arco, DDS Phone Number 706-228-3100. |
Allura Liposuction in Maryland\nAllura liposuction is a state of the art body sculpting procedure which combines cutting edge laser technology with the proven treatment of liposuction. In this procedure, Dr. Mallalieu uses the Sciton Allura laser to gently melt and loosen fat in preparation for removal. Once the fat is treated with laser, Dr. Mallalieu uses thin cannulas (approximately the size of a pencil) to effectively remove the unwanted fat. The laser helps to minimize brusing and bleeding during this process. To make the treatment complete, Dr. Mallalieu finishes by using the Allura laser to help tighten the skin from the area treated with liposuction.\nLiposuction Before & After\nWhy should I choose Dr. Mallalieu?\nDr. Mallalieu has over 10 years experience using the Allura device and has performed over 1,000 cases. Unlike many offices where patients don’t see the physician before surgery, Dr. Mallalieu evaluates all his patients in person and creates a treatment plan tailored to each patient. Additionally, Dr. Mallalieu offers 2 complimentary incision treatments to all of his liposuction patients. These laser treatments are performed during your post-operative visits and help to visible reduce any scarring.\nWhat is Laser Liposuction?\nLaser Liposuction is a minimally invasive way to get rid of unsightly fat! Laser Liposuction can be used to lose those love handles, tighten skin, or as part of a mommy-makeover.\nWho is the ideal candidate?\nSomeone with body fat that they want to get rid of.\nDo I need general anesthesia?\nAllura liposuction can be performed under local anesthesia, oral sedation (where the patient takes only a pill for relaxation) or full anesthesia in our Medicare Certified operating suite. Many smaller cases require only local numbing with something called Kleins solution. This a numbing solution which allows Dr. Mallalieu to perform liposuction without the need for general anesthesia. If patients undergo longer cases we will use general anesthesia.\nWhat complications or risks are associated with the procedure?\nOf course, it’s a surgical procedure so all the standard risks apply but that is why you are entrusting your care to Dr. Mallalieu.\nWhat’s my recovery?\nLiposuction in any form is what’s called an ambulatory procedure. This means patients are up and moving from the time surgery ends. For small cases most patients return to work the next day. For cases involving multiple areas patients usually take 24-48 hours off. Patients should refrain from strenuous exercise for 2 weeks or until cleared by Dr. Mallalieu.\nWhat areas of the body can be treated?\nUnder chin, jowls, Back of neck, Upper arms, Upper back, Upper & lower abdomen, Love Handles and Flanks, Hips and Waist, Inner and outer thighs, Buttocks, Inside of knees, Male chest (enlarged breasts).\nLaser Liposuction vs Traditional Liposuction\nThe most significant difference is how much the skin tightens after the procedure. Heat produced by the laser tightens skin and rebuilds collagen. Traditional liposuction does not have this feature.\nIs Laser Liposuction safe?\nYes! Laser Center of Maryland uses the Allura system from Sciton, which has full FDA approval. Our surgical team follows every precaution to give you an excellent result.\nWhen can I expect to see results?\nAfter swelling subsides, roughly 3 weeks.\nDoes the procedure produce visible scars?\nWe treat our incision sites with the same lasers we use for scar removal for several months after surgery. Incisions are 1/2 cm wide and closed with glue; typically they resolve without a visible mark within 6 months.\nCan I combine liposuction with other procedures?\nMany patients will combine liposuction with other procedures. Many patients who have had C-section will do a scar revision and mini-tummy tuck during their Allura procedures. Additionally, Dr. Mallalieu can take some of the unwanted fat and use it to enhance the breast or buttocks with fat grafting. Facial fat grafting can also be performed to enhance the lips or replace lost check volume.\nDr. Jared Mallalieu\nDr. Mallalieu practices cosmetic surgery at the Laser Center of Maryland in Severna Park. He brings the innovation of 90210 to 21146 and beyond!\nSign Up For Our\nInformation and new article posts right to your inbox. |
Airway-related problems are the most common perioperative complications in pediatric anesthesia. Incidences in the literature are as high as 53% in children taken to non-cardiac procedures under general anesthesia,1 resulting in higher perioperative morbidity and mortality. In fact, Bhananker et al reported that out of 193 cardiorespiratory arrests occurring in children under 18 years of age between 1998 and 2004 in the United States, 49% were anesthesia-related and, of those, 27% were associated with airway complications, laryngospasm being the main cause (6%).2 Moreover, it has been documented that, in itself, the treatment of this condition may actually increase postoperative morbidity.3–5\nGrowing interest has emerged recently regarding the potential association between this outcome and the type of device used for securing the airway during anesthesia. Although the endotracheal tube (ET) is considered the standard device for airway management, it has been found to be associated with an increased incidence of laryngospasm,6 apparently as a result of direct stimulation on the larynx and the trachea.7\nThe increasingly frequent use of the classic laryngeal mask (LM) in pediatric anesthesia led to consider that it would remove the main trigger of laryngospasm and that the incidence of this complication in the pediatric population would improve. However, 3 prospective studies8,9 have not found a difference in the incidence of laryngospasm between the 2 devices; and, in contrast, 2 retrospective studies1,3 showed an increase in this complication with the use of the LM as compared with the use of ET in children.\nIn view of these contradicting findings and bearing in mind the absence of any prior clinical trials, a non-inferiority clinical trial was undertaken with the aim of determining the risk of developing laryngospasm with the use of ET versus LM as methods for securing the airway in a pediatric population taken to surgery under general anesthesia in a referral healthcare centre in the city of Medellin, Colombia.\nNon-inferiority, single-blind, controlled clinical trial of parallel groups with 1 to 1 random assignment. The study was submitted for evaluation and approval by the bioethics committees of Antioquia University and San Vicente Fundación University Hospital in Medellín, Colombia, through approval certificate No. 009 of June 7, 2018.\nThe study population included children 2 to 14 years of age, American Society of Anaesthesiology (ASA) classification I to III, scheduled for elective surgery under general anesthesia in the San Vicente Fundación University Hospital, whose parents agreed to their participation in the study. Excluded were patients going to head and neck, thoracic, or abdominal surgery; positions other than supine decubitus; surgeries of more than 3 hours; high risk of aspiration such as gastrointestinal bleeding, gastroparesis, and gastroesophageal reflux; difficult airway criteria; and anticipated mechanical ventilation in the immediate postoperative period.\nPatients were assessed in the pre-anesthetic preparation area and following a medical history and verification of compliance with eligibility criteria, the patients and their parents were invited to participate in the study, and the informed consent was signed.\nIn the operating room, basic ASA monitoring was instituted (electrocardiogram, capnography, oximetry, and non-invasive blood pressure measurement) and anesthetic induction was performed either with inhalation agents, intravenous, or mixed anesthesia, depending on whether the subject arrived with a peripheral or central access line, and in accordance with the anesthetist's preference regarding the use of opioids and nitrous oxide.\nIn general, doses used for intravenous induction were the following: fentanyl 1 to 2 μg/kg, lidocaine 1 mg/kg, propofol 2 to 5 mg/kg and dexamethasone 0.15 to 0.2 mg/kg. For inhalation induction, 6% sevoflurane was used in oxygen flow mixed or not with 50% nitrous oxide, fentanyl 1 to 2 μg/kg and dexamethasone 0.15 to 0.2 mg/kg.\nLater, the patient was assigned to 1 of the 2 groups: LM, Laryngeal Mask Device (LMA Classic Airway, Teleflex Medical Europe Ltd, Dublin Road, Westmeath, Ireland); and ET (Well Lead Oral Endotracheal Tube, SSEM Mthembu Medical Ltd, Wynberg, Johannesburg, Republic of South Africa) (Kendall Carity, Well Lead Medical, Medite), assigning the size and use of the balloon cuff according to age.\nThe main outcome was laryngospasm, clinically manifested in the form of inspiratory or expiratory stridor, absence of respiratory sounds, and paradoxical thoracic/abdominal movement.\nThe secondary outcomes were: arterial desaturation lower than 90% and bardycardia, defined as heart rate below the 5th percentile for the age; additionally, any other related complication was assessed, for example, cardiac arrest and death.\nThe sample size was calculated using the method described by Christensen10 for non-inferiority clinical trials, taking as a basis an expected incidence of laryngospasm of 12% in both groups, which is the mean incidence reported by Bordet et al,7 and is the annual incidence standard in the healthcare center where the study was conducted.\nIn addition, a 10% non-inferiority margin between the 2 interventions was considered. With these data and an alpha error of 0.05 and 80% power, a sample size of 130 patients per group was obtained, for a total of 260 patients. Given the type of intervention, no losses to follow-up were considered.\nThe random sequence was generated by an outside research assistant, using the RADN (Random Number Generator Software; Steven Piantadosi MD, Ph.D, Jhons Hopkins Oncology Center, Baltimore, Maryland, United States) software package by means of variable-size block permutations (4, 6, and 8). The sequence was veiled using numbered opaque sealed envelopes, opened by the treating anesthetist once the patients met the eligibility criteria.\nThe study was blinded for the patient and for the person in charge of determining outcomes. Given the nature of the intervention, blinding of the anesthetist who performed the intervention was not possible, Once the treating anesthetist introduced the device in the airway, a second anesthetist, blinded to the intervention, made the clinical assessment of the presence of the outcome during induction, maintenance and, postoperatively, once the device was removed. Blinding to the intervention for the second anesthetist was maintained by means of the use of the screen to block viewing of the device on the patient's face.\nBaseline characteristics of the subjects were described as frequencies and percentages for qualitative variables, and as central trend and scatter for quantitative variables. Normality for quantitative variables was analyzed using the Olmogorov–Smirnov test. Normal variables were reported as means and standard deviation; non-normal variables were reported as means and interquartile ranges.\nProportion differences in the 2 groups were evaluated for the laryngospasm endpoint and the Chi square test was used to determine statistical significance. Each result was reported with its respective 95% confidence interval (CI) and P value, and a P value of less than 0.05 was considered statistically significant. No subgroup analyses or interim goodness analysis were performed. Per protocol and intention to treat analyses were performed. All the analyses were carried out using the IBM SPSS 20.0 software package (IBM SPSS Statistics; IBM Corporation, Armonk, New York, United States).\nDuring the patient recruitment time period between October 2013 and May 2014, 934 patients were evaluated for selection and, of them, 270 were randomized to participate in the study (Fig. 1). One patient in the ET group had to be taken, intubated, to the intensive care unit due to perioperative complications not related to anesthesia, and 1 patient assigned to the LM group had to be intubated due to poor ventilation resulting from leaks in the device.\nBaseline clinical and demographic characteristics of the patients are shown in Table 1. Characteristically, the majority of the patients in the study were healthy patients (62.2%) taken to orthopedic surgery and pediatric surgery (58%). There was a personal history of prior respiratory infections in 21% of patients and of passive cigarette smoking in 28.5%.\nThe anesthetic management of the patients taken to different surgical procedures is described in Table 2 and Fig. 2.\nLaryngospasm occurred in 3.3% of all patients evaluated; 7 patients (5.2%) in the LM group, and 2 patients (1.5%) in the ET tube group developed laryngospasm, with a difference in risk of 3.7%, 95% CI (−0.7% a 7.9%), and a P value of 0.147 (Fig. 3). The per protocol analysis did not reveal any difference as compared with the results of the intention-to-treat analysis.\nThe majority of laryngospasm cases occurred during emergence from anesthesia (85.7%). No statistically significant differences were found for the other outcomes evaluated (Table 3).\nIn this study, laryngospasm occurred in 3.3% of the children taken to surgical procedures under general anesthesia. This incidence is within the ranges published in previous studies, which vary between 0.04% and 14%.7,11,12 Due to incidence found was much lower than the reported in the same institution, the authors decided to modify the non-inferiority margin by using the synthetic method,13 which allows to establish the margin according to the data thrown by the study and the clinical judgment of these. In this case, it is decided to generate a delta of 2% (see Figure 3). According to the above, and taking into account the incidences difference between them was 3.7% with a 95% CI (−0.7 to 7.9%), it can not be declared non-inferiority between the devices used, laryngeal mask and endotracheal tube. Additionally, and given that the confidence interval crosses zero, it is not possible to declare superiority of one device over another (see Figure 3). These results show consistency when intention to treat or per protocol analyses are performed, the latter being the right analysis to declare non-inferiority of 1 group compared with the other.13\nIn terms of the other outcomes, no difference was found for the main complications derived from the development of laryngospasm, including bradycardia or oxygen desaturation. However, it is important to report that one of the patients in the LM group went into cardiac arrest due to sustained bradycardia, but with no fatal outcome or secondary neurological complications. This single finding does not allow to arrive at conclusions of superiority of 1 group over the other in terms of morbidity.\nOur study found that more than half of the cases of laryngospasm occurred upon awakening, while the remaining were divided equally between induction and maintenance. These results are in contrast with a case–control study in pediatric patients which found a greater frequency of laryngospasm during anesthesia induction.14 When the ET was used, laryngospasm occurred more frequently upon awakening, while with the use of the LM, it occurred more frequently during induction or maintenance.15 It may be that the highest risk moment depends both on the anesthetic technique as well as on airway management.\nAnother striking aspect of our results is that the incidence of this outcome is far lower than expected, even much lower than the range of 15% to 7% found in this type of population in our hospital, where staff in training participate quite actively in the management of the pediatric airway (Fig. 2). This situation may be attributed to 2 possible explanations: the way the airway was managed, in particular during emergence from anesthesia, when the recommendations for this setting were used in the majority of patients: ET removal with the patient fully awake, and removal of the LM with the patient still asleep but under spontaneous ventilation (Table 2).16–21\nIn fact, this hypothesis is reinforced by the fact that the 2 patients in the ET group who developed laryngospasm did so while still asleep, and 5 of the 7 patients of the LM group developed laryngospasm long after emergence. A second explanation, very much related to the first one, is the potential Hawthorne effect of the treating anesthetist or student.\nThe blind, randomized design of this study is one of its strengths, considering that it allowed control of some confounding factors such as a history of acute infectious or chronic respiratory disease and patient exposure to cigarette smoking. In addition, several concomitant interventions were controlled from the beginning of the exposure to the evaluated factor (Tables 1 and 2). Another aspect worth highlighting is that the age range described in the inclusion criteria and the multiple surgical procedures evaluated allow extrapolation of these results to a large proportion of patients in the common pediatric anesthesia practice. Finally, the sample size, although it may have been small for the incidence found, is among the largest reported in the literature for these types of studies.\nThe study has several limitations, the most important being that the incidence found was much lower than expected. This result may lead to an oversized difference between the 2 groups based on which the adequate non-inferiority margin was determined, without disregarding the fact that a difference between the 2 groups as low as 3.7% may eventually be sustained in larger studies. For this reason, a study with a larger sample size may be required to demonstrate this difference. This study being a perioperative management study, it has the additional limitation of the inability to blind the treating anesthetists, which may explain the results. Finally, the study was conducted in a level IV university hospital where perioperative management may be different than in level II or III hospitals that serve this type of population. Consequently, our results may need to be confirmed in a multicenter study with a wider range of pediatric clinics and hospitals.\nThis study did not show that, in pediatric patients taken to surgical procedures under general anesthesia, airway management using LM is not inferior or superior to the ET in terms of the occurrence of laryngospasm. Greater morbidity or mortality secondary to the use of either of the devices used was not demonstrated. A larger sample size study may be needed to confirm non-inferiority in the outcomes studied.\nWe are grateful to doctors Carolina Rodríguez, Eliana Castañeda Marín, Diomer Avendaño, Lacides Moscote, Andrés Barrios for their participation in data collection and synthesis.\nAnaesthesiology Group of Hospital San Vicente Fundación who facilitated the research and participated in its development.\nHuman and animal protection. The authors declare that the procedures used in the study followed the ethical standards for responsible human experiments and were in accordance with the World Medical Association and the Declaration of Helsinki.\nData confidentiality. The authors declare having followed the protocols of their centre of work regarding patient data disclosure.\nRight to privacy and informed consent. The authors obtained the informed consent of the patients and/or subjects reported in the article; the form is kept by the corresponding author.\nAuthors’ own resources and funding provided by Hospital San Vicente Fundación.\nConflicts of interest\nThe authors have no conflicts of interest to disclose.\n1. Flick RP, Wilder RT, Pieper SF, et al. Risk factors for laryngospasm in children during general anesthesia\n. Pediatr Anesth\n2. Bhananker SM, Chandra R. Anesthesia\n-related cardiac arrest in children: update from the pediatric perioperative cardiac arrest registry. Anesth Analg\n3. Burgoyne LL, Anghelescu DL. Intervention steps for treating laryngospasm in pediatric patients. Pediatr Anesth\n4. Al-alami AA, Zestos MM, Baraka AS. Pediatric laryngospasm: prevention and treatment. Curr Opin Anaesthesio\n5. Tait AR, Malviya S, Voepel-Lewis T, et al. Risk factors for perioperative adverse respiratory events in children with upper respiratory tract infections. Anesthesiology\n6. Olsson GL. Bronchospasm during anaesthesia. A computer aided incidence study in 136,929 patients. Acta Anaesthesiol Scand\n7. Bordet F, Allaouchiche B, Lansiaux S, et al. Risk factors for airway complications during general anaesthesia in paediatric patients. Paediatr Anaesth\n8. O Neill B, Templeton J, Caramico L, et al. The laryngeal mask airway in pediatric patients factors affecting ease of use during insertion and emergence. Anesth Analg\n9. Harnett M, Kinirons B, Heffernan A, et al. Airway complications in infants: comparison of laryngeal mask airway and the facemask-oral airway. Can J Anesth\n10. Christensen E. Methodology of superiority vs equivalence trials and non inferiority trials. J Hepatol\n11. Green SM, Klooster M, Harris T, et al. Ketamine sedation for pediatric gastroenterology procedures. J Pediatr Gastroenterol Nutr\n12. Schreiner MS, O’Hara I, Markakis DA, et al. Do children who experience laryngospasm have an increased risk of upper respiratory tract infection? Anesthesiology\n14. Sinha A, Sood J. Safe removal of LMA in children—at what BIS? Pediatr Anesth\n15. Orliaguet GA, Gall O, Savoldelli GL, et al. Case scenario: perianesthetic management of laryngospasm in children. Anesthesiology\n16. Splinter WM, Reid CW. Removal of the laryngeal mask airway in children: deep anesthesia\nversus awake. J Clin Anesth\n17. Samarkandi AH. Awake removal of the laryngeal mask airway is safe in paediatric patients. Can J Anaesth\n18. Kitching AJ, Walpole AR, Blogg CE. Removal of the laryngeal mask airway in children: anaesthetized compared with awake. Br J Anaesth\n19. Patel RI, Hannallah RS, Norden J, et al. Emergence airway complications in children: a comparison of tracheal extubation in awake and deeply anesthetized patients. Anesth Analg\n20. Von Ungern-Sternberg BS, Davies K, Hegarty M, et al. The effect of deep vs. awake extubation on respiratory complications in high-risk children undergoing adenotonsillectomy. Eur J Anaesthesiol\n21. Visvanathan T, Kluger MT, Webb RK, et al. Crisis management during anaesthesia: laryngospasm. Qual Saf Health Care\nLaryngismus; Anesthesia; Child; Laryngeal Masks; Intubation, Intratracheal; Laringísmo; Anestesia; Niño; Máscaras Laríngeas; Intubación intratraqueal\nSupplemental Digital Content\n© 2018 by Lippincott Williams & Wilkins, Inc. |
A new, case-oriented and practical guide to one of the core techniques in respiratory medicine and critical care. Concise, practical reference designed for use in the critical care setting Case-oriented content is organised according to commonly encountered clinical scenarios Flow charts and algorithms delineate appropriate treatment protocols\nPart I - Non-invasive Ventilation. 1. NIV introduction. 2. NIV Physiology. 3. NIV Acute Respiratory Dailure COPD. 4. NIV Acute Respiratory Failure CHF. 5. NIV Acute Respiratory Failure other than COPD or CHF. 6. NIV for Chronic Respiratory Failure - COPD. 7. NIV Chronic Repiratory Failure other than COPD. 8. NIVWeaning. Part II - Invasive Mechanical Ventilation. 1. Respiratory Failure. 2. Airway Management Chapters. a. Bag-valve-mask ventilation. b. Endotracheal intubation. c. Cuff leaks. d. The Difficult Airway. e. Emergent Cricothyroidotomy. 3. Ventilator Mechanics. 4.Ventilator Modes. 5. Assessing Lung Physiology. 6.Mechanical Ventilation in Restrictive Lung Disease. 7. Mechanical Ventilation in Obstructive Lung Disease. 8.Ancillary Methods to Mechanical Ventilation. 9.Patient Outcomes post Mechanical Ventilation. Part III - Discontinuation from Mechanical Ventilation. 1. Definitions. 2. Readiness testing and predictors. 3. Physiologic barriers. 4. Ventilatory modes used during weaning. 5. Extubation. 6. Adjuncts to facilitate weaning. 7. Tracheostomy. 8. Putting it all together: protocols and algorithms.\n"As a respiratory therapist with two decades of intensive care experience, I found this book to be an excellent read and a worthy resource for physicians as well as a terrific review for respiratory therapists." (Doody's, 23 September 2011)\nMechanical ventilation is an essential life support for patients in the intensive care unit, emergency department and operating room who cannot sustain adequate homeostasis through spontaneous ventilation. This life-saving modality is implemented in a wide spectrum of clinical situations that result in respiratory failure, whether it be hypoxic or hypercapnic, acute or chronic. The wide breadth of causes of respiratory failure encompasses many specialties in both adult and pediatric practices: critical care medicine, pulmonary medicine, emergency medicine, anesthesiology, surgery, cardiology, neurology, and others. A Practical Guide to Mechanical Ventilation provides a practical introduction to the equipment, techniques and protocols of mechanical ventilation. It is a comprehensive reference guide to both invasive and non-invasive procedures, and provides detailed guidance on weaning from mechanical ventilation. Each section is devised to be accessible and clinically relevant, and each topic is illustrated by clinical cases and decision-making algorithms. Concise, practical reference designed for use in the critical care setting Case-oriented content, organized according to commonly encountered clinical scenarios Flow charts and algorithms delineate appropriate treatment protocols The book is of interest to all clinicians working in respiratory medicine, critical or intensive care, and anesthesia in hospitals and medical centers.\nDiese Produkte könnten Sie auch interessieren:\nNeuheitenEfficiency in Natural Product Total... 174,99 €\nDer Service Guide 21,99 €\nKleingeldhelden 12,99 €\nBevor der Sturm beginnt 21,99 €\nConscious 19,99 € |
Today I had a diagnostic hysteroscopy performed at a surgical center. The actual procedure took about 8 minutes only but the whole process was rather long and left me with a good bit of cramping.\nApparently I have some scars in a small localized area but otherwise the uterus looks healthy. The doctor wants to do a procedure via hysteroscopy to remove the scars. But I would rather not go through it unless I absolutely have to. Firstly I do not know (and the doc was a bit puzzled) about the origin of the scars - i never had an former procedures done on the uterus, no miscarriages. Many people seem to report that getting invasive procedures tends to give them even more scars. Make me nervous!\nAnyways, for someone looking for info on the procedure, here is my experience: I had the procedure done without sedation/anesthesia. As the process was happening the docs constantly monitored my vitals.\nIts started off like a pap smear with a speculum-like instrument inserted in the cervix. The doctor then filled my uterus with sterile water and inserted the camera in. The process hurt but the pain was bearable. As he started moving the camera around the uterine cavity, a screen showed the interiors. After looking through, he also collected some endometrium samples for biopsy.\nI did not take antibiotics or painkiller. I had cramping for several hours after the procedure and some discharge like CD3. Otherwise I am doing fine (except that I now have this scar to worry about).\nWith the procedure I am so sore that I hardly feel like BDing! Hope this cycle doesn’t go bust! |
Have you ever considered a career in Urgent Care or Occupational Medicine with no call or late nights? Are you looking to work in a state of the art facility with highly trained staff? Do you want opportunities to advance your career within a highly respected, leading Midwest Urgent Care Practice?\nAbout Physicians Immediate Care:\n- We are one of the largest urgent care practices in the nation with 43 clinics in Illinois and Indiana.\n- We are anticipating significant growth throughout the Midwest over the next several years and are looking to add to staff\n- We offer competitive salary, generous CME allowance, flexible scheduling, and exceptional benefits!\n- Relocation bonus available!\nDuties and Responsibilities:\n- Provide and manage direct patient care including physical examinations, evaluations, assessments, diagnoses, and treatment\n- Manage private, pre-employment, and workers compensation patients effectively\n- Order diagnostic tests such as x-ray, electrocardiogram, and laboratory tests and interpret test results\n- Perform digital blocks and regional anesthesia\n- Perform minor outpatient surgical procedures such as tendon repair, wound closure and management, incision and drainage, and needle biopsy\n- Perform diagnostic and therapeutic procedures such as aspirations and injection of joints, bursae, and cysts\n- Perform closed reductions of fractures and dislocations\n- Apply and modify braces, casts, splints, and other orthopedic appliances\n- Communicate patient needs, diagnosis, and course of treatment to the patient, company, as well as other clinical staff and instruct and educate patients about discharge instructions if applicable |
The treatment of stroke caused by carotid artery is experiencing gratifying developments. With the techniques developed by the Turkish professor, 45 days after stroke has the chance to gain the health on suitable patients.\nOne of the negative consequences of arteriosclerosis, strokes caused by the carotid artery, is the leading disease-related mortality rates. In recent years, “Stroke Surgery” has been developed by Prof. Dr. Yusuf Kalko. There was also being hope for eligible patients which a week and ten days after stroke. Prof.Kalko, in their last case samples, stated that they can get positive response after surgery in appropriate patients who have passed 45 days after stroke.\nCardiovascular Surgery Specialist Prof. Dr. Yusuf Kalko emphasize on fact changed about, “intervene of the patient 6 hours after the stroke has not notable benefit.” Dr.Kalko said, “In the medical literature, the fact that changed which about intervene 6 hours after the stroke to patient with paralyzed by carotid artery occlusion has not notable benefit . Stroke surgery can be used until 10th day. We can bring to life for patients who have different degrees. This success; dependent to the general condition of the patient, sometimes even the ability to talk comes back , sometimes we can even get our patients to stand up.In the last case examples we have seen, we have achieved positive results in eligible patients who have passed 45 days after stroke. ”\n“100% CLOSED VESSEL CAN BE OPENED, ALSO 100-YEAR-OLD PATIENT CAN BE\nProf. Dr. Kalko said that, not matter the patient age in vascular blocked surgery. Only with local anesthesia can do all kinds of vascular surgery and he said his oldest patients were 103 years old. Kalko Stating that ”Stroke Surgery” technique performed with local anesthesia and Minimally Invasive Vascular Surgery technique can be applied to patients with advanced age and additional chronic illnesses, also stated that the method also gives an opportunity to interfere with 100% occluded vessels.\nStroke surgery performed under local anesthesia is kept open to the patient’s consciousness and they can control the return of sensation lost due to carotid artery stroke in this way. Prof. Dr. Yusuf Kalko said that, “The risks to be exposed to the patient are minimized by the use of local anesthesia. This way you avoid complications of general anesthesia. We observe the patient’s consciousness during surgery. This is especially important for elderly patients. Because these patients are not only vascular problems; it also struggles with many ailments from sugar to blood pressure, heart to lung problems. We chatted with them during this operation that we performed only by numbing the patient’s neck during carotid surgery. This conversation keeps them vigorous and prevents loss of consciousness. In case of a slight deterioration in consciousness, we send blood to the brain with the help of a cannula and keep the patient vigorous. Meanwhile, we clean the inside of the vessel and close it quickly. The operation is completed in 30-50 minutes. These surgeries are also advantageous in patients who are not suitable for stents. ”\nTHE SUCCESS RATE OF HYBRID METHODS IS HIGH\nDr. Kalko underlined that the recently used Hybrid Method is an important improvement in stroke treatment. Dr. Kalko stated that “Although we try to emphasize preventive medicine about vascular health and draw attention to the early diagnosis, unfortunately, as we see from our patients, people refer to the physician only when the disease progresses. This brings serious difficulties in treatment. We have been able to open a large number of vessels in appropriate patients during the operations we performed by talking with the patient under local anesthesia with Minimally Invasive Vascular Surgery for nearly 10 years. We have made serious progress in vascular surgery on behalf of our country with operations for leg veins and carotid artery. With the recent “hybrid” methods, we perform both open surgery, angiography and stent procedures at the same time. We have seen very complicated cases and vessels that cannot be opened are opened with this method. Of course, this is progressing within the framework of a personalized treatment plan. We cannot talk about the same method in all patients. In some patients, the results can be achieved only by surgery and in others by interventional methods and in others by Hybrid methods. Experienced team, experienced surgeon and patient appropriate method of treatment planning are among the important criteria. “ |
Ice Shot Mesotherapy Injector\n1. ICE SHOT Product configuration\nModel No. : ICE SHOT\nRated voltage and frequency : AC 100-240V, 50/60Hz. 50VA Negative pressure : mmHg ± 20%\nProduct Name : Electric Drug Syringe A79010.01\n2. ICE SHOT Mesotherapy Injector Introduction\nIce Shot Injector is an innovative skin boosters injector system (with Suction Screw Multi Needle) utilizing Ice Shot Aspirator. ICESHOT is the third generation Korean made first hyaluronic injector equipped with cooling handpiece that has RED light function and It has Ice anesthesia that functions and promotes skin reproduction. Its own Suction Screw Multi needle consisting of 9 needles is easily injected to the firm inject-sites. Ice Shot Aspirator makes inject-sites firm by pulling it upward with suction. This procedure occurs simultaneously and injection can be made surprisingly easily and fast. If you inject hyaluronic after (-15)Ice anesthesia on the target area, the pain will be reduced and the patient will also feel relaxed. In addition to this, after injecting Ice massage and emitting 640mn RED light on the skin, the swelling subsides and recovers. Ice Shot can be adjust auto injection mode to manual injection mode, it’s very convenient and easy to use.\nApplicable customer group:\n- Dry and rough skin\n2. Mixed skin which lack of moisture and elasticity at the same time\n3. Dull skin\n4. Fine lines\n5. Skin preparation for important events such as graduations, weddings and interviews\n6. Skin that causes various problems during the season\n3. ICE SHOT instruction\n3-1. Smart AUTO SUCTION INJECTOR instruction\n- Compatible with other brands of needles, easy to set-up functions and menus that anyone can use – just paste it on the skin to automatically complete the injection. No need to press keys manually\n- As long as the skin is touched, suction will be on and skin boosters are injected into the skin at the same time – disposable filters and suction tubes are used to make management more hygienic.\n- Injected with cooling massage function can fully absorb the skin boosters evenly without leaking.\n- When the solution in the syringe is used up, the automatic back-off function will be on, which is more convenient – in order to achieve more accurate and stable operation, the built-in setting can perfectly set the needle and the needle tube fixed.\n3-2. Ice cooling anesthesia massager\nUsing ice massager to massage skin before operation reduces pain, redness and heat. Helps to quickly respond to wounds and bruises, edema and other effects.\n3-3. LED RED LIGHT Red Light Regeneration\nWavelength : 640nm\nPenetration depth of skin penetration : 1~6mm skin cells regeneration / promote blood\nRecycle wound regeneration / improve aging / calm skin.\n4-1. How to use the injection handle\n1 ice handle and injection handle link with body.\n2 Install the needle (see below).\n3 Fix the syringe with the locking device. (As shown below) (Please note that if the screw rotates in the opposite direction, there is a possibility of falling.)\n4 The needle and filter are inserted into the needle handle and are connected with the tube. – Three kinds of sterilization needles available (1PIN, 5PIN, 9PIN)\n5 Press SET to end SETUP. (See SETUP)\n6 Select MANUAL/AUTO at SUCTION UNIT.\n7 Use the injection knob ▲/ ▼ to adjust the air inside the syringe.\n8 Press the Dose activator button to place the injection handle on the injection site and start the injection. When the Shot is over, there will be a “click” sound, move the injection handle to another location, and continue the injection.\n9 The machine stops operating when “0” is on COUNT. When you press the ▼ key, the machine will reset, and then replace the injection after resetting completely.\n4-2. Injector Handle\n1 When Set up – S key on the injection handle is pressed, the digits in the entire display flash, and the mode can be adjusted later.\n2 Press “TYPE” key to select syringe specification (If you do not know syringe manufacturer, set to S mode)\n3 Press“LEVEL ▶ ”key to select the injection volume\n4 COUNT is automatically displayed according to the Syringe specification and injection volume.\n5. Press SET (S key) to end the setting.\n6 Use the “◀” “▶” key to release the air remaining in the needle and use it.\n4-3. How to Use Iced Handle\n1 Select the time of operation. (Composed of 10 minutes, 20 minutes, and 30 minutes.)\n2 Press START/STOP on the host computer to select start and stop. )\n2,071 total views, 3 views today |
Anesthesia Industry and Market News: eAlerts\neAlerts are the latest industry information regarding regulatory changes, helpful compliance reminders, or any number of relevant topics in the fast-paced, ever-evolving specialty of anesthesia.\nIf you would like to sign up to receive our anesthesia news eAlerts automatically every Monday, please complete the simple form below.\nDeductibles: Impact on the Physician\nDeductibles: Impact on the Physician\nArne Pedersen, MBA, FACMPE, Director of Client Services, ABC\nEvery year, it seems like health care premiums continue to rise along with the deductibles that accompany the latest versions of health care plans. Multitudes of questions abound regarding the size of deductibles, the collections of deductibles, and strategies to address deductibles. These are all good questions to discern. But, are these the only questions to ask? This article seeks to explore the impact of deductibles on physicians.\nDeductibles have been a part of health care financing in various forms from the beginning of health insurance coverage. Health insurance began as disability insurance covering lost time from work in the 1800s leaving patients to pay for all of their medical bills1. Of course, healthcare was not the large industry that it is today with the plethora of clinical and technological advances we have come to expect. Over time, it has morphed into various other forms. In the last two decades, the trend for deductibles has been quite remarkable. The Kaiser Foundation has conducted several studies regarding types of insurance products (plans), increases in deductibles, and increases of worker’s contribution to health care premiums.\nIn addressing the various insurance products, it is important to note that this article is going to focus on the standard insurance approach. The difference between full insurance and self-insurance and their respective trends is left for a future article. As an illustration, Table 1 above from the Kaiser Foundationdemonstrates the changes over time with the types of plans in the market and the trends of what employers of all sizes purchase for employees.\nThe chart begins in 1988, makes a rapid move through the 1990’s, and explores the first decade of the 21st century. There are a few salient points to anchor in the article. The first one is that the PPO plan became very popular over the last decade and a half. The PPO plans include co-pays and deductibles. The deductibles were small when first introduced and have grown with the market since. Another salient point is the introduction of the high deductible health plan in the current product mix. In a trip down memory lane, I rememberworking for Anthem Blue Cross and Blue Shield more than a decade ago when the Consumer Directed Products were being designed and introduced. The idea was to get the consumer (patient) engaged in the cost of healthcare with the goal of lowering healthcare costs.\nHealth Reimbursement and Health Savings Accounts were introduced to provide employers with options to help employees to take a more active role in the cost of care. The success of these programs is measured by the adoption rate of these products, the increase in the number of workers paying higher deductibles, and, the increase in the number of workers paying a greater share of the healthcare premiums.\nThe adoption rate for the HRA and HSA is reflected in the High Deductible Health Plans’ (HDHPs’) growth from four percent in 2006 to 17 percent in 2010. In terms of the expansion of workers paying higher deductibles, the Kaiser Foundation again has some superb research, which is demonstrated above, in Figure 1 and Figure 2.\nThe keys to these two particular graphs are found in the rising annual deductibles. As stated earlier, the PPOplan is still the most popular plan. That is the reason for these levels of deductibles. The HDHP deductibles tend be much higher on average. The one group in these two graphs that has experienced the highest deductibles is the small firm (3-199 workers). This is important to note primarily because small firms create most of the jobs. Small firms have less leverage to work with in terms of negotiating more favorable healthcare premium rates. Therefore, they tend to choose less expensive plans with larger deductibles.\nOne last point in the history section is the cost shifting of premiums from employers to employees. This phenomenon influences the average employee to carry a higher deductible in their insurance plan. The greater impact is to the employee (consumer) who now must decide how much health insurance they can afford. Figures 3 and 4 on the next page, again from the Kaiser Foundation, show the shift of premium dollars as well as the shift to less comprehensive health insurance plans.\nIn Figure 3, both the worker’s contribution to premiums and health insurance premiums have seemingly risen in tandem from 1999 through 2011. While this has been happening, the worker’s earnings have risen by much less a margin over the same period. This leaves the American worker far less choice in health insurance plans and potentially leaves a gap between actual needs and coverage.\nThis stark reality is represented in Figure 4. In this graphical representation, all firms seem to be showing signs of reduced scope of benefits and increased share of the premium cost to the workers. The simple family calculation for healthcare dollars in recent economic times demonstrates the gap between the needs and the ability to pay. The demand is simply outpacing supply in healthcare and is creating an unsustainable situation. Hence, the question of collecting deductibles comes into play.\nWhen does a patient meet his or her deductible? How much of the deductible does a group have to go after? The complex answers begin with something called a plan design. Health insurance companies have a plethora of plans with multiple designs to meet the needs of the consumers, both employers and individuals. These plans come with a variety of co-pays, deductibles, and co-insurance. To further complicate this matter, the plans also have differences between in-network and out-of-network. These and other factors make billing and collecting deductibles challenging at best.\nIn office and surgery centers which tend to be more “retail” in nature,physicians and facilities look to collect all or a portion of the deductibles at the point of service. After all, the sooner you get money from the patient, the better. In most cases, this approach does not apply to anesthesia due to the nature of the brief relationship with the patient and because the determination of charges is after the fact. Therefore, the insurance is billed first and after the determination of what the patient still owes on their deductible, the patient is then billed for their portion of the anesthesia service.\nPatients will pay in full, make payments, or not pay at all. The first is the ideal, with the second being preferred over the third. The latter two approaches to patient payments can also have an adverse effect on the patient portion of the accounts receivable. This leads to the last point: strategies to address deductibles.\nStrategies to Address Deductibles\nThere is a finite number of strategies for anesthesiologists to address deductibles. They can attempt to collect money up front, provide letters to remind patients of their responsibilities, hold the bills, do nothing, or write the payment off.\nCollecting money up front sounds great but needs a practical application. Analysis will help to determine the best approach to executing this strategy. Most importantly, groups should work with their billing partner to determine if this course of action makes sense. If so, they can need help implement the best solution.\nProviding letters to remind patients of their responsibilities is reasonable... The effort is not great. The cost is associated with the developing, printing, signing, and copying of these letters to go into patient packets. Of course, groups will need to communicate with their respective facility to have this included into the packet. The word of caution with this strategy is that this is just a reminder letter and is part of a larger patient packet.\nHolding bills can be effective. However, it is not for every group. The basic goal is to capture more of the insurance dollars instead of attempting to collect a larger deductible amount from the patient. To achieve this goal, the practice holds its bills while other providers including the facilities are submitting theirs. Their bills will bounce up against the deductible before the practices bill does. This provides the greatest opportunity to collect more from the payor and less from the patient. There are gating factors to consider when reviewing this strategy. It is important to work with your billing partner to determine if this is a viable strategy.\nThere are times when doing nothing is the right strategy due to timing issues or a lack of a compelling strategy. There are also times when doing nothing is a very dangerous strategy that could produce adverse affects to a group. In the instances when a group is struggling to come to some consensus on a strategy, using a third party to facilitate a discussion makes sense. The third party can provide the fresh perspective to help facilitate an appropriate decision.\nWriting off bad debt is never an easy task. The hard part for an anesthesiologist is that every business has bad debts that they must write off. Since the practice is a modified cash-based business, prudent write offs make sense. This alone, though, is not a solid strategy to address deductibles. It will negatively affect the group’s cash flow by itself. Coupled with other strategies, it becomes viable as part of the overall solution.\nUltimately, groups who work with their partners will be able to develop the best set of strategies to address the ever-increasing deductibles.\nArne Pedersen, MBA, FACMPE serves as Director of Client Services for ABC. He is a Fellow of the American College of Medical Practice Executives. His distinguished background includes serving as a former Anesthesia Group Administrator, an expert on leadership, and a Bronze Star Medal recipient from the Persian Gulf War. Mr. Pedersen authored the book, “Lead with Intent” a comprehensive, yet practical leadership bible with a vision of training leaders. Mr. Pedersen serves an adjunct professor at the University of Notre Dame in the Executive Education Certificate Program and teaching Performance Management. He can be reached at [email protected].\n1 Fundamentals of Health Insurance: Part A, Health Insurance Association of America, 1997 |
This action might not be possible to undo. Are you sure you want to continue?\n(Planning) (3) NURSING PROCESS FORM Nursing Interventions STUDENT’S NAME: Kim\nEvaluation of Goals\nRationale for Interventions * must list sources\nAcute Pain related to abdominal surgical incision AEB verbal reports of pain, grimacing, moaning, and guarding of abdominal area when assessed.\nGiven the prescribed nursing care, the patient will have relieved/controlled pain within one hour AEB: 1. Patient verbally states relieved/decreased pain. 2. Nonverbal indicators of pain including grimacing and moaning will be absent/diminished. 3. Patient will not guard abdominal incision area during assessment.\n1) Assess patient’s pain including: location, onset/duration, frequency, quality, and intensity using a pain scale of 0-10 every two hours.\n1) To ensure that a patient receives effective pain relief, you must conduct a thorough and accurate pain assessment. (Lippincott, Williams & Wilkins, pg. 361) 2) Acute pain activates the sympathetic branch of the ANS causing such responses as increasing blood pressure, and rapid heart and respiratory rates. (Lippincott, Williams & Wilkins, pg. 362) 3) Behavioral and physiologic responses are indicators of pain in patients. (Searingen, pg. 40) 4) Analgesics are helpful in relieving pain and in aiding the recovery process by promoting greater ventilator excursion. (Swearingen, pg. 423) 5) Non-\nGoal was met. 1. Patient verbally reported decreased pain as being “much better.” 2. Nonverbal indicators of pain were absent upon observation. 3. Patient did not guard abdominal incision area upon assessment.\n2) Monitor patient’s vital signs for signs of pain including: increased heart rate, blood pressure, and respiratory rate every two hours.\n3) Observe patient for nonverbal indicators of pain including: facial grimacing, moaning, guarding, and crying during assessment of pain and vital signs. 4) Administer prescribed analgesics as ordered by physician, monitor the patient’s response to pain medication 5-10 minutes after administration, and document appropriately when given. 5) Provide and teach caregivers non-pharmacologic comfort measures including repositioning and creating a low stimulus\nResources: Swearingen, Pamela. (2008). All-in-One Care Planning Resource. (2nd Edition). St. Louis, MO: Mosby, Inc. Lippincott, Williams & Wilkins. (2006). Best of Incredibly Easy! (1st Edition). Philadelphia, PA:\nWolters Kluwer. environment when patient reports pain prior to discharge. (Swearingen. pharmacologic measures support analgesia therapy in reducing pain. pg. Co. 423) REV 8/09 . |
Based in sunny Malaysia, Hoganbo believes in simplicity in using natural ingredients to take care of our body. We care so much about what we put in and on our bodies so only ingredients with strong clinical evidence are carefully selected. We want something simple, effective, and backed by real science. We’re proud of the products we’ve put together with nutrients in their best forms.\nHoganbo Online Store features two evidence-based natural health supplements:\n- Hoganbo HD-1, to improve fatty liver, NAFLD and for alcohol detox.\n- Hoganbo PGB-3, to improve poor vascular health and high cholesterol conditions.\nWe provide complimentary courier globally for any purchase of Hoganbo HD-1 (120 tablets) or PGB-3 (120 tablets). Schedule a consultation with our professionals through WhatsApp.\nHoganbo is exclusively for you who wants the best in life.\nHow We Discovered Hovenia Dulcis, and Hoganbo HD-1\nHaving experienced first-hand the health benefits of Hovenia Dulcis berry, Mr. Yap, the founder of Hoganbo truly believes in the Hoganbo HD-1 as it has helped him and his family alleviate many health issues.\nMr. Yap came to know about Hovenia Dulcis berry through a distant relative who was diagnosed with diabetes and fatty liver. His relative was taking insulin for his diabetes but was having a hard time recuperating. Eventually this relative started taking Hovenia Dulcis berry through a friend’s recommendation and experienced excellent results. His liver condition swiftly improved and he even went off insulin shortly after that.\nDuring this time, Mr. Yap had to undergo surgery which made him realized how important it is to proactively take care of your health instead of waiting until you fall sick. His surgery required full anesthesia. Generally, while anesthesia is a necessity for surgical procedures, its side effects are usually very unpleasant – patients will experience nausea and vomiting, chills, dizziness and sometimes even confusion and memory loss. Fortunately, Mr. Yap had Hoganbo Hovenia Dulcis berry with him at that time and he took a dose immediately after his surgery. He was pleasantly surprised about how effective the supplement was – his post-surgery side effects were mild and almost unnoticeable. Convinced about the efficacy of the product, this led him to quit his senior position from a global healthcare company and founded this company to focus on developing solutions to address chronic diseases.\nIt was a meticulous process of over 15 months of research and development, Hoganbo team have successfully registered Hoganbo HD-1 as the first product made of Hovenia Dulcis berry extract, approved by the Ministry of Health, to help maintain good liver health.\nPurchase Genuine Products\nNote: Avoid counterfeit products by always purchasing genuine Hoganbo HD-1 to ensure 100% safe consumption. Our product has been recognized by Ministry of Food and Drug Safety (Korea) as well as Ministry of Health (Malaysia) for its safety and efficacy in maintaining good liver health.\nAwards & Accolades\n- 2008: Pioneer product derived from Hovenia Dulcis Berry was certified as a “Health Functional Food” by the Ministry of Food and Drug Safety (Korea)\n- 2013, 2014, 2015: For three consecutive years Dawon, the principal company of Hoganbo HD-1, has won the Korea Quality Competitive Firm awards by the Seoul Economic News for their export sales |
ARTICLE DOI: 10.31480/2330-4871/044\nREVIEW ARTICLE OPEN ACCESS\nDexmedetomidine-induced neuroprotection: is it translational?\n1Department of Anesthesiology, University of Virginia, Charlottesville, Virginia 22901, USA\n2Department of Anesthesiology, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, China\nZhiyi Zuo, MD, PhD Robert M. Epstein Professor of Anesthesiology, Professor of Neurological Surgery, and Neuroscience, University of Virginia, E-mail: [email protected]\nRuquan Han, MD, PhD, Professor and Chair, Department of Anesthesiology, Beijing Titan Hospital, Capital University. Tele: 86-10-67096660, Fax: 86-10-67031947, E-mail: [email protected]\nEditor: Renyu Liu, MD; PhD. Associate Professor, Director of Preoperative Medicine, Department of Anesthesiology and Critical Care; Perelman School of Medicine at the University of Pennsylvania, 336 John Morgan building, 3620 Hamilton Walk, Philadelphia, PA 19104 . Phone: 2157461485; FAX: 2153495078. Email: [email protected]\nReceived: September 16, 2015 | Accepted: November 11, 2016 | Published: November 12, 2016\nCitation: Wang Y, Han R, Zuo Z. Dexmedetomidine– induced neuroprotection: is it translational? Transl Perioper & Pain Med 2016; 1(4): 15-19.\nDexmedetomidine is often used in anesthesia and critical care medicine practice to sedate patients. Its neuroprotective effects have been shown in various ischemic and hemorrhagic brain injury models of animals. Randomized clinical trials have indicated that dexmedetomidine can improve outcome of patients under intensive care. Clinical trials are needed to determine whether dexmedetomidine can provide neuroprotection against ischemic and hemorrhagic stroke.\nDexmedetomidine; ischemic stroke; neuroprotection; ICU\nDexmedetomidine has become a commonly used drug in anesthesia and critical care medicine practice. The molar mass of dexmedetomidine is 200.28 g/mol with formula of C13H16N2. The generic name of dexmedetomidine is precedex or dexdor. It is a selective agonist of α2-adrenergic receptor with anxiolytic, sedative and analgesic effects. It provides sedation without inhibiting respiration. Patient can be cooperative or semi-arousal under the sedation with dexmedetomidine. Its main side effects include bradycardia and hypotension, which can be treated pharmacologically. In this review, we will discuss the potential neuroprotective effects of dexmedetomidine.\nEvidences from animal models\nIt has been reported that dexmedetomidine has neuroprotective effects in animals with various insults to the brain. Dexmedetomidine attenuates central sympathetic activity and decreases anesthetic requirements. Hoffman et al. determined the effects of dexmedetomidine on neurological and histopathological outcome after incomplete cerebral ischemia in rats about 25 years ago . The results show that dexmedetomidine given during brain ischemia improved neurological and histopathological outcome after incomplete ischemia in rats anesthetized with fentanyl and nitrous oxide. This effect was reversed by atipamezole, indicating that the effect is mediated by α2-adrenergic receptors. Improvement with dexmedetomidine was not mediated by changes in plasma glucose or other physiologic variables during ischemia. It was concluded that dexmedetomidine decreased ischemic brain injury after incomplete cerebral ischemia by decreasing sympathetic activity. In another study with using a model of focal cerebral ischemia caused by occluding the left internal carotid, anterior and middle cerebral arteries for 2 h , rabbits received dexmedetomidine or normal saline 10 min after the occlusion. A plasma level of dexmedetomidine was maintained at 4.0 ± 0.15 ng/ ml. The area of ischemic neuronal injury in the cortex was significantly decreased by about 47.6% in the group treated with dexmedetomidine. These results suggest that treatment with dexmedetomidine, at a dose to reduce the requirements of anesthetics by 50%, provides neuroprotection against focal cerebral ischemia.\nPerinatal asphyxia can lead to death and severe disability. Brain hypoxia-ischemia (HI) injury is the major pathophysiology contributing to death and severe disability after perinatal asphyxia. Ren, et al. studied the effects of dexmedetomidine on seven day old Sprague Dawley rats with left brain HI . These animals received intraperitoneal dexmedetomidine various times after brain HI. They were evaluated 7, 28 and 43 days after the brain HI. Dexmedetomidine induced neuroprotective effects when it was applied within 1 h after the brain HI. The brain cell and tissue loss as well as neurological and cognitive dysfunction evaluated from 28 days after brain HI were attenuated by dexmedetomidine. These results indicate that dexmedetomidine post-treatment induces neuroprotection against HI-induced brain injury in the neonatal rats. This protective effect may be mediated by inhibiting inflammation in the ischemic brain tissues via α2-adrenergic receptor activation.\nIn addition to the protective effects against ischemia, dexmedetomidine also shows neuroprotection in rats with subarachnoid hemorrhage (SAH) . Dexmedetomidine was applied in two-month old Sprague Dawley rats with SAH. The SAH model was established by perforating the junction of the right middle and anterior cerebral arteries. Animals received dexmedetomidine immediately or 2 h after SAH. They were evaluated 2 days after SAH. SAH worsened neurological functions, induced brain edema and increased blood-brain barrier permeability. These detrimental effects were reduced by dexmedetomidine post-treatment. However, the neuroprotective effects of dexmedetomidine was abolished by inhibition of extracellular signal-regulated kinase (ERK) activation. The conclusion in this study is that dexmedetomidine post-treatment induces neuroprotection to reduce SAH-induced brain injury. This effect may be mediated by activating ERK.\nEvidence from human studies\nDexmedetomidine also shows some neuroprotective effects in human. Medications inducing sedation and analgesia are often administrated to patients ventilated mechanically to reduce anxiety and pain and to permit invasive procedures in the intensive care unit (ICU). The MENDS (maximizing efficacy of targeted sedation and reducing neurological dys function) randomized controlled trial was designed to determine whether dexmedetomidine reduces the duration of delirium and coma in mechanically ventilated ICU patients while providing adequate sedation as compared with lorazepam . Total 106 adult medical and surgical ICU patients ventilated mechanically in 2 tertiary care centers were randomly assigned to two groups. They were sedated by dexmedetomidine or lorazepam for as long as 120 hours. Patients were assessed for delirium with using the Confusion Assessment Method for ICU patients twice daily. Patients sedated with dexmedetomidine had more coma-free or coma and delirium-free days and a lower prevalence of coma than sedation with lorazepam. More patients sedated with dexmedetomidine completed post-ICU neuropsychological testing and had similar scores in those tests assessing global cognitive, motor speed, and attention functions. In those ICU patients that were managed with individualized targeted sedation, dexmedetomidine infusion led to more coma or coma and delirium-free days than with a lorazepam infusion at the targeted level of sedation.\nInterestingly, it has been shown that benzodiazepines and α2-adrenoceptor agonists the effects of benzodiazepines and α2-adrenoceptor agonists on innate immunity and mortality in animals with infection may be different. Benzodiazepines impair neutrophil and macrophage functions [6, 7]. α2-adrenoceptor agonists increase macrophage phagocytosis but have limited effects on neutrophil functions [8, 9]. Benzodiazepines increase the mortality of animals with infection while α2-adrenoceptor agonists improve mortality in animals with infection . In a sub analysis of the MENDS data, the authors compared the effect of dexmedetomidine with that of lorazepam on septic patients . Among them, 63 patients had sepsis and 40 patients were without sepsis. Septic patients sedated with lorazapam had 3.2 more days with delirium/coma on average, 1.5 more days with delirium and more days requiring a ventilator. These protective effects of dexmedetomidine were enhanced in septic patients than patients without sepsis. Mortality at 28 days were reduced by 70% in septic patients sedated by dexmedetomidine as compared to the patients in the lorazepam group. A randomized, double-blinded, placebo-controlled trial was just published Lancet. The study determined the effectiveness of dexmedetomidine to prevent delirium in elderly patients after non-cardiac surgery . Total 700 patients aged 65 years or older were assigned to receive either placebo or dexmedetomidine (0.1 μg/kg/h). The incidence of postoperative delirium was significantly lower in the dexmedetomidine group than in the placebo group. Regarding the safety, the incidence of hypertension and tachycardia were higher with placebo than with dexmedetomidine. Thus, it was concluded that a low-dose of dexmedetomidine significantly decreased the occurrence of delirium during the first 7 days after non-cardiac surgery in elderly ICU patients.\nAs described above, dexmedetomidine can inhibit inflammation and decrease sympathetic activity via α2-adrenergic receptor activation. It also can activate some protective signal pathway, such as ERK and phosphoinositide 3-kinase (PI3K) /Akt pathway, to provide neuroprotection . The activation of ERK by dexmedetomidine may be via mechanisms independent of α2-adrenergic receptor activation (Figure 1).\nFigure 1: Potential mechanisms for dexmedetomidine to induce neuroprotection (ERK: extracellular signal-regulated kinase; PI3K: phosphatidylinositol 3-kinase).\nIn summary, dexmedetomidine can provide neuroprotection in animals with various insults to the brain. It appears that dexmedetomidine also improves neurological outcome in patients without primary neurological diseases. It improved neurological dysfunction, such as delirium, in mechanically ventilated patients and in elderly ICU patients after non-cardiac surgery. It also decreased mortality in septic patients. It is not known yet whether dexmedetomidine can provide neuroprotection against ischemia or hemorrhagic brain injury in human. Prospective clinical studies are needed to determine whether those effects shown in animals are translational in human.\nDisclosure of Funding\nResearch in Dr. Zuo's laboratory is currently supported by grants (GM098308 and AG047472) from the National Institutes of Health, Bethesda, MD, and the Robert M. Epstein Professorship endowment, University of Virginia, Charlottesville, VA.\nConflict Interests Disclosure\nThe authors have no conflicting interests to disclose.\n- Hoffman WE, Kochs E, Werner C, Thomas C, Albrecht RF. Dexmedetomidine improves neurologic outcome from incomplete ischemia in the rat. Anesthesiology. 1991;75:328-32.\n- Maier C, Steinberg GK, Sun GH, Zhi GT, Maze M. Neuroprotection by the alpha 2-adrenoreceptor agonist dexmedetomidine in a focal model of cerebral ischemia. Anesthesiology. 1993;79(2):306-12. PubMed PMID: 8102042.\n- Ren X, Ma H, Zuo Z. Dexmedetomidine Postconditioning Reduces Brain Injury after Brain Hypoxia-Ischemia in Neonatal Rats. Journal of neuroimmune pharmacology : the official journal of the Society on NeuroImmune Pharmacology. 2016;11(2):238-47. doi: 10.1007/s11481-016-9658-9. PubMed PMID: 26932203.\n- Wang Y, Han R, Zuo Z. Dexmedetomidine post-treatment induces neuroprotection via activation of extracellular signal-regulated kinase in rats with subarachnoid haemorrhage. British journal of anaesthesia. 2016;116(3):384-92. doi: 10.1093/bja/aev549. PubMed PMID: 26865131; PubMed Central PMCID: PMC4748945.\n- Pandharipande PP, Pun BT, Herr DL, Maze M, Girard TD, Miller RR, et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. Jama. 2007;298(22):2644-53. doi: 10.1001/jama.298.22.2644. PubMed PMID: 18073360.\n- Finnerty M, Marczynski TJ, Amirault HJ, Urbancic M, Andersen BR. Benzodiazepines inhibit neutrophil chemotaxis and superoxide production in a stimulus dependent manner; PK-11195 antagonizes these effects. Immunopharmacology. 1991;22(3):185-93. PubMed PMID: 1663497.\n- Kim SN, Son SC, Lee SM, Kim CS, Yoo DG, Lee SK, et al. Midazolam inhibits proinflammatory mediators in the lipopolysacchari deactivated macrophage. Anesthesiology. 2006;105(1):105-10. PubMed PMID: 16810001.\n- Miles BA, Lafuse WP, Zwilling BS. Binding of alpha-adrenergic receptors stimulates the anti-mycobacterial activity of murine peritoneal macrophages. Journal of neuroimmunology. 1996;71(1-2):19-24. PubMed PMID: 8982098.\n- Nishina K, Akamatsu H, Mikawa K, Shiga M, Maekawa N, Obara H, et al. The effects of clonidine and dexmedetomidine on human neutrophil functions. Anesthesia and analgesia. 1999;88(2):452-8. PubMed PMID: 9972773.\n- Domingues Junior M, Pinheiro SR, Guerra JL, Palermo Neto J. Effects of treatment with amphetamine and diazepam on Mycobacterium bovis induced infection in hamsters. Immunopharmacology and immunotoxicology. 2000;22(3):555-74. doi: 10.3109/08923970009026012. PubMed PMID: 10946832.\n- Hofer S, Steppan J, Wagner T, Funke B, Lichten stern C, Martin E, et al. Central sympatholytics prolong survival in experimental sepsis. Critical care. 2009;13(1):R11. doi: 10.1186/cc7709. PubMed PMID: 19196475; PubMed Central PMCID: PMC2688128.\n- Pandharipande PP, Sanders RD, Girard TD, Mc Grane S, Thompson JL, Shintani AK, et al. Effect of dexmedetomidine versus lorazepam on outcome in patients with sepsis: an a priori designed analysis of the MENDS randomized controlled trial. Critical care. 2010;14(2):R38. doi: 10.1186/cc8916. PubMed PMID: 20233428; PubMed Central PMCID: PMC2887145.\n- Su X, Meng ZT, Wu XH, Cui F, Li HL, Wang DX, et al. Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo controlled trial. Lancet. 2016. doi: 10.1016/S0140-6736(16)30580-3. PubMed PMID: 27542303.\n- Zhu YM, Wang CC, Chen L, Qian LB, Ma LL, Yu J, Zhu MH, Wen CY, Yu LN and Yan M. Both PI3K/Akt and ERK1/2 pathways participate in the protection by dexmedetomidine against transient focal cerebral ischemia/reper fusion injury in rats. Brain Res, 2013; 1494:1-8 PubMed PMID:23219579.\n- Dahmani S, Paris A, Jannier V, Hein L, Rouelle D, Scholz J, Gressens P and Mantz J. Dexmedetomidine increases hippocampal phosphorylated extracellular signal-regulated protein kinase 1 and 2 content by an alpha 2-adrenoceptor-independent mechanism: evidence for the involvement of imidazoline I1 receptors. Anesthesiology, 2008; 108 (3):457-466 PubMed PMID:18292683. |
Hair follicles from the nape donor area manual punchor micromotor punchwith one by one is collected. If the donor area is not sufficient, hair follicles can be collected from body hair or beard with FUE. The hair follicles obtained are called ‘graft’ or ‘graft’. These grafts are collected in a sterile environment and planted in the needed area.\nSlit Knife Planting Technique\nBy using small razor blades to place the nape donor hair follicles, namely grafts, collected with the FUE technique, channels as many as the number of hairs to be transplanted are opened into the skin in total. Then, all the hairs taken into the opened channels are placed one by one. Hair transplantation and eyebrow transplantation are performed in this way.\nRound Needle Planting Technique (Stick&Place)\nThe nape donor hair follicles collected with the FUE technique are placed one by one with needles resembling round injector needles. graft As many channels as the number of channels are not opened from the beginning, a channel is opened and hair is placed in it immediately. Hair transplantation and eyebrow transplantation are performed in this way.\nHair transplantation is performed on people diagnosed with male pattern hair loss and hair loss. Male pattern hair loss is a very accelerated state of the cyclical life of the hair follicle from birth to death.\nThe person who will have hair transplantation should stop taking drugs such as aspirin, which is one of the leading blood thinners, if they are using it, 1 week in advance, and should not drink alcohol. Do not use drugs not recommended by the doctor.\nHair is cut 1 mm long. Sometimes, all the hair may not be cut depending on the number of grafts planned to be transplanted. Blood is taken from the person who will have hair transplantation, and routine blood and biochemical tests are performed. The patient’s head is washed with antiseptics. He is taken to the operation room where the hair transplant will be performed. If hair follicles are to be taken from either the nape donor or another donor area under local anesthesia, the grafts are collected manually with the FUE technique or with the help of a micromotor. Collected grafts are stored in glass containers under sterile and appropriate conditions.\nAfter the collection process is finished; The patient’s planting area is also anesthetized by giving local anesthesia. Channels are opened into the skin as many as the number of hair follicle-grafts taken into the area to be transplanted. When the channel opening process is finished, individual hairs and grafts are placed into the opened channels. Stick and Place(Drill and Place)- If the round needle technique is to be used, the grooving process is performed one by one, and the hair follicle is immediately placed into the opened single channel.\nThe total of this procedure may differ depending on the number of hair follicles to be transplanted, the technique chosen and the hair structure of the patient. But to give a time, it can take an average of 8-9 hours.\nAfter the hair transplantation process is finished, the treated areas of the patient are wrapped. The dressing remains for 12-24 hours, after which it is removed.\nFUE In the procedure, the donor area is completely healed in 5-7 days, and the transplant area is completely healed in 8-10 days. During this period, the person who has hair transplantation can hide the crusty appearance by using a hat. Eyebrow transplantation can also be performed with the FUE technique. It is based on the same principles, the recovery time is shorter. |
Do You Need An Apicoectomy In San Marcos, Texas?\nNo one wants to have to deal with a painful, annoying oral infection. After a root canal, an infection can sometimes form. If an infection does form after one or multiple root canals, you may be in need of an apicoectomy procedure. An apicoectomy is meant to save a tooth from needing extraction in the event of a strong infection. Your dentist may refer you to an oral surgeon if they believe that you need an apicoectomy. After making an appointment with an oral surgeon, the surgeon will review your medical records and take a few x-rays and decide from there whether or not you are in need of an apicoectomy. It is also likely that the surgeon will prescribe antibiotics to try and eliminate or control the existing infection. If the infection persists after the follow up appointment, an apicoectomy procedure will be scheduled.\nLike in most oral procedures, an anesthetic will be administered. Following the anesthesia, the surgeon will make a small incision in the gum above the infected area. The gum will be lifted gently so that the tooth, root and bone are all exposed. After this exposure, the surgeon will removed the tip of the root as well as any other infected tissue in the surrounding area. A filling will then be placed at the tip of the remaining root. This filling prevents an infection from returning to this area. The surgeon will then take a few x-rays before closing the gum. An apicoectomy anywhere from 30 to 90 minutes. The length of the procedure depends on how intense the infection is.\nAfter The Procedure\nIt is not uncommon for a patient to experience swelling and pain after an apicoectomy. The pain has been described as mild or moderate for most patients. The pain can be controlled or managed by over the counter pain medication, or prescribed pain medication.The surgeon will prescribe antibiotics to reduce the probability of a new infection forming and/or to prevent the past infection from returning. A follow up appointment will be scheduled.\nAustin Oral Surgery: A Staff You Can Trust\nIf you are looking for an oral health care office that puts patients first, Austin Oral Surgery is what you are looking for. Austin Oral Surgery has 45 years of experience and has been proudly serving the community or Austin and many of the surrounding areas, including San Marcos.We are dedicated to bringing our patients the highest quality oral health care and hiring the most experienced and friendly staff. Our staff is well trained in all of the services that we offer, including the apicoectomy procedure. We provide on-call doctors, 24/7 to ensure that our patients can reach us at any hour of the day. There are currently ten locations serving the Austin area and surrounding communities.Our website is also very detailed so that patients or potential patients can receive the information that they need about certain procedures. We put our patients first and hope that we can add you to the list!\nMake An Appointment With Austin Oral Surgery Today\nThe Austin Oral Surgery offices and staff can be reached at 512-02-6677 or through our website’s contact page. Schedule your appointment today! A representative will get a hold of you within 48 hours. |
Liposuction is Not Just a Women’s Procedure\nThe media so often focuses on women’s bodies. We’re told that women should care more about what they look like, which is why it’s been more socially acceptable for them to turn to plastic surgery to improve their appearances.\nBut just because society places more importance on women’s bodies doesn’t mean that men don’t have their own insecurities and aesthetic goals. Though it’s not as widely publicized, plastic surgery for men is a booming industry. In fact, the number of plastic surgery procedures performed on men has increased by more than 100% in the past 20 years.\nIt’s becoming much more acceptable for men of all ages to turn to plastic surgery to address their problem areas. And for many men, that means getting rid of excess fat on one or more areas of their body through liposuction.\nLiposuction is Quickly Gaining in Popularity\nIn simple terms, liposuction is a surgical procedure that lets you target excess fat in one or more areas of your body and remove it.\nLiposuction has been a widely practiced surgical procedure for decades—performed on both men and women of all ages. It’s become so popular, that liposuction is now one of the top 5 plastic surgery procedures across the United States.\nThis statement is true whether you’re talking about plastic surgery as whole, plastic surgery for men, or plastic surgery for women. And we’re betting that this popularity is going to continue for years to come.\nAqualipo: The Most Advanced Form of Liposuction for Men\nWhile liposuction has been around for decades, Aqualipo liposuction is a more recent advancement in the industry. Instead of cutting away at your fat with sharp tools, Aqualipo lets doctors use the gentle power of water to eliminate fat from your problem areas.\nBecause of this, Aqualipo is considered a minimally-invasive procedure. It can also be performed under a combination of local anesthesia and IV sedation—rather than general anesthesia—which makes it a less expensive, more comfortable, and safer option for you.\nMen, in particular, often turn to Aqualipo liposuction to remove excess fat in their love handles, lower abdomen, neck, or chest—though it can be performed virtually anywhere. During a consultation, you and your doctor will discuss which area(s) you’d like to improve through Aqualipo. The end results and number of areas that can be treated will depend on your aesthetic goals and the amount of fat to be removed.\nReclaim Your Figure & Your Confidence with Aqualipo Liposuction\nAqualipo lets you enjoy better contouring and a more proportionate figure. Not to mention, the biggest advantage is the confidence you’ll gain from your new, more toned physique. Whether it’s due to age, genetics, lifestyle factors, or something else, you don’t have to suffer with a body you aren’t confident in. Aqualipo can help you reclaim both your figure and your confidence.\nContact us to learn more about how it works or to schedule a consultation at one of our state-of-the-art facilities in Tennessee.\nAbout NuBody Concepts:\nWe are a cosmetic surgery practice in Brentwood, Tennessee, that is dedicated to helping women and men transform their bodies with fat removal, plastic surgery, and facial aesthetics. Our services focus on affordability, a great patient experience, and a fast recovery. |
Neutering (castrating) a male pet is a fairly simple procedure. For dogs, an incision is made in front of the scrotum, the blood vessels leading to the testicles are clamped and tied, and the testicles are removed. The incision is then closed with sutures. For cats, the procedure is about the same except the sutures are usually not needed. Your pet will be released from the hospital when he is awake and recovered from anesthesia.\n*Laser surgery is available for this procedure |
Spaying and neutering rabbits\nA spay or ovariohysterectomy is the removal of the uterus and ovaries from a female rabbit. A neuter, castration, or orchidectomy is the removal of the testes from the scrotal sacs in a male rabbit. Although usually reserved in reference to males, neutering can also refer to a spay as the term technically refers to the removal of reproductive organs, regardless of sex. Colloquially, the terms altering or fixing is used to refer to the gender-neutral procedure.\n- 1 Reasons to spay and neuter\n- 2 Age to spay and neuter\n- 3 Choosing a clinic\n- 4 Costs of a spay or neuter\n- 5 Care\n- 6 Surgical techniques\n- 7 Complications\n- 8 Further reading\n- 9 See also\n- 10 References\nReasons to spay and neuter\nSurgery for spaying and neutering can be as safe on rabbits as any animal, given that you find an experienced veterinarian to perform the procedure. Mortality rates for a skilled veterinarian should be no more than 1%, and most of the danger is from the anesthesia. The House Rabbit Society has had over 1000 rabbits spayed or neutered with approximately 0.1% mortality due to anesthesia.\nDo not allow any vets that are not experienced with safe rabbit surgery techniques to work on your rabbit. Make sure that they use a rabbit-safe anesthetic such as isofluorene.\n- Healthier and live longer than unaltered rabbits.\n- Calmer, more loving, and dependable once urge to mate is removed.\n- Less prone to destructiveness (chewing, digging) and aggressiveness (biting, lunging, circling, growling) behavior after surgery.\n- Easier and more reliable to litter train.\n- Will not contribute to the overpopulation of pet rabbits. Having a spayed or neutered rabbit in the case that rehoming is necessary will make the pet easier to adopt out and give reassurance that the rabbit will not go on to make any unwanted babies.\n- Can safely have a friend to bond with. Hormones will encourage sexual and aggressive behaviors toward other rabbits.\n- Eliminates all or reduces risk of developing reproductive cancers (ovarian, uterine, mammarian). There is a high 50%-80% incidence rate of uterine cancer in intact does over the age of 4 years. See Uterine Cancer for more information.\n- Prevents pseudopregnancy. It is stressful for rabbits to go through nest building, milk production and aggressive protection of territory. This can make the pet very difficult to handle during this period and can progress to decreased appetite and gastrointestinal problems.\n- Reduces sexual aggression.\n- Stops spraying behavior.\n- Reduces and eliminates risks of testicular and prostate cancers (although risks are not conclusively proven through research).\nSeveral myths have been perpetuated about spaying and neutering pets.\n- Your pet will not become "fat and lazy" after being altered. A lack of exercise, too much food, and boredom will cause an animal to be so, regardless of altering.\n- Your pet will still be bonded with you after its surgery. While he may be calmer due to lack of hormonal frustrations, the underlying personality will not be changed, especially if altered at a young age. However, if you are basing your rabbit's personality on hormone-driven behaviors such as circling, humping, and biting, then such behaviors will be eliminated or reduced after altering.\nAge to spay and neuter\nAlthough not all rabbits will show undesirable habits upon reaching sexual maturity, most rabbits do. Behaviors include the following:\n- loss of previously good litterbox habits\n- spraying urine\n- mounting and humping of objects such as toys or your body\n- growling and boxing\n- territorial biting and nipping\n- aggressive and possessive lunging and biting\n- circling and honking\n- excessively destructive chewing and digging (especially in females)\nAs Dana Krempels writes,\nWhen intact, both male and female rabbits usually mount one another endlessly out of sex drive and/or to establish social dominance. Same-sex pairs who tolerated each other as babies will often begin ferocious fighting upon reaching sexual maturity. This can result in permanent "unbonding," not to mention serious physical injury.\nOpposite sex pairs will begin reproducing as soon as they mature. Left unchecked, an unspayed rabbit and her intact female descendants can produce more than 1300 offspring in a year. Over the course of five years this number balloons exponentially to more than 94 million!\nFemales can usually be spayed as soon as they become sexually mature, around 5 months old.:87 It is advisable to spay females after puberty but before maturity when large amounts of abdominal fat can complicate the surgery.:87 An immature rabbit will have structures that are not well developed, making the surgery more difficult.:87 Some veterinarians may want to wait until the rabbit is older at ~6 months.\nMales can be neutered as soon as their testicles descend, usually around 4 months of age.:87 Some rabbits may have testicles descend at around 10-12 weeks. Motile spermatozoa appear in the ejaculate from about 4 months of age.:87 Some veterinarians may want to wait until the rabbit is older at ~5 months. If they are too young, the neutering may require abdominal surgery which makes the process more complicated. Males can be considered sterile 5-6 weeks after the operation.:87\nOlder rabbits (6+ yrs) may need to have blood work done beforehand to make sure they do not react negatively to anesthesia. Small rabbits may need to grow bigger before they may be dosed with an anesthetic for surgery. Giant breeds of rabbits may reach maturity a couple of months later so the surgery might be done a little later in these breeds if necessary.\nChoosing a clinic\nTo choose a veterinarian for the procedure, some good questions to ask are the following:\n- About how many rabbit clients does the veterinarian see in a year?\n- How many spays and neuters of rabbits has the veterinarian has done in the past year?\n- What is your success rate? If any were lost, what was the cause? According to the House Rabbit Society,\n90% success is way too low. Every doctor, whether for animals or humans will occasionally lose a patient; usually because of an undiagnosed problem. Veterinarians across the country who spay and neuter rabbits for the House Rabbit Society have lost on average less than 1/2 of 1%.\n- Does the veterinarian remove both uterus and ovaries? They should be. Uterine cancer prevention requires the entire removal of the organ, and without the removal of the ovaries, the rabbit will still be hormonal and problematic behaviors will not cease after the operation.\n- Does the veterinarian do "open" or "closed" neuters? Closed is preferable, but let the veterinarian explain the difference.\n- Is entry to the testicles made through the scrotum or the abdomen? Entry via the abdomen unnecessarily increases the trauma for male rabbits.\n- Does the veterinarian require withholding of food and water prior to surgery in rabbits? Rabbits should never be fasted before surgery. Rabbits cannot vomit, so there is no risk of that during surgery, and rabbits should never be allowed to get empty digestive tracts.\n- What anesthetics are used? Make sure it's rabbit-safe. Some common anesthetics used include isoflurane and sevoflurane. See Drugs for more resources.\n- Review the procedure (op and immediate post-op) with your vet. See the Costs section below for more procedure-related questions.\nCheck out Low Cost Spay/Neuter Clinics for some low-cost options to spay and neuter your rabbit.\nThe links below are some more resources when choosing a veterinarian for surgical procedures.\n- Jan Langer. (2003). Surgery Considerations\nCosts of a spay or neuter\nCosts of a spay or neuter will vary based on your location and availability of the service. On the low end, the procedure can begin at ~US$50 at low cost spay/neuter clinics. At certain veterinarians, the cost can be US$300+. Usually, a neuter is less expensive than a spay; however, if a male rabbit has cryptorchidism or undescended testicles, the costs may end up similar to a spay due to the more invasive procedure.\nYou can find more about the cheaper options at Low cost spay/neuter clinics.\nFrom the Colorado House Rabbit Society, \nThere is a wide variety of charges for a rabbit spay or neuter. Before deciding who to use, find out what the differences are in the care your rabbit will get. Specifically:\n- Is a thorough "exotic exam" done? If not, is any kind of exam done?\n- Is pre-anesthetic blood-work done?\n- Is the anesthetic used injected, or is it a gas (which is much safer)?\n- Is the rabbit intubated (a breathing tube placed)?\n- Is a vet tech monitoring the rabbit's vital signs throughout the surgery?\n- What monitoring equipment is used?\n- Respiratory monitor?\n- Blood pressures?\n- Body temperature?\n- Is an IV catheter and fluids used throughout the surgery?\n- Are pain medications given either before or after the surgery?\n- How is the skin closed?\n- Will there be external sutures or staples which need to be removed?\n- Is the rabbit kept overnight?\n- If so, why? (i.e., will there be someone monitoring the rabbit throughout the night?)\n- Is any pain medication sent home with the rabbit for use later that day or the next day?\nThe links below include some more information about how much rabbit spays and neuters cost and what they include.\n- howmuchisit.org. (2018). How Much Does Rabbit Spaying Cost?\n- howmuchisit.org. (2018). How Much Does Rabbit Neutering Cost?\nThe following article describes the differences in care that may occur between a private veterinary clinic and a low-cost spay/neuter clinic:\n- Carolyn Karrh. (2015). THE DIFFERENCE\nThe following are a sample neutering invoices:\nSurgery can be very emotionally and mentally stressful, and the following tips can help you and your rabbit get through this operation with maximal safety and minimal worries.\nBefore the operation\n- Make sure to schedule surgery with a rabbit-savvy veterinarian. The vet should be very familiar with the rabbit's unique anatomy and physiology and has had a great deal of experience and success with rabbit anesthesia and surgery. See How to Choose a Rabbit Veterinarian for more resources on finding a rabbit-savvy vet as well as the sections above.\n- Schedule the surgery early in the week and also so that you can bring your rabbit home the same evening. Many vet offices are not open on the weekends, so having the operation on a Monday or Tuesday allows for more leeway in case something goes wrong with your rabbit's recovery. Try not to board your rabbit at the vet unless it is guaranteed to have 24/7 care. Many clinics often do not have techs that watch the pets overnight. Bringing your rabbit home to a familiar safe place is almost always better than leaving it in a strange lonely place with other dogs and cats within hearing or sight. Stress can easily make a recovery process lengthier.\n- Continue to feed your rabbit until you leave for the surgery. Often non-rabbit-savvy receptionists will inform you to fast your rabbit the night before the operation, but this is very dangerous for your rabbit. Cats and dogs should be fasted before a surgery to prevent aspiration from vomiting, but rabbits are unable to vomit, and fasting them early increases the likelihood of GI stasis after the operation and a slower recovery. Be sure to tell the veterinarian what the receptionist informed you, and if the veterinarian does not disagree, find a new vet.\nSince rabbits are unable to vomit, it is not mandatory to withhold the food and water before a planned surgery. In fact, rabbits, whose accessibility to food is removed over a longer period of time, show an increased tendency of becoming hypoglycemic during surgery or became post-surgical disturbances of the gastro-intestinal tract due to dysbiosis. Growth of pathogenic bacteria leads to the development of enterotoxaemia. The rate of recovery is furthermore slowed down in rabbits whose food was taken away hours before surgery. It is nevertheless advised to remove food up to an hour before anesthetic preparations are started. Indeed, some rabbits tend to accumulate food and water in the oral cavity and the oropharynx; withdrawing food one hour prior to surgery will assure that the oral cavity does not contain food rests and that the stomach is not overloaded. Food and water should be available immediately after the rabbit recovers from the anesthesia.\nFasting for more than 1 hour is unnecessary and should be avoided.\nAfter the operation\nAt the clinic, rabbits are usually given a shot of antibiotics and painkillers. The rabbit should be allowed to recover in a warm quiet environment and given access to food and water. Provide a water bowl for your rabbit even if you usually use a water bottle to decrease the amount of effort needed to drink. A well-hydrated rabbit recovers and feels better more quickly.\nFor the first few days, the rabbit should be bedded on a soft surface, such as puppy pad, towels, or linoleum, to prevent abrasive bedding materials interfering with the wound. Remove any toys that the rabbit can jump on top of to prevent damage to the incision from activity. Generally, male rabbits should be on cage rest with limited exercise for about 3 days, and female rabbits should be on cage rest for about 7 days.\nPlease obtain pain medications from your veterinarian for use after the surgery even if they say that it is not needed. While your rabbit should get a shot of analgesics after the operation, pain management the next few days after the surgery are critical for a smooth recovery. Rabbits will be sore for one to several days. Common analgesics include meloxicam (Metacam, Meloxidyl), buprenorphine, or tramadol.\nMost rabbits will not need an Elizabethan collar (e-collar) after the surgery, but rabbits that are persistent in bothering their surgical site will need to have the area protected. See First aid for rabbits#E-collars for recommendations and options.\nKeep recently neutered males away from intact females for at least 6 weeks. They can still have viable sperm in their tubes and impregnate the female.\nSee the links below for more information about pre- and post-op care.\n- Kinenchen, Quick Tips for Before and After Surgery.\n- Dana Krempels, Ph.D., Pre- and Post-operative care of Rabbits\n- Dana Krempels, Ph.D., Post-operative care of Rabbits\n- House Rabbit Society, FAQ: Spaying and Neutering > What's the proper pre- and post-operative care?\n- CottonTails Rabbit Rescue, Mairwen Guard, MBE, How To Minimise Risks When Having Your Rabbit Neutered\n- Georgia House Rabbit Society, Spay & Neuter Post-Op Care\n- Colorado House Rabbit Society, Nancy J. LaRoche, Care of Your Rabbit After Spaying or Neutering\n- Cristina Forbes, Rabbit Spay/Neuter Preparations\n- RabbitsOnline.net, Watermelons, Preparing For Your Bunny's Spay/Neuter and Coming Home\n- Bearsted Veterinary Surgery, Rabbit Spay Post Operative Care Sheet\n- East Bay SPCA, Rabbit Spay and Neuter Post-Operative Care Instructions\n- CottonTails Rescue. (n.d.) NEUTERING – a study\nThe following resources include some detailed descriptions and examples of the procedures used to spay and neuter rabbits.\n- NAVC Conference 2008, Joerg Mayer, Surgical Techniques for Spaying Rabbits and Rats\n- Angela Lennox, DVM, DABVP, Comparing elective neutering techniques (Proceedings)\n- MediRabbit, Esther van Praag, Ph.D., Male reproductive tract and orchidectomy (castration surgery) (Graphic)\n- Long Beach Animal Hospital, Neuter- Rabbit (Graphic)\nThe following are some recorded procedures of veterinarians neutering rabbits:\n- YouTube, Greg Martinez DVM, Dr Greg castrates a male rabbit (Graphic)\n- Merle E. Olson and Jim Bruce, Ovariectomy, Ovariohysterectomy and Orchidectomy in Rodents and Rabbits\n- Matthew S. Johnston, VMD, Diplomate ABVP (Avian), Rabbit Ovariohysterectomy (Graphic)\n- MediRabbit, Esther van Praag, Ph.D., Female reproductive tract and ovariohysterectomy (spay surgery) (Graphic)\n- Long Beach Animal Hospital, Spay- Rabbit (Graphic)\nThe following are some recorded procedures of veterinarians spaying rabbits:\n- YouTube, FastUpOnRabbitCare\n- YouTube, sheltervet, Rabbit Spay (Graphic)\nSome male rabbits may have undescended testicles, called cryptorchidism. Testes in rabbits normally descend by 12 weeks of age, and it is considered abnormal if they have not descended by the time they reach 16 weeks old. A rabbit with cryptorchidism will require a surgical procedure similar to a spay through the abdomen, and neutering is recommended due to the increased risk of development of testicular cancer.\nPotential complications that can arise after a spay can include the following:\n- Opening of the wound due to self-trauma or excessive activity.\n- Seroma (a pocket of fluid) formation.\n- Haemorrhage (ruptured blood vessel).\n- GI stasis — especially if the GI tract is handled roughly or excessively.\n- Reaction to suture material.\n- Hepatic lipidosis (fatty liver disease) — associated with the fasting of obese individuals during the procedure and recovery period.\nSee the resources below for information about possible complications.\n- House Rabbit Network, Kyle Eslinger, Complications of a Spay\nThe following articles include general information about spaying and neutering rabbits, covering most of the topics above.\n- Kinenchen, Why should I spay or neuter my rabbit?\n- Ontario Rabbit Education Organization, Spaying / Neutering\n- San Diego House Rabbit Society, Altering Your Rabbit's Future\n- House Rabbit Society, FAQ: Spaying and Neutering\n- House Rabbit Society, Amie Espie, Spay/Neuter = Win/Win\n- House Rabbit Society, Amy Espie, An Unmixed Blessing: The Generative Power of Spay/Neuter\n- Buckeye House Rabbit Society, Harelines, William A. Mandel, DVM, Rabbit Spay FAQ’s\n- Foster and Smith, Inc., Spaying and Neutering\n- VeterinaryPartner.com, To Neuter or Not to Neuter Rabbits... That is the Question!\n- House Rabbit Network, Astrid Kruse, DVM, Why Spay Your Rabbit?\n- Rabbit Welfare Association & Fund, The RWF guide to having your rabbit neutered\n- Happy Hoppers Rabbit Forum, Neutering (Spaying & Castration)\n- Save a Fluff, Why do I need to have my rabbits neutered?\n- Holly Nash, DVM, MS, Spaying and Neutering\n- NetVet.co.uk, Neutering a female rabbit\n- The Paw Blog, Spaying or Neutering Your Rabbit\n- Griffin Avian and Exotic Veterinary Hospital, Did you know…. Spaying your rabbit is important!!!\n- Animed Veterinary Group, Neutering rabbits\n- All About Pets, The Blue Cross, Neutering Rabbits\n- Dana Krempels, Ph.D., To Breed or Not to Breed?\n- e Silva, Carolina Salgueiro Costa, Uterine Adenocarcinoma in pet rabbits: a review\n- Zenopa.com, Alfaxan anaesthetic licensed for use in Rabbits, October 2017\n- Merriam-Webster, neuter\n- House Rabbit Society, FAQ: Spaying and Neutering\n- British Small Animal Veterinary Association, Policy Statement on the Neutering of Rabbits\n- kanin.org. (2008). Why you should spay/neuter your rabbit. Retrieved 31 March 2016 from http://kanin.org/node/182\n- Dana Krempels, Ph.D., Spay or Neuter my Rabbit?\n- Varga, M. (2013). Textbook of rabbit medicine. (2nd ed.).\n- Frances Harcourt-Brown, Textbook of Rabbit Medicine, 2002.\n- Give Us a Home, Rabbits\n- McLeod, L. (2014). At What Age Can I Have My Rabbit Spayed or Neutered? Retrieved 14 March 2016 from http://exoticpets.about.com/cs/rabbits/f/rabbitsnage.htm\n- Colorado House Rabbit Society. (2012). A Guide to Having Your Rabbit Safely Neutered. Retrieved 5 April 2016 from https://coloradohrs.org/a-guide-to-having-your-rabbit-safely-neutered/\n- Richardson, V.C.G. (2000). Rabbits: Health, Husbandry and Diseases.\n- MediRabbit. (n.d.). Pre-anesthetic preparations of the rabbit. Retrieved 27 Sep 2018 from http://www.medirabbit.com/EN/Surgery/Anesthesia/Pre/anes_pre_en.htm\n- HRS-Anesthesia Protocols for Rabbits. Retrieved 17 Nov 2018 from https://rabbit.org/anesthesia-protocols-for-rabbits/\n- Krempels, D. (2011). Pre- and Post-operative care of Rabbits. Retrieved 18 Dec 2019 from http://www.bio.miami.edu/hare/opcare.html.\n- Wildpro. (n.d.). Cryptorchidism in Bears and Lagomorphs. Retrieved 28 Jan 2019 from http://wildpro.twycrosszoo.org/S/00dis/Miscellaneous/Cryptorchidism_Bears.htm\n- Lesa Longley, Saunders Solutions in Veterinary Practice: Small Animal Exotic Pet Medicine, 2010. |
Medical Plaza North\nCervical stenosis is a degenerative condition in which the spinal canal is too small for the spinal cord and nerve roots. This can cause damage to the spinal cord or pinch nerves as they exit the spinal canal.\nSymptoms may include:\n- Neck pain\n- Pain or numbness in one or both arms\n- Electrical sensation that shoots down the back when the head moves\n- Heavy feeling in the legs\n- Inability to walk at a brisk pace\n- Deterioration in fine motor skills\nThoracic Spinal Stenosis\nThoracic spinal stenosis is a condition in which the spinal cord or spinal nerves are compressed by narrowing of the spinal canal or the openings between vertebrae.\nMost thoracic stenosis is due to degenerative changes common to aging, like arthritis, bone spurs, and disc degeneration. As the degeneration progresses, pain develops in the back and legs, either a leg ached when walking that improves with rest, or pain that radiates down the back and legs. Problems with walking or loss of bowel or bladder function may also occur.\nPatients may see improvement with conservative treatment, including anti-inflammatory medications and physical therapy. Steroid injections or nerve blocks may help manage the pain.\nIf the pain is uncontrolled or if there are signs of cord compression, surgery is usually necessary to relieve pressure on the cord or spinal nerves.\nMost often occurring in the neck and lower back, spinal stenosis is a narrowing of the spine’s open spaces, which can put pressure on the spinal cord and the nerves that travel through the spine. The disease typically affects people over the age of 50.\nWhile some people have no symptoms, spinal stenosis can cause leg, buttock, groin, and back pain; numbness; muscle weakness; and problems with bowel or bladder function. |
What To Think About\n- In some cases, a small sample of tissue may be removed and examined under a microscope (Reference biopsy Opens New Window) to identify certain diseases of the Reference pericardium Opens New Window. This surgery will be done under Reference general anesthesia Opens New Window.\n- An echocardiogram may be done at the same time as pericardial drainage. For more information, see the topic Reference Echocardiogram.\n|By:||Reference Healthwise Staff||Last Revised: Reference June 13, 2012|\n|Medical Review:||Reference Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology\nReference George Philippides, MD - Cardiology |
|Year : 2020 | Volume\n| Issue : 1 | Page : 118-120\nUltrasound-guided truncal/plane blocks: Are they safe in anticoagulated patients?\nDepartment of Anaesthsiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, India\n|Date of Submission||15-Sep-2019|\n|Date of Acceptance||15-Sep-2019|\n|Date of Web Publication||18-Feb-2020|\nDr. Rashmi Salhotra\nA-2/268, Second Floor, Paschim Vihar, New Delhi - 110 063\nSource of Support: None, Conflict of Interest: None\n|How to cite this article:|\nSalhotra R. Ultrasound-guided truncal/plane blocks: Are they safe in anticoagulated patients?. J Anaesthesiol Clin Pharmacol 2020;36:118-20\n|How to cite this URL:|\nSalhotra R. Ultrasound-guided truncal/plane blocks: Are they safe in anticoagulated patients?. J Anaesthesiol Clin Pharmacol [serial online] 2020 [cited 2020 Oct 1];36:118-20. Available from: http://www.joacp.org/text.asp?2020/36/1/118/278463\nUltrasound (US) has gained great popularity in the recent times. It's avenues have grown from a radiological diagnostic modality to an interventional one embraced by surgeons, anesthesiologists, critical care and emergency physicians alike. A wide variety of nerve and plexus blocks are being administered under US guidance. With gain of expertise, many new fascial plane blocks like transversus abdominis, rectus sheath, quadratus lumborum, serratus plane block, PECS block, retrolaminar and erector spinae plane block (ESPB) have been introduced. Fascial plane blocks are technically easier to perform under US guidance.\nIn this issue Arun, et al. report the case of a 52-year old female on anticoagulant and antiplatelet therapy with deranged prothrombin time and international normalized ratio who received bilateral US-guided ESPB for postoperative pain after extended cholecystectomy for carcinoma gall bladder. Catheter for continuous local anesthetic infusion for 48 h was also inserted and there were no reported perioperative complications. I congratulate them for the successful management of this patient.\nThe case management raises some very pertinent questions. What is the incidence of vascular injuries/hematoma formation after administration of US-guided blocks? Do we have sufficient data on safety of US-guided blocks to support their use in patients on anticoagulant therapy? Are there any international guidelines regarding the same? This commentary focuses on searching for evidence to answer these queries.\nClinical trials on anticoagulated patients receiving peripheral or plexus nerve blocks are lacking but cases of bleeding complications after deep and superficial nerve blocks and peripheral nerve catheters have been reported., The exact figures on the frequency of complications are not available. There is an undefined risk of developing a hematoma and hence peripheral nerve blocks into deep and non-compressible sites are fraught with risks. Enough evidence is available to support that in patients on anticoagulant therapy, morbidity due to hematoma formation is more frequent and serious than neurological complications. For deep plexus or deep peripheral blocks in patients on anticoagulation and antithrombotic medication, American Society of Regional Anesthesia and Pain Medicine (ASRA) guidelines recommend that similar precautions as applicable for neuraxial blocks should be followed. A new recommendation in the latest ASRA guidelines states “....the decision regarding performance of the block, catheter insertion and maintenance should be based upon the site compressibility, vascularity and consequences of bleeding.”\nThe utility and safety of US over traditional techniques for administering truncal blocks is also not substantiated with enough randomized controlled trials. Ultrasound guidance may increase the success rate of these blocks and is expected to reduce intraperitoneal needle placement or hollow viscous injury but there is no level I/II evidence to prove this. As per the American Institute of Ultrasound in Medicine, the risk of developing complications under US guidance cannot be eliminated. In fact, the complication rates are similar to those reported using traditional nerve localization tools. Proficiency of the operator performing the US-guided block is a big determining factor for the success of the block and number and seriousness of complications. Advancement of needle without visualizing its tip has been stated as one of the most common errors during US-guided blocks which may end up in intravascular/intraneural placement. US alone using the grey scale may be incapable of identifying, and thus avoiding injury to, vascular structures. According to the results of a simulation training study on US-guided hip joint injection, it was found that the incidence of accidental arterial puncture may be as high as 22% with the use of US guidance alone. Hence to prevent vascular injury, the authors advised incorporation of Doppler imaging in addition to US to identify vessels during needling in high risk patients especially those with bleeding tendency or on anticoagulant therapy.\nLet us now have a look at the anatomy, the technique and safety concerns with ESPB, the block in question, in patients on anticoagulant therapy. The ESPB is a relatively recent block first described in 2016. Its clinical applications and indications are still under investigation. Pneumothorax has been stated as one of the major complications but it is expected that more side effects and complications will be revealed once the block is used widely in clinical practice., A pooled review of 242 cases of ESPB states that it is a superficial block and so the risk of dural puncture and hematoma along the spinal cord is low. Adhikary et al. have reported a series of five patients who underwent thoracotomy for placement of left ventricular assist device. They administered ESPB and placed catheter for post-thoracotomy pain relief in these patients and did not encounter any complication related to the block or catheter placement. The site of ESPB administration is deep in the erector spinae muscle and superficial to the tips of the thoracic transverse processes, distant from the pleura and major blood vessels.\nIn the absence of safety trials on a large number of patients, it is prudent to avoid these blocks in anticoagulated patients. If at all they are performed under US guidance, needling should be done by an expert with careful needle tip visualization. Doppler imaging should be incorporated to improve the safety profile. Indwelling catheters should not be inserted routinely. The ASRA guidelines regarding the timing of block administration and removal of catheter with respect to the anticoagulant dose timings should be adhered to. Patients should be watched closely for the complications and instant interventions should be undertaken if there is a suspicion of hematoma formation.\n| References|| |\nArun N, Singh S. Is ESP block an answer for upper abdominal surgeries where epidural analgesia can't be used? J Anaesthesiol Clin Pharmacol 2020;36:117-8. [Full text]\nKlein SM, D'Ercole F, Greengrass RA, Warner DS. Enoxaparin associated with psoas hematoma and lumbar plexopathy after lumbar plexus block. Anesthesiology 1997;87:1576-9.\nWelle RS, Gerancher JC, Crews JC, Wade KL. Extensive retroperitoneal hematoma without neurologic deficit in two patients who underwent lumbar plexus block and were later anticoagulated. Anesthesiology 2003;98:581-5.\nHorlocker TT, Vandermeuelen E, Kopp SL, Gogarten W, Leffert LR, Benzon HT. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy. American society of regional anesthesia and pain medicine evidence-based guidelines (Fourth edition). Reg Anesth Pain Med 2018;43:263-309.\nNeal JM, Brull R, Chan VW, Grant SA, Horn JL, Liu SS, et al\n. The ASRA evidence-based medicine assessment of ultrasound-guided regional anesthesia and pain medicine. Executive summary. Reg Anesth Pain Med 2010;35:S1-9.\nAIUM Practice Parameter for the use of ultrasound to guide vascular access procedures. J Ultrasound Med 2019;38:E4-18.\nSites BD, Spence BC, Gallagher JD, Wiley CW, Bertrand ML, Blike GT. Characterizing novice behavior associated with learning ultrasound-guided peripheral regional anesthesia. Reg Anesth Pain Med 2007;32:107-15.\nZhang M, Pessina MA, Higgs JB, Kissin EY. A vascular obstacle in ultrasound-guided hip joint injection. J Med Ultrasound 2018;26:77-80.\n] [Full text]\nMissair A, Flavin K, Paula F, Benedetti de Marrero E, Benitez Lopez J, Matadial C. Leaning Tower of Pisa? Avoiding a major neurologic complication with the erector spinae plane block. Reg Anesth Pain Med 2019;44:1713-4.\nEl-Boghdadly K, Pawa A. The erector spinae plane block: Plane and simple. Anaesthesia 2017;72:434-8.\nTsui BC, Fonseca A, Munshey F, McFadyen G, Caruso TJ. The erector spinae plane (ESP) block: A pooled review of 242 cases. J Clin Anesth 2019;53:29-34.\nAdhikary SD, Prasad A, Soleimani B, Chin KJ. Continuous erector spinae plane block as an effective analgesic option in anticoagulated patients after left ventricular assist device implantation: A case series. J Cardiothorac Vasc Anesth 2019;33:1063-7. |
Rate Dr. JOHN W. COOK\nDr. JOHN W. COOK's Ratings\nDr. Cook took plenty of time to explain my medical condition and treatments. Very knowledgeable. I would highly recommend Dr. Cook.\nSubmitted June 26, 2013 | flag\nThe best!Has helped me over the years. I have had many types of foot problems.Dr. Cook is extremely competent\nSubmitted Nov. 4, 2011 | flag\nWe found our experience to be very different than the first. His office staff was very polite and helpful. He was very professional in the office and performed a bunionectomy on my daughter. The collaboration with the surgery center and Dr. Cook was very pleasant and they seemed to get along quite well. It's been almost 2 years and she has had no problems and you can barely see her scar. I would recommnend him to my friends and family.\nSubmitted Dec. 9, 2010 | flag\nHe was okay with me but i saw how he treated his staff and hospital staff. He thought I was completely under anesthesia and was screaming at the OR staff. He was extremely rude, foul mouth, intimidating, arrogant and obnoxious. He attcked the staff when they were doing their best and were asking how if he could explain what was his displeasure.There are better providers out there, than to waste your money. No one deserves to be treated the way this man acted.\nSubmitted Oct. 17, 2010 | flag\nTop Hospitals in Fredericksburg, VA\nTop Urgent Care Centers in Fredericksburg, VA\nFind a Doctor by Specialty\n#1 of 13\n#2 of 13\n#3 of 13\n#4 of 13\n#5 of 13 |
If you’d like to have firmer, tighter skin, but the thought of having a surgical face-lift worries you, consider a mesh contour thread lift. This procedure offers impressive results without pain, anesthesia, or a long recovery. Board-certified surgeon Pekka Soini, MD, and his team at Hermosa Cosmetic Center in Chicago, Illinois, perform mesh contour thread lifts that firm, tighten, and smooth your skin. To learn how a thread lift can give you a boost of confidence, call Hermosa Cosmetic Center, or book an appointment online today.\nA mesh contour thread lift, also known as a PDO thread lift, is a procedure that uses surgical sutures to lift and tighten facial skin. The threads also stimulate the production of new collagen in the treated area.\nCollagen gives youthful skin its firmness and strength, but collagen production declines as you get older. By replenishing collagen, a thread lift has a rejuvenating effect on the elasticity and volume of older skin.\nUnlike full cosmetic surgery, a thread lift doesn’t require the removal of excess skin. The threads eventually dissolve, but due to the replenished collagen, a mesh contour thread lift offers results that can last up to three years.\nYou may qualify for a thread lift at Hermosa Cosmetic Center if you’re generally healthy and you have concerns such as the following:\nA thread lift can also lift and smooth skin on the neck and chest. Depending on your personal goals, your provider at Hermosa Cosmetic Center may recommend combining dermal fillers with a mesh contour thread lift for optimal anti-aging results.\nA thread lift doesn’t require anesthesia or recovery time. During the procedure, your provider at Hermosa Cosmetic Center uses a long, sterile needle to place the threads underneath your skin. To complete the treatment, your provider gently pulls the threads, elevating, and tightening your skin.\nYou may experience some mild swelling following your thread lift; this should subside within a few days.\nCompared to a surgical face-lift, a thread lift holds minimal risk. However, there is some risk of irritation or infection, or of the sutures showing beneath the skin. Removing the threads can address all of these concerns.\nIf you’d like to tighten sagging skin and smooth away lines and wrinkles without surgery, schedule a consultation for a mesh contour thread lift at Hermosa Cosmetic Center. Call the office today, or make an appointment online. |
What is outpatient anesthesia?\nWhat is Outpatient Anesthesia? Also known as ambulatory anesthesia, outpatient anesthesia is administered for minor procedures where an overnight stay is not anticipated.\nWhat is the common Anaesthetic used earlier in surgery?\nThese medications are usually given pre-operatively to relax a patient before getting to the operating room. Anesthesiologists commonly give midazolam (Versed®) via IV injection for this purpose. In children, midazolam can be given orally as a liquid or nasal, as a spray, prior to a procedure.\nWhat is the most common anesthesia for surgery?\nWhile there are many types and levels of anesthesia — medication to keep you from feeling pain during surgery — general anesthesia is most commonly used for major operations, such as knee and hip replacements, heart surgeries, and many types of surgical procedures to treat cancer.\nWhat kind of anesthesia do they use for outpatient surgery?\nAnesthesia for ambulatory surgery includes general and regional anesthesia, local anesthesia, monitored anesthesia care (MAC), or a combination of these methods.\nWhat anesthesia is used for short surgery?\nLocal anesthesia lasts for a short period of time and is often used for minor outpatient procedures (when patients come in for surgery and can go home that same day).\nIs propofol a general anesthesia?\nPropofol is used as an “induction agent”—the drug that causes loss of consciousness— for general anesthesia in major surgery. In lower doses it is also used for “conscious sedation” of patients getting procedures on an outpatient basis at ambulatory surgery centers.\nWhat drug is general anesthesia?\nPropofol is one of the most commonly used intravenous drugs employed to induce and maintain general anesthesia. It can also be used for sedation during procedures or in the ICU.\nDo they always put a tube down your throat during surgery?\nNOSE AND THROAT SURGERIES SUCH AS TONSILLECTOMY AND RHINOPLASTY: Almost all nose and throat surgeries require an airway tube, so anesthetic gases and oxygen can be ventilated in and out through your windpipe safely during the time the surgeon is working on these breathing passages.\nWhat is general anesthesia vs local anesthesia?\nlocal anaesthesia is where a small area of the body is numbed and you remain fully conscious – often used during minor procedures. general anaesthesia is where you’re totally unconscious and unaware of the procedure – often used for more serious operations. |
Does this sound familiar? You have a stuffy nose with thick, yellowy mucus.\nYou’re tired, achy and coughing, maybe even feverish. Breathing\nthrough your nose is difficult, if not impossible, and you may even have\ntrouble smelling things.\nPerhaps it’s a cold, but the medicines you try don’t help.\nTo make matters worse, you develop a dull headache that won’t go\naway. When you finally decide to see your doctor, you find out—it’s\nIf this has happened to you once, or perhaps numerous times, you are not\nalone. The Centers for Disease Control reports more than 28 million American\nadults suffer from sinusitis, resulting in nearly 12 million visits to\nthe doctor each year.\nWhat is sinusitis?\nYour sinuses are hollow spaces located inside the bones around your nose.\nThey produce mucus that drains into the nose. If the inside of your nose\ngets swollen, this can create painful blockage of the sinuses. If left\nuntreated, sinusitis can go on for long periods of time. If it becomes\na chronic condition, sinusitis can continue for months or even years.\nDoctors have usually treated sinusitis with medication, including antibiotics,\ndecongestants and pain relievers. They’ve also recommended using\nheat pads on the inflamed area, saline nasal spray and a vaporizer. Your\ndoctor may also prescribe oral steroids, which can have side effects.\nIf these medications and treatments fail to clear up the problem, patients\nmay need surgery to improve sinus drainage and reduce blockage. In the\npast, this could mean a stay in the hospital and a painful recovery.\n“The good news is technology is continuing to improve our ability\nto treat persistent sinusitis,” reported Jason Van Tassel, M.D.,\na board certified ear, nose and throat specialist with Washington Township\nMedical Foundation. “With a noninvasive procedure called balloon\nsinuplasty, or sinus dilation, we can relieve chronic sinusitis safely\nand comfortably in the office, with the patient under local anesthesia.\nThis can improve their quality of life significantly.”\nCome to a free seminar\nYou can learn more about balloon sinuplasty and its benefits in treating\nsinusitis at a free community health seminar on Tuesday, Sept. 16 from\n1 p.m. to 3 p.m. Called “Relief from Sinus Issues” and sponsored\nby Washington Hospital, the class will be held in the Conrad Anderson\nM.D. Auditorium in the Washington West Building next to Washington Hospital\nat 2500 Mowry Ave. in Fremont. To reserve your spot,\nclick here, or call (800) 963-7070.\nDoctors have been performing balloon sinuplasty to treat chronic sinusitis\nsince 2005. At that time, the procedure was done in the hospital operating\nroom with the patient under general anesthesia. With the development of\nsmaller balloon catheters and the advancement of a specialized endoscope\nused for visualization, doctors can now perform the procedure safely and\neffectively in the office with just a local anesthetic to keep the patient\nAt the seminar, Dr. Van Tassel will talk about the short and long term\noutcomes for patients after balloon sinuplasty.\n“Recovery time from the procedure continues to get shorter and shorter,”\nhe stated. “And, rarely is there a case when patients require packing\nof the sinus cavity afterwards. We are able to relieve a lot of sinus\ndiscomfort, congestion and pressure, while restoring a patient’s\nability to breathe and smell.”\nStudies comparing the office-based, non-invasive sinuplasty to the traditional\nsurgery revealed that patients in the office tolerated the procedure well,\nwith low pain scores. After surgery, they experienced better and faster\nimprovement of symptoms and quicker recovery, with return to normal activities\nin about two days, on average.\nIn addition, there was less need for follow-up revision surgery. Long term\nrelief also meant people who had balloon sinuplasty tended to be more\nproductive at work, had fewer doctor visits and needed to take antibiotics\nFind out more about sinusitis, attend Dr. Van Tassel’s free seminar\non Sept. 16. For more information or to reserve your spot, go online\nclick here or call (800) 963-7070. You can also go to the website of the National\nInstitute for Allergy and Infectious Diseases, part of the National Institutes\nof Health, at |
Use the wrong term to describe an experience associated with an experimental drug, and it can be the nail in the coffin.\nThe wording was key.\nUse the wrong term or phrase to describe a peculiar experience associated with an experimental drug, and it’s sure to be the old nail in the molecule’s coffin. Find the right words, and you open up a world of pharmacological possibilities.\nThat’s where Drs. Edward Domino and Guenter Corssen were in 1965, as they prepared to publish results from a clinical trial testing ketamine, a derivative of PCP (phencyclidine). PCP — known on the street as angel dust — was used as an anesthetic in the U.S. at the time but was on the verge of being outlawed due to its schizophrenomimetic —or mind altering — effects and high potential for abuse. Laboratory testing showed ketamine was a kinder, gentler version of PCP.\nThe year prior, Drs. Domino and Corssen were given permission to conduct the first human trials of ketamine. A group of prisoners from Jackson Prisoners in Michigan volunteered to be their guinea pigs. Once administered the experimental medication, the participants described feeling limbless and as if they were floating in outer space. But when it came to publishing those study results, the researchers were flummoxed. Using the term “schizophrenomimetic” to describe what the participants felt would almost certainly quash future research with the promising new agent.\nDrs. Domino and Corssen had “a good deal of discussion” about the terminology to use for the euphoric state the participants described. They had almost settled on the word “dreaming” as a replacement when Dr. Domino spoke to his wife, Toni, about the dilemma. How else to explain this “disconnected” feeling, he asked? She was the first to suggest the term “dissociative anesthetic,” and the name stuck.\nMore research on ketamine ensued. It was ultimately approved for human use in 1970 by the U.S. Food and Drug Administration (FDA), and quickly began to prove its worth on the battlefields in Vietnam. Unlike morphine, ketamine doesn’t cause a drop in blood pressure or depress breathing, and thus doesn’t require monitoring. Another added effect is that ketamine gave wounded soldiers a sense of calm in the midst of a tragic situation.\nKetamine has since become one of the most widely used anesthetics in the world, and is considered by the World Health Organization (WHO) to be an essential medicine for pain relief in both adults and children. It has been listed on the organization’s Essential Medicines List since 1985, and is also on the WHO Essential Medicines list for Children.\nIn the 1990s, new light was shed on the potential therapeutic benefits for ketamine, when researchers from Yale University School of Medicine discovered that the sedative blocked certain glutamine receptors in the brain associated with depression. This meant that ketamine could relieve symptoms of depression in a matter of hours as opposed to the weeks or months it took for antidepressants like Prozac or Lexapro to work. Ketamine clinics began opening across the United States offering IV infusions for patients with depression, anxiety or other mental illnesses.\nKetamine treatments at these clinics aren’t cheap — about $350 to $1,000 per session with most patients prescribed at least six sessions. Insurance usually doesn’t foot the bill. Clinics report great success but reliable studies to back up those claims appear lacking.\nHowever, pharmaceutical companies took note of the drug’s potential and began developing their own ketamine therapies. In 2019, the FDA approved Johnson & Johnson’s nasal spray version of ketamine, called esketamine, and are marketing it under the brand name “Spravato.” Esketamine became the first depression treatment approved by the FDA in 35 that offered a different approach than traditional antidepressants.\nHowever, Spravato can only be administered at certified offices or clinics under a doctor’s watchful eye because it is assumed esketamine carries the same potential for abuse and misuse as ketamine.\nKetamine is derived from PCP, and at higher doses it can have a similar hallucinogenic — or schizophrenomimetic — effect. Some users refer to this dissociative state as falling into a “K-hole.” Recreational use of the drug has also been reported through the years, beginning with soldiers during the Vietnam war and later with the 1978 publication of Marcia Moore’s book, Journeys into the Bright World, and John Lilly’s The Scientists, both of which feature the authors’ accounts of their psychedelic experiences with ketamine.\nIn more recent years, ketamine has also become the drug of choice among young professionals. As Anna Silman describes it, writing for The Cut, taking a bump of “Special K” helps melt away work-day stress and lets “anxieties float off like helium balloons.”\nBut it’s also considered one of the most common “date rape” drugs. Because of this, and its abuse potential, in 1999, ketamine was listed as a Schedule III drug by the U.S. Drug Enforcement Administration (DEA). It joins other medications with “moderate to low potential for physical and psychological dependence,” such as anabolic steroids, testosterone, and Tylenol with codeine. Ketamine is considered less dangerous than Schedule I and II drugs like heroin and OxyContin, respectively, but riskier than Schedule IV drugs like Xanax, Valium, and the sleeping pill Ambien.\nWHO has vehemently lobbied against countries scheduling ketamine, finding little evidence that it poses a global health risk and reporting incidences of abuse somewhat rare. The organization also fears that scheduling restrictions would limit this vital drug’s availability for surgery and anesthesia for both human and veterinary care.\nMany doctors agree. Among them is Dr. Darragh O’Carroll, an emergency room physician in Hawaii, who was quoted in VIce saying that ketamine is not only safe and effective, but versatile in treating everything from severe asthma and chronic pain, to anxiety and depression. It may even offer anti-tumor effects.\n“If the above reasons don’t make [ketamine] planet Earth’s most interesting pharmaceutical,” Dr. O’Carroll says, “I’ll go one step further and deem ketamine my favorite medicine of all time.\nLeave a ReplyWant to join the discussion?\nFeel free to contribute! |
The 5-Second Trick For rhinoplasty NYC recovery\nWhat Is Rhinoplasty?\nRhinoplasty, typically called a rhinoplasty, is a type of plastic surgery designed to repair or improve the nose. As one of one of the most noticeable features on your face, your nose has a large bearing on your look and can affect how you feel regarding yourself. People who are displeased with the dimension or shape of the nose can benefit from rhinoplasty as a result of the possibility it supplies to totally alter the look of the nose. Rhinoplasty has the capacity to raise or minimize the dimension of the nose in its totality, removing a bump, changing the shape of the bridge or the idea of your nose, narrowing the nostril openings, and also customizing the angle in between your nose as well as your lips.\nRhinoplasty can not be efficiently done up until the nose has maintained and nasal bone has quit expanding. This usually takes place around age 14 to 15 in women and also age 15 to 16 in young boys. Any type of surgery executed before this factor runs the risk of having to be redone once nasal development has ceased, considering that the nose has the prospective to remain to alter and develop till that factor. Rhinoplasty is periodically performed on more youthful youngsters when it comes to extreme injury to the face, to ensure that the nose can be brought back as close as possible to its initial sizes and shape.\nMost rhinoplasty procedures are performed on an outpatient basis under basic anesthesia. There are exemptions to rhinoplasty NYC cost this regulation, however. People undergoing extreme reconstructive surgery may be kept track of overnight to make certain that no difficulties arise. Individuals seeking to have their nose "set" after a negative break will occasionally get anesthetic only.\nDuring the treatment the surgeon makes an incision either inside the nostrils or with the columella, the external strip of cells that divides the nostrils. The skin is then divided far from the framework of the nose itself so the medical professional can access the underlying cartilage. In order to reshape the nose, the soft flexible cartilage material and also bone are controlled right into the proper setting and also shape. Depending on the preferred outcomes, tissue may be removed or included in change the angle or shape of the nose. A sculpt or submit may be utilized throughout the procedure, the majority of regularly to remove a bulge from the bridge of the nose. Once the nose has actually been sculpted right into the wanted form, the skin is resituated and also the nose is splinted to protect it. Nasal pads may be utilized for the first couple of days following the surgical treatment to load the nose and safeguard the delicate septum.\nRhinoplasty, as with all other surgical procedures, is not risk-free. In addition to the common wounding as well as swelling, clients need to be aware of a number of prospective side-effects that can result from the treatment. These consist of an infection of the nose, nosebleeds, tingling, scarring, as well as a reaction to the anesthetic. Some clients report the bursting of tiny blood vessels externally of the skin as well as hematomas, or collections of blood that pool under the skin. The opportunity also exists that a follow-up treatment will certainly be needed in order to correct an over-correction or under-correction of the nose.\nWhen effectively carried out by a highly-qualified cosmetic surgeon, rhinoplasty can considerably boost the look of your nose and improve your confidence. If you are considering rhinoplasty as well as would certainly like even more info about this treatment, get in touch with a reliable surgeon in your area and also arrange for an individual examination.\nDr. Ronald Espinoza, DO, PC\n162 E 78th St, New York, NY 10075\nSpecializing in: Rhinoplasty NYC |
Isoflurane Side Effects\nFor the Consumer\nApplies to isoflurane: inhalation solution\nWhat are some side effects that I need to call my doctor about right away?\nWARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:\n- Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.\n- Signs of high potassium levels like a heartbeat that does not feel normal; feeling confused; feeling weak, lightheaded, or dizzy; feeling like passing out; numbness or tingling; or shortness of breath.\n- Very bad dizziness or passing out.\n- Trouble breathing, slow breathing, or shallow breathing.\n- A heartbeat that does not feel normal.\n- Muscle stiffness.\n- Change in color of skin to a bluish color like on the lips, nail beds, fingers, or toes.\n- This drug may cause a very bad and sometimes deadly problem called malignant hyperthermia. Call your doctor right away if you have a fast heartbeat, fast breathing, fever, or spasm or stiffness of the jaw muscles.\n- Very bad and sometimes deadly liver problems have happened with this drug. Call your doctor right away if you have signs of liver problems like dark urine, feeling tired, not hungry, upset stomach or stomach pain, light-colored stools, throwing up, or yellow skin or eyes.\nWhat are some other side effects of this drug?\nAll drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:\n- Upset stomach or throwing up.\nThese are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.\nYou may report side effects to the FDA at 1-800-FDA-1088. You may also report side effects at http://www.fda.gov/medwatch.\nFor Healthcare Professionals\nApplies to isoflurane: inhalation liquid\nGeneral side effects including malignant hyperthermia and shivering have been observed in the postoperative period.\nIn general, side effects encountered in the administration of isoflurane are dose dependent extensions of pharmacophysiologic effects and include respiratory depression, hypotension, and arrhythmias.[Ref]\nHepatic side effects have included rare reports of mild, moderate, and severe (sometimes fatal) postoperative hepatic dysfunction and hepatitis. There have also been rare postmarketing reports of hepatic failure and hepatic necrosis associated with the use of potent volatile anesthetic agents, including isoflurane.[Ref]\nIsoflurane can react with desiccated carbon dioxide (CO2) absorbents to produce carbon monoxide, which may result in elevated levels of carboxyhemoglobin in some patients.[Ref]\nRespiratory side effects including elevated carboxyhemoglobin levels have been reported.[Ref]\n1. "Product Information. Forane (isoflurane)." Baxter Pharmaceutical Products, Inc, New Providence, NJ.\nSome side effects may not be reported. You may report them to the FDA.\nMore about isoflurane\n- Isoflurane Side Effects\n- During Pregnancy or Breastfeeding\n- Drug Interactions\n- Support Group\n- Pricing & Coupons\n- 0 Reviews\n- Drug class: general anesthetics |
March 1st, 2021 ― Doha: Qatar Red Crescent Society’s (QRCS) Little Hearts project is going on in Indonesia, in cooperation with the Indonesian Red Cross Society (PMI) and Indonesia’s Ministry of Health (MOH).\nThe $106,560 project is aimed at treating 40 children with congenital heart defects, including ventricular septal defects (VSD) and patent ductus arteriosus (PDA).\nIt involves performing catheterizations at the National Cardiac Center Harapan Kita (NCCHK) in Jakarta. So far, 15 children ranging from one month to eight years of age have been operated on the heart.\nThree groups of 16 specialized doctors and consultants are engaged in the project, covering the specialties of pediatric cardiology, diagnostic non-invasive cardiology, and anesthesia.\nThe COVID-19 pandemic limited the speed of NCCHK’s interventions. Prior to the interventions, COVID-19 screening process has to be finalized. The NCCHK put more effort to tighten the COVID-19 protocols, re-disinfected the areas, and conducted self-swab tests for both the patients and health workers in order to reduce the risks to COVID-19 around the hospital.\nAt the inauguration ceremony, attended by NCCHK’s board members, PMI Secretary-General, and team members, the project was commended as rarely implemented in Indonesia, where the numbers of congenital heart diseases (CHD) are increasing. On average, nine out of 1,000 born-alive infants have CHD, with a total of 40,000 babies. Being the first Little Hearts project to be executed in Indonesia, it is part of the Medical Convoys program, which involves providing treatment for poor patients, performing surgeries in many medical specializations, supplying the host hospitals with surgical equipment and consumables, and training medical professionals in the latest medical advancements.\nEnd of Text |
Ralph C Harvey, DVM, MS, Diplomate ACVAA, UTCVM\nDr. Ralph Harvey teaches anesthesia and pain management in the Department of Small Animal Clinical Sciences at the University of Tennessee College of Veterinary Medicine in Knoxville, Tennessee. He previously served as the Section Head for the Small Animal Surgical Services and as a member of the University Faculty Senate. His veterinary degree is from the UTCVM and his post-graduate training included internship, residency, and fellowship at Cornell’s Veterinary and Medical Colleges.\nDr. Harvey has worked in private small animal practice. He is certified as a specialist by the American College of Veterinary Anesthesia and Analgesia, has served as their Executive Secretary and as a member of the ACVAA Board of Directors. He currently is a member of the Fear-Free Executive Council. |
Lasers allow many dental procedures to be performed with no noise and very little pain. They also make it possible to perform several procedures during a single appointment, so you don't have to come back many times to complete your treatment. Advanced DDS is happy to offer our patients the option of Laser Dentistry. In New York, we were among the first to begin utilizing this technology for the benefit of our patients. Lasers are versatile tools that can be used in oral surgery, curing of restorative materials, and removal of hard and soft tissue. Other benefits of laser dentistry over traditional methods can include:\nMany patients find that laser dentistry is far more comfortable than traditional methods using drills. The only noise comes from air as it cools the area being treated. Laser Dentistry is perfect for children, teens, and adults who wish to seek an alternative to the discomfort and sound associated with drills. Advanced DDS has all the new technology in laser dentistry to maximize patient safety and achieve the best possible outcome. These include:\nThe Waterlase MD™ features an all-new MD laser technology platform that heralds the next generation of dentistry with superior clinical outcomes and a more pleasant patient experience for many dental procedures - with fewer shots and less anesthesia.\nMany procedures performed with the Waterlase MD™ do not require shots or anesthesia, eliminating a major source of patient anxiety and creating a more relaxing experience. Patients typically experience less bleeding, swelling and postop discomfort and require less pain medication. You will find that procedures that once took several appointments to complete, such as multiple fillings, can now be finished in just one visit. Also, Waterlase MD™ creates a better bonding surface for fillings. In all, Waterlase Dentistry can transform your experience at the dentist’s office.\nThe Waterlase MD™ is a revolutionary device that uses a combination of YSGG laser energy and water, a process called HydroPhotonics™, to perform many traditional dental procedures with less anesthesia. The precision and accuracy of the Waterlase MD™ allows Dr. Raskin and Dr. D'Orlando to treat targeted areas of tooth structure and soft tissue, leaving surrounding areas unaffected while maintaining the structural integrity of the tooth. Studies have shown that the Waterlase MD™ is less invasive and less traumatic than the drill, scalpel or electrosurge. Less invasive means more conservation of tooth structure and tissue... and a happier you.\nIn dentistry, diode lasers are useful for a number of soft tissue procedures. They are able to reshape the gums to create better symmetry in the smile and to cut back on excess gum tissue, exposing more of the healthy tooth for a more attractive smile. They treat lesions, ulcers and benign soft-tissue growths and remove areas of tooth decay. They have recently been shown to eliminate pockets of infected tissue in the gums. This can be an enormous benefit in halting the progress of gum disease as well as preventing it from occurring. In addition to their periodontal applications, diode lasers are highly effective in numerous endodontic treatments. To name a few, they aid in the uncovering of dental implants, the retraction of tissue for impression-taking, and pulpotomies. They can also be used to reduce tooth sensitivity.Diode lasers have proven to be extremely safe and valuable tools in surgical dentistry for the cutting and removal of soft tissue, since they provide accurate and bloodless incisions, reduce pain during and after the procedure, reduce surgical risks such as infection, and offer patients a faster recovery than traditional methods.\nFind and treat cavities even when you can't see them.\nThe KaVo DIAGNOdent is an invaluable tool in the detection of cavities (caries) when the tooth looks whole and healthy on the surface, or when only a small portion of the cavity is visible. The DIAGNOdent's sensitive laser probe locates even the smallest and newly-developed hidden caries in the teeth with high accuracy and no scraping, no tissue damage and no radiation. It works by measuring differences in fluorescence between healthy and diseased tissue. Its laser light can penetrate into tiny fissures to allow dentists to see further inside the tooth with more detail than has ever been possible with traditional dental instruments, including x-rays. Based on the DIAGNOdent's findings, your dentist will recommend the best course of treatment, from simple preventive measures to minimally invasive restoration to more extensive dental work. |
Dr. Kacey Montgomery MD\nPain Management Physicians — Seattle, WAContact Dr. Montgomery\nDr. Kacey Montgomery specializes in pain management, anesthesiology in Seattle, Washington. Details of Dr. Montgomery's experience as an MD and her hospital affiliation are available on your free doctor report.\nDr. Montgomery has been compared\nPrimary Location for Dr. Montgomery\n1959 NE Pacific St\nSeattle, WA 98195\nRatings and Reviews for Dr. Kacey MontgomeryNo ratings yet\nThere are no ratings or reviews available for Dr. Kacey Montgomery at this time. Reviews may not be ready for viewing or are still processing.\nBe the first to rate and review Dr. Kacey Montgomery by clicking the following button.\nBoard Certification, Specialty and Expertise\nDr. Kacey Montgomery identified specializing in\nPain ManagementPain Management\nA physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. and AnesthesiologyAnesthesiology\nAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an operation, an obstetric or diagnostic procedure. The anesthesiologist assesses the risk of the patient undergoing surgery and optimizes the patient's condition prior to, during and after surgery. In addition to these management responsibilities, the anesthesiologists diagnose and treat acute, long standing and cancer pain problems; diagnose and treat patients with critical illnesses or severe injuries; direct resuscitation in the care of patients with cardiac or respiratory emergencies, including the need for artificial ventilation; and supervise post anesthesia recovery..\nA hospital affiliation covers any doctor who has an affiliation, association or admitting privilege with a hospital. A doctor's particular affiliation to a specific hospital can translate to the overall quality of that provider.\nDr. Montgomery is affiliated with 1 hospital:\nShands Live Oak\n1100 11th St SW\nLive Oak, FL\nPatients may also know Dr. Kacey Montgomery MD as:\n- Kacey A Montgomery\n- K Montgomery\nTop searched Pain Management Physicians in Seattle, WA:\nWe found 5 doctors nearby Dr. Montgomery who also specialize in Pain Management:\nAre you Dr. Kacey Montgomery?\nUpdate your information\nHealth Tools & Offers |
Anesthesia Central is an all-in-one web and mobile solution for treating patients before, during, and after surgery. This collection of drug, procedures and test information is derived from Davis’s Drug, MGH Clinical Anesthesia Procedures, Pocket Guide to Diagnostic Tests, and MEDLINE Journals. Explore these free sample topics:\nQuiring, Courtney, et al. "Fat Emulsion." Davis's Drug Guide, 16th ed., F.A. Davis Company, 2019. Anesthesia Central, anesth.unboundmedicine.com/anesthesia/view/Davis-Drug-Guide/51294/all/fat_emulsion.\nQuiring C, Sanoski CA, Vallerand AH. Fat emulsion. Davis's Drug Guide. 16th ed. F.A. Davis Company; 2019. https://anesth.unboundmedicine.com/anesthesia/view/Davis-Drug-Guide/51294/all/fat_emulsion. Accessed October 22, 2019.\nQuiring, C., Sanoski, C. A., & Vallerand, A. H. (2019). Fat emulsion. In Davis's Drug Guide. Available from https://anesth.unboundmedicine.com/anesthesia/view/Davis-Drug-Guide/51294/all/fat_emulsion\nQuiring C, Sanoski CA, Vallerand AH. Fat Emulsion [Internet]. In: Davis's Drug Guide. F.A. Davis Company; 2019. [cited 2019 October 22]. Available from: https://anesth.unboundmedicine.com/anesthesia/view/Davis-Drug-Guide/51294/all/fat_emulsion.\n* Article titles in AMA citation format should be in sentence-case\nTY - ELEC\nT1 - fat emulsion\nID - 51294\nA1 - Quiring,Courtney,\nAU - Sanoski,Cynthia A,\nAU - Vallerand,April Hazard,\nBT - Davis's Drug Guide\nUR - https://anesth.unboundmedicine.com/anesthesia/view/Davis-Drug-Guide/51294/all/fat_emulsion\nPB - F.A. Davis Company\nET - 16\nDB - Anesthesia Central\nDP - Unbound Medicine |
Anesthesia and Pain\nThe Health Law Partners, P.C. is a unique healthcare law firm with lawyers who understand the multitude of legal, regulatory and contract issues facing anesthesiologists and chronic pain management physicians and practices. Since the time that the American Society of Anesthesiologists (“ASA”) issued its compliance guide addressing the specific risk factors in anesthesia billing and the OIG issued its voluntary compliance program guidance for physician practices, anesthesiologists/anesthesia practices have understood the importance of implementing and maintaining compliance programs. With the permanent implementation of the Medicare Recovery Audit Contractor (“RAC”) program and the Office of Inspector General (OIG)’s focus on interventional pain, compliance continues to be of particular importance in the anesthesia and pain management field.\nAbby Pendleton, Esq.. one of the founders of The Health Law Partners, P.C., has worked with anesthesia and pain practices around the country for over a decade. The firm can assist anesthesia and pain practices in a broad array of areas, including but not limited to:\n- Exclusive contracts;\n- Compliance Programs addressing specific anesthesia and pain management risk areas, including without limitation:\n- Medical direction elements and documentation requirements\n- Anesthesia time\n- OB anesthesia billing\n- Acute/post-op pain and invasive monitoring lines\n- Medical necessity and documentation for chronic pain procedures\n- Incident-to services\n- Compliance Education and In-services;\n- Development of narcotic agreements;\n- Regulatory and fraud and abuse (e.g., Stark and Anti-kickback) analysis and guidance with regard to proposed ventures and relationships;\n- Corporate and transactional matters;\n- Employment and independent contractor agreements;\n- Appeals of Medicare and other payor denials;\n- Staff privilege matters;\n- HIPAA; and\n- The Red Flag Rules\nThe attorneys of The Health Law Partners also assist billing and management companies specializing in anesthesia and pain management.\nMs. Pendleton regularly speaks and writes on anesthesia and pain management healthcare law topics. She also authored a chapter in the 2010 AHLA/AAPC Coding Manual entitled, "Deciphering Codes: Fraud & Abuse for Coders and Coding Insight for Healthcare Lawyers."\nAnesthesia Resources and Links\nBy letter dated June 16, 2010, the American Society of Anesthesiologists (“ASA”) continued its efforts to request that the OIG intervene to issue a Special Advisory Bulletin prohibiting what is called the anesthesia “company model.” The ASA originally made the request to the OIG in March of 2009; however, to date, the OIG has not responded. Given that the company model has been gaining traction among ambulatory service center (“ASC”) owners, the ASA renewed its request and also attached an article published in March of 2010 specifically discussing the risks and concerns presented by the company model. The anesthesia company model involves the creation of a separate anesthesia company by the same or similar owners of the ASC. The establishment of this company essentially allows the owners of the ASC to share in the profits earned through the provision of anesthesia services at the ASC. The anesthesia company employs the anesthesia providers and bills for the professional anesthesia services. The same anesthesiologists who once held a professional service contract to provide anesthesia at the ASC and bill for those services are now required to be employed by the anesthesia company in order to continue to provide anesthesia services for facility patients. The ASA asserts that the company model is designed to incentivize over-utilization for anesthesia services since the owners of the ASC also own the anesthesia company and have a stake in the profits generated from anesthesia billing. The ASA notes that this problem leads to increases in the cost of care and may subject patients to unnecessary services. Moreover, the ASA takes the position that the company model results in anesthesia providers essentially being required to pay remuneration to the facility for the ability to provide anesthesia at the facility. Conversely, ASC owners respond that they have structured these arrangements to comply with the Anti-Kickback Statute.\nIn January 2011, CMS issued a transmittal clarifying the Interpretive Guidelines for the hospital conditions of participation for anesthesia services. This transmittal removes previous interpretive language that, “The administration of medication via an epidural or spinal route for the purposes of analgesia, during labor and delivery, is not considered anesthesia and therefore is not subject to the anesthesia supervision requirements at 42 CFR 482.52(a)”. The revised Interpretive Guidelines note that, "there is often no bright line, i.e., no clear boundary, between anesthesia and analgesia. This is particularly the case... with respect to labor epidurals." Hospitals are required to "establish policies and procedures, based on nationally recognized guidelines, that address whether specific clinical situations involve anesthesia versus analgesia... [H]ospital anesthesia services policies and procedures are expected to also address the minimum qualifications and supervision requirements for each category of practitioner who is permitted to provide analgesia services."\nOn June 1, 2012, the Department of Health and Human Services Office of Inspector General (the “OIG”) issued Advisory Opinion No. 12-06, which provides long-awaited guidance to the health care industry regarding the legal permissibility of an anesthesia delivery service model commonly referred to as the "company model." Insofar as Advisory Opinion No. 12-06 is the initial OIG guidance that specifically focuses on such an arrangement and determines that the factual paradigms presented implicate risks under the Medicare and Medicaid Antikickback Statute (the "AKS"), this Advisory Opinion understandably is capturing broad attention within the medical and legal communities. While OIG Advisory Opinion 12-06 clarifies the almost-axiomatic observation that company model arrangements, especially those that contain the indicia that the OIG historically has identified as problematic under the AKS, certainly have the potential to violate the AKS, the legal permissibility of each company model arrangement should continue to be analyzed based upon each arrangement's unique facts and circumstances. Stated otherwise, OIG Advisory Opinion 12-06 should not be interpreted to mean that all company model frameworks necessarily are violative of the AKS; rather, the Advisory Opinion reinforces the consistent guidance provided by The Health Law Partners that these arrangements need to incorporate the requisite structural safeguards. For further analysis by The Health Law Partners of OIG Advisory Opinion 12-06, click here.\nCMS Transmittals: Medicare Claims Processing Manual, 100-04, Trans. No. 2634, January 11, 2013—Internet Only Manual (IOM) Update to Payment for Medical or Surgical Services Furnished by CRNAs. This CR rescinds and fully replaces CR 8027, (Jan. 15, 2013).\nClick here for ASA's June 2011 article "Billing for Anesthesia Services and the QZ Modifier: A Lurking Problem."\nClick here for the ASA's FAQs on ACOs.\nClick here for an HLP blog regarding an anesthesia care package RAC issue.\nClick here for the guidelines regarding the payment rules for anesthesia services and teaching CRNAs.\nClick here Conditions of Participation, Hospital and Anesthesia Services\nClick here for the Final Revisions to Hospital Interpretive Guidelines Pertaining to Anesthesia\nClick here for the MLN article on Teaching Anesthesiologists and Teaching CRNAs\nClick here to access the Anesthesia regulations and Anesthesia rules\nClick here to access the Medicare Claims Processing Manual\nClick here to access the OIG Report of Medicare Payments for Facet Joint Injections.\nClick here to access the OIG Compliance Program Guidance for Physicians\nClick here to access the CMS Anesthesia Page\nU.S. ex rel. Kosenske v. Carlisle HMA, Inc., 2009 WL 129888 (C.A. 3Pa., January 21, 2009)\nUnited States v. Martinez, Nos. 06-3882/4206 (6th Cir. Dec. 1, 2009).\nAnesthesia and Pain Questions?\nAnesthesia and pain inquiries can be directed to Abby Pendleton, Esq. at (248) 996-8510 or (212) 734-0128. |
The plaintiff's contact lenses were packaged in a solution that was contaminated with pseudomonas. It caused an infection and scarring of the plaintiff's cornea. As a result of his now poor eyesight, the plaintiff fell, ruptured his spleen, and died.\nA 58-year-old man underwent a surgical procedure to correct his incontinence due to a prostate operation. Because the surgery was unsuccessful, a urinary prosthesis was implanted to correct the incontinence. The device repeatedly failed and the patient underwent numerous surgical procedures for replacement of\nA dentist, while opening a package of elastic ligature thread, suffered a severe laceration of his right thumb when the cutting utensil in the string dispenser flew out of the package. The manufacturer did not warn of this danger and later discontinued the use\nPlaintiff, a man in his early 60s, had been implanted with a pacemaker. The device malfunctioned and increased his heartbeat to between 150 and 200 beats per minute (the average being 80-100 beats per minute). He was taken to the hospital for emergency treatment\nDuring an operation, an unconscious, anesthetized patient required the administration of air. The anesthesiologist turned on the air from the wall supply and the "quick connect" coupling of the air machine to the wall air supply became disconnected under the pressure of the Air Hose\nAn elderly woman was undergoing radiation therapy following a mastectomy. When she was strapped to the stretcher assembly of the therapy machine and was being raised into position, the machine failed to shut off, and she was crushed between the stretcher assembly and the\nThe plaintiff had pain in her lower back and legs which her doctors were unwilling to continue to control by the administration of medication. She therefore underwent the implantation in her spinal column of a device designed to generate an electrical current that was\nThe plaintiff, a woman in her 20s, was using an IUD as a form of birth control. After repeated complaints of pain and discomfort, her physicians diagnosed an ovarian cyst and recommended surgery. During the operation, however, the surgeon discovered that an infection had |
Understanding fees and billing\nIt is USAP’s goal to minimize the confusion and hassle associated with resolving a patient's financial obligations. USAP participates in most managed care plans in the areas in which we provide service in order to minimize the financial burden on our patients.\nYou will likely receive a separate bill for your anesthesia service\nYour anesthesia providers are specialists like your surgeon or internist, and you will receive a bill for your anesthesia provider’s professional service separate from your surgeon’s services. USAP will submit most bills directly to your insurance company for payment on your behalf. Your hospital or surgery center will ask you for insurance and demographic information. Your cooperation in giving complete information will help get your insurance claim filed quickly.\nUSAP will file a claim with your insurance company\nIf we are provided with complete insurance information, we will file a claim to your insurance carrier. We usually allow the insurance company 30 days to process and pay our claim. If you have not received an explanation of benefits from your insurance company within this time, you may want to contact your insurance carrier directly to find out the status of the claim. Please note that the insurance company may hold a claim due to missing information from the insured or from another healthcare provider.\nIf there is an outstanding balance\nIn many cases, there may still be a balance due from you for deductible or co-payment amounts after your insurance has paid our claim. If we have been supplied with information regarding your secondary insurance, we will bill them for any balance due. If you do not have secondary insurance, you will receive a statement for the amount due. This balance is due upon receipt of our statement. If you do not have insurance or cannot afford to pay the balance after insurance in full within 30 days, please contact the billing department to set up a monthly payment arrangement after receiving your first statement.\nWe understand that the medical billing process is complicated and that the expenses associated with a surgery can be overwhelming. We are available to help answer any questions you have and to do what we can to accommodate your financial needs. |
Having undesirable fat in various areas of your body can have a substantial influence on your health and self-esteem. While traditional weight loss through exercise and diet is an excellent way to drop weight overall, even the very best exercises can't target issue locations like the stomach, inner thighs, arms, and buttocks. Liposuction is a time evaluated treatment that is used to remove excess fat from specific areas of the body, enabling an individual to form and contour their body to their liking. Is liposuction right for you? Discover now.\nPros of Liposuction\nThere are lots of benefits to this cosmetic treatment, including:\n• Right away visible changes. Unlike conventional weight loss, liposuction develops modifications that are instantly visible in the body. Some distinction is noticeable immediately, and the preferred results are usually accomplished in simply a few days.\n• Proven and safe. This cosmetic treatment has been carried out by knowledgeable surgeons all over the world for years and the technique has actually been refined over and again to be safe and effective.\n• Recovery time is generally quick. The downtime required after having this type of treatment is normally much less than what is required for other types of cosmetic treatments, consisting of tummy tucks, breast reduction, and more. Individuals who have had the treatment can typically return to work far more rapidly than they prepared for and can get back to living a healthy, active way of life.\n• Weight-loss can be long-term. With the right upkeep techniques, the fat that was eliminated during the liposuction treatment will not return.\n• Complete control over your body. With liposuction, an individual can have complete control over how they want to look, beyond exactly what traditional diet and exercise can offer. Giving people this power over their bodies enhances self-esteem and aid individuals feel their best.\nWhile there are numerous benefits to liposuction, there are of course a couple of caveats that need to be taken into account prior to making the final decision to move forward with the treatment.\nCons of Liposuction\nPrior to having actually liposuction done, it is essential to analyze the prospective drawbacks of the procedure and determine if the advantages surpass the dangers in your particular case. Your specialist can assist you find out more about the dangers connected with the treatment and can assist you decide if moving on is the right thing for you.\n• Issues with general anesthesia. Due to the fact that liposuction is carried out under general anesthesia, the treatment brings the exact same risks as any other type of surgical treatment where general anesthesia is used. Hidden medical conditions may enhance these threats.\n• Unfavorable responses. Bruising, bleeding, and pain are all to be expected, however, in uncommon cases can trigger more considerable complications.\n• The potential to gain the weight back. After having actually liposuction done, it is vital to preserve a healthy diet and exercise effectively as recommended by your physician. Failure to do so might lead to acquiring back the weight that was lost or potentially even more.\nThere are threats associated with liposuction, for many people, the benefits far outweigh them. Educate yourself about the procedure by having thorough discussions with your cosmetic surgeon and consider how liposuction has the potential to impact you as a special individual. Just you and your specialist can figure out if liposuction will supply you with the outcomes you are trying to find within your expectations.\nLaser Liposuction procedure is a new non invasive procedure to loose unwanted bodyfat in Bowler Wisconsin\nLaser liposuction is a more recent, minimally intrusive treatment that includes heating the fat cells to melting point and removing the melted fat through a small cannula. The procedure is typically done right in your doctor's workplace and is an excellent choice for people who have less than 500 ml of fat to eliminate from any one location. Laser liposuction can be a safe, complementary procedure to weight-loss in order to shape the body you've always wanted.\nContact a Surgeon in your Bowler Wisconsin today.\nIf you're thinking about liposuction as a weight-loss option, it is necessary that you discuss your desires with a certified cosmetic surgeon in your location. Your specialist will carry out a complete examination and health history questionnaire to determine if liposuction can benefit you and help you reach your physical and emotional objectives. Call today for an assessment and learn more about how liposuction can assist you attain the body of your dreams. |
Hi, well "everyone" is a broad term. I work in an out patient surgery and GI clinic. We all have ACLS, it is required to work PACU.\nIn a GI only clinic, an RN giving moderate sedation, I'm not sure of the rules, depends on that states Board of Registered Nursing, to the Dr's scope of practice, his licensing, etc. Giving moderate sedation in my area of the country requires the nurse to have ACLS. |
By Dr. Gary RadzAnyone who’s ever been to the Four Seasons Hotel or Nordstrom’s department store has experienced great\nWe like to think that our office’s high tech/high touch approach creates a positive experience that will not only make our patients leave feeling like they had a great experience, but make them want to tell their friends as well.\nOne of the best moves I made 10 years ago was hiring an office manager who shares my belief that patients are our only priority. Teri has helped me assemble a team of professionals that understands that great dentistry and great patient care include providing great patient comfort.\nI have a team of seven ladies that have been with me four or more years that all understand this overlying philosophy of making sure that patients always know they are our priority. Their comfort in our office is part of this overlying principle.\nAs soon as patients enter the office, they are greeted with a smile and a handshake. The reception area is small for several reasons: 1) we expect to stay on time, 2) we want to create an intimate atmosphere where our patients feel like they are not just a number, and 3) this area needs to be quiet. Patients, especially new ones, often arrive to the office feeling nervous. I feel that a calm, quiet reception area can help reduce their stress.\nWhen a patient is taken into the clinical area, the dental hygienist or dental assistant calls them by name and greets them with a smile and a handshake. In our office we like to use first names when we greet patients, as we consider them friends. However, this is acceptable for our part of the world.\nIn my previous practice in North Carolina no one, including the dentist, called a patient by first name until they were given permission. But the point is that whatever is appropriate for your community, region, or culture, be sure to address the patient in a polite and friendly manner.\nIn the clinical area we have made every effort to make the patient experience as comfortable as possible. We have slightly oversized operatories and an “open wall” design, so that the clinical area does not feel claustrophobic. Using All Dental Prodx line of products, we use subtle aromatherapy to eliminate the dental/medical smell. In each operatory we have comfortable and well-padded dental chairs by Midmark. The new Elevance chairs have vibration and heat built into them. Patients rave about this. We show our patients how to control both the vibration and the heat, thereby starting their experience with a level of some control. I believe that this small level of control helps them become more relaxed.\nMost dental offices are kept pretty cold because the dental professionals are hot working with gloves, masks, and gowns, and sweating on patients is not acceptable. We acknowledge that it feels like a meat locker in the operatory and provide warm fleece blankets (with our logo on them of course) for patients so that they are comfortable. We recently found neck pillows (www.dentalfilmclub.com) made of form fitting foam that are extremely comfortable and allow a patient’s head/neck to cradle into a position that is comfortable to maintain through long procedures.\nWe recently started using the NuCalm system (www.nucalm.com) for relaxation in the office. NuCalm is a non-narcotic system that uses cranial electrotherapy stimulation, neuroacoustic stimulation, blackout glasses, and a tablet containing gamma-aminobutyric and acid L-theanine that allows anxious patients to have a comfortable experience without narcotics. Our short experience with this system has been very well received.\nAs a needle phobic myself I have developed a system to provide patients with the most comfortable experience possible when administering local anesthetic. The first key is proper use of topical anesthetics. First, I dry the injection site.\nThen I place a topical anesthetic (20% benzocaine, Kolorz, DMG America) on a cotton roll on the injection site for three to four minutes.\nAfter two to four minutes I let the patient know that I’m going to get them more numb and deliver the rest of the carpule. Nine times out of 10 they tell me they didn’t feel a thing with the second injection.\nOkay, it’s a little more involved than that. What I described works great in the maxillary arch using 2% lidocaine with 1:100,000 epi. We all know that the mandibular arch is a different animal. From second premolar to second premolar I have used the above technique with Septocaine (Septodont) with great results. With years of clinical experience with this drug I have found that I get excellent anesthesia on the molars with my smaller adult patients.\nWith larger adults I have found that I need to provide a block (either an IA or Gow-Gates). But even then I’ve found that if I do multiple injections using smaller amounts over a slightly longer time I can make even the uncomfortable mandibular blocks more comfortable.\nFinally, the introduction of OraVerse (Septodont) has been a nice option for patients. OraVerse allows patients to regain sensation quickly to an anesthetized area. This is a very popular option for patients that come in in the middle of the workday.\nDuring the procedure we use many techniques and technologies to create a more positive experience. Recently we purchased an Isolite system. Not only can I work faster in the well isolated and illuminated environment, patients have a comfortable bite block so they don’t have to concentrate on staying open (which is needed because patients on NuCalm tend to close because they are so relaxed). It’s a great system that I should have bought years ago.\nI could not practice without my NV diode laser (Discus). Every day I perform several soft tissue surgical procedures with this laser. Not only is it quick and easy, diode laser procedures consistently have no postoperative discomfort.\nI cannot remember the last time I received a phone call or needed to prescribe a narcotic after doing surgery with my diode laser. The other item that my patients love as much as I do is my electric handpieces (NSK, Brasseler). I love these for the remarkable torque and precision, but patients notice the reduced noise that they associate with a negative dental experience.\nUpon completion of the dental procedure, the team or I will review postoperative instructions and answer any questions. Even if we are running behind on the schedule we make an effort for patients not to feel like they are being rushed out the door. Then one of us will walk the patient to the front desk and hand them off to the business team. Upon arrival at the front our team members have all paperwork ready to be filled out, and they are ready to receive payment.\nOther things that we do for patients to make them feel welcome, comfortable, and enhance their experience with our office\n► We have created a Zen room (see Figs. 3 and 4) (an idea that I shamelessly stole from Dr. Dennis Wells). This is a small room in a quiet part of the office that contains a massage chair and a 40-inch flat screen TV. If we are running behind, if a patient is waiting to see me after a hygiene appointment, or if a patient just wants a short break during a long procedure, one of our team members will offer the patient the option of relaxing in the massage chair. Just the other day we got a great posting on our Facebook fan page from a patient raving about the chair, and she posted it while sitting in the chair.\n► A big part of the stress of dental procedures for many patients is the cost. We provide the option of financing care with Springstone Financing. With this company the patient can apply for credit while in the office, and often receive an answer within 10 minutes. This quick response helps patients move ahead with treatment. It also allows us to provide an alternate treatment plan that will fit their budget.\n► Using digital technology we are able to keep in constant contact with our patients. Smile Reminder has been a wonderful service to remind patients about their appointments via email or text. With this company we are able to get out a monthly electronic newsletter. We can also send out surveys to patients to find out what we’re doing well and where we can improve. On our website we have installed a “chat box” (www.staffeddentalchat.com) that allows patients the opportunity to ask questions and get information immediately.\n► A recent addition to our office technology is the 3M Lava C.O.S. digital impression machine. For many patients, impressions are an uncomfortable part of their dental experience. Replacing impression material with a video camera has been very well received by our patients. We even have patients come specifically to us because they fear impressions so much that they’re willing to switch offices to avoid the experience. Other patients just think the technology is really cool and enjoy seeing what we’re doing to create their dental restorations.\nThe fun part is we have just scratched the surface of all the things we can do to provide our patients with a better, more comfortable dental experience. In our office, new ideas from the team and the patients are welcome, seriously considered, and often implemented.\nThese are just some of the things we are doing. What are you doing for your guests?\nDr. Gary Radz maintains a private practice in downtown Denver, Colo. He is an associate clinical professor at the University of Colorado School of Dentistry. For more information about Dr. Radz, go to www.garyradz.com.\nFor more on this topic, go to www.dentaleconomics.com and search using the following key words: ultimate team goal, relaxation, customer service, office manager, Dr. Gary Radz. |
Loss of The Airway During a Deep Brain Stimulation Procedure – A Case Report\nSofia Geralemou, M.D. & Angele Theard, M.D.\nDeep brain stimulation (DBS) is a surgical procedure in which electrodes are implanted to stimulate areas of the brain responsible for the disease it treats. It has five FDA-approved indications in the United States, including Parkinson’s Disease, essential tremors, drug-resistant epilepsy, dystonia, and obsessive-compulsive disorder. 1 Off-label/experimental indications are epilepsy, depression, Tourette syndrome, headache, obesity, Alzheimer’s disease, and the minimally conscious state. 2\nDBS surgery is a two-stage procedure. In the first stage, the electrodes are implanted in the brain. In the second stage, an internal pulse generator (IPG) is implanted and connected to the electrodes.\nThe success of DBS surgery depends on precision and accurate electrode insertion. Using a stereotactic frame is a common method to find the target coordinates with the assistance of magnetic resonance imaging or computed tomography using computer software. The patient’s frame is then attached to the operating room table and a geometric arc is placed to allow the target to be achieved from any angle given a stable radius. However, a frameless stereotaxy is available and is increasingly used. It has the advantage of reduced surgical procedure time and less patient discomfort and provides better airway access. 3\nWhen the coordinates are identified, a skin incision and a burr hole are made. The dura is then opened, and the electrode is introduced. At this point, the process of microelectrode recording is started (MER), and the patient’s feedback is used to monitor the effect of stimulation. Electrodes are implanted in the treatment target area and then connected to an internal pulse generator implanted subcutaneously in the upper chest.\nA 56-year-old patient with Parkinson’s disease (PD) was scheduled for (MER) for insertion of DBS. The past medical history was significant for hypertension, obesity, and obstructive sleep apnea (OSA). We opted for an Asleep Awake Asleep (AAA) technique for this procedure. The patient was induced, and the airway was secured with a laryngeal mask airway (LMA). The surgeon made a burr hole and started introducing the electrodes. The anesthetic was then discontinued. When the patient began to emerge, the LMA was removed. The patient started following commands, and the microelectrode recording (MER) was initiated. Minutes later, the patient began moving his arms in discomfort. Several small boluses of fentanyl were given. Minutes later, the patient started to obstruct and desaturate. We applied a jaw thrust and a trial of positive pressure ventilation, but both failed. The airway was then resecured with an LMA after the administration of a propofol bolus. A nasal airway was inserted, and a dexmedetomidine bolus followed by an infusion was started. Another attempt to emerge the patient was made. The LMA was removed successfully, and the patient remained calm for the duration of the procedure. After the electrode placement was completed, the patient was sedated for closure, and the procedure concluded uneventfully.\nDeep brain stimulation\nThe therapeutic success of DBS surgery depends on the precise localization of electrodes to the target subthalamic nucleus. Several methods are used, including stereotactic frame-based imaging, intraoperative MER, stimulation testing of an awake patient, or the use of intraoperative magnetic resonance imaging (MRI).\nMER is spontaneous and stimulus-evoked neuronal discharges that are recorded via a microelectrode as it is advanced toward the target nuclei. MER is an electrophysiological guidance method to localize the target nuclei. In stimulation testing, the implanted DBS electrodes are used to stimulate the target nucleus briefly in an awake patient to confirm the improvement in symptoms such as tremors and rigidity without causing side effects.\nAwakening the patient during MER will facilitate the process. MER can be successful under light sedation as well as under general anesthesia (based on anatomical coordinates).\nPreoperative preparation: The patient’s long-term disease-specific medications are usually discontinued so that the symptoms become more apparent for intraoperative testing. All antiparkinsonian medications are withdrawn 12 hours before the surgery. Hypotension is a common side effect in patients with antiparkinson drugs. By withholding antiparkinsonian medications, hypertension may result. Additionally, beta blockers are held in movement disorders. To minimize the risks of intracranial hemorrhage, anesthesia providers should screen patients for preoperative uncontrolled hypertension and coagulopathy. The routine discontinuation of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) in this particular procedure may be avoided as it is considered an independent predictor of hypertension requiring more aggressive intraoperative therapy. 4Benzodiazepines are direct GABA agonists that can abolish the recording. If midazolam is needed, a single small dose is recommended a few hours before MER to facilitate the placement of the stereotactic frame. However, propofol is preferred because of its extra short duration 5.\nA stereotactic head frame is usually placed under local anesthetic infiltration or by using scalp blocks while the patient is awake. The frame is a fixed, rigid metal that is placed parallel to the anterior commissure–posterior commissure line. It extends from the lateral canthus/orbital floor to the tragus. The head should be centered so that the midline lies within the center of the head frame system.\nIntraoperative Management: Anesthesia ranges from monitored anesthetic care (MAC) and asleep-awake-asleep (AAA) to general anesthesia (GA). 6 GA is indicated in pediatric and uncooperative patients. Localization of STN using intraoperative MER is possible and showed no difference with a variety of inhalational and intravenous anesthetic agents. 7 Scalp blocks were shown to be superior to local anesthetic infiltration in terms of better intraoperative hemodynamics and less need for antihypertensive medications during surgery. 8\nIn the AAA technique, GA with a protected airway is used in the asleep part. This is needed for the scalp incision, burr hole, and dural opening. A laryngeal mask airway (LMA) is usually used to maintain the airway as it is easy to remove when the patient is wakened before the MER. During the MER, the patient is either kept completely awake by turning off all the medications 15 minutes before or lightly sedated using low doses of dexmedetomidine, remifentanil, or propofol infusions. Then, after the localization of the target areas, the patient is induced once again, and an LMA is inserted for closure.\nEffect of Anesthetics on MER: Anesthetics such as benzodiazepines, barbiturates, propofol, etomidate, and volatile agents can potentiate the inhibitory actions of GABA within the basal ganglia and can worsen or abolish MER. 9 Although propofol and remifentanil can inhibit MER significantly and propofol can induce sneezing, MER was successful under low-dose propofol and remifentanil. Using the proper dose of the medication is more important to facilitate the MER. Using target-controlled analgesia, a plasma concentration of 0.8–2 mg/ml provided enough sedation and did not inhibit MER. 10\nDexmedetomidine is becoming increasingly utilized for this procedure for its sedative, analgesic, and anxiolytic effects without significant effects on MER. It was found that dexmedetomidine at low doses (< 0.5 μg/kg/h) does not significantly impact the quality of MER in either the GPi or STN. 11 One possible drawback of dexmedetomidine is hypotension which can be magnified in patients with PD and rebound hypertension once the infusions are discontinued. Paradoxical agitation is another drawback, especially with the higher infusion doses. 12\nAirway Management: The airway can be challenging in these cases for several reasons. Patients with PD can have upper airway dysfunction due to uncoordinated involuntary movements of the pharyngeal, glottic, and supraglottic structures resulting in the retention of secretions, intermittent upper airway obstruction, and aspiration. 13 The operating room table is also usually turned 180 degrees away from the anesthesia provider, which adds to the difficulty. Also, if a stereotactic frame is placed, the standard adult anesthesia circuit face mask cannot be utilized. To prevent obstruction of the airway, Scharpf et al.14 described using a tourniquet around the chin and face to provide a hand-free chin-lift to prevent airway obstruction or inserting a nasopharyngeal airway.\nIn an emergency airway situation, the use of a pediatric face mask or laryngeal mask airway can be utilized. 15 Also, tools to remove the stereotactic frame should be immediately available.\nHemodynamic Management: Intracranial hemorrhage due to uncontrolled hypertension during surgery is a devastating complication that can result in a permanent neurological deficit. A target systolic blood pressure of 140 mmHg is usually used as an endpoint for the prevention of intracerebral hemorrhage. Comfortable patient positioning, pain control (i.e., scalp nerve blocks 16), temperature control, prevention of bladder distension, and avoidance of excessive fluid administration may help to control blood pressure.\nSecond Stage: The second stage of DBS is performed by tunneling the electrodes and connecting the extension cable through the scalp subcutaneously on the side of the neck to an infraclavicular area where it is connected to the pulse generator. This can be done on the same day or on another day. This second stage is usually done under GA. If done on the same day, there may be difficulty maintaining adequate cerebral perfusion after the use of intraoperative antihypertensive medications 17\nComplications of Anesthesia during DBS:\nVenous air embolism and seizures are possible complications. 18 Anesthesia providers should also be aware of the possibility of an akinetic crisis typically found in patients with severe PD disease, in which the patient is alert and conscious but unable to communicate. 19\nAcknowledgment: I would like to thank Sergio Bergese, MD, and Charles Mickell II for reviewing this manuscript.\n- DeLong MR, Wichmann T. Basal Ganglia Circuits as Targets for Neuromodulation in Parkinson Disease. JAMA Neurol. Nov 2015;72(11):1354-60. doi:10.1001/jamaneurol.2015.2397\n- Grant R, Gruenbaum SE, Gerrard J. Anaesthesia for deep brain stimulation: a review. Curr Opin Anaesthesiol. Oct 2015;28(5):505-10. doi:10.1097/ACO.0000000000000230\n- Piano C, Bove F, Mulas D, Bentivoglio AR, Cioni B, Tufo T. Frameless stereotaxy in subthalamic deep brain stimulation: 3-year clinical outcome. Neurol Sci. Jan 2021;42(1):259-266. doi:10.1007/s10072-020-04561-9\n- Rajan S, Deogaonkar M, Kaw R, et al. Factors predicting incremental administration of antihypertensive boluses during deep brain stimulator placement for Parkinson’s disease. J Clin Neurosci. Oct 2014;21(10):1790-5. doi:10.1016/j.jocn.2014.04.005\n- Venkatraghavan L, Manninen P. Anesthesia for deep brain stimulation. Curr Opin Anaesthesiol. Oct 2011;24(5):495-9. doi:10.1097/ACO.0b013e32834a894c\n- Erickson KM, Cole DJ. Anesthetic considerations for awake craniotomy for epilepsy and functional neurosurgery. Anesthesiol Clin. Jun 2012;30(2):241-68. doi:10.1016/j.anclin.2012.05.002\n- Wang JJ, Tian H, Rao J, et al. Efficacy and safety of general anesthesia deep brain stimulation for dystonia: an individual patient data meta-analysis of 341 cases. Neurol Sci. Jul 2021;42(7):2661-2671. doi:10.1007/s10072-021-05214-1\n- Yang X, Ma J, Li K, et al. A comparison of effects of scalp nerve block and local anesthetic infiltration on inflammatory response, hemodynamic response, and postoperative pain in patients undergoing craniotomy for cerebral aneurysms: a randomized controlled trial. BMC Anesthesiol. Jun 1 2019;19(1):91. doi:10.1186/s12871-019-0760-4\n- Hippard HK, Watcha M, Stocco AJ, Curry D. Preservation of microelectrode recordings with non-GABAergic drugs during deep brain stimulator placement in children. J Neurosurg Pediatr. Sep 2014;14(3):279-86. doi:10.3171/2014.5.PEDS13103\n- Maltete D, Navarro S, Welter ML, et al. Subthalamic stimulation in Parkinson disease: with or without anesthesia? Arch Neurol. Mar 2004;61(3):390-2. doi:10.1001/archneur.61.3.390\n- Rozet I, Muangman S, Vavilala MS, et al. Clinical experience with dexmedetomidine for implantation of deep brain stimulators in Parkinson’s disease. Anesthesia and analgesia. Nov 2006;103(5):1224-8. doi:10.1213/01.ane.0000239331.53085.94\n- Rozet I. Anesthesia for functional neurosurgery: the role of dexmedetomidine. Curr Opin Anaesthesiol. Oct 2008;21(5):537-43. doi:10.1097/ACO.0b013e32830edafd\n- Easdown LJ, Tessler MJ, Minuk J. Upper airway involvement in Parkinson’s disease resulting in postoperative respiratory failure. Canadian journal of anaesthesia = Journal canadien d’anesthesie. Apr 1995;42(4):344-7. doi:10.1007/BF03010713\n- Scharpf DT, Sharma M, Deogaonkar M, Rezai A, Bergese SD. Practical considerations and nuances in anesthesia for patients undergoing deep brain stimulation implantation surgery. Korean J Anesthesiol. Aug 2015;68(4):332-9. doi:10.4097/kjae.2015.68.4.332\n- Schulz U, Keh D, Fritz G, et al. [“Asleep-awake-asleep”-anaesthetic technique for awake craniotomy]. Der Anaesthesist. May 2006;55(5):585-98. “Schlaf-Wach-Schlaf”-Technik zur CS Wachkraniotomie. doi:10.1007/s00101-006-1023-6\n- Krauss P, Marahori NA, Oertel MF, Barth F, Stieglitz LH. Better Hemodynamics and Less Antihypertensive Medication: Comparison of Scalp Block and Local Infiltration Anesthesia for Skull-Pin Placement in Awake Deep Brain Stimulation Surgery. World Neurosurg. Dec 2018;120:e991-e999. doi:10.1016/j.wneu.2018.08.210\n- Nada EM, Rajan S, Grandhe R, et al. Intraoperative Hypotension During Second Stage of Deep Brain Stimulator Placement: Same Day versus Different Day Procedures. World Neurosurg. Nov 2016;95:40-45. doi:10.1016/j.wneu.2016.07.050\n- Venkatraghavan L, Manninen P, Mak P, Lukitto K, Hodaie M, Lozano A. Anesthesia for functional neurosurgery: review of complications. J Neurosurg Anesthesiol. Jan 2006;18(1):64-7. doi:10.1097/01.ana.0000181285.71597.e8\n- Schulz U, Keh D, Barner C, Kaisers U, Boemke W. Bispectral index monitoring does not improve anesthesia performance in patients with movement disorders undergoing deep brain stimulating electrode implantation. Anesthesia and analgesia. Jun 2007;104(6):1481-7, table of contents. doi:10.1213/01.ane.0000261516.45687.ee |
Laryngeal Cancer: Surgery\nLaryngeal cancer is commonly treated with surgery to remove the cancer. All or part\nof the larynx, or voice box, may be removed. This surgery is called a laryngectomy.\nThe type of procedure needed depends on where the cancer is in the larynx and how\nbig it is. Laryngectomy is often done along with other treatments, like chemotherapy\nor radiation therapy, to destroy the cancer and help keep it from coming back.\nTypes of surgery for laryngeal cancer\nDifferent surgeries can be done based on the stage of the cancer and where it is.\nIf the cancer has spread, then some of the nearby lymph nodes or muscles in the neck\nnear the larynx may also need to be removed. Types of procedures that might be done\nPartial laryngectomy. This removes part of the larynx, or voice box. You can talk after this surgery, but\nyour voice may not sound the same.\nTotal laryngectomy. Surgery to remove the entire larynx. This may be the only choice for advanced laryngeal\ncancer. A hole is made in the front of your neck so you can breathe. You won’t be\nable to talk after this surgery.\nHemilaryngectomy. Surgery to remove only half or one side of the larynx. You will be able to speak\nafter this surgery, but your voice may sound different.\nThyroidectomy. Surgery to remove the thyroid gland. If the entire gland is removed, you'll need\nto take thyroid hormones the rest of your life.\nCordectomy. Surgery to remove some or all of the vocal cords. Your voice will be hoarse if some\nof the cords are removed. If all of the cords are removed, you won't be able to talk\nVocal cord stripping. This removes the cancer cells from the surface of the vocal cords. Most people don't\nhave changes in their ability to talk.\nLaser surgery. Uses a laser to remove a tumor or defect on the surface of the larynx. This can cause\nyour voice to sound hoarse.\nSupraglottic laryngectomy. Removes only the top portion of the larynx, above your vocal cords. It doesn't affect\nNeck dissection. Surgery to remove the lymph nodes in the neck where cancer has or is likely to have\nspread. In a full radical neck dissection, nerves and muscles are removed along with\nthe lymph nodes. This can affect how you move your neck and shoulders.\nThe larynx is part of how we eat, breathe, and talk. Surgery in this area might also\naffect how you look. There are many ways to treat this cancer with surgery. Be sure\nyou understand what type of surgery is best for you and how your body will work and\nlook after it.\nRisks of laryngeal cancer surgery\nAll surgery has risks. The risks of laryngeal surgery include:\nPossible long-term or permanent side effects depend on the type of surgery and include:\nDamage to nerves and other tissues near the cancer that causes numbness\nChanges in how you eat and swallow\nChanges in your sense of smell and taste\nChanges in how you talk or not being able to talk the way you did before\nChanges in how you breathe\nChanges in how you look\nTalk with your healthcare provider about the side effects you may have and your chances\nof side effects after surgery.\nGetting ready for your surgery\nYour healthcare team will talk with you about the surgery choices that are best for\nyou. Make sure to ask:\nWhat type of surgery will be done\nWhat will be done during surgery\nWhat the risks and possible side effects of the surgery are\nIf there will be changes in how you talk, breathe, or eat\nWhen you can return to your normal activities\nWhat you will look like after surgery\nAfter you have discussed all the details with the surgeon, you will sign a consent\nform. This gives the surgeon permission to do the surgery.\nYou’ll also meet the anesthesiologist and can ask questions about the anesthesia and\nhow it will affect you. Just before your surgery, an anesthesiologist or a nurse anesthetist\nwill give you the anesthesia drugs so that you fall asleep and don’t feel pain.\nWhat to expect after surgery\nAfter surgery for laryngeal cancer, you may have to adjust to new ways of eating,\ndrinking, speaking, and breathing. The types of changes you have depend on the type\nof surgery that was done.\nLearning to speak\nTotal laryngectomy takes away your ability to speak using your vocal cords. A therapist\ncalled a speech-language pathologist will work with you to help you to speak again.\nBut your voice will sound different. Surgery might also be done later to help you\nIf your entire larynx is removed, you'll need to learn to speak in a new way. This\nwill take practice. Before surgery or soon after, the speech-language pathologist\nmay talk with you about your choices for speech. These include:\nEsophageal speech. For this approach, the speech-language pathologist teaches you how to swallow and\nthen release air like a burp from the walls of your throat. You can learn how to form\nwords from the released air with your lips, tongue, and teeth.\nTracheoesophageal puncture. This surgery is done either at the same time the larynx is removed or as a separate\nsurgery later. The surgeon makes a small hole between your trachea and esophagus and\nplaces a small device in the opening. With practice, you can learn to speak by covering\nthe hole and forcing air through the device. The air makes sound by vibrating the\nwalls of your throat.\nElectric larynx. An electric larynx is a small, battery-powered device. It makes a humming sound like\nthe vocal cords, and you move your lips to form words. Some models are used in the\nmouth, while other models are placed on the neck.\nThe larynx also plays an important role in how you breathe. When all of the larynx\nis removed, you'll need a new way of breathing. The surgical team will make a hole\nin your neck called a tracheostomy. They will permanently connect your windpipe (trachea),\nwhich carries air to the lungs, to this hole in the front of your neck. Breathing,\ncoughing, and sneezing will then be done through this hole, called a stoma, rather\nthan through your nose and mouth.\nThe stoma may be held open with a tube you breathe through. This tube is called a\ntracheostomy tube, or trach tube. The trach tube stays in for a few weeks, until the\nskin around the stoma heals. Some people continue to use the trach tube all or part\nof the time. Or, it can be removed and a smaller tracheostomy button, called a stoma\nbutton, can be used instead. After a while, some people don’t use a tube or a button\nin their stoma.\nAfter a partial laryngectomy, a short-term tracheostomy may be needed. Then the trach\ntube is removed. Over the next few weeks, the stoma closes. You then breathe and speak\nin the usual way, although your voice may not sound the same as before.\nThe stoma must be correctly cared for to prevent problems and complications. Your\nhealthcare team will help you learn how to care for it.\nEating on your own\nFor a few days after surgery, you won’t be able to eat or drink. At first, you’ll\nget nutrients through a tube into one of your veins. This is called IV or intravenous\nIn a day or so, your digestive tract will return to normal. But you won’t be able\nto swallow because your throat won’t be healed. You’ll get foods and liquids through\na feeding tube that goes through your nose and throat to your stomach. It will be\ntaken out in 2 or 3 weeks when your throat heals. This will allow you to swallow again\nand take in enough food through your mouth to maintain your weight.\nSwallowing may be hard at first, and you may need the help of a nurse or speech-language\npathologist to learn how to swallow again. Over time, you'll return to a regular diet.\nRecovering at home\nWhen you get home, you may get back to light activity. But you shouldn't do any strenuous\nactivity for about 6 weeks. Your healthcare team will tell you what kinds of activities\nare OK while you recover.\nIf you had surgery to remove lymph nodes in your neck, your shoulder and neck may\nbe weak and become stiff. A physical therapist can help you with special exercises\nif this happens.\nWhen to call your healthcare provider\nLet your healthcare provider know right away if you have any of these problems after\nBreathing problems or shortness of breath\nRedness, swelling, or fluid leaking from the incision\nFever of 100.4° (38°C) or higher, or as directed by your healthcare provider\nChanges in how your urine looks or smells\nNew swelling, redness, warmth, or pain in an arm or leg\nThere may be other things your healthcare provider wants you to watch for. Be sure\nyou know what to watch for. Also know how to reach your provider after office hours\nand on weekends and holidays. |
Neck Lift – Enhance the Appearance of Your Neck\nA neck lift can enhance the look of your neck. The neck usually reveals signs of aging years prior to the face does. Both males and females can gain from this treatment. At Lexington Plastic Surgery in Lexington, Kentucky, patients can expect outstanding outcomes and also an overall experience that meets or surpasses expectations. This workplace gives the best quality of individual care and the highest level of individual complete satisfaction.\nNeck-lift treatments can refine the look of the jaw line as well as neck. They can be performed as component of a facelift or on their own. Lexington Cosmetic surgery uses a mix of strategies to achieve the preferred outcomes. They can utilize lipo to correct excess fat as well as tissue and can use limited-incision methods to fine-tune the jaw line and neck. In most cases, these procedures can be done on an outpatient basis under moderate sedation.\nA neck lift is a non-surgical procedure that can enhance drooping neck skin or a dual chin. This treatment creates natural-looking results that last for several years. It can additionally be done to correct crooked or level noses. Plastic Surgery Consultants in Lexington, KY, and also the bordering locations give these solutions.\nA neck lift is an usual plastic surgery procedure that boosts the appearance of the neck and jaw line. The treatment is normally carried out as component of a facelift or as a standalone procedure. The Louisville Plastic Surgery team utilizes a variety of methods to create a natural-looking outcome. These include lipo and also limited-incision strategy to improve the jaw line. The surgical treatment normally calls for little cuts behind the earlobes as well as under the chin. Recuperation for a neck lift is similar to that of a facelift. People are usually called for to put on a chin assistance garment for one night complying with surgical procedure. The treatment is normally executed under general anesthetic in a Lexington KY surgery center.\nA neck lift can provide you an extra younger appearance by lifting the skin at the neck of the neck. While it is usually executed combined with a facelift, it can additionally be done by itself. For this procedure, a physician makes a cut under the chin and small lacerations at the earlobes. During the procedure, excess skin and fat in the neck are eliminated. The healing duration resembles that of a facelift. The surgical treatment takes roughly two to three hrs, and you will need to put on a chin assistance garment for one evening after the procedure. Generally, the procedure is performed under basic anesthesia at the Lexington Surgery Center.\nGetting a neck lift\nGetting a neck lift is a common procedure that restores your necks youthful appearance. This aesthetic treatment is a great choice for any person seeking to improve the look of drooping skin around the neck as well as to deal with a double chin. The arise from this procedure are natural-looking and can last for years. Lexington Plastic Surgery, Kentucky, provide this treatment for both males and females. Lexington Plastic Surgery dedicated to give excellent outcomes that surpass their patients expectations.\n3363 Tates Creek Rd # 209, Lexington, KY 40502\n( 859) 279-2111\nLexington Plastic Surgery\n3363 Tates Creek Rd #209 |
Laminectomy is a major surgery that involves removing some of all of your vertebral bone or lamina. The surgery is also known as decompression surgery, and it is performed to create extra spacing in your spinal canal, thus reducing pressure on the spinal cord and nerves caused by a damaged disc.\nLaminectomy is the last result when all forms of treatments have failed to yield results. In addition, the surgery helps in relieving pressure caused by narrowing of the canal, injury, or herniated disc. The pressure is typically caused by bony overgrowths within the spinal canal. These overgrowths are sometimes referred to as “bone spurs,” and they are a common side effect of the human aging process.\nWhat is a laminectomy?\nWhen a dense bone in the spinal canal causes limitations in its spinal canal space, it causes numbness or weakness. The numbness, pain, or weakness felt in your arms, neck, and legs may cause you pain and limit most of your movement (without you realizing it). At Ceda Orthopedic Group, we typically recommend laminectomy if:\n- All other treatments recommended, like physical therapy, or medications don’t produce results.\n- You lose total or complete control of your bowels and bladder.\n- You experience muscle numbness or weakness in your arms or legs, making standing and walking difficult.\nIn some cases, laminectomy surgery may treat a herniated disc by removing part of the lamina to reach the damaged disc. Laminectomy is performed when more conservative treatments, like injections, medications, or physical therapy have failed to relieve your back pain. It is also recommended by surgeons if the symptoms have severely worsened.\nIf you think your pain could be healed with the help of an orthopedic surgeon in Miami, Florida, contact a specialist at Ceda Orthopedic Group for more information on Laminectomy or other similar procedures.\nRisk of laminectomy procedure\nGenerally, laminectomy is a safe procedure and poses lower risks to the patients who receive the surgery. However, any surgery major or minor has the potential for risks, such as:\n- Nerve injury\n- Blood clots\n- Spinal fluid leak\nWhen a laminectomy procedure is performed, it’s common for a hospital gown to be provided, which you will change into comfort, and to make the procedure easier for the surgeon. The surgical nurse will start you on an IV either in your arm or your hand to administer anesthesia. Once you are under anesthesia and asleep, a nurse will proceed to insert a urinary drainage catheter. If you have excessive hair on the surgical location, it will be clipped or shaved away to prevent distractions or infections; however, your orthopedic surgeon at Ceda Orthopedic Group will have already informed you on all this before the surgery occurs in your preoperative appointments.\nDuring the laminectomy procedure, the surgeon will either lay you on your side or belly on the operating table. Your heart rate, breathing, blood pressure, and oxygen will be under close monitor by the anesthesiologist all through the entire surgery. The surgeon will cut the damaged vertebrae then spread the muscle apart.\nThe surgeon will then remove the bone arch of the lamina to ease the pressure on the affected nerve area.\nThe procedure may sometimes involve removing bone spurs, removing the part, and sometimes all the disc and growth.\nIf need be, a spinal fusion may be performed simultaneously if your orthopedic recommends it. Spinal fusion is joining two or more damaged vertebrae in your spine to stop their movements. The incision is then closed by either surgical staples or stitches. These will need to be removed after the incision has healed after the procedure.\nFinally, after the laminectomy surgery, you will be under observation in the recovery room until your blood pressure, heart rate, breathing, and pulses are stable, then moved to your hospital room once you are awake and everything is stable. Your surgeon will prescribe medication and rest to help the healing process. Your surgeon might also recommend physical therapy to speed up the recovery process.\nSee the results from a laminectomy for yourself: book a laminectomy procedure at Ceda Orthopedic Group\nCeda Orthopedic Group in Miami, Florida, can help relieve pressure caused by narrowing of the spinal canal, injury, or herniated disc. Laminectomy is the last result when all forms of treatments have failed to yield results.\nSchedule an appointment with a Ceda Orthopedic Surgeon, and we will recommend pain medication or an exercise plan to help you get back to your usual self. During this initial appointment, we will determine if your back pain could improve with a Laminectomy procedure.\nContact Ceda Orthopedic Group to book an appointment with one of our medical physicians to help with your pain. |
Administering local anesthetics (LAs) peri- and post-operatively aims to prevent or mitigate pain in surgical procedures and after tissue injury in cases of osteoarthritis (OA) and other degenerative diseases. PGE2 levels in the Pazopanib inhibitor database co-cultures further indicating MSC-independent macrophage attenuation. MSC functional recovery from LA exposure was assessed by pre-treating MSCs Pazopanib inhibitor database with LAs prior to co-culture with macrophages. Both MSC attenuation of TNF- and PGE2 secretion were impaired by pre-exposure to the more potent bupivacaine and high dose of lidocaine in a concentration-dependent manner. Therefore, LAs can affect anti-inflammatory function by both directly attenuating macrophage inflammation and MSC secretion and possibly by altering the local Pazopanib inhibitor database microenvironment which can secondarily reduce MSC function. Furthermore, the LA effect on MSC function may persist even after LA removal. Introduction Mesenchymal stromal cells (MSCs) possess many tissue protective and regenerative properties, including modulation of inflammatory and immune cells and chondrogenic differentiation, which make them attractive as a cellular therapeutic to treat osteoarthritis (OA).1-6 We and others have demonstrated that MSCs respond to their microenvironment and play an important role in promoting tissue regeneration in part by attenuating pro-inflammatory macrophage secretion of tumor necrosis factor (TNF)- via production of prostaglandin E2 (PGE2).7 Progression of OA occurs in conjunction with an increase in pro-inflammatory (M1) macrophages which not only exacerbate articular damage, but also reduce the chondrogenic potential of implanted MSCs.4, 8 Local anesthetics (LAs) are commonly used to reduce incisional pain associated with a number of surgical procedures including intra-articular surgery and may be used in conjunction with MSC implantation.1-3, 9-12 While the main therapeutic targets of LAs are voltage-gated sodium channels in neuronal cells, there is potential for them to have off-target effects on other cells in the microenvironment, including MSCs and macrophages. Several studies have demonstrated anti-inflammatory effects to LAs. These include reduced interleukin (IL)-1 secretion from mononuclear cells, concentration-dependent inhibition of macrophage phagocytosis and oxidative metabolism, Rabbit Polyclonal to DSG2 reduced leukocyte adhesion,13, 14 and decreased IL-1 and IL-8 secretion from epithelial cells in conjunction with increased levels of anti-inflammatory IL-1 receptor antagonist (IL-1RA) secretion.15 In fact, LAs have been used to treat inflammation associated with burn injuries, arthritis, and other pathologies with fewer side effects than traditional non-steroidal anti-inflammatory drugs (NSAIDs) and steroids.13 Given the fact that perioperative states are often associated with overactive inflammatory responses, regulating inflammation is particularly important.14, 16 However, LAs may also exhibit cytotoxicity17 and the effect of LAs Pazopanib inhibitor database on both macrophage pro-inflammatory function and MSC attenuation of this behavior has not been extensively explored. We have previously described the effect of a panel of LAs on the secretome of quiescent and pro-inflammatory cytokine activated MSCs which indicated activation state- and anesthetic-specific changes, including decreased constitutive PGE2 secretion by high concentrations of bupivacaine.18 Using a previously established macrophage/MSC co-culture assay for MSC anti-inflammatory function,7 the current studies were designed to assess the effects of two commonly used lower or higher potency LAs, lidocaine and bupivacaine respectively, on lipopolysaccharide (LPS)-activated M1 macrophages and MSC attenuation of inflammation. Our results indicate that LA can inhibit MSC anti-inflammatory function either directly or by modulating the inflammatory microenvironment, and in concert reduce MSC efficacy even after LA withdrawal. These studies suggest that effect of LA administration must be considered when developing MSC therapeutic protocols. Materials and Methods Chemicals and Reagents Lidocaine, bupivacaine, and other chemicals were purchased from Sigma Aldrich (Oakville, Ontario, Canada), unless otherwise stated. Lipopolysaccharide (LPS) was purchased from InvivoGen (San Diego, CA). All cell culture reagents were purchased from Life Technologies (Carlsbad, CA), unless otherwise stated. For comparative purposes, LA and LPS concentrations were selected based on previous studies performed by our group and others.6, 7, 15, 18-23. Mesenchymal Stromal Cell Culture Human bone marrow-derived mesenchymal stromal cells (MSCs) were purchased from the Institute for Regenerative Medicine (Texas A&M College of Medicine, Temple, TX). Cryopreserved MSCs were thawed at passage 2, plated as a monolayer at 3105 cells per. |
CHICAGO, IL (June 1, 2009) The latest advances in polyp detection, assessment of colorectal cancer risk, and patient sedation during colonoscopy will be presented today at Digestive Disease Week 2009 (DDW). Research regarding the size and type of polyps detected during colonoscopy and the risk associated with developing colon cancer offers new insight into the recommended frequency of follow-up preventive colonoscopy. New research also examines the risk of perforation during colonoscopy and new tools allowing physicians to more closely examine polyps during colonoscopy including optical biopsy and deep sedation of the patient will be presented. DDW is the largest international gathering of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.\n"Advances in technology and our ability to assess polyps during colonoscopy are the key to early detection of colorectal cancer. Perfecting the frequency of colonoscopy and identification of potentially cancerous polyps are the latest in our arsenal in the fight against this cancer," said Kenneth K. Wang, MD, AGAF, FASGE, Mayo Clinic, Rochester.\nMore Large Polyps Are Seen on Screening Colonoscopy with Deep Sedation Compared with Moderate Conscious Sedation (Abstract #722)\nDeep sedation (DS) during colonoscopy may result in greater detection of polyps, which could save more lives by alerting doctors and patients to colon cancer at its earliest, most treatable stages.\nInvestigators sought to discover whether patients who are more fully sedated during colonoscopy are more likely to have polyps detected because the patient is more relaxed and the physician can focus completely on polyp detection. Patients who are deeply sedated are not awake, whereas patients under moderate conscious sedation (MCS) are able to hear and respond to directions during the procedure.\nResearchers examined a database detailing endoscopy reports from 61 practice sites across the U.S. from patients who underwent average risk screening colonoscopy done with MCS or DS. They found that even with no difference in prep quality between the two sedation levels, significantly more large polyps were found with DS than with MCS, even after controlling for such factors as age, gender and race; the rate of polyps detected was 25 percent more in patients sedated using deep sedation.\n"We don't know for sure whether these polyps would have been found if the patients were examined under moderate sedation," said Katherine M. Hoda, MD, senior fellow, department of gastroenterology, Oregon Health & Science University. "Our study suggests that DS finds more polyps, which could have an impact on the way physicians conduct colonoscopies."\nDr. Hoda cautioned that further studies of many more patients are needed to compare the effects of DS and MCS. This study was small and not randomized, and because it entailed studying information in a database, it may be less definitive than looking at a larger, randomized trial.\nDr. Hoda will present these data on Tuesday, June 2 at 10:30 a.m. CDT in S104, McCormick Place.\nLarge Tubular Adenomas, Villous Polyps, and Lesions with High Grade Dysplasia: Can We Really Be Comfortable Waiting 3 Years Before Repeat Colonoscopy? A Retrospective VA Medical Center Study (Abstract #435)\nAfter patients undergo colonoscopy with removal of advanced pre-malignant polyps, including those greater than 10mm in size and those with villous or high grade dysplastic features, current guidelines recommend that follow-up colonoscopy be performed after a 3 year interval. However, a recent study suggests that maybe this recommendation should be revisited, as patients who underwent colonoscopy sooner were found to have a high detection rate of advanced polyps, which are more likely to transform into colon cancer.\nInvestigators sought to examine a group of patients that are at higher risk for developing cancer and therefore require more frequent colonoscopy. The visualization and removal of large, villous, or high grade dysplastic polyps signifies the need for repeat colonoscopy in 3 years. All three of these features are typically considered equivalent, and it has been difficult to determine whether one of these polyp characteristics is more predictive of subsequent cancer.\n"We wanted to evaluate whether or not one of these polyp features is more predictive of subsequent cancer, and whether 3 years is always appropriate," said Jonathan Mellen, MD, gastroenterology fellow, Phoenix VA Health Care System. "In addition, we wanted to find out more about how a sooner second colonoscopy or a subsequent third colonoscopy might maximize the level of cancer prevention."\nInvestigators reviewed data from more than 25,000 colonoscopies and only included patients with advanced polyps removed and who underwent both a second and third colonoscopy. Patients were divided into three groups according to which advanced polyp feature was reported. They found that all three groups had a substantial rate of advanced polyp detection at second colonoscopy. The study found that removal of polyps with villous and high grade features was particularly predictive of more future advanced polyps and therefore increased susceptibility to cancer.\nIn addition, they found that the rate of discovering advanced polyps at third colonoscopy was less than second colonoscopy, although still high enough to suggest that continued exams in this group is an efficient use of resources.\nDr. Mellen will present these data on Monday, June 1 at 3:15 p.m. CDT in S104, McCormick Place.\nCan We Really Expect a Therapeutic Benefit After Two Preventive Colonoscopies? A Retrospective VA Medical Center Study (Abstract #432)\nA new report suggests that although patients are recommended to undergo multiple repeat colonoscopies after removal of pre-malignant polyps, some of these patients might have a risk of colon cancer that is no greater than the general population after two colonoscopies. This study found that patients with consecutive colonoscopies performed at least three years apart, with at least one being free of tubular adenomas (the most common type of premalignant polyp), are at very low risk of developing colon cancer after a second colonoscopy.\nCurrent guidelines usually call for repeat colonoscopy anywhere from three to five years after removal of premalignant polyps, based on the number, size and microscopic description of the polyps removed. Depending on results of the second colonoscopy, a third is recommended after another three to five years despite a small body of evidence supporting this practice.\n"This is problematic because as more of our resources are dedicated to these repeat colonoscopies, more resources are diverted away from our goal of screening the entire population over 50," said Jonathan Mellen, MD, gastroenterology fellow, Phoenix VA Health Care System. "These findings could help reduce the number of unnecessary colonoscopies, and therefore facilitate more opportunity to perform screening exams. The overall goal is to create a more efficient way to prevent colorectal cancer with reasonable use of our resources."\nInvestigators sought to determine the value of performing a third colonoscopy on a patient who had already undergone two previous exams. They reviewed endoscopic data from more than 25,000 colonoscopy reports; patients were included if they had undergone at least three colonoscopies, with a three year interval between exams. A total of 154 patients were included, and these patients were grouped according to whether they had pre-malignant polyps removed during the first two colonoscopies.\nResults found that patients who had pre-malignant adenomas removed during both the first and second colonoscopy were at higher risk for developing subsequent pre-malignant adenomas after the second colonoscopy. Most importantly, more than 8 percent of this group had more concerning, advanced adenomas removed at the third colonoscopy (including one cancer) vs. 0 percent for all other patients. Although patients with a negative first or second colonoscopy might be appropriate for a third examination after a 10 year interval (similar to the general population), the group with adenomas found at first and second colonoscopy should undergo third colonoscopy as dictated by current guidelines, Mellen said.\nDr. Mellen will present these data on Monday, June 1 at 2:15 p.m. CDT in S104, McCormick Place.\nOptical Biopsy at Colonoscopy: Are We Ready? DISCARD Study: Early Results (Abstract #721)\nResearchers have studied a method that may be more effective at examining and identifying polyps that are precancerous, thereby eliminating the time and expense of sending biopsies to pathology.\nUnder the current colonoscopy protocol, the majority (90 percent) of polyps removed during the procedure are small, less than 10mm, in size and are sent for evaluation of pathology after removal. The removal of polyps reduces the risk of cancer and the number of polyps removed is the basis for determining the frequency of subsequent colonoscopies. Typically, only half of the polyps removed during colonoscopy are discovered to be precancerous.\nIn a study at St. Mark's Hospital in London, investigators followed four endoscopists with varying levels of experience with optical diagnosis during colonoscopies. The participating colonoscopists used one or a combination of optical modalities to predict the histopathology of each polyp encountered. Each polyp was then removed and sent for formal histopathology. Researchers found that out of the 85 adenomas removed, 92 percent were correctly diagnosed and of the 38 hyperplastic polyps, 95 percent were correctly diagnosed by the colonoscopists making the optical diagnosis.\n"Optical diagnosis allows us to predict accurately whether a polyp should be removed immediately during the colonoscopy. This not only spares the patient the risk involved in the unnecessary removal of non-precancerous polyps, but eliminates the wait time and expense involved in the current protocol of sending biopsies to pathology," said Ana Ignjatovic, BMBCh, endoscopy research fellow at the Wolfson Unit for Endoscopy at St. Mark's Hospital.\nBoth Dr. Ignjatovic and Brian P. Saunders, MD, director of the Wolfson Unit for Endoscopy, believe that the next steps should be to expand the study beyond an academic center to determine the level of training that would need to be provided before the procedure could be used on a wider scale.\nDr. Ignjatovic will present these data on Tuesday, June 2 at 10:30 a.m. CDT in S406A, McCormick Place.\nRisk of Perforation During Colonoscopy: A Systematic Review and Meta-analysis (Abstract #210)\nPerforation rates for both diagnostic and therapeutic colonoscopies are quite low and reported rates are decreasing, according to the largest analysis to date of colonoscopy perforation rates.\nUsing meta-analysis, a type of systematic review that includes formal statistical techniques to combine the results of previous research, investigators under the mentorship of Philip S. Schoenfeld, MD, at the University of Michigan sought to establish an accurate measure of colonoscopy perforation rates. According to previous research, reported rates of perforation in the literature range from as low as 0.01 percent (1 in 10,000) to as high as 1.1 percent (1 in 100).\n"Perforation is one of several potential complications of colonoscopy including cardiopulmonary events, hemorrhage and pain," said S. M. Abbas Fehmi, MD, MSc, clinical faculty at University of Pennsylvania School of Medicine. "Of these risks, perforation has been considered by some to be the most serious, so we wanted to determine the actual rate of perforation to help patients and their physicians make informed decisions. The good news is that we found the risk of perforation during colonoscopy is extremely low."\nFehmi and his colleagues searched databases from 1950 through 2007 for all English language abstracts of prospective studies related to perforation rates. They also reviewed abstracts presented at all major national and international gastroenterology meetings from 2005 to 2007. Seventeen studies, consisting of 274,265 colonoscopies, met the inclusion criteria.\nPooled perforation rate in therapeutic colonoscopies was found to be 0.066 percent or approximately 1 in 1500 and in diagnostic colonoscopies was found to be .017 percent or approximately 1 in 6000. Therapeutic colonoscopy, which is required to remove lesions if polyps are present, was associated with a higher risk of perforation. The analysis also identified a trend towards decreasing perforation rates for both therapeutic procedures and diagnostic procedures.\nFehmi said that while colonoscopy is a safe procedure, there are some risks that need to be explored further. Studies should be done in the community and university setting and patients should be stratified by different risk factors and indications. Future prospective studies should also employ a systematic follow up (at day seven or 30) to ensure capture of all complications. These quoted rates of perforation can serve as a quality, performance, or outcome benchmark.\nDr. Choksi will present these data on Sunday, May 31, 2009 at 2:15 p.m. CDT in S406A, McCormick Place.\n|Contact: Aimee Frank|\nAmerican Gastroenterological Association |
New York, NY (May 2012) -- As part of The New York Eye and Ear Infirmary’s Surgical Suite Initiative, overall a $13 million renovation and expansion of operating room facilities, a new PACU was opened for the recovery of post-anesthesia patients. It is a new extension onto the North (main hospital) Building, and encompasses 18 individual recovery bays – 14 for adults, 4 for pediatric patients -- with highest tech vital signs monitoring systems for all. The individual pediatric bays already make the surgical experience more child- and family-friendly, with further enhancements to come. The next phase will turn the previous PACU into four private pediatric rooms.\nIf you are a reporter seeking an interview with a doctor at The New York Eye and Ear Infirmary, please contact Jean Thomas, at (212) 979-4274.\nHome > NYEEI Opens New PACU |
How Much Would It Cost to Do the Back Rolls\n- Asked by Deidra2837\n- 1 year ago\nI have back rolls and want them removed what's the price range?\nThe cost of liposuction.\nThe cost of liposuction varies geographically as well as by the body area and also by the extent of work needed.\nIn my Salt Lake City, Utah plastic surgery office I charge for liposuction based on the amount of time needed to achieve the results that you want. I think that is the most fair and equitable way to charge and I think my patients appreciate it.\nBack rolls do good with liposuction!\nWhen a patient has back rolls of fat, they often need adjacent areas liposuctioned as well. It is not uncommon to do the axillae(under arm areas) and even posterior arms with the midback or back rolls which run roughly $5000 on special or $6000 with the hips thrown in. If only the mid back(backrolls) then expect roughly $4000 on special since usually the 1st area is the most expensive and each additional area is only a little more on top of it. It can be done easily under local anesthesia and with a quick recovery. Sincerely,\nWeb reference: http://www.TheBestLipoDoc.com/drdavidhansen/landing/\nRecent Liposuction Reviews\nThese answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship. |
Does sensitivity in the posterior region of your mouth concern you? Wisdom teeth molars are your last set of teeth emerging. However, they are unnecessary for correctly chewing and speaking. Therefore many people must have their wisdom teeth removed.\nOccasionally, when your wisdom teeth break through your gums, they begin drifting to impact eruption from the gums, shift and affect the alignment of your teeth and jaw. In such cases, dentists suggest the removal of wisdom teeth optimal for oral and dental health.\nIn most cases, wisdom teeth emerge at different angles, or the teeth have insufficient space in the jaw to accommodate them. General dentistry professionals recommend wisdom teeth removal immediately if they have partially emerged, are hidden beneath the gums, or crowd the neighboring teeth.\nMany dentists recommend removing wisdom teeth before emerging completely. In addition, dentists suggest wisdom teeth extraction at a younger age to ensure quicker and easier recovery because the tooth and bone have not completely formed. This is why many young people get their wisdom teeth removed before they start to create problems.\nSigns indicating your wisdom teeth need removal include if you experience changes in the wisdom teeth site causing the tooth pain, repeated soft tissue infection behind the last lower teeth, fluid-filled cysts or sacs, tumors, damage to adjacent teeth, periodontal disease, and excessive tooth decay.\nYou may also experience inflamed and bleeding gums, earaches and headaches, jaw stiffness and pain, sinus problems, and crooked or overcrowded teeth. Although the decision to remove wisdom teeth is not always clear, you can discuss with the dentist or an oral surgeon about the positioning and health of the tooth, asking for suggestions on what is best for your situation.\nWisdom teeth extractions are relatively straightforward and performed by general dentists and oral surgeons in an outpatient procedure in the dentist’s office or hospital setting, indicating you can return home on the day of your surgery.\nBefore scheduling your wisdom teeth removal surgery, the dentist in Phoenix will inquire into your overall health, asking about any conditions affecting you and the medications you take, whether prescription, over-the-counter, or herbal. Dentists need the information to provide adequate anesthesia tailored to your situation.\nYour dentist will also discuss anesthesia options inquiring into your dental anxiety to determine whether you can undergo the procedure under local anesthesia or need more potent anesthetics during Wisdom teeth removal.\nWhen you arrive for your surgery at the dentist’s office to remove your wisdom teeth, you will receive anesthesia near the tooth to block pain impulses and numb the soft tissues around the tooth. If required, the dentist offers you intravenous anesthesia or sedation if you are anxious about the procedure.\nRelying on the positioning of the tooth, the dentist makes incisions in your gums and removes any bone blocking access to the third molar to expose the wisdom tooth. After that, they may cut the wisdom tooth into pieces if removing it is challenging. After removing the wisdom tooth, the dentist will suture the area to complete the surgical process.\nYou can return home immediately after wisdom tooth removal if you receive local anesthesia in the mouth without intravenous anesthesia or sedation. However, if you have received a combination of the two, you must remain in the dentist’s office until you recover and the dentist permits you to return home with help from a friend or family.\nYou can expect discomfort from the surgical process after approximately four to six hours as the anesthesia starts wearing off. Therefore, the dentist recommends you avoid strenuous activities for the next 24 hours to prevent bleeding from the surgical site advising you to rest. While you don’t have to remain bedridden, you must avoid straining yourself because it can cause bleeding.\nYou will require about ten days to recover from the surgical process, although you can return to everyday activities within 72 hours. After getting wisdom teeth removed, it helps if you follow the dentist’s after-care instructions to ensure you don’t disturb the blood clot and become a victim of a dry socket, a painful condition requiring sedative dressing and delaying your recovery. The situation will also need help from an emergency dentist, primarily if it occurs beyond office hours.\nThe Phoenix dentist recommends taking prescription or over-the-counter painkillers to manage the discomfort after wisdom teeth removal. In addition, you receive suggestions not to have crunchy and hard foods, avoid smoking or consuming alcohol, and remaining cautious when cleaning near the surgical site and use saltwater rinses several times daily because it has antiseptic properties and helps clean your mouth to remove any food particles trapped in the surgical site.\nWhen you experience the problems described earlier in the back of your mouth, it indicates your wisdom teeth are best removed before they become more concerning. Therefore it helps if you schedule your appointment with Open Wide Dental to have the teeth extracted and follow the dentist’s instructions to the letter T to ensure you recover quickly without complications.\nWe welcome patients from all surrounding locations to visit our dental office in Phoenix, AZ |
Craniotomy and Craniectomy Procedures\nA craniotomy is a procedure in which part of the skull is the temporary removed. This procedure is performed to treat hematoma, remove brain tumors, and more.\nThe Craniotomy Procedure\nA craniotomy may be performed under general or local anesthesia. The latter is required when the patient's participation is necessary to check for brain function during the procedure. At the beginning of the operation, an incision is made in the scalp to allow access to the treatment site, either with a special saw or a medical drill (for keyhole craniotomies).\nThe scalp is pulled up and clipped to control bleeding while providing access to the brain. The dura mater, or thick outer membrane covering the brain, is separated from the bone and carefully cut apart to allow any excess fluid that has accumulated to drain. At times, microsurgical instruments may be used under magnification to enable the surgeon to visualize the area more precisely. Once the procedure has been completed, the tissue that has been cut is sutured and normally the bone flap is reattached.\nRecovery from a Craniotomy Procedure\nThe postsurgical craniotomy patient spends some time in intensive care (ICU) until vital signs are stable and the patient is alert. Once out of ICU, the patient will remain hospitalized for several days and oxygen will be administered. Respiratory therapy will be given to make sure the patient's lungs re-expand and that the patient doesn't develop pneumonia.\nDuring recovery in the hospital, the patient will also wear sequential compression devices (SCDs) to prevent the formation of blood clots in the legs and will periodically be administered neurological and cognitive testing to check brain function. While some swelling of the head is expected following the craniotomy procedure, the patient's head is kept elevated to keep such swelling to a minimum. Many patients who have undergone a craniotomy spend several days in a rehabilitation facility after the procedure.\nA craniectomy is a surgical procedure performed when the portion of the skull removed during brain surgery is not replaced immediately. Reasons for the neurosurgeon to perform a craniectomy include: creating room the brain swelling after traumatic injury, removing infected portions of the skull, or removing portions of the skull where traumatic injury has resulted in multiple fragments. The procedure is always performed as a lifesaving measure.\nThe Craniectomy Procedure\nDuring a craniectomy, once the patient is anesthetized, the skin on the scalp and the underlying tissues are cut and clipped out of the way. The primary surgical tools employed in the surgery are a drill, used to make holes in the skull, and a saw to cut and remove a bone flap.\nAfter the craniectomy, the bone flap is normally stored in a sterile environment until proper healing has taken place so that the reparative operation can be performed. Usually, bone flaps are replaced 6 weeks to 3 months after a craniectomy. At times, if the damage to the patient's skull is too extensive, or there is infection present, it may be necessary to use synthetic materials, instead of the patient's own bone, to make the repair.\nProtecting the Craniectomy Site\nIt is necessary that the surgical site be carefully protected. In many cases, patients who have had a craniectomy are sent home from the hospital with a protective helmet. For at least 6 weeks, the patient should refrain from any activity that may result in a hit to the head or a fall.\nRisks of a Craniectomy\nWhile very often highly effective, brain surgery carries inherent risk. In addition to the risks of any surgical procedure, such as breathing difficulty, excessive bleeding, blood clots and adverse reactions to anesthesia or medication, the major risks of a craniectomy are bleeding in the brain and infection, either of which may lead to further brain damage. It may take at least a year for a patient to fully recover from a craniectomy and rehabilitative treatment may be necessary.\nThere are several signs that signal the need for urgent medical attention following a craniectomy. These include:\n- Altered behavior, mood or mental ability\n- Repeated vomiting\n- Drainage or swelling at the surgical site\n- Seizural activity\nAny headache unrelieved by over-the-counter medication is also cause for concern. |
Acupuncture can significantly reduce surgical patients’ post-operative pain, and their need for powerful opioids to treat pain, according to new research from Duke University Medical Center that was published in October, 2007.\nAnesthesiologists from Duke University combed over data from over 15 randomized clinical trials from China, the United Stated and the United Kingdom to reach their conclusion. The results showed that an acupuncture treatment before surgery followed by acupuncture treatments after the surgery significantly reduced levels of postoperative pain as well as the use of painkillers after surgery.\n“The most important outcome for the patient is the reduction of the side effects associated with opioids,” said T.J. Gan, M.D., the Duke anesthesiologist who presented the study at the annual scientific conference of the American Society for Anesthesiology in San Francisco in October 2007.\nMore research, presented at the American Society of Anesthesiologists' meeting in 2005 showed that acupuncture reduced rates of postoperative nausea by 32%, pruritus by 25%, dizziness by 38%, and urinary retention by 71% compared with control groups\nAcupuncture is excellent for post-surgical side effects including:\n- Pruritis (itch or a sensation that makes a person want to scratch)\n- Avoiding Surgery with Acupuncture |
Generic Name: Levorphanol tartrate\nDosage Form: tablet\nRevised: December 2016\nAddiction, Abuse, and Misuse\nLevorphanol Tartrate Tablets exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death. Assess each patient's risk prior to prescribing Levorphanol Tartrate Tablets, and monitor all patients regularly for the development of these behaviors and conditions [see WARNINGS].\nLife-Threatening Respiratory Depression\nSerious, life-threatening, or fatal respiratory depression may occur with use of Levorphanol Tartrate Tablets. Monitor for respiratory depression, especially during initiation of Levorphanol Tartrate Tablets or following a dose increase [see WARNINGS].\nAccidental ingestion of Levorphanol Tartrate Tablets, especially by children, can result in a fatal overdose of Levorphanol Tartrate Tablets [see WARNINGS].\nNeonatal Opioid Withdrawal Syndrome\nProlonged use of Levorphanol Tartrate Tablets during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated, and requires management according to protocols developed by neonatology experts. If opioid use is required for a prolonged period in a pregnant woman, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available [see WARNINGS].\nRisks from Concomitant Use with Benzodiazepines or Other CNS Depressants\nConcomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death [see WARNINGS]\n- Reserve concomitant prescribing of Levorphanol Tartrate Tablets and benzodiazepines or other CNS depressants for use in patients for whom alternative treatment options are inadequate.\n- Limit dosages and durations to the minimum required.\n- Follow patients for signs and symptoms of respiratory depression and sedation.\nLevorphanol Tartrate Tablets, contain Levorphanol, an opioid agonist with a molecular formula of\nC17H23NO • C4H6O6 • 2H2O and molecular weight 443.5. Each milligram of Levorphanol tartrate is equivalent to 0.58 mg Levorphanol base. Levorphanol's chemical name is levo-3- hydroxy-Nmethylmorphinan. The USP nomenclature is 17- methylmorphinan 3-ol tartrate (1:1)(Salt) dihydrate. The material has 3 asymmetric carbon atoms. The chemical structure is:\nLevorphanol tartrate is a white crystalline powder, soluble in water and ether, but insoluble in chloroform.\nEach tablet, for oral administration, contains 2 mg Levorphanol tartrate. In addition, each tablet contains anhydrous lactose, corn starch, and magnesium stearate.\nMechanism of Action\nLevorphanol is a full opioid agonist and is relatively selective for the mu-opioid receptor, although it can bind to other opioid receptors at higher doses. The principal therapeutic action of Levorphanol is analgesia. Like all full opioid agonists, there is no ceiling effect for analgesia with Levorphanol. Clinically, dosage is titrated to provide adequate analgesia and may be limited by adverse reactions, including respiratory and CNS depression.\nThe precise mechanism of the analgesic action is unknown. However, specific CNS opioid receptors for endogenous compounds with opioid-like activity have been identified throughout the brain and spinal cord and are thought to play a role in the analgesic effects of this drug.\nPharmacodynamicsEffects on the Central Nervous System\nThe principal therapeutic action of Levorphanol is analgesia.\nLevorphanol produces respiratory depression by direct action on brain stem respiratory centers. The respiratory depression involves a reduction in the responsiveness of the brain stem respiratory centers to both increases in carbon dioxide retention and electrical stimulation.\nLevorphanol causes miosis, even in total darkness. Pinpoint pupils are a sign of opioid overdose but are not pathognomonic (e.g., pontine lesions of hemorrhagic or ischemic origins may produce similar findings). Marked mydriasis rather than miosis may be seen due to hypoxia in overdose situations.Effects on the Gastrointestinal Tract and Other Smooth Muscle\nLevorphanol causes a reduction in motility associated with an increase in smooth muscle tone in the antrum of the stomach and duodenum. Digestion of food in the small intestine is delayed and propulsive contractions are decreased. Propulsive peristaltic waves in the colon are decreased, while tone may be increased to the point of spasm, resulting in constipation. Other opioid-induced effects may include a reduction in biliary and pancreatic secretions, spasm of sphincter of Oddi, and transient elevations in serum amylase.Effects on the Cardiovascular System\nLevorphanol produces peripheral vasodilation which may result in orthostatic hypotension or syncope. Manifestations of histamine release and/or peripheral vasodilation may include pruritus, flushing, red eyes, sweating, and/or orthostatic hypotension.Effects on the Endocrine System\nOpioids inhibit the secretion of adrenocorticotropic hormone (ACTH), cortisol, and luteinizing hormone (LH) in humans [see ADVERSE REACTIONS]. They also stimulate prolactin, growth hormone (GH) secretion, and pancreatic secretion of insulin and glucagon.\nChronic use of opioids may influence the hypothalamic-pituitary-gonadal axis, leading to androgen deficiency that may manifest as low libido, impotence, erectile dysfunction, amenorrhea, or infertility. The causal role of opioids in the clinical syndrome of hypogonadism is unknown because the various medical, physical, lifestyle, and psychological stressors that may influence gonadal hormone levels have not been adequately controlled for in studies conducted to date [see ADVERSE REACTIONS].Effects on the Immune System\nOpioids have been shown to have a variety of effects on components of the immune system. The clinical significance of these findings is unknown. Overall, the effects of opioids appear to be modestly immunosuppressive.Concentration–Efficacy Relationships\nThe minimum effective analgesic concentration will vary widely among patients, especially among patients who have been previously treated with potent agonist opioids. The minimum effective analgesic concentration of Levorphanol for any individual patient may increase over time due to an increase in pain, the development of a new pain syndrome, and/or the development of analgesic tolerance [see DOSAGE AND ADMINISTRATION].Concentration–Adverse Reaction Relationships\nThere is a relationship between increasing Levorphanol plasma concentration and increasing frequency of dose-related opioid adverse reactions such as nausea, vomiting, CNS effects, and respiratory depression. In opioid-tolerant patients, the situation may be altered by the development of tolerance to opioid-related adverse reactions [see DOSAGE AND ADMINISTRATION].\nThe pharmacokinetics of Levorphanol have been studied in a limited number of cancer patients following intravenous (IV), intramuscular (IM) and oral (PO) administration. Following IV administration plasma concentrations of Levorphanol decline in a triexponential manner with a terminal half-life of 11 to16 hours and a clearance of 0.78 to 1.1 L/kg/hr. Based on terminal halflife, steady-state plasma concentrations should be achieved by the third day of dosing.\nLevorphanol is rapidly distributed (<1 hr) and redistributed (1 to 2 hours) following IV administration and has a steady-state volume of distribution of 10 to 13 L/kg. In vitro studies of protein binding indicate that Levorphanol is only 40% bound to plasma proteins.\nNo pharmacokinetic studies of the absorption of IM Levorphanol are available, but clinical data suggests that absorption is rapid with onset of effects within 15 to 30 minutes of administration.\nLevorphanol is well absorbed after PO administration with peak plasma concentrations occurring approximately 1 hour after dosing. The bioavailability of Levorphanol Tartrate Tablets compared to IM or IV administration is not known.\nPlasma concentrations of Levorphanol following chronic administration in patients with cancer increased with the dose, but the analgesic effect was dependent on the degree of opioid tolerance of the patient. Expected steady-state plasma concentrations for a 6-hour dosing interval can reach 2 to 5 times those following a single dose, depending on the patient's individual clearance of the drug. Very high plasma concentrations of Levorphanol can be reached in patients on chronic therapy due to the long half-life of the drug. One study in 11 patients using the drug for control of cancer pain reported plasma concentrations from 5 to 10 ng/mL after a single 2 mg dose and up to 50 to 100 ng/mL after repeated oral doses of 20 to 50 mg/day.\nAnimal studies suggest that Levorphanol is extensively metabolized in the liver and is eliminated as the glucuronide metabolite. This renally excreted inactive glucuronide metabolite accumulates with chronic dosing in plasma at concentrations that reach fivefold that of the parent compound.\nThe effects of age, sex, hepatic and renal disease on the pharmacokinetics of Levorphanol are not known. As with all drugs of this class, patients at the extremes of age are expected to be more susceptible to adverse effects because of a greater pharmacodynamic sensitivity and probable increased variability in pharmacokinetics due to age or disease.Clinical Trials\nClinical trials have been reported in the medical literature that investigated the use of Levorphanol Tartrate Tablets as a preoperative medication, as a postoperative analgesic, and in the management of chronic pain due primarily to malignancy. In each of these clinical settings Levorphanol Tartrate Tablets has been shown to be an effective analgesic of the mu-opioid type and similar to morphine, meperidine, or fentanyl.\nLevorphanol Tartrate Tablets has been studied in chronic cancer patients. Dosages were individualized to each patient's level of opioid tolerance. In one study, starting doses of 2 mg twice a day often had to be advanced by 50% or more within a few weeks of starting therapy. A study of Levorphanol Tartrate Tablets indicates that the relative potency is approximately 4 to 8 times that of morphine, depending on the specific circumstances of use. In postoperative patients, intramuscular Levorphanol was determined to be about 8 times as potent as intramuscular morphine, whereas in cancer patients with chronic pain, it was found only to be about 4 times as potent.Individualization of Dosage\nAccepted medical practice dictates that the dose of any opioid analgesic be appropriate to the degree of pain to be relieved, the clinical setting, the physical condition of the patient, and the kind and dose of concurrent medication.\nLevorphanol has a long half-life similar to methadone or other slowly excreted opioids, rather than quickly excreted agents such as morphine or meperidine. Slowly excreted drugs may have some advantages in the management of chronic pain. Unfortunately, the duration of pain relief after a single dose of a slowly excreted opioid cannot always be predicted from pharmacokinetic principles, and the inter-dose interval may have to be adjusted to suit the patient's individual pharmacodynamic response.\nLevorphanol is 4 to 8 times as potent as morphine and has a longer half-life. Because there is incomplete cross-tolerance among opioids, when converting a patient from morphine to Levorphanol, the total daily dose of oral Levorphanol should begin at approximately 1/15 to 1/12 of the total daily dose of oral morphine that such patients had previously required and then the dose should be adjusted to the patient's clinical response. If a patient is to be placed on fixed- schedule dosing (round-the-clock) with this drug, care should be taken to allow adequate time after each dose change (approximately 72 hours) for the patient to reach a new steady-state before a subsequent dose adjustment to avoid excessive sedation due to drug accumulation.\nINDICATIONS AND USAGE\nLevorphanol Tartrate Tablets are indicated for the management of pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate.\nLimitations of Use\nBecause of the risks of addiction, abuse, and misuse, with opioids, even at recommended doses [see WARNINGS], reserve Levorphanol Tartrate Tablets for use in patients for whom alternative treatment options [e.g., non-opioid analgesics or opioid combination products]:\n- Have not been tolerated, or are not expected to be tolerated,\n- Have not provided adequate analgesia, or are not expected to provide adequate analgesia\nLevorphanol Tartrate Tablets are contraindicated in patients with:\n- Significant respiratory depression [see WARNINGS]\n- Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment [see WARNINGS]\n- Known or suspected gastrointestinal obstruction, including paralytic ileus [see WARNINGS]\n- Hypersensitivity to Levorphanol or any of the formulation excipients (e.g., anaphylaxis) [see WARNINGS]\nAddiction, Abuse, and Misuse\nLevorphanol Tartrate Tablets contains Levorphanol, a Schedule II controlled substance. As an opioid, Levorphanol Tartrate Tablets exposes users to the risks of addiction, abuse, and misuse [see DRUG ABUSE AND DEPENDENCE].\nAlthough the risk of addiction in any individual is unknown, it can occur in patients appropriately prescribed Levorphanol Tartrate Tablets. Addiction can occur at recommended dosages and if the drug is misused or abused.\nAssess each patient's risk for opioid addiction, abuse, or misuse prior to prescribing Levorphanol Tartrate Tablets, and monitor all patients receiving Levorphanol Tartrate Tablets for the development of these behaviors and conditions. Risks are increased in patients with a personal or family history of substance abuse (including drug or alcohol abuse or addiction) or mental illness (e.g., major depression). The potential for these risks should not, however, prevent the proper management of pain in any given patient. Patients at increased risk may be prescribed opioids such as Levorphanol Tartrate Tablets, but use in such patients necessitates intensive counseling about the risks and proper use of Levorphanol Tartrate Tablets along with intensive monitoring for signs of addiction, abuse and misuse.\nOpioids are sought by drug abusers and people with addiction disorders and are subject to criminal diversion. Consider these risks when prescribing or dispensing Levorphanol Tartrate Tablets. Strategies to reduce these risks include prescribing the drug in smallest appropriate quantity and advising the patient on the proper disposal of unused drug [see PRECAUTIONS; Information for Patients]. Contact local state professional licensing board or state controlled substances authority for information on how to prevent and detect abuse or diversion of this product.\nLife Threatening Respiratory Depression\nSerious, life-threatening, or fatal respiratory depression has been reported with the use of opioids even when used as recommended. Respiratory depression, if not immediately recognized and treated, may lead to respiratory arrest and death. Management of respiratory depression may include close observation, supportive measures, and use of opioid antagonists, depending on the patient's clinical status [see OVERDOSAGE]. Carbon dioxide (CO2) retention from opioidinduced respiratory depression can exacerbate the sedating effects of opioids.\nWhile serious, life-threatening, or fatal respiratory depression can occur at any time during the use of Levorphanol Tartrate Tablets, the risk is greatest during the initiation of therapy or following a dosage increase. Monitor patients closely for respiratory depression, especially within the first 2472 hours of initiating therapy with and following dosage increases of Levorphanol Tartrate Tablets.\nTo reduce the risk of respiratory depression, proper dosing and titration of Levorphanol Tartrate\nTablets are essential [see DOSAGE AND ADMINISTRATION]. Overestimating the\nLevorphanol Tartrate Tablets dosage when converting patients from another opioid product can result in a fatal overdose with the first dose.\nAccidental ingestion of Levorphanol Tartrate Tablets, especially by children, can result in respiratory depression and death due to an overdose of Levorphanol Tartrate Tablets.\nThe initial dose of Levorphanol Tartrate Tablets should be reduced by 50% or more when the drug is given to patients with any condition affecting respiratory reserve or in conjunction with other drugs affecting the respiratory center. Subsequent doses should then be individually titrated according to the patient's response.\nNeonatal Opioid Withdrawal Syndrome\nProlonged use of Levorphanol Tartrate Tablets during pregnancy can result in withdrawal in the neonate. Neonatal opioid withdrawal syndrome, unlike opioid withdrawal syndrome in adults, may be life-threatening if not recognized and treated, and requires management according to protocols developed by neonatology experts. Observe newborns for signs of neonatal opioid withdrawal syndrome and manage accordingly. Advise pregnant women using opioids for a prolonged period of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available [see PRECAUTIONS; Information for Patients, Pregnancy].\nRisks from Concomitant Use with Benzodiazepines or Other CNS Depressants\nProfound sedation, respiratory depression, coma, and death may result from the concomitant use of\nLevorphanol Tartrate Tablets with benzodiazepines or other CNS depressants (e.g., nonbenzodiazepine sedatives/hypnotics, anxiolytics, tranquilizers, muscle relaxants, general anesthetics, antipsychotics, other opioids, alcohol). Because of these risks, reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate.\nObservational studies have demonstrated that concomitant use of opioid analgesics and benzodiazepines increases the risk of drug-related mortality compared to use of opioid analgesics alone. Because of similar pharmacological properties, it is reasonable to expect similar risk with the concomitant use of other CNS depressant drugs with opioid analgesics [see PRECAUTIONS, Drug Interactions].\nIf the decision is made to prescribe a benzodiazepine or other CNS depressant concomitantly with an opioid analgesic, prescribe the lowest effective dosages and minimum durations of concomitant use. In patients already receiving an opioid analgesic, prescribe a lower initial dose of the benzodiazepine or other CNS depressant than indicated in the absence of an opioid, and titrate based on clinical response. If an opioid analgesic is initiated in a patient already taking a benzodiazepine or other CNS depressant, prescribe a lower initial dose of the opioid analgesic, and titrate based on clinical response. Follow patients closely for signs and symptoms of respiratory depression and sedation.\nAdvise both patients and caregivers about the risks of respiratory depression and sedation when Levorphanol Tartrate Tablets are used with benzodiazepines or other CNS depressants (including alcohol and illicit drugs). Advise patients not to drive or operate heavy machinery until the effects of concomitant use of the benzodiazepine or other CNS depressant have been determined. Screen patients for risk of substance use disorders, including opioid abuse and misuse, and warn them of the risk for overdose and death associated with the use of additional CNS depressants including alcohol and illicit drugs [see PRECAUTIONS; Information for Patients, Drug Interactions].\nLife-Threatening Respiratory Depression in Patients with Chronic Pulmonary Disease or in Elderly, Cachectic, or Debilitated Patient\nThe use of Levorphanol Tartrate Tablets in patients with acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment is contraindicated.\nPatients with Chronic Pulmonary Disease: Patients treated with Levorphanol Tartrate Tablets with significant chronic obstructive pulmonary disease or cor pulmonale, and those with a substantially decreased respiratory reserve, hypoxia, hypercapnia, or pre-existing respiratory depression are at increased risk of decreased respiratory drive including apnea, even at recommended dosages of Levorphanol [see WARNINGS].\nElderly, Cachectic, or Debilitated Patients: Life-threatening respiratory depression is more likely to occur in elderly, cachectic, or debilitated patients because they may have altered pharmacokinetics or altered clearance compared to younger, healthier patients [see WARNINGS].\nMonitor such patients closely, particularly when initiating and titrating Levorphanol Tartrate Tablets and when Levorphanol Tartrate Tablets are given concomitantly with other drugs that depress respiration [see WARNINGS]. Alternatively, consider the use of non-opioid analgesics in these patients.\nCases of adrenal insufficiency have been reported with opioid use, more often following greater than 1 month of use. Presentation of adrenal insufficiency may include non-specific symptoms and signs including nausea, vomiting, anorexia, fatigue, weakness, dizziness, and low blood pressure. If adrenal insufficiency is suspected, confirm the diagnosis with diagnostic testing as soon as possible. If adrenal insufficiency is diagnosed, treat with physiologic replacement doses of corticosteroids. Wean the patient off of the opioid to allow adrenal function to recover and continue corticosteroid treatment until adrenal function recovers. Other opioids may be tried as some cases reported use of a different opioid without recurrence of adrenal insufficiency. The information available does not identify any particular opioids as being more likely to be associated with adrenal insufficiency.\nThe use of Levorphanol Tartrate Tablets in acute myocardial infarction or in cardiac patients with myocardial dysfunction or coronary insufficiency should be limited because the effects of Levorphanol Tartrate Tablets on the work of the heart are unknown.\nLevorphanol Tartrate Tablets may cause severe hypotension including orthostatic hypotension and syncope in ambulatory patients. There is increased risk in patients whose ability to maintain blood pressure has already been compromised by a reduced blood volume or concurrent administration of certain CNS depressant drugs (e.g., phenothiazines or general anesthetics) [see PRECAUTIONS; Drug Interactions]. Monitor these patients for signs of hypotension after initiating or titrating the dosage of Levorphanol Tartrate Tablets. In patients with circulatory shock Levorphanol Tartrate Tablets may cause vasodilatation that can further reduce cardiac output and blood pressure. Avoid the use of Levorphanol Tartrate Tablets with circulatory shock.\nRisks of Use in Patients with Increased Intracranial Pressure, Brain Tumors, Head Injury, or Impaired Consciousness\nIn patients who may be susceptible to the intracranial effects of CO2 retention (e.g., those with evidence of increased intracranial pressure or brain tumors), Levorphanol Tartrate Tablets may reduce respiratory drive, and the resultant CO2 retention can further increase intracranial pressure. Monitor such patients for signs of sedation and respiratory depression, particularly when initiating therapy with Levorphanol Tartrate Tablets.\nOpioids may also obscure the clinical course in a patient with a head injury. Avoid the use of Levorphanol Tartrate Tablets in patients with impaired consciousness or coma.\nRisks of Use in Patients with Gastrointestinal Conditions\nLevorphanol Tartrate Tablets are contraindicated in patients with known or suspected gastrointestinal obstruction, including paralytic ileus.\nThe Levorphanol in Levorphanol Tartrate Tablets may cause spasm of the sphincter of Oddi. Levorphanol Tartrate Tablets has been shown to cause moderate to marked rises in pressure in the common bile duct when given in analgesic doses. It is not recommended for use in biliary surgery. Opioids may cause increases in serum amylase. Monitor patients with biliary tract disease, including acute pancreatitis, for worsening symptoms.\nIncreased Risk of Seizures in Patients with Seizure Disorders\nThe Levorphanol in Levorphanol Tartrate Tablets may increase the frequency of seizures in patients with seizure disorders, and may increase the risk of seizures occurring in other clinical settings associated with seizures. Monitor patients with a history of seizure disorders for worsened seizure control during Levorphanol Tartrate Tablets therapy.\nAvoid the use of mixed agonist/antagonist (e.g., pentazocine, nalbuphine, and butorphanol) or partial agonist (e.g., buprenorphine) analgesics in patients who are receiving a full opioid agonist analgesic, including Levorphanol Tartrate Tablets. In these patients, mixed agonist/antagonist and partial analgesics may reduce the analgesic effect and/or precipitate withdrawal symptoms.\nRisks of Driving and Operating Machinery\nLevorphanol Tartrate Tablets may impair the mental or physical abilities needed to perform potentially hazardous activities such as driving a car or operating machinery. Warn patients not to drive or operate dangerous machinery unless they are tolerant to the effects of Levorphanol Tartrate Tablets and know how they will react to the medication [see PRECAUTIONS; Information for Patients/Caregivers].\nUse in Liver Disease\nLevorphanol Tartrate Tablets should be administered with caution to patients with extensive liver disease who may be vulnerable to excessive sedation due to increased phamacodynamic sensitivity or impaired metabolism of the drug.\nInformation for patients\nAdvise the patient to read the FDA-approved patient labeling (Medication Guide).Addiction, Abuse, and Misuse\nInform patients that the use of Levorphanol Tartrate Tablets even when taken as recommended, can result in addiction, abuse, and misuse, which can lead to overdose and death [see WARNINGS]. Instruct patients not to share Levorphanol Tartrate Tablets with others and to take steps to protect Levorphanol Tartrate Tablets from theft or misuse.Life-Threatening Respiratory Depression\nInform patients of the risk of life-threatening respiratory depression, including information that the risk is greatest when starting Levorphanol Tartrate Tablets or when the dosage is increased, and that it can occur even at recommended dosages [see WARNINGS]. Advise patients how to recognize respiratory depression and to seek medical attention if breathing difficulties develop.\nMost cases of serious or fatal adverse events involving Levorphanol Tartrate Tablets reported to the manufacturer or the FDA have involved either the administration of large initial doses of the drug or too frequent doses of the drug to non-opioid tolerant patients, or the simultaneous administration of Levorphanol Tartrate Tablets with other drugs affecting respiration [see\nINDIVIDUALIZATION OF DOSAGE and WARNINGS]. The initial dose of Levorphanol Tartrate Tablets should be reduced by approximately 50% or more when it is given to patients along with another drug affecting respiration.Accidental Ingestion\nInform patients that accidental ingestion, especially by children, may result in respiratory depression or death [see WARNINGS]. Instruct patients to take steps to store Levorphanol Tartrate Tablets securely and to dispose of unused Levorphanol Tartrate Tablets by flushing down the toilet.Interactions with Benzodiazepine and Other CNS Depressants\nInform patients and caregivers that potentially fatal additive effects may occur if Levorphanol Tartrate Tablets are used with benzodiazepine or other CNS depressants, including alcohol, and not to use these drugs concomitantly unless supervised by a healthcare provider [see WARNINGS, PRECAUTIONS; Drug Interactions].Serotonin Syndrome\nInform patients that opioids could cause a rare but potentially life-threatening condition resulting from concomitant administration of serotonergic drugs. Warn patients of the symptoms of serotonin syndrome and to seek medical attention right away if symptoms develop.\nInstruct patients to inform their physician or healthcare provider if they are taking, or plan to take serotonergic medications [see PRECAUTIONS; Drug Interactions].Adrenal Insufficiency\nInform patients that opioids could cause adrenal insufficiency, a potentially life-threatening condition. Adrenal insufficiency may present with non-specific symptoms and signs such as nausea, vomiting, anorexia, fatigue, weakness, dizziness, and low blood pressure. Advise patients to seek medical attention if they experience a constellation of these symptoms [see WARNINGS].Hypotension\nInform patients that Levorphanol Tartrate Tablets may cause orthostatic hypotension and syncope. Instruct patients how to recognize symptoms of low blood pressure and how to reduce the risk of serious consequences should hypotension occur (e.g., sit or lie down, carefully rise from a sitting or lying position) [see WARNINGS].Anaphylaxis\nInform patients that anaphylaxis has been reported with ingredients contained in Levorphanol Tartrate Tablets. Advise patients how to recognize such a reaction, and if they develop signs of allergy such as a rash or difficulty breathing to stop taking Levorphanol Tartrate Tablets and seek medical attention. [see CONTRAINDICATIONS, ADVERSE REACTIONS].Pregnancy\nNeonatal Opioid Withdrawal Syndrome\nInform female patients of reproductive potential that prolonged use of Levorphanol Tartrate Tablets during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated [see WARNINGS, PRECAUTIONS; Pregnancy]\nInform female patients of reproductive potential that Levorphanol Tartrate Tablets can cause fetal harm and to inform the prescriber of a known or suspected pregnancy [see WARNINGS, PRECAUTIONS; Pregnancy].Lactation\nAdvise nursing mothers to monitor infants for increased sleepiness (more than usual), breathing difficulties, or limpness. Instruct nursing mothers to see immediate medical care if they notice these signs [see PRECAUTIONS; Nursing Mothers].Infertility\nInform patients that chronic use of opioids may cause reduced fertility. It is not known whether these effects on fertility are reversible [see ADVERSE REACTIONS].Driving or Operating Heavy Machinery\nInform patients that Levorphanol Tartrate Tablets may impair the ability to perform potentially hazardous activities such as driving a car or operating heavy machinery. Advise patients not to perform such tasks until they know how they will react to the medication [see PRECAUTIONS].Constipation\nAdvise patients of the potential for severe constipation, including management instructions and when to seek medical attention [see ADVERSE REACTIONS].\nDisposal of Unused Levorphanol\nAdvise patients to flush unused Levorphanol Tartrate Tablets down the toilet.\nDrug InteractionsBenzodiazepines and Other Central Nervous System (CNS) Depressants\nDue to additive pharmacologic effect, the concomitant use of benzodiazepines or other CNS depressants, including alcohol, and other sedatives/hypnotics, anxiolytics, tranquilizers, muscle relaxants, general anesthetics, antipsychotics and other opioids, can increase the risk of hypotension, respiratory depression, profound sedation, coma, and death.\nReserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate. Limit dosages and durations to the minimum required. Follow patients closely for signs of respiratory depression and sedation [see WARNINGS].Serotonergic Drugs\nThe concomitant use of opioids with other drugs that affect the serotonergic neurotransmitter system, such as selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), triptans, 5-HT3 receptor antagonists, drugs that affect the serotonin neurotransmitter system (e.g., mirtazapine, trazodone, tramadol), and monoamine oxidase (MAO) inhibitors (those intended to treat psychiatric disorders and also others, such as linezolid and intravenous methylene blue), has resulted in serotonin syndrome. [see PRECAUTIONS; Information for Patients].\nIf concomitant use is warranted, carefully observe the patient, particularly during treatment initiation and dose adjustment. Discontinue Levorphanol Tartrate Tablets if serotonin syndrome is suspected.Mixed Agonist/Antagonist and Partial Opioid Analgesics\nThe concomitant use of opioid with other opioid t analgesics, such as butorphanol, nalbuphine, pentazocine, may reduce the analgesic effect of Levorphanol Tartrate Tablets and precipitate withdrawal symptoms.\nAdvise patient to avoid concomitant use of these drugs.Muscle Relaxants\nLevorphanol may enhance the neuromuscular blocking action of skeletal muscle relaxants and produce an increased degree of respiratory depression.\nIf concomitant use is warranted, monitor patients for signs of respiratory depression that may be greater than otherwise expected and decrease the dosage of Levorphanol Tartrate Tablets and/or the muscle relaxant as necessary.Diuretics\nOpioids can reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. If concomitant use is warranted, monitor patients for signs of diminished diuresis and/or effects on blood pressure and increase the dosage of the diuretic as needed.Anticholinergic Drugs\nThe concomitant use of anticholinergic drugs may increase risk of urinary retention and/or severe constipation, which may lead to paralytic ileus.\nIf concomitant use is warranted, monitor patients for signs of urinary retention or reduced gastric motility when Levorphanol Tartrate Tablets is used concomitantly with anticholinergic drugs.\nCarcinogenesis, Mutagenesis, Impairment of FertilityCarcinogenesis\nLong-term studies in animals to evaluate the carcinogenic potential of Levorphanol have not been conducted.Mutagenesis\nAnimal studies to evaluate the mutagenic potential of Levorphanol have not been conducted.Impairment of Fertility\nAnimal studies to determine the effect of Levorphanol on fertility have not been conductedInfertility\nChronic use of opioids may cause reduced fertility in females and males of reproductive potential. It is not known whether these effects on fertility are reversible [see ADVERSE REACTIONS].\nProlonged use of opioid analgesics during pregnancy may cause neonatal opioid withdrawal syndrome [see WARNINGS]. Available data with Levorphanol Tartrate Tablets in pregnant women are insufficient to inform a drug-associated risk for major birth defects and miscarriage.\nIn animal reproduction studies, oral Levorphanol produced malformations and nearly 50% embryo lethality in mice at 10 and 12 times the human daily dose of 12 mg/day, respectively. Paternal exposure to Levorphanol prior to mating to an untreated female resulted in reduced litter birth weights, developmental delays, and aberrant behavior in a swim maze at 34 times the human daily dose of 12 mg/day.\nAll pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively.Clinical Considerations\nFetal/Neonatal Adverse Reactions\nProlonged use of opioid analgesics during pregnancy for medical or nonmedical purposes can result in physical dependence in the neonate and neonatal opioid withdrawal syndrome shortly after birth. Neonatal opioid withdrawal syndrome presents as irritability, hyperactivity and abnormal sleep pattern, high pitched cry, tremor, vomiting, diarrhea, and failure to gain weight. The onset, duration, and severity of neonatal opioid withdrawal syndrome vary based on the specific opioid used, duration of use, timing and amount of last maternal use, and rate of elimination of the drug by the newborn. Observe newborns for symptoms of neonatal opioid withdrawal syndrome and manage accordingly [see WARNINGS].\nLabor or Delivery\nOpioids cross the placenta and may produce respiratory depression and psycho-physiologic effects in neonates. An opioid antagonist, such as naloxone, must be available for reversal of opioid-induced respiratory depression in the neonate. Levorphanol Tartrate Tablets are not recommended for use in pregnant women during or immediately prior to labor, when other analgesic techniques are more appropriate. Opioid analgesics, including Levorphanol Tartrate Tablets can prolong labor through actions which temporarily reduce the strength, duration, and frequency of uterine contractions. However, this effect is not consistent and may be offset by an increased rate of cervical dilation, which tends to shorten labor.\nMonitor neonates exposed to opioid analgesics during labor for signs of excess sedation and respiratory depression.\nIn a published study, Levorphanol has been shown to cause central nervous system malformations consistent with neural tube defects (kinking of the spinal cord, hydromyelia, dilation of the fourth ventricle, and brachyury) in pregnant mice when given a single subcutaneous dose of 25 mg/kg (10 times the human daily dose of 12 mg/day based on a body surface area comparison) on Gestation Day 9. Subcutaneous administration of 30 mg/kg Levorphanol to pregnant mice on Gestation Day 9 resulted in approximately 50% mortality of the mouse embryos (12 times the human daily dose of 12 mg/day).\nIn another published study, male mice were injected subcutaneously twice daily with increasing daily doses of Levorphanol up to 42 mg/kg/day (34 times the human daily dose of 12 mg based on body surface area) for 5.5 to 8.5 days prior to mating with an untreated female. Paternal exposure to Levorphanol resulted in reduced birth weights of the litters, developmental delays in the offspring, and aberrant swim patterns in the progeny when measured at 6.5 to 8.5 weeks of age.\nThe developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for Levorphanol Tartrate Tablets and any potential adverse effects on the breastfed infant from Levorphanol Tartrate Tablets or from the underlying maternal condition.Clinical Considerations\nInfants exposed to Levorphanol Tartrate Tablets through breast milk should be monitored for excess sedation and respiratory depression. Withdrawal symptoms can occur in breastfed infants when maternal administration of an opioid analgesic is stopped, or when breastfeeding is stopped.Data\nStudies of Levorphanol concentrations in breast milk have not been performed. However, morphine, which is structurally similar to Levorphanol, is excreted in human milk. Because of the potential for serious adverse reactions from Levorphanol in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.\nLevorphanol Tartrate Tablets are not recommended in children under the age of 18 years as the safety and efficacy of the drug in this population has not been established.\nElderly patients (aged 65 years or older) may have increased sensitivity to Levorphanol. In general, use caution when selecting a dosage for an elderly patient, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function and of concomitant disease or other drug therapy. The initial dose of Levorphanol Tartrate Tablets should be reduced by 50% or more in the infirm elderly patient.\nRespiratory depression is the chief risk for elderly patients treated with opioids, and has occurred after large initial doses were administered to patients who were not opioid- tolerant or when opioids were co-administered with other agents that depress respiration. Titrate the dosage of Levorphanol Tartrate Tablets slowly in geriatric patients and monitor closely for signs of central nervous system and respiratory depression [see WARNINGS].\nThis drug is known to be substantially excreted by the kidney, and the risk of adverse reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function\nIn approximately 1400 patients treated with Levorphanol Tartrate Tablets in controlled clinical trials, the type and incidence of side effects were those expected of an opioid analgesic, and no unforeseen or unusual toxicity was reported.\nDrugs of this type are expected to produce a cluster of typical opioid effects in addition to analgesia, consisting of nausea, vomiting, altered mood and mentation, pruritus, flushing, difficulties in urination, constipation, and biliary spasm. The frequency and intensity of these effects appears to be dose related. Although listed as adverse events these are expected pharmacologic actions of these drugs and should be interpreted as such by the clinician.\nThe following adverse events have been reported with the use of Levorphanol Tartrate Tablets: Body as a Whole: abdominal pain, dry mouth, sweating\nCardiovascular System: cardiac arrest, shock, hypotension, arrhythmias including bradycardia and tachycardia, palpitations, extra-systoles\nDigestive System: nausea, vomiting, dyspepsia, biliary tract spasm\nNervous System: coma, suicide attempt, convulsions, depression, dizziness, confusion, lethargy, abnormal dreams, abnormal thinking, nervousness, drug withdrawal, hypokinesia, dyskinesia,\nhyperkinesia, CNS stimulation, personality disorder, amnesia, insomnia Respiratory System: apnea, cyanosis, hypoventilation\nSkin & Appendages: pruritus, urticaria, rash, injection site reaction\nSpecial Senses: abnormal vision, pupillary disorder, diplopia\nUrogenital System: kidney failure, urinary retention, difficulty urinating\nThe following adverse reactions have been identified during post approval use of Levorphanol. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.\n- Serotonin syndrome: Cases of serotonin syndrome, a potentially life-threatening condition, have been reported during concomitant use of opioids with serotonergic drugs.\n- Adrenal insufficiency: Cases of adrenal insufficiency have been reported with opioid use, more often following greater than one month of use.\n- Anaphylaxis: Anaphylaxis has been reported with ingredients contained in Levorphanol Tartrate Tablets.\n- Androgen deficiency: Cases of androgen deficiency have occurred with chronic use of opioids [see Clinical Pharmacology].\nDRUG ABUSE AND DEPENDENCE\nLevorphanol Tartrate Tablets contains Levorphanol, a Schedule II controlled substance.\nLevorphanol Tartrate Tablets contains Levorphanol, a substance with a high potential for abuse similar to other opioids including fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone, oxymorphone and tapentadol. Levorphanol can be abused and is subject to misuse, addiction, and criminal diversion [see WARNINGS].\nAll patients treated with opioids require careful monitoring for signs of abuse and addiction, because use of opioid analgesic products carries the risk of addiction even under appropriate medical use.\nPrescription drug abuse is the intentional nontherapeutic use of a prescription drug, even once, for its rewarding psychological or physiological effects.\nDrug addiction is a cluster of behavioral, cognitive, and physiological phenomena that develop after repeated substance use and includes: a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal.\n“Drug-seeking” behavior is very common in persons with substance use disorders. Drug- seeking tactics include emergency calls or visits near the end of office hours, refusal to undergo appropriate examination, testing, or referral, repeated “loss” of prescriptions, tampering with prescriptions, and reluctance to provide prior medical records or contact information for other treating health care provider(s). “Doctor shopping” (visiting multiple prescribers to obtain additional prescriptions is common among drug abusers and people suffering from untreated addiction. Preoccupation with achieving adequate pain relief can be appropriate behavior in a patient with poor pain control.\nAbuse and addiction are separate and distinct from physical dependence and tolerance. Health care providers should be aware that addiction may not be accompanied by concurrent tolerance and symptoms of physical dependence in all addicts. In addition, abuse of opioids can occur in the absence of true addiction.\nLevorphanol Tartrate Tablets, like other opioids, can be diverted for non-medical use into illicit channels of distribution. Careful record-keeping of prescribing information, including quantity, frequency, and renewal requests, as required by state and federal law, is strongly advised.\nProper assessment of the patient, proper prescribing practices, periodic reevaluation of therapy, and proper dispensing and storage are appropriate measures that help to limit abuse of opioid drugs.Risks Specific to Abuse of Levorphanol Tartrate Tablets\nLevorphanol Tartrate Tablets are for oral use only. Abuse of Levorphanol Tartrate Tablets poses a risk of overdose and death. The risk is increased with concurrent abuse of Levorphanol Tartrate Tablets with alcohol and other central nervous system depressants.\nParenteral drug abuse is commonly associated with transmission of infectious diseases such as hepatitis and HIV.\nBoth tolerance and physical dependence can develop during chronic opioid therapy. Tolerance is the need for increasing doses of opioids to maintain a defined effect such as analgesia (in the absence of disease progression or other external factors). Tolerance may occur to both the desired and undesired effects of drugs, and may develop at different rates for different effects.\nPhysical dependence results in withdrawal symptoms after abrupt discontinuation or a significant dosage reduction of a drug. Withdrawal also may be precipitated through the administration of drugs with opioid antagonist activity (e.g., naloxone, nalmefene), mixed agonist/antagonist analgesics (e.g., pentazocine, butorphanol, nalbuphine), or partial agonists (e.g., buprenorphine). Physical dependence may not occur to a clinically significant degree until after several days to weeks of continued opioid usage.\nLevorphanol Tartrate Table should not be abruptly discontinued in a physically-dependent patient [see DOSAGE AND ADMINISTRATION]. If Levorphanol Tartrate Tablets are abruptly discontinued in a physically- dependent patient, a withdrawal syndrome may occur. Some or all of the following can characterize this syndrome: restlessness, lacrimation, rhinorrhea, yawning, perspiration, chills, myalgia, and mydriasis. Other signs and symptoms also may develop, including: irritability, anxiety, backache, joint pain, weakness, abdominal cramps, insomnia, nausea, anorexia, vomiting, diarrhea, or increased blood pressure, respiratory rate, or heart rate.\nInfants born to mothers physically dependent on opioids will also be physically dependent and may exhibit respiratory difficulties and withdrawal signs [see PRECAUTIONS; Pregnancy].\nAcute overdose with Levorphanol Tartrate Tablets can be manifested by respiratory depression, somnolence progressing to stupor or coma, skeletal muscle flaccidity, cold and clammy skin, constricted pupils, and, in some cases, pulmonary edema, bradycardia, hypotension, partial or complete airway obstruction, atypical snoring, and death. Marked mydriasis rather than miosis may be seen with hypoxia an overdose situations.\nTreatment of Overdose\nIn case of overdose, priorities are the reestablishment of a patient and protected airway and institution of assisted or controlled ventilation, if needed. Employ other supportive measures (including oxygen and vasopressors) in the management of circulatory shock and pulmonary edema as indicated. Cardiac arrest or arrhythmias will require advanced life- support techniques.\nThe opioid antagonists, naloxone or nalmefene, are specific antidotes to respiratory depression resulting from opioid overdose. For clinically significant respiratory or circulatory depression secondary to resulting from opioid overdose. For clinically significant respiratory or circulatory depression secondary to Levorphanol Tartrate Tablets overdose, administer an opioid antagonist. Opioid antagonists should not be administered in the absence of clinically significant respiratory or circulatory depression secondary to Levorphanol Tartrate Tablets overdose.\nBecause the duration of opioid reversal is expected to be less than the duration of action of Levorphanol in Levorphanol Tartrate Tablets, carefully monitor the patient until spontaneous respiration is reliably reestablished. If the response to an opioid antagonist is suboptimal or only brief in nature, administer additional antagonist as directed by the product's prescribing information.\nIn an individual physically dependent on opioids, administration of the recommended usual dosage of the antagonist will precipitate an acute withdrawal syndrome. The severity of the withdrawal symptoms experienced will depend on the degree of physical dependence and the dose of the antagonist administered. If a decision is made to treat serious respiratory depression in the physically dependent patient, administration of the antagonist should be initiated with care and by titration with smaller than usual doses of the antagonist.\nDOSAGE AND ADMINISTRATION\nImportant Dosage and Administration Instructions\nUse the lowest effective dosage for the shortest duration consistent with individual patient treatment goals [see WARNINGS].\nInitiate the dosing regimen for each patient individually, taking into account the patient's severity of pain, patient response, prior analgesic treatment experience, and risk factors for addiction, abuse, and misuse [see WARNINGS].\nMonitor patients closely for respiratory depression, especially within the first 24-72 hours of initiating therapy and following dosage increases with Levorphanol Tartrate Tablets and adjust the dosage accordingly [see WARNINGS].\nInitial DosageUse of Levorphanol Tartrate Tablets as the First Opioid Analgesic\nInitiate treatment with Levorphanol Tartrate Tablets in a dosing range of 1 to 2 mg every 6 to 8 hours as needed for pain, provided the patient is assessed for signs of hypoventilation and excessive sedation. If necessary, the dose may be increased to up to 3 mg every 6 to 8 hours, after adequate evaluation of the patient's response. Higher doses may be appropriate in opioid tolerant patients. Dosage should be adjusted according to the severity of the pain; age, weight and physical status of the patient; the patient's underlying diseases; use of concomitant medications; and other factors [see INDIVIDUALIZATION OF DOSAGE, WARNINGS AND PRECAUTIONS].Conversion from Other Opioids to Levorphanol Tartrate Tablets\nThere is inter-patient variability in the potency of opioid drugs and opioid formulations. Therefore, a conservative approach is advised when determining the total daily dosage of Levorphanol Tartrate Tablets. It is safer to underestimate a patient's 24-hour Levorphanol Tartrate Tablets dosage than to overestimate the 24-hour Levorphanol Tartrate Tablets dosage and manage an adverse reaction due to overdose.\nThe dosage of Levorphanol in patients with cancer or with other conditions for which chronic opioid therapy is indicated must be individualized. Levorphanol is 4 to 8 times as potent as morphine and has a longer half-life. Because there is incomplete cross-tolerance among opioids, when converting a patient from morphine to Levorphanol, the total daily dose of Levorphanol should begin at approximately 1/15 to 1/12 of the total daily dose of oral morphine that such patients had previously required and then the dose should be adjusted to the patient's clinical response. If a patient is to be placed on fixed-schedule dosing (round-the-clock) with this drug, care should be taken to allow adequate time after each dose change (approximately 72 hours) for the patient to reach a new steady-state before a subsequent dose adjustment to avoid excessive sedation due to drug accumulation.\nNote: As with all controlled substances, abuse by health care personnel is possible and the drug should be handled accordingly.Geriatric Patients\nElderly patients (aged 65 years or older) may have increased sensitivity to Levorphanol. In general, use caution when selecting a dosage for an elderly patient, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function and of concomitant disease or other drug therapy. The initial dose of Levorphanol Tartrate Tablets should be reduced by 50% or more in the infirm elderly patient. [see PRECAUTIONS].\nTitration and Maintenance of Therapy\nIndividually titrate the dose of Levorphanol Tartrate Tablets that provides adequate analgesia and minimizes adverse reactions. Continually reevaluate patients receiving Levorphanol Tartrate Tablets to assess the maintenance of pain control and the relative incidence of adverse reactions, as well as monitoring for the development of addiction, abuse, or misuse [see WARNINGS]. Frequent communication is important among the prescriber, other members of the healthcare team, the patient, and the caregiver/family during periods of changing analgesic requirements, including initial titration.\nIf a patient is to be placed on fixed-schedule dosing (round-the-clock) with this drug, care should be taken to allow adequate time after each dose change (approximately 72 hours) for the patient to reach a new steady state before a subsequent dose adjustment to avoid excessive sedation due to drug accumulation.\nIf the level of pain increases after dosage stabilization, attempt to identify the source of increased pain before increasing Levorphanol Tartrate Tablets dosage. If unacceptable opioid- related adverse reactions are observed, consider reducing the dosage. Adjust the dosage to obtain an appropriate balance between management of pain and opioid-related adverse reactions.\nLevorphanol has a long half-life. The duration of pain relief after a single dose cannot always be predicted from pharmacokinetic principles, and the inter-dose interval may have to be adjusted to suit the patient's individual pharmacodynamic response.\nDiscontinuation of Levorphanol Tartrate Tablets\nWhen a patient who has been taking Levorphanol Tartrate Tablets regularly and may be physically dependent no longer requires therapy with Levorphanol Tartrate Tablets taper the dose gradually, by 25% to 50% every 2 to 4 days, while monitoring carefully for signs and symptoms of withdrawal. If the patient develops these signs or symptoms, raise the dose to the previous level and taper more slowly, either by increasing the interval between decreases, decreasing the amount of change in dose, or both. Do not abruptly discontinue Levorphanol Tartrate Tablets in a physically-dependent patient [see WARNINGS, DRUG ABUSE AND DEPENDENCE].\nLevorphanol Tartrate Tablets USP, 2 mg White, scored tablets (Identified 54 410).\nNDC: 42358-102-10 Bottles of 100 tablets.\nStore at 20° to 25°C (68° to 77°F). [See USP Controlled Room Temperature.]\nDispense in an amber airtight container as defined in the USP.\nSentynl Therapeutics, Inc.\nSolana Beach, CA 92075\nRevised December 2016 LV20161201.1\nLevorphanol Tartrate (lee vor' fa nol tar' trate) Tablets, CII\n|Levorphanol Tartrate Tablets are:\n|Important information about Levorphanol Tartrate Tablets:\n|Do not take Levorphanol Tartrate Tablets if you have:\nsevere asthma trouble breathing, or other lung problems\na bowel blockage or have narrowing of the stomach or intestines.\npreviously had an allergic reaction to Levorphanol\n|Before taking Levorphanol Tartrate Tablets, tell your healthcare provider if you have a history of:|\n|Tell your healthcare provider if you are:\n|When taking Levorphanol Tartrate Tablets:\n|While taking Levorphanol Tartrate Tablets DO NOT:\n|Get emergency medical help if you have:\n|These are not all the possible side effects of Levorphanol Tartrate Tablets. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. For more information go to dailymed.nlm.nih.gov|\nDistributed by: Sentynl Therapeutics, Inc. 420 Stevens Ave Suite 200 Solana Beach, CA 92075, or call 1-888-227-8725\nThis Medication Guide has been approved by the U.S. Food and Drug Administration.\nPackage/Label Display Panel\nNDC: 42358-102-10 Bottles of 100 tablets\nSentynl Therapeutics, Inc.\nLevorphanol tartrate tablet\n|Labeler - Sentynl Therapeutics, Inc. (078313706)|\n|Boehringer Ingelheim Roxane Inc||833490464||MANUFACTURE(42358-102)|\nMore about levorphanol\n- Side Effects\n- During Pregnancy\n- Dosage Information\n- Drug Images\n- Drug Interactions\n- Support Group\n- Pricing & Coupons\n- En Español\n- 11 Reviews – Add your own review/rating\n- Drug class: narcotic analgesics\nOther brands: Levo-Dromoran |
Dr. Basseri is committed to offering patients in Los Angeles, CA, the most advanced treatment options for colon cancer, from the earliest stages to the most advanced stages, so men and women can make informed decisions about their health and feel confident in the care they receive.request an appointment\nColon cancer is the third leading cause of cancer death in the U.S., causing about 50,000 deaths each year. More than 140,000 people are diagnosed with colon cancer each year, making it the third most commonly diagnosed cancer in the U.S.\nWhat symptoms does colon cancer cause?\nIn its very early stages, colon cancer may cause few if any symptoms, which is why having a colonoscopy is so important to maintaining your health and diagnosing cancer when it’s most treatable. As colon cancer progresses, it can cause symptoms such as:\n- blood in the stool\n- rectal bleeding\n- diarrhea, constipation or other changes in bowel habits\n- changes in the consistency of your stool\n- persistent cramps, bloating or abdominal pain\n- unexplained weight loss\nSymptoms can vary, depending on where the tumor is located as well as its size.\nHow is colon cancer diagnosed?\nColonoscopy is the gold standard for diagnosing colonoscopy. The American Cancer Society recommends colon cancer screening begin at age 50 or earlier if you have a family history of the disease or certain risk factors that make you more likely to develop colon cancer.\nHow is colon cancer treated?\nIn early stages when the cancer is small and restricted to one or more small polyps, it may be completely removed during a colonoscopy. Larger polyps may be removed through an endoscopic procedure called a resection or laparoscopically using very small incisions. In invasive cancer, surgery will be needed to remove a portion of your colon along with the tumor. Radiation or chemotherapy (or both) may also be recommended following surgery. Radiation may also be used prior to surgery to reduce the size of very large tumors. Targeted drug therapy may also be effective.\nHow is colon cancer screening performed?\nColon cancer screening relies on a simple, minimally-invasive procedure called colonoscopy to look inside the colon for polyps, fleshy growths which are sometimes an indication of early colon cancer, and other abnormal signs. When a polyp is located, it can be removed during the colonoscopy procedure and sent to a lab where it can be more completely evaluated for the presence of cancer cells. Colon cancer is performed under sedation on an outpatient basis and typically takes less than a half hour to perform.\nWhat kind of preparation is required for a colonoscopy?\nIn order to view your colon, it needs to be clear of fecal matter. The day before your colonoscopy, you’ll need to take a medication that will cause you to empty your bowel so it will be empty for your procedure. You’ll also be restricted to clear liquids during the preparation period, and you’ll need to fast for about 12 hours prior to your procedure.\nWhat happens once the colonoscopy is complete?\nOnce your procedure is over, you’ll go to a recovery area for a brief period of time while the sedation wears off before being discharged to go home. You’ll be able to eat normally, but because you will have been sedated for the procedure, you’ll need someone to drive you home. If polyps were removed, you may have some very mild spotting for a brief period of time. You may be a little tired from the sedation, but you’ll be able to return to work the next day.\nWho should be screened for colon cancer?\nThe American Cancer Society says everyone should be screened for colon cancer beginning at age 50 and every 10 years thereafter. People with risk factors for colon cancer should be screened earlier and more often, beginning at age 40 and every five years thereafter. |
Sedation dentistry offers individuals with general anxiety about going to the dentist or fears about a specific dental procedure the opportunity to have a stress free and more comfortable experience. Utilizing safe and controlled sedation techniques prior to the dental procedure the patient is eased into a state of complete relaxation. This eliminates any discomfort, pain, and preoperative anxiety that may be associated with a particular dental visit. With sedation dentistry patients typically feel more at ease post-operatively as they have little or no memory of the actual moment-to-moment dental procedure.\nOral Sedation means that you will be given a prescription for an oral medication prior to you appointment. Taken at the recommended time before your appointment, this medication allows you to fully relax by the time your procedure begins. When receiving oral sedation, a patient must have an escort on the day of the procedure to drive them to and from the office.Go Back |
What is Anesthesia Machine\nAn anesthesia machine is a pneumatic device that supplies a mixture of oxygen, gas, and an anesthetic agent to a patient, allowing the patient to remain unconscious during surgery but at the same time breathe.\nThe device supplies oxygen and at the same time ensures that the patient does not inhale the life-threatening CO2, which the patient had previously released.\nThe design of the anesthesia machine has remained relatively the same since its invention. The components required for an anesthesia machine are as follows:\nVentilators are used for the patient to breathe during surgery. Ventilators help maintain close to normal respiratory rates and normal blood chemistry for patients. Older machines have ventilators with 2 settings: on or off.\nVentilators were set up for deeply anesthetized patients to breathe. The new machines boast 7 different modes of ventilation to match the flexibility needed to keep patients breathing effortlessly, sick and heavy.\n2. Breathing circuit\nUsed to allow air and gases to travel safely to the patient.\nBreathing circuits deliver oxygen and anesthetic gases to patients and eliminate the CO2 they release. These machines provide adaptable breathing circuits for a wide variety of patients, from newborns weighing less than 10 lbs.\nIt is primarily used for obese patients who weigh 300 pounds or more. There are 2 types of breathing circuits: non-breathing and circle. Circle breathing circuits are becoming the most popular system in use today.\nThese circuits purge the CO2 exhaled from the patient, allowing the exhaled anesthetic gases to be breathed in again. They allow patients to breathe in a constant concentration of anesthetic.\nRespiratory systems conserve heat and humidity; And they are more suitable for low-flow anesthetic delivery.\n3. Scavenging system\nIt’s meant to flush out “used” gases like CO2.\nScavenging systems collect and then remove the expelled anesthetic gases. Systems are active (suction is applied to remove gases) or passive (gas exits through tubing into a room’s ventilation exhaust grille).\nWhen active systems are used, the patient’s airway is protected from suction devices and positive pressure build-up of waste gases. Passive systems require only positive pressure monitoring.\nMost new scavenging systems are open to the atmosphere, which is safer for the patient than older closed systems that release waste gas into the atmosphere through valves.\n4. Safety Mechanism\nThis is for an emergency, which does not endanger the patient.\nSafety Measures The newest machines have more electronically operated components than ever before. In the 1950s the lack of electricity only affected much of the ventilation capabilities of the machine, but less so on today’s new machines that do not require electricity.\nRight now having an emergency generator makes everything easier. Anesthesia machines need to have enough battery backup power to run for 45 minutes to close the surgery and bring the patient to consciousness.\nNever plug external monitoring devices into an outlet located on the back of the anesthesia machine. This can overload the machine’s circuits and burn the machine and jeopardize the functioning of the monitor. Instead, always plug the monitor into a wall socket.\nNitrous oxide is a greenhouse gas, but it is used in such small amounts in OR that its impact on the environment is negligible. Collection of the waste anesthetic is still important, however, especially in limiting the surgical team’s exposure to high concentrations of expelled gases.\nArticle About:- Health & fitness\nArticle About:- Medical Technology\nWhat is the principle of Anesthesia Machine\nAnesthetic Vapor The most effective and powerful doctor circulatory air, nitrous air such as air, nitrous disease, etc., through the transmission of low-impact valves. This is a powerful transplant for a measurement anesthesia machines that transmits data. To convert the canister to temperature, it is necessary to import in the amount of shiver. Communication occurs in the body environment from the infected body to the infected body, which is activated in the environment of the human body and transformed into the environment of the human body. compatibility to alert the deadly form of organs and change every once in a while. to get the project.\nOf easy air\nAffected by the effect of the weather, the night diseases are affected according to the weather, under the influence of the wind test. CO2 line, start deflating bulla.\nFor future steps, have a healthy one to update and switch off.\nFor se tuck\nAccording to time, prophecy is full. Cleaning the system from excess air containing high blood pressure.\nFor forced practice, the driller performs exercises on the bellows. Belo money is checked. So, to preside. Align, a ball applied. It is the presi grinder which is out of the scavenging system.\nExpiry season I give I. Now, it’s for laundry\nHow to work anesthesia machine\nIt is impossible to imagine surgery without anesthesia. Some also attribute patient anxiety to fear of the anesthetic, but understanding how doctors administer anesthesia can be incredibly beneficial for reducing a patient’s stress. The more we know this, the less we fear.\nAnesthesia machines are the most important medical equipment in the healthcare industry. These pneumatic devices help doctors to sedate their patients before surgery and keep them asleep while breathing throughout the procedure.\nPrimarily, the function of the anesthesia machine is to help surgeons reduce their patient’s pain during a medical operation. But few people understand the inner workings of the device.\nWhat is the cost of anesthesia machine?\nA new anesthesia machine can cost from $30,000 to more than $150,000. It is also considered according to global standards.\nHow many type of anesthesia\nMovie is a small part of the body. Lateral procedure is good for 24 hours. For example, stitches signal time, data time.\nRegional Anesthesia: –\nAnesthesia is used at the moment of this procedure. For example, textstick.\nThe patient is in a state of unconsciousness during the procedure. to use\nArticle About:- Health & fitness\nArticle About:- Medical Technology\nwhat are the functions of Anesthesia machine\n- Connections to piped oxygen, medical air & nitrous oxide from wall supply in healthcare facility/Reserve gas cylinder of oxygen.\n- Pressure gauges, regulators & “pop-off” valves, to monitor gas pressure throughout.\n- High-Flow oxygen flush.\nAdvantages of Anesthesia machine\n- Enables the patient to tolerate the surgical procedures that would otherwise inflict the unbearable pain\n- The potentiate extreme physiologic exacerbations\n- It allows the proper muscle relaxation for the prolonged periods of time\nDisadvantages of Anesthesia machine\n- Anesthesia requires the increased complexity of care and the associated costs\n- It requires some degree of preoperative patient preparation.\n- It is associated with less serious complications such as nausea or vomiting.\nWhat is the Components of Anesthesia Machine\n- Oxygen source Patients will need help breathing while under and oxygen is important.\n- Oxygen flowmeter The flowmeter keeps the flow of oxygen at a set point.\n- Vaporizer The vaporizer takes the liquid form of the anesthetic and transforms it into a vapor, so the patient can inhale it.\n- general anesthesia, local anesthesia, anesthesia machine, anesthesia\nTroubleshooting of Anesthesia Machine\nCommon issues with anesthesia machines\nTypical problems with anesthesia machines are power problems, gas supply, vaporizer malfunctions, ventilator and alarm system malfunctions.\n- Electrical and electrical issues: Identify and resolve electrical issues, such as faulty electrical connections, circuit breaker tripping, and battery problems.\n- Gas Supply Problems: Troubleshoot gas supply issues including gas leaks, pressure regulator problems and cylinder changes.\n- Malfunctioning vaporizer: Address vaporizer malfunctions, such as clogged valves, incorrect flow rates, and vaporizer servicing.\n- Ventilator Problems: Explore and troubleshoot common ventilator issues, such as abnormal breathing patterns, improper tidal volume and disconnection.\n- Alarm System Malfunctions: Troubleshoot alarm system malfunctions, including false alarms, alarm silence, and alarm parameter adjustments.\n- Preventive Maintenance: Emphasizing the importance of regular preventive maintenance to keep anesthesia machines in optimal working condition, including cleaning, lubrication and inspection procedures.\n- Routine calibration and testing: Perform calibration and testing of anesthesia machine components and sensors to ensure accurate and precise performance.\nHow equipment works anesthesia machine\nAn anesthesia machine is a complex piece of equipment used to administer anesthesia to patients during medical procedures. How Anesthesia Machine Works:\ngas supply system.\nHow to check anesthesia machine\nChecking an anesthesia machine is crucial to ensure its proper functioning and patient safety.\nExternal Inspection: Begin by visually inspecting the machine for any obvious damages, loose connections, or signs of wear. Check the power source and ensure the machine is properly plugged in.\nLeak Test. ..\nGas Cylinder Check. ..\nFlow Meter Calibration. ..\nVaporizer Check. ..\nVentilator Functionality. ..\nMonitoring Equipment. ..\nAlarms and Safety Features. ..\nHow much does an anesthesia machine cost\nAnesthesia machine cost can vary depending on various factors like brand, features and specifications. which may contribute to their cost. Additionally, the inclusion of advanced technologies and monitoring capabilities may also affect the price. The cost of an anesthesia machine typically ranges from $10,000 to $30,000 USD. However, more advanced models with additional features and capabilities can range from $30,000 to $100,000 USD. |
You’ve been considering getting facelift surgery – the problem is, you’re not sure which particular surgery you should opt for.\nSure, the full facelift promises more results that can last for a long time. But then again, the mini facelift can target neck issues, and the surgery is performed under local anesthesia.\nSo when it comes down to it, which is better: the mini facelift or the full facelift?\nAll About the Full Facelift\nA full facelift – more formally known as a rhytidectomy – is a surgical procedure that aims to correct skin sagging that’s particularly prominent around the mid-facial region, including the cheeks and underneath the eyes. The full facelift also helps minimize wrinkles and folds that may have appeared as a result of skin sagging, thus helping to take years off of a patient’s appearance.\nThe full facelift is performed under general anesthesia and usually requires about two weeks of downtime before patients can return back to work or social activities. Costs range from $7,000 to $15,000, depending on the facial surgeon’s experience and location.\nThe Inside Scoop on the Mini Facelift\nThe mini facelift – also referred to as the Weekend Lift – is a minor facial surgery that focuses on correcting skin sagging predominantly located along the jawline and neck. Because this procedure is so focused, patients only see results around the lower facial regions (the eyes and forehead are not touched).\nThe mini facelift is performed under local anesthesia, with patients able to return to their normal activities within a few days. Mini facelift costs can range from $3,500 to $6,500.\nMini Facelift & Facelift Consultations Available\nWhich One is Better for Me?\nThe answer will largely depend on the problems you want to address with the facial surgery, as well as the results you’re looking for. To help you determine if the mini facelift or traditional facelift is right for you, ask yourself the following questions:\n- Are you bothered by skin sagging around the mouth and jawline?\n- Do you feel self-conscious about the appearance of jowls?\n- Do you find that you look tired all the time, even if you’ve been getting a good night’s sleep?\n- Are you bothered by skin sagging in different parts of your face?\nIf you answered yes to the first two questions, you’re a good candidate for a mini facelift. If you answer yes to the last two questions or to all four questions, you’ll probably see better results with a traditional facelift.\nI saw Dr Farole for a consult recently, and I was positively impressed. The staff were helpful and efficient, the x-ray tech was super personable and made me feel comfortable, and Dr Farole had a stellar bedside manner. He gave me a lot of valuable time to put me at ease about the purpose of my visit, and I left feeling great.\nIf I or my family needs an oral surgeon in the future, we will be calling on Dr Farole and his staff. |
Getting a rhinoplasty procedure (nose job) is one of the top ways to enhance your appearance and feel more confident. In some cases, a rhinoplasty is performed to improve breathing, along with improving nose shape, projection, and size. No matter your reason for needing a rhinoplasty, board-certified plastic surgeon Darren M. Smith, MD, can help.\nAs one of the only board-certified plastic surgeons in the nation to have completed a craniofacial surgery fellowship and an aesthetic surgery fellowship, Dr. Smith brings a unique perspective and\nskillset to rhinoplasty surgery. To learn more about modern rhinoplasty procedures, book a consultation with us either online or over the phone.\nA rhinoplasty, more commonly known as a “nose job,” involves surgically reshaping your nose to improve your overall facial appearance, achieve facial balance, and improve your breathing. A rhinoplasty can:\nWhile commonly requested for aesthetic purposes, a rhinoplasty is sometimes needed for medical purposes, too. For instance, if you have a deviated septum or obstructed airway that makes it difficult for you to breathe – or that causes you to snore – a rhinoplasty can finally bring you relief.\nEach rhinoplasty procedure is unique. During your consultation, Dr. Smith will work with you to understand your desired aesthetic and functional goals. He can also offer digital simulations of outcomes while planning the most attractive changes for your facial structure.\nWhile all our procedures are highly-customized and based on the individual patient’s anatomy and their goals, perhaps no operation in plastic surgery is as different from one patient to the next as rhinoplasty. This is because the range of possibilities in nasal anatomy is particularly diverse. Therefore, the maneuvers that may need to be performed to achieve a given result vary tremendously from patient to patient.\nMost of the maneuvers that may be performed during rhinoplasty can be grouped into several categories:\nA different combination of grafts, sutures, septal surgery and osteotomies is performed in each rhinoplasty, although some rhinoplasties may not require maneuvers from each category.\nRhinoplasties can be performed “open” or “closed,” depending on the specifics of the case. In open rhinoplasty, a small incision is made on the columella (the structure separating your nostrils on the bottom of your nose) and the nasal skin is moved out of the way to allow access to the underlying structures. The resulting scar is very faint and well-hidden. In closed rhinoplasty, incisions are made inside the nasal passages, and are therefore hidden after the procedure.\nA rhinoplasty can be performed under general anesthesia (the patient is completely asleep) or “twilight” anesthesia (the patient is awake and breathing on his or her own but not aware of his or\nher surroundings). After the procedure you will recuperate in the recovery room and can generally return home one to two hours after surgery.\nAfter surgery, you will have a small plastic splint on your nose that will stay in place for approximately 5 days. Most of your bruising and swelling will resolve to the point that you can return to work after 5-7 days.\nYou will feel swollen and a little sore after the procedure, but this also improves rapidly during the first week. The first week of your recovery should be spent taking short walks and with minimal exertion. During the second week, you can gradually increase your activity level.\nAfter two weeks, you will be ready to resume your standard activity level, although the nose should be protected from direct trauma for approximately 6 weeks. Dr. Smith has advanced training in cutting-edge techniques, so your downtime, scarring and recovery are as low-impact as possible.\nBook your rhinoplasty evaluation at the office of Darren M. Smith, MD, today with the online scheduler or call the office directly. |
I am exploring breast implant explantation, and in many Q&As, the Doctors refer to the 'capsule' created by the implant. What is this made of? What are they refering to? And what are the risks associated with keeping it in the body versus removing it? I am also keen to understand the risks associated with local versus general anesthetic for the explantation. I had silicon implants put in 16 years ago when I was 21 years old. I had a 32A cup prior to the operation and a 32C after. Thanks!\nWhat is the Capsule That Many Doctors Refer to with Regards to Breast Implants?\nDoctor Answers (7)\nBreast implant removal and capsules\nA breast implant capsule is the way the body heals around an implant or any foreign body that it cannot heal into. It is made of scar tissue similar to scars on the surface of the skin from incisions. There is nothing abnormal about most capsules and no reason to remove them just because they're there. Removing them will result in a new layer of scar tissue as the body heals the raw area from the removal of the capsule and the surgery involved with removing them is much more involved and carries its own risks. I am always surprised by how many plastic surgeons seem to think something must be done for the capsule. Even with a ruptured silicone gel implant you are not going to clear the body of silicone by removing the capsule and there's no evidence that the microscopic silicone causes problems wether the implant is there or not. There are situations where the capsule might need to be removed. If it is thickened, calcified, or inflamed then it might be indicated to remove part or all of it.\nRemoving saline-filled implants can be done under local anesthesia with a minimal incision in the inframammary crease (one of the minor advantages of the saline breast implant), but removing silicone-gel filled implants is more problematic and the surgeon must be prepared for a possible ruptured gel implant or capsule work if there is an abnormal area. Therefore, a full scale breast surgery approach is needed with either IV sedation/local or general anesthesia. This is more involved and costly.\nRemoving implants that were properly sized and placed and did not distort the breast should result in a natural looking breast that looks the way it would have if the implant had not been there aside from the external scar. This is usually the case whether the implant is removed or the implant and the capsule.\nWhat is the capsule\nThe capsule is basically an inflammatory reaction to the implant itself. It is the body trying to wall off the material. If the capsule is removed it increases the risk of bleeding. If a silicone gel implant has ruptured then removal of the capsule would be recommended otherwise I would leave it alone unless it was calcified. If there is distortion of the breast after implant removal may also be a reason to remove the capsule. The capsule probably never fully gets resorbed and refinements will be there for a long time. This would not cause a health risk.\nWhat is the capsule around breast implants\nThe capsule that is being described is scar tissue that forms around the implant. This is a normal occurrence in the body and happens with all breast implants. If you choose to have your implants removed you do not necessarily have to remove the scar capsules as well. Your body will break down and absorb the scar capsule over time.\nYou might also like...\nCapsules around implants\nsimply put, the capsule is scar tissue. it is a colection of collagen (scar tissue) which surrounds the implant. the scars may be soft or thick but it is neverheless scar tissue.\nThe body forms a natural barrier of collagen around the implant. Usually this stays soft and thin but in some patients that capsule becomes thick and tight.\nThe capsule is a very thin layer of your own tissue around the breast implants.\n1) There is always a capsule around implants. It is the body's natural reaction. What you do with the capsule depends on whether the implants are leaking. If they are leaking, most of the capsule should be removed because there might be bits of silicone in it.\n2) If the implants are intact, we simply curette (scrape) the surface of the capsule and leave it in place. It disappears spontaneously after the implants are gone.\n3) The surgery is best done under light general anesthesia. We always use suction drains in the breasts for several days to prevent fluid accumulations (seromas).\nBreast Implant Removal and Capsules?\nThank you for the question.\nWhen breast implants, or any other foreign body, is inserted into the human body, the body forms a lining around it. This lining is referred to as the “capsule”. This capsule is normally very thin and soft; however, it can become thick and hardened in a process called encapsulation or capsular contracture.\nIn the process of breast implant removal, assuming the breast implant capsules are soft and asymptomatic, there is no reason to remove them (capsulectomy). Removal of breast implant capsular tissue increases the risks of surgery (for example bleeding).\nGenerally speaking what breasts look like after explantation depends on several factors such as: the quality of skin elasticity (the better the elasticity the better the skin will bounce back), the size of the implants used (the larger the implant the more trouble you may have with redundant skin), and the amount of breast tissue present at this time (which may have changed since the time of your breast augmentation).\nLife experience since your breast augmentation procedure, such as pregnancy or weight gain weight loss, will potentially influence the factors discussed above. If you take these factors into consideration and apply them to your specific circumstances you may get a good idea of what to expect after the implants are removed.\nBreast implants can be removed safely under local or general anesthesia depending on the specific situation and patient.\nI hope this helps. |
WISDOM TOOTH EXTRACTION\nWisdom teeth, so-called because of their eruption in the mature age, have a tendency to become infected, painful and overall uncomfortable. These are the third molars and make the last set of adult teeth found at the very end.\nWisdom tooth surgery aims to relieve the pain and discomfort of these teeth through a quick and safe extraction procedure.\nWho Needs a Wisdom Tooth Extraction in Singapore?\nNot everyone needs to get their wisdom teeth removed. Many times wisdom teeth erupt at crooked angles that impinge and damage adjacent teeth. They are also prone to becoming infected.\nWhen your wisdom teeth begin to hurt you or cause some kind of discomforting symptom, that’s when you should consider getting them extracted.\nIn general, wisdom tooth extraction is indicated when:\n- the wisdom tooth damages or puts pressure on neighbouring molars\n- the surrounding gums become swollen, tender and infected\n- when the wisdom tooth doesn’t fully erupt and becomes impacted\n- a cyst forms around the tooth\n- when your oral hygiene is compromised, and the wisdom tooth starts to decay\nWhat To Expect From a Wisdom Tooth Extraction?\nWisdom tooth surgery is a simple and comfortable procedure performed as outpatient surgery at Wellness Dental Studio.\nTo make the surgery painless, a local anesthetic or numbing agent is applied to the site of the wisdom tooth in Singapore.\nAlternatively, patients can also opt for sedation anesthesia if they wish to make the procedure even more comfortable.\nDuring the procedure, our orthodontist will first make a surgical cut in the gum to create flaps and expose the teeth and bone underneath. This will allow the dentist to access the tooth and remove it from its root.\nThe surrounding area is cleaned, and the gum is stitched back together. These stitches will be removed in a second appointment a few days after the surgery.\nRecovery After Wisdom Tooth Extraction\nImmediately after the extraction, you may feel pressure discomfort around the area of the wisdom tooth in Singapore. This can be relieved by taking simple painkillers and consuming soft foods for the first few days.\nOnce the wound heals, you will be asked to visit for a follow-up and your stitches will be removed. |
Monday, May 13, 2013\nScheduled for surgery? You might want to read this!\nJust because the conscious mind is 'asleep', doesn't mean there isn't an effect on the consciousness of the person being operated on!\nThere is a great need for our surgeons to be especially mindful of their thoughts and emotions, especially when the patient being treated is open to suggestion. Yet how many are? In an world where materialism appears to rule, not enough respect is given to the emotional impact of negative words on the patient's psyche.\nPost-hypnotic suggestions can soothe or traumatise a patient recovering from surgery, and influence how that person recovers, or whether they recover at all.\nHere is an excerpt from the best-selling book, 'Many Lives, Many Masters' by Dr Brian Weiss, first published back in 1994.\n"'About the anesthesia. When they give you anesthesia, can you hear? You CAN hear!' She had answered her own question...\n'Your mind is very much aware of what's going on. They were talking about my choking, about the possibility of me choking when they did the surgery on my throat.'\nI remembered Catherine's vocal cord surgery, which was performed just a few months before her first appointment with me. She had been anxious prior to the surgery, but she was absolutely terrified upon awakening in the recovery room. It had taken the nursing staff hours to calm her. Now it appeared that what was said by the surgeons during the operation, during the time she was under deep anesthesia, had precipitated her terror.\nMy mind flipped back to medical school and my surgery rotation. I remembered the casual conversations during operations, while the patients were anesthetized. I remembered the jokes, the cursing, the arguments, and the surgeons' temper tantrums.\nWhat had the patients heard, at a subconscious level? How much registered to affect their thoughts and emotions, their fears and anxieties, after they awakened?\nWas the postoperative course, the patient’s very recovery from the surgery, influenced positively or negatively by the remarks made during the operation?\nHad anyone died because of negative expectations overheard during surgery? Had they, feeling hopeless, just given up?"\nThe physical part of our experience is only a small part of our everyday lives - by far, the greater portion is the emotional, mental and spiritual aspects of our lives.\nThe next time you, or a loved one, are scheduled to have surgery, ask your surgeon to mind their language! If they don't understand, print out this article, and give them a copy!\nFounder and Director of Energy Therapy |
Location: Tallahassee, FL\nTravel Nurse RNFA - CVOR Tallahassee FL\nAre you ready for your next assignment in beautiful Tallahassee, FL?\nA Registered Nurse First Assist (Nationally Certified) for a Cardiovascular Operating Room is needed. This is for a travel contract nursing position at a facility in the state capital of Florida.\nThe RNFA CVOR nurse participates in the sedation of patients and assists physicians during the procedure by administering medications, monitoring vital signs, and applying dressings. Perform a unique perioperative role as a first assistant to surgeons during surgical procedures in the operating room. The candidate must possess the credentials allowing vein harvesting, along with the ability to close after surgery.\nDuration: 13 weeks\nShift: M-F 6:45AM - 5:15PM\nFL or Compact, Multistate RN license\nMust have FA National Certification\n2+ years of CVOR experience, required\nMust have credentials allowing vein harvesting, along with the ability to close after surgery\nTravel experience, preferred\nIf you, or anyone you know have an interest in this position, please apply for this position below, or if you would like to learn more about this, or other opportunities contact me directly.\nNational Hiring Manager\n#flrnjobs #cvornjobs #rnfajobs #healthcarejobs #tallahasseejobs #hotjobs\nEqual Opportunity Employer Minorities/Women/Veterans/Disabled |
Media Articles Related to Capital and Codeine (Acetaminophen / Codeine)\nTemple study suggests a novel approach for treating non-cardiac chest pain\nSource: GastroIntestinal / Gastroenterology News From Medical News Today [2014.10.24]\nChest pain doesn't necessarily come from the heart. An estimated 200,000 Americans each year experience non-cardiac chest pain, which in addition to pain can involve painful swallowing, discomfort...\nExtra-Depth Shoes May Help Ease Foot Pain in Elderly\nSource: Medscape NeurologyHeadlines [2014.10.23]\nFor seniors with disabling foot pain, off-the-shelf extra-depth footwear reduced pain and improved function in a new study.\nReuters Health Information\nChanging how primary-care doctors treat pain, fatigue and other common symptoms\nSource: Pain / Anesthetics News From Medical News Today [2014.10.23]\nCommon symptoms such as pain or fatigue account for over half of all doctor's office appointments in the United States, translating into more than 400 million visits annually.\nHealth Tip: Coping With Chronic Pain\nSource: MedicineNet Chronic Pain Specialty [2014.10.23]\nTitle: Health Tip: Coping With Chronic Pain\nCategory: Health News\nCreated: 10/23/2014 12:00:00 AM\nLast Editorial Review: 10/23/2014 12:00:00 AM\nTear duct implant effective at reducing pain and inflammation in cataract surgery patients\nSource: Eye Health / Blindness News From Medical News Today [2014.10.21]\nThe first tear duct implant developed to treat inflammation and pain following cataract surgery has been shown to be a reliable alternative to medicated eye drops, which are the current standard of...\nPublished Studies Related to Capital and Codeine (Acetaminophen / Codeine)\nEconomic evaluation of controlled-release oxycodone vs oxycodone-acetaminophen for osteoarthritis pain of the hip or knee. [2006.04]\nOBJECTIVE: To examine, in routine practice, the effectiveness and cost-effectiveness of oxycodone (OxyContin) compared with standard therapy for osteoarthritis pain. STUDY DESIGN: Open-label active-controlled randomized naturalistic 4-month study of oxycodone vs a combination of oxycodone-acetaminophen (Percocet)... CONCLUSIONS: From the societal perspective, oxycodone was more effective and less costly than oxycodone-acetaminophen. From the healthcare perspective, oxycodone (compared with generic oxycodone-acetaminophen) fell within the acceptable range of cost-effectiveness between 50,000 US dollars and 100,000 US dollars per QALY gained.\nAnalgesic efficacy of rofecoxib compared with codeine/acetaminophen using a model of acute dental pain. [2005.10]\nOBJECTIVE: To determine analgesic efficacy of a single oral dose of rofecoxib 50 mg compared with acetaminophen/codeine 600/60 mg, we conducted a double-blind, randomized, placebo- and active-comparator-controlled, parallel-group study... CONCLUSION: Rofecoxib provided superior analgesic efficacy compared with codeine/acetaminophen with fewer gastrointestinal and nervous system adverse events.\nComparison of ibuprofen and acetaminophen with codeine following cosmetic facial surgery. [2009.10]\nOBJECTIVES: To compare the efficacy and side effects of ibuprofen and acetaminophen with codeine when given postoperatively following cosmetic facial surgery and to assess whether bruising is worse or the incidence of hematoma is greater when ibuprofen is taken postoperatively. DESIGN: Prospective, double-blind, randomized trial. SETTING: Accredited outpatient surgery centre... CONCLUSIONS: Ibuprofen 400 mg is as effective as acetaminophen/codeine 600/60 mg for pain relief following cosmetic facial surgery. Ibuprofen is better tolerated, with fewer side effects, than acetaminophen with codeine. Ibuprofen given postoperatively does not result in increased bruising or increased incidence of hematoma.\nCodeine-acetaminophen versus nonsteroidal anti-inflammatory drugs in the treatment of post-abdominal surgery pain: a systematic review of randomized trials. [2009.08]\nBACKGROUND: Cesarean section, episiotomy, and third and perineal tears are associated with significant tissue damage, causing pain in the immediate postpartum period. The current standard in North America is to prescribe oral acetaminophen/codeine (A + C) for postpartum pain. Codeine has opioid-related adverse effects and may not be safe during breastfeeding in the postpartum period for all neonates. Nonsteroidal anti-inflammatory drugs (NSAIDs) are devoid of opioid-related adverse effects and could be a possible alternative for analgesia in postpartum pain. The objective of this systematic review was to compare the analgesic effect and safety profile of acetaminophen/codeine (A + C) with NSAIDs in the management of pain after laparotomy... CONCLUSIONS: None of the studies found A + C to be superior to NSAIDs in controlling postlaparotomy pain. NSAIDs appear to be an equipotent alternative in the treatment of postlaparotomy pain. Four of the 9 studies reported less adverse effects in the NSAID group. There appears to be an overall better risk/benefit ratio for the use of NSAIDs for postpartum pain.\nClinical Trials Related to Capital and Codeine (Acetaminophen / Codeine)\nEvaluation of Skeletal Maturity for Slipped Capital Femoral Epiphysis [Recruiting]\nThis study is being done for two reasons: 1) to evaluate growth problems in the hip in\npatients with Slipped Capital Femoral Epiphysis (SCFE) as they continue to grow into adults,\nand 2) to help doctors determine which patients are at risk for developing a SCFE on their\nopposite hip. Studies show that up to 60% of patients with a SCFE will go on to develop a\nSCFE on their other side. Being able to better determine which patients are at risk for\ndeveloping a SCFE on the other side will help physicians better monitor patients with a\nhistory of a SCFE and perhaps treat them before they develop a SCFE on the opposite side. By\nstudying the growth centers seen on X-rays of your child's legs and elbow, the investigators\nmay be able to better predict which children with a SCFE are at risk for developing a SCFE\non their opposite hip and potential growth problems as they continue to grow.\nCarvedilol Post-intervention Long-term Administration in Large-scale Trial [Recruiting]\nThe purpose of this study is to evaluate whether beta-blocker therapy improves 6-year\nclinical outcomes in patients with ST-segment elevation acute myocardial infarction and\npreserved left ventricular ejection fraction after primary percutaneous coronary\nA Comparison of Postoperative Tramadol Versus Acetaminophen With Codeine in Children Undergoing Tonsillectomy [Recruiting]\nTonsillectomy is the most common pediatric surgical procedure performed in the US. The\npostoperative period can be particularly painful. Codeine (usually in mixed formulation with\nacetaminophen) is the most commonly prescribed opioid in the US. However, evolving data\nquestions its ability to provide optimal pain relief, while avoiding side effects,\nespecially in the postoperative setting. Tramadol may be a better option for children in the\npostoperative setting due to its well-documented analgesic properties, low potential for\nside effects, and excellent safety profile. Seventy-two children scheduled to undergo\ntonsillectomy (with or without adenoidectomy) at Children's will be invited to participate\nin a randomized, prospective, double-blinded study to evaluate the efficacy and side effects\nof codeine with acetaminophen versus tramadol. Using a 10-day take-home diary, caregivers\nwill be asked to record daily information about their child's postoperative pain and other\ncore outcomes and domains as recommended in the recent consensus statement put forth by the\nPediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials\n(IMMPACT) (McGrath et al., 2008). This study will offer new information regarding the\nefficacy and side effects associated with tramadol as compared with codeine/acetaminophen\n(the current practice standard) in a pediatric population.\nH1: Children who receive scheduled tramadol following tonsillectomy will report better pain\ncontrol than children who receive scheduled codeine/acetaminophen.\nH2: Children who receive scheduled tramadol following tonsillectomy will report fewer side\neffects than children who receive scheduled codeine/acetaminophen.\nFibrinogen Concentrate as Initial Treatment for Postpartum Haemorrhage: A Randomised Clinically Controlled Trial [Recruiting]\nSevere maternal bleeding is a serious complication of birth and causes 125. 000 deaths\nworldwide each year. The investigators aim to investigate if early treatment with fibrinogen\nconcentrate versus saline can reduce the incidence of blood transfusion in women with\nA low level of fibrinogen has been associated with increased blood loss and transfusion\nrequirements in different clinical settings including obstetrical bleeding. Early up-front\ntreatment with fibrinogen may reduce incidence of transfusion by securing optimal\nhaemostatic capacity in women with postpartum haemorrhage.\nThe investigators plan to enrol 245 patients on four hospitals in the Capital Region of\nDenmark during a two year period.\nAs safety measure the investigators plan to use TEG®/Functional Fibrinogen/Rapid-TEG as\nhaemostatic monitoring of all participants during the trial: Baseline test is taken at\ninclusion before administration of fibrinogen concentrate/placebo. Further tests are taken\nimmediately after intervention, 4 hours and 24 hours after. Baseline test is blinded to the\nproviders of treatment - the rest is clinically available.\nShort-Term Prognosis Evaluation of Transient Ischemic Attack Patients Using ABCD2 Score [Recruiting]\nThe purpose of this study is to determine whether the ABCD2 score can be used in patients\nwith transient ischemic attack, admitted to Beijing anzhen hospital, to evaluate the\nprognosis, risk factor of those patients. |
Franchise Fee: $50,000\nTotal Investment: $108,475 - $133,130\nCan Be Home Based: Yes\nVetFran Member: Yes\nSBA Approved: Yes\nAuxo Medical is a nationwide franchise providing service, sales, and refurbished medical equipment for clients including hospitals, ambulatory surgery centers, universities, laboratories, and physician offices. Our team of certified technicians complete all levels of services on sterile processing, biomedical equipment, and anesthesia equipment. At Auxo Medical, our owners and their technicians focus on the customer to provide valuable products and services. Auxo Medical technicians have a “Can Do” spirit as problem solvers because of the training and confidence in our support and proven processes.\nFranchise owners have access to a large operating territory, serving customers with an in-demand service and providing value to customers with the sale of refurbished equipment.\nRequest More Information |
Recover from Wisdom Tooth Extraction Surgery\nEdited by Bobby-Jo Keats, Eng\nWisdom teeth are commonly known for the dental problems they can cause. They are the last permanent teeth to develop and often begin to break though the gums during a person's late teens or twenties. However, removing them is often required in order to eliminate pain or discomfort as well as to prevent future problems. The following are some simple ways to manage wisdom tooth extraction surgery and recovery.\nBefore and After Surgery\n- 1It is very common for people's jaws to be too small for the wisdom teeth to grow in properly, which means they become impacted. This means, they may come in angled or sideways and may push against molars which can make it difficult to reach them or clean them properly. This can lead to all kinds of problems such as tooth decay, pain, cysts, infection and gum disease.Understand why they need to be extracted.\n- 2Everyone's situation is unique and some extraction surgeries can be far more difficult or risky than others, so it is very important to understand the risks involved and discuss the process in detail. Before surgery, your dentist should fully evaluate your situation with x-rays and an examination of your teeth and jaws. If it is a particularly difficult surgery required, your dentist will refer you to an oral surgeon who specializes in the mouth and jaw and will further evaluate you.Talk to your dentist and oral surgeon.\n- 3Impacted wisdom teeth can grow in almost any direction. Wisdom teeth which have grown straight upward or angled toward the teeth aren't quite as difficult to remove as those angled away from the other teeth or parallel to the gum line. The older you are during the removal procedure, the more difficult it can be as well. This is because over time, the roots continue to grow and become more solidly fused within your jaw and the risk of complications increase with age. These include soreness in your jaw, joints and muscles and problems opening your mouth, a dry socket, infection, anesthesia side-effects, sinus problems, weakening of the jaw or nerve injury, either temporarily or permanently. This is because of how close the tooth or its roots might be to a major nerve in the jaw which transmits feeling from the chin, gums, teeth and lips. Many nerves and blood vessels enter and exit the tooth through the roots.Recognize the risks involved.\n- 4Prepare yourself for surgery.\n- 5There are different types of anesthesia and which one you will receive may depend on factors such as insurance coverage or previous reactions to anesthesia. These include local anesthetic used to numb the area around the tooth and it's usually used even if another type is administered. Another is a sedative which helps you stay relaxed while awake during surgery. These can be given in pill form, as a gas you inhale (laughing gas) or by IV. Another type is general anesthesia which will put you to sleep during surgery and is used during more difficult procedures. Regardless of the type used, the procedure should take approximately 45 minutes to 2 hours, including recovery time.Choose which type of anesthesia will be used.\n- 6After the extraction surgery, bleeding, swelling and bruising are very common so your surgeon will give you instructions on how to properly care for the extraction site which will likely contain a few stitches which will dissolve within the first 10 days after the procedure. These instructions will include getting enough rest, eating and drinking nutritious foods to promote healing.Follow your surgeon's advice after the extraction.\n- 7Do not brush your teeth or rinse your mouth for the first day or two and do not drink through a straw. This could pull the blood clot which is forming and could cause a dry socket. Also, do not smoke or this could not only cause a dry socket, but increase your risk of infection.Protect the extraction site.\n- 8Control the bleeding.\n- 9Your surgeon will likely prescribe you an antibiotic in order to help prevent infection and will prescribe you pain killers so you can manage the pain and discomfort and get the rest you need to start the healing process.Take medication as directed.\n- 10Reduce swelling.\n- 11Once bleeding has stopped, drink vegetable juice, 100% fruit juice, milk and protein drinks. There are protein and vitamin filled milkshakes designed for seniors which will help coat your stomach while you take pain medication which can be particularly hard on your stomach when you haven't eaten.Drink healthy liquids.\n- 12Get lots of rest following your surgery. Sleep will help you heal faster and help you to avoid the pain temporarily so you will probably want to get as much rest as you can.Rest.\n- 13If the bleeding doesn't stop within 2-6 hours or is getting worse, call your surgeon immediately. Also, if you are having problems breathing or swallowing or if you have a fever of 100.4 or higher or if swelling gets worse, give your surgeons office a call. If you experience ongoing nausea or vomiting or have a rash or are itching, this may be an indication of an allergic reaction to your medication, so call your surgeon and let them know.Call your surgeon if you experience difficulty.\n- 14Keep the extraction site clean.\nCategories : Health & Wellness\nRecent edits by: Bobby-Jo Keats |
This material must not be used for commercial purposes, or in any hospital or medical facility. Failure to comply may result in legal action.\nAdrenal Gland Biopsy\nWHAT YOU NEED TO KNOW:\nAn adrenal gland biopsy is a procedure done to take a tissue sample from your adrenal gland. A biopsy is usually done if your caregiver wants to check a tumor on the adrenal gland for cancer.\nHOW TO PREPARE:\nThe week before your procedure:\n- Ask someone to drive you home when you are ready to leave the hospital. Do not drive yourself home.\n- Your caregiver may do a physical exam. Your caregiver may check for health risks that could lead to post procedure problems. Tell your caregiver about any medical problems you have.\n- Tell your caregiver if you are allergic to any medicine. You may need to stop any blood thinning medicines before your procedure such as aspirin or heparin. Tell your caregiver if you use any over-the-counter medicines, herbs, or food supplements. Bring your medicine bottles or a list of your prescribed medicines when you see your caregiver.\n- You may need an ultrasound, CT scan, or an MRI before your procedure. These tests may help your caregiver plan the safest way to take a sample of your adrenal gland. Blood tests may be needed to check if you have bleeding problems and your hormone levels. Ask your caregiver for more information about these and other tests you may need. Write down the date, time, and location of each test.\n- If you have bleeding problems, you may need a fresh frozen plasma (fluid part of blood) transfusion. The transfusion is normally given through an IV. An IV is a tube placed in your vein for giving medicine or liquids. You may also be given a shot of vitamin K. Ask your caregiver more information about these treatments, and if you may need them.\nThe night before your procedure:\n- Ask your caregiver about directions for eating and drinking.\nThe day of your procedure:\n- Write down the correct date, time, and location of your procedure.\n- You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.\n- Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.\n- An anesthesiologist will talk to you before your surgery. You may need medicine to keep you asleep or numb an area of your body during surgery. Tell caregivers if you or anyone in your family has had a problem with anesthesia in the past.\nWHAT WILL HAPPEN:\nWhat will happen:\n- You will be taken to the room where your procedure will be done. You may be placed lying on your back, side, or stomach. A numbing medicine called anesthesia may be given to keep you free from pain during your procedure.\n- A CT scan, MRI, or ultrasound may be used to guide your caregiver during your biopsy. In some cases, a special scope may be put through a small incision in your abdomen. The scope is a long tube with a light and camera on the end. A long biopsy needle will then be inserted through your skin, or scope, and into your adrenal gland. Your caregiver may need to insert the needle more than once to get enough tissue for testing. The needle and scope will be removed once your caregiver has a large enough tissue sample for testing.\nAfter your procedure:\nThe tissue sample will be sent to a lab for tests. You will be taken to a room where you will rest until you are fully awake. Do not try to get out of bed until your caregiver says it is OK. Once your caregiver sees that you are OK, you may be able to go home. If you are staying in the hospital, you will be taken to your room. Your caregiver will check your biopsy area soon after your procedure.\nThis is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.\nCONTACT YOUR HEALTHCARE PROVIDER IF:\n- You cannot make it to your procedure.\n- You get a cold or the flu.\n- You have a fever.\nSeek Care Immediately if\n- You have severe pain in the area where you are having your procedure.\n- You may have an allergic reaction to the anesthesia used for your procedure. You may bleed more than expected or get an infection. The tissue sample taken may be too small for testing and you may need another biopsy. Your pancreas and other nearby organs may become inflamed or be damaged during your procedure. The scope or needle used may cut into your chest lining and cause air to get inside. Air in your chest lining may cause your lungs to collapse. If the mass in your adrenal gland is cancer, this procedure may cause your cancer to spread.\n- An adrenal biopsy may also lead to a hypertensive crisis (severe high blood pressure). This may occur if you have a type of adrenal gland tumor called a pheochromocytoma and it is punctured during your biopsy. A hypertensive crisis may be life-threatening and you may die. Without this procedure, you may not learn if the tumor in your adrenal gland is cancer. Your caregiver may not be able to plan the best treatment for your condition. Call your caregiver if you are worried or have questions about your procedure, condition, or care.\nCare AgreementYou have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.\n© 2015 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.\nThe above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you. |
Credihealth is a medical tourism company providing complete assistance for medical treatment in India. Our medical experts support international patients starting from airport pickup till hospital discharge.\nConnecting you to most reputed surgeons and doctors in India\nWe have collaborated with NABH & JCI accredited hospitals in India to ensure high quality and affordable treatment cost.\nSee what patients from 25 countries around the world say about Credihealth’s servicesView All Stories\nSharing Beautiful Experience of my Wife’s Treatment ...\nAsif Father’s CABG Surgery Experience - Mr Asif\nLaryngectomy is a surgical procedure that involves complete or partial removal of the voice box (larynx).\nTotal Laryngectomy involves removal of the complete larynx. A part of the pharynx may or may not be taken out. Pharynx is the mucous membrane-lined passage between your nasal passages and esophagus. A patient who has had this surgery will need to help with swallowing, breathing and talking.\nThere are a few less invasive techniques that can help patients depending on the severity of their case. These are: endoscopic (or transoral resection), vertical partial laryngectomy, horizontal or supraglottic partial laryngectomy, and supracricoid partial laryngectomy.\nThis procedure is suggested by a doctor to\nThe doctor may recommend the following:\nLaryngectomy is a major procedure performed by an experienced head and neck surgeon. It is performed under general anesthesia and may take upto 5 to 7 hours.\nAfter anesthesia is administred, during the procedure,\nAfter the procedure is complete, the patient will not be able to speak. IV Line will be administered to fulfill the nutrition requirement.\nThe patient can swallow semi-solid food after 2 to 4 days. Generally, the patient is discharged within 7 days.\nRegular followups with speech therapist will be required.\nLaryngectomy involves the following risks and complications: |
VBAC: Participation During Birth\nTopic Overview Back to top\nYou and your birth partner can participate more fully in a vaginal birth than you can in a cesarean delivery.\n- Some mothers feel very strongly about being able to bond with the baby immediately after birth. Unless there is some complication, a mother can usually hold her baby within the first few minutes after a vaginal birth. After a cesarean, the mother's time with her baby may be briefly delayed as her surgery is completed. This delay can be extended if she remains in the recovery room for a time afterward.\n- When a general anesthetic is used, usually during an emergency cesarean, the mother is unconscious through her baby's birth.\n- If regional anesthetic is used during a cesarean, the mother remains awake but may not be as actively involved in the birth as during a natural birth or a birth without using medicines. If sedatives are given, she may be groggy, fall asleep, or not remember much about the birth.\nWhether you plan a vaginal birth after cesarean (VBAC) or a repeat cesarean delivery, discuss anesthesia options with your doctor before your delivery.\nIf you have a routine cesarean delivery, your birth partner can hold the baby while your medical needs are taken care of.\nCredits Back to top\n|Primary Medical Reviewer||Sarah Marshall, MD - Family Medicine|\n|Specialist Medical Reviewer||Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology|\n|Last Revised||March 28, 2011|\nLast Revised: March 28, 2011\nAuthor: Healthwise Staff\nTo learn more visit Healthwise.org\n© 1995-2013 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. |
Deep peels must be performed by a medical doctor and can take 14 to 21 days to heal. Deep peels require special aftercare including antiviral medication, ointments and follow-up visits, according to the American Society for Dermatologic Surgery. The chemical solution used for deep peels may be phenol or trichloroacetic acid, which both reach far into the middle layer of your skin and remove damaged skin cells. Phenol chemical peels may require sedation and should only be done on the face, as the skin on the hands and neck is too thin. The American Society for Dermatologic Surgery explains this procedure may only be performed one time on a patient and is not recommended for people with darker skin or freckles, as it can cause hypopigmentation. Deep peels may cost anywhere from $3,500-$5,000—not including the doctor’s fees.\nStarting in the mid 1990s, chemical peels were one of the most common cosmetic procedures performed in dermatologists’ offices, according to the American Society for Aesthetic Plastic Surgery. (1) And while recent advances in laser skin treatments and anti-aging injections, such as Botox or Xeomin, made chemical peels less popular for some years, many feel that the chemical peel is now back and better than ever.\n"Healing from a tummy tuck does involve some level of discomfort for the first week or two, and restricting activities is an important component of a smooth recovery," says Dr. Jon A. Perlman, a Beverly Hills, California, plastic surgeon. He says that incisions can be "healed and strong" after two weeks and become less visible and flat over nine months to a year.\nThorough preparation and a proper, well-monitored recovery spent carefully following your surgeon's instructions can result in a beautiful, natural-looking enhancement that provides you with many years of comfort, satisfaction, and boosted self-esteem. Patience is a virtue in every stage of your treatment. Be ready to discuss your medical history in great detail during your pre-op evaluation, and understand that you will be dramatically reducing your physical activity immediately following surgery.\nDeep chemical peels involve a longer procedure and longer recovery time that lasts up to several months in some cases. Patients who want to correct blotches caused by sun exposure or age, minimize coarse wrinkles, or remove a pre-cancerous growth may benefit from a deep peel. There are certain factors which must be taken into consideration when contemplating a deep chemical peel. Darker-skinned patients and individuals with heart problems are not ideal candidates. Potential chemical peel candidates should be aware that the treatment may take an hour or more, and may require sedation. Anyone who decides on this procedure should be prepared for a long, slow recovery period, and should wear sunscreen whenever exposed to sun. |
Outlaw the declawing of any animal worldwide. Most of the world does not declaw and for good reason. In practically every country where cats are companion animals, declawing is illegal or effectively banned. It is still common in the U.S. and Canada, why?\nDeclawing is a major operation. The "patient" is first put under general anesthesia, as the pain would be torturous without it. A tourniquet is placed around the first paw to be declawed. The veterinarian then performs a series of ten amputations. Each amputation removes the claw and the bone into which it is firmly rooted. The supporting tendon and ligament for each claw are severed. The surrounding soft tissue and flesh is cut off. A veterinary technician bandages up the paws to soak up the blood. The animal is now declawed. The retractable claws that would have been used throughout their life for scratching, playing, walking, and self-defense lie in a heap on the table, waiting to get thrown out with the trash. The inhumanity of the procedure is clearly demonstrated by the nature of the cats' recovery from anesthesia following the surgery. Unlike routine recoveries, including recovery from neutering surgeries, which are fairly peaceful, declawing surgery results in cats bouncing off the walls of the recovery cage because of excruciating pain. Cats that are more stoic huddle in the corner of the recovery cage, immobilized in a state of helplessness, presumably by overwhelming pain. . . . [Declawing] serves as model of severe pain for testing the efficacy of analgesic drugs. This clearly removes any doubt of the excruciating pain involved. Even though analgesic drugs can be used postoperatively, they rarely are, and their effects are incomplete and transient anyway, so sooner or later the pain will emerge.\nThe paws bear the full weight of the cat. Cats stand and walk on the entire paw. When the end of the paw is amputated, as it is during a declawing operation, the cat has to modify her stance accordingly. Being forced to walk unnaturally can put a strain on the paws and cause long-term pain. The pain may build up gradually, and may be aggravated if the cat is overweight. A cat can't tell you directly that her paws ache. You'll find that out when she starts avoiding the litter box.\nKeep up the great work. Look what you've accomplished!\ngrab this widget\nfor your site or blog\nMake a difference for the issues you care about while adding cool interactive\ncontent. Your readers sign without ever leaving your site. It's simple, just choose\nyour widget size and color and copy the embed code to your site or blog. |
This is the newest technology that was developed by Bovie medical. A leader is electrocautery devices. The technology uses cold plasma energy which is generated from helium and radiofrequency. We use it under the skin to tighten, form and revitalize your face and body to look years younger.\nThis allows us to get the Natural Results that we strive for here at Natural Results by North Valley, office of Dr. Carlos Mata. Since this is a minimally invasive procedure that is performed in the office under local anesthesia, the recovery is substantially faster. J-Plasma is a one of kind device were the plasma energy applied the outside or underside of the skin generates instantaneous skin tightening. This gives amazing results according to our patients that have been treated.\nMost conventional facelifts, mini facelifts, tummy tucks or body sculpting procedure good results with extensive downtimes and long scars. The J-Plasma procedure can give improved results without the long scars and the long downtime, by shrinking the lax skin. Since there are no long scars, the complications will be substantially less for this new alternative in Aesthetic/Cosmetic surgery.\nWhy choose J-plasma over traditional surgery?\n- Can work on face, neck, stomach, arms, and legs\n- Hidden liposuction scars\n- No long scars that take time to scar\n- 1-3 day downtime(typical liposuction recovery)\n- FDA approved for the skin\n- Natural Results by Carlos Mata MD, MBA, FACS\n"I had two procedures done earlier this year by Dr. Mata. The tummy tuck was in January 2016 and following after in February, thigh lift. After working out so many years, it was the excess skin and fat I had removed. For all my future procedures and for friends and family, I definitely recommend Dr. Mata. Growing up with physicians in my family ( my mother was a Pediatrician), he has a wonderful disposition very reminiscent of the days when doctors cared and took all the time you needed to address concerns. Dr. Mata also made sure I was mentally prepared for the procedures and was 100% transparent with what I can expect. It's not a form of weight loss, but body sculpting. He has a very nurturing way about him as well. My healing experience has been the most positive under his care and the care of the staff. You are given written directions and the nurses will answer any questions you have. After the procedures, of course, new clothes feel great in smaller sizes, but it's not seeing the unwanted skin and fat, always getting larger sizes to disguise my trouble spots that brings me happiness. I have no regrets. I highly recommend Dr. Mata and I'm so grateful. My arms are next! :-)"- L.N. / Google / Jul 06, 2016\n"Dr Mata is amazing. He sculpts the body and really listens to what you want. He also guarantees his work and cares. I highly recommend him."- J.W. / Yellowpages / Jul 28, 2017\n"Excellent Doctor - Dr. Mata is very knowledgeable and honest. He took the time to listen to my concerns and questions and did not rush me at all during the consultation. The office staff are very friendly and kind and put me at ease. I received Juvaderm for my nasolabial folds and Botox. I am very pleased with my results. It is obvious that Dr. Mata is highly skilled and takes great care with his work. I will be..."- M. / RealSelf / Jul 24, 2017\n"This review only contains a rating"- T.C. / Google / Jul 24, 2017\n"An amazing man with undeniable talent! Go see him now and start the change to a new You!! I had my procedures last September and have been thrilled ever since!"- L.L. / Facebook / Jul 21, 2017\nWho is a Candidate?\nThe best candidates for the procedure are any individual that can tolerate local anesthesia that wants tighter skin with less laxity without the scars of typical surgery. Dr. Mata performs the J-Plasma face and body procedures on men and women of all age groups ranging from 21 to over 70s. J-Plasma face and Body is perfect for anyone with loose skin from the aging process of lift, weight gain and weight loss, pregnancy, and poor liposuction or non-surgical body contouring (coolsculpting) results. Surgical correction with a facelift or tummy tuck (abdominoplasty) is advocated for those with extensive loose skin. Patients pick the J-Plasma procedure in order to save time, money and because the results can be seen the next day with minimal downtime with little scarring.\nThis innovative procedure is performed in the office and using local anesthesia only but can be done under conscious sedation if the patient wishes. Dr. Mata begins the J-plasma procedure with tiny, hidden liposuction incisions placed in locations that can be covered by clothes. Once this is done, the patient will receive the local anesthesia (lidocaine ). Then we make room for the J-plasma device by creating small channels. Dr. Mata will then use the J-Plasma® device sub-dermally (under the skin) or over the skin to deliver cold plasma, which instantly tightens, contracts the skin from the inside out or outside in. Results can be seen immediately and will continue to get better as your body heals fully which can take up 6 weeks for the scar tissue to tighten.\nAreas that Dr. Mata can treat\n- Abdomen(upper and lower)\n- Back (upper and lower)\n- Bra area\n- Buttocks / Banana Roll\n- Thighs (inner and outer)\nDr. Mata and the Natural Results team see the day after your procedure to make sure that things are going as planned. It is normal for your face/neck or body to be tight and certainly sore after about 2-4 hrs after the procedure. We recommend you use Tylenol for pain control but you will be given narcotics just in case the pain is more severe. However, if you have discomfort that is not controlled with either, please call our after hours number 480-418-5300 and choose the option to talk to Dr. Mata directly.\nPlan Your Procedure\n- Recovery Time\n- 2 weeks\n- Average Procedure Time\n- 60 min per area\nWhat is Plasma Energy?\nAccording to the dictionary plasma is an ionized gas consisting of positive ions and free electrons in proportions resulting in more or less no overall electric charge, typically at low pressures (as in the upper atmosphere and in fluorescent lamps) or at very high temperatures (as in stars and nuclear fusion reactors). So what does this mean for you as a patient.\nCold plasma is nothing more than a type of energy that is made when helium a stable gas with combined with radiofrequency. It requires little energy to become effective at causing the desired skin changes. As the name implies, the energy is cold and not hot thus causing less thermal damage to skin and surrounding tissues. J-plasma will have less risk and damage to the tissue because of the cold energy. No current devices such as lasers, ultrasounds or the latest in radiofrequency can create this kind of skin rejuvenation safely with cold energy.\nWhat is J-Plasma\nJ-Plasma uses cold plasma energy which is produced by helium combined with radiofrequency. Once placed under or over the skin, it shrinks and tighten the bodies skin giving you natural looking results.\nHow long does it take?\nThe J-Plasma face and Body Procedure takes about 60minutes to do per area. Tightness after the surgery is expected and normal. Pain is managed with Tylenol and occasionally narcotics. Compression garments are must for 3 days after the procedure and can be removed when showering and replaced. There will be inflammation and bruising which can be alleviated with Arnica Montana. It can take up to 2 weeks for this to resolve. Most of the patients feel they can go back to normal activities in just one day but most in about one week. |
The use of opioids in the ICU and the post-operative period is common, with patients often receiving opioids even after simple surgeries. Though opioids are effective in providing fast pain relief, the side effects of respiratory depression, cough suppression, confusion, drowsiness, nausea, vomiting and potential addiction make the sole reliance on opioids risky.\nICU clinicians are formulating more effective strategies to manage patient pain while minimizing the risks. In an article published in ICU Management and Practice, Dr. Xavier Capdevila, Head of the Department of Anesthesia and Critical Care Medicine at Lapeyronie University Hospital, France, outlines the concept of multimodal analgesia as an alternative to administering solely opioids to patients.\nThe Multimodal Analgesia Approach\n- Multimodal analgesia in the ICU includes the following strategies:\n- Using non-opioid analgesics such as NSAIDs (anti-inflammatory drugs) in combination with (low dose) opioids whenever possible\n- Prescribing the lowest effective dose of an opioid to limit the risk of addiction\n- Using analgosedation, or using analgesia before administering sedatives\n- Using light sedation rather than deep sedation whenever possible\n- Combining regional anesthesia and epidural analgesia with analgosedation\nDr. Capdevila points out that in many cases the use of a non-opioid drug is a better choice for the patient. The combined use of these analgesics allows clinicians to administer lower total doses. These lower doses in turn reduce the number of side effects. As a result, multimodal analgesia can reduce postoperative pain (Jin and Chung 2001).\nAnalgesia before Sedation\nMultimodal analgesia also reduces the need for total sedation. The practice of analgosedation in the ICU (using analgesia before sedation) is becoming increasingly common. One study demonstrated that patients who received more fentanyl and fewer benzodiazepines or more dexmedetomidine and less propofol required lower sedation (Faust et al. 2016).\nA French study showed that the use of multimodal analgesia in mechanically ventilated critically ill patients decreases sedation and delirium while avoiding the need for opioids. Patients given multimodal analgesia were also more likely to have fewer organ failures compared to patients who received opioids alone (Payen et al. 2013). Dexmedetomidine, an alpha 2 antagonist and a potent anxiolytic, is another drug that ICU clinicians should consider within the multimodal analgesia approach. Dexmedetomidine has shown to limit the duration of mechanical ventilation compared to Midazolam (Jakob et al. 2012). However, Dr. Capdevila points out that more studies are needed to compare this drug’s benefits versus its adverse side effects.\nRegional Anesthesia and Epidural Analgesia\nA study published in Anesthesia and Analgesia compared patients with a paravertebral blockade with rib fractures who received only sedation and opioids to similar patients who also received regional anesthesia. The patients who received regional analgesia experienced an optimized rehabilitation with a decreased use of opioids. The mixed use of sedative agents with opiates coupled with regional anesthesia helped improve patient rehabilitation in the postoperative period (Malekpour et al. 2017).\nThe addition of epidural analgesia to general anesthesia was also associated with long-term survival. A study published in JAMA Surgery analyzed patients who received abdominal aortic aneurysm repair. Patients who received epidural analgesia exhibited fewer complications than patients who received only analgosedation (Bardia et al. 2016). Clinical evidence shows that epidural analgesia can decrease mortality, complications, and morbidity after surgery. Epidural analgesia also limits the need for opiates, thereby decreasing opioid-related complications (Pöpping et al. 2014).\nThrough the proper application of multimodal analgesia, ICU clinicians can effectively manage patient pain while reducing the need for opioids and heavy sedation. Dr. Capdevila concludes multimodal analgesia optimizes pain management and decreases organ dysfunction while demonstrating a positive impact on the long-term mortality in patients after major surgeries.\nBardia A, Sood A, Mahmood F, Orhurhu V, Mueller A, Montealegre-Gallegos M, Shnider MR, Ultee KH, Schermerhorn ML, Matyal R et al. (2016). Combined Epidural-General Anesthesia vs. General Anesthesia Alone for Elective Abdominal Aortic Aneurysm Repair: JAMA Surgery, 151(12):1116-1123.\nCapdevila, X. (2019, Spring). Pain management through multimodal analgesia in the ICU: ICU Management and Practice, Volume 19, Issue 1. Retrieved from https://healthmanagement.org/uploads/article_attachment/icu-v19-i1-xavier-capdevila-pain-management-through-multimodal-analgesia-in-the-icu.pdf (VI-VIII).\nFaust AC, Rajan P, Sheperd LA, Alvarez CA, McCorstin P, Doebele RL et al. (2016). Impact of an Analgesia-Based Sedation Protocol on Mechanically Ventilated Patients in a Medical Intensive Care Unit: Anesthesia Analgesia, 123(4):903-9.\nJakob et al. (2012). Dexmedetomidine vs. midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials: JAMA, 307(11):1151-60.\nJin F and Chung F (2001). Multimodal Analgesia for Postoperative Pain Control: Journal of Clinical Anesthesia, 13:524- 539.\nMalekpour M, Hashmi A, Dove J, Torres D, Wild J et al. (2017). Analgesic choice in management of rib fractures: paravertebral block or epidural analgesia?: Anesthesia and Analgesia, 124:1906-11.\nPayen JF, Genty C, Mimoz O, Mantz J, Bosson JL, Chanques G et al. (2013). Prescribing non-opioids in mechanically ventilated critically ill patients: Journal of Critical Care, 28(4):534.e7-12.\nPöpping DM, Elia N, Van Aken HK, Marret E, Schug SA, Kranke P, Wenk M, Tramèr MR et al. (2014). Impact of epidural analgesia on mortality and morbidity after surgery: systematic review and meta-analysis of randomized controlled trials: Annals of Surgery, 259(6):1056-67. |
Why Are Dog X-Rays So Expensive?\nWhy are x-rays so expensive? A dog x-ray stomach cost is likely to turn you off the first time you hear it because veterinary costs have increased significantly in the past decade or so, and there’s no telling when the costs will stabilize. In general, veterinary care is pricey, so pet insurance is a practical solution to reduce expenses when necessary. Accidents like swallowing inedible or offensive objects can already increase dog care costs – and one of the most common expenses in veterinary care is the x-ray.\nNot all dog x-rays require sedation or anesthesia. A dog x-ray without sedation is usually done on the chest and back, but other parts of the dog’s body may require sedation so that the x-ray would be accurate. Sedation may sound a little excessive to pet owners. However, your dog needs to be super still during an x-ray, and even a slight turn or tail wag can ruin a good x-ray. There is a reason why sedation is a commonplace additional when taking a dog’s x-ray.\nHow much does it cost to x-ray a dog’s leg?\nDog x-rays can cost at least $150 to a high of $250, depending on where you are getting the x-ray done in the first place. Before you blow your top on the price of a dog x-ray, take note that veterinary clinics need to invest in x-ray machines and other machines that require thousands of dollars of investment. Therefore, it is only normal for clinics to place a premium on dog x-rays because the equipment needed is no joke.\nThe price of a dog x-ray, surprisingly, will depend on how big and heavy your dog is. Remember the need for sedation? Sedation only works when your dog is given the right amount of sedative first. If you have a super big dog, like over ninety pounds, your dog will require much more sedation before it goes under the anesthetic. In contrast, if you have a teacup dog that is barely six pounds, your dog will need much less sedative, and the vet will be able to carry out the x-ray examination much more easily.\nAre dog x-rays safe? Yes. Expert vets will tell you that the amount of radiation found in x-rays is only equivalent to natural radiation that your dog will be exposed to anyway, after about ten days romping about. So x-rays are painless, and they don’t pose any risk to your dog/s at all.\nSome conditions that require an x-ray before proper treatment include:\n- Broken bones – Fractures necessitate x-rays so the veterinarian can put a good case on the affected bones.\n- Inborn conditions – Some genetic conditions like hip dysplasia can be fixed medically, but again, the veterinarian needs to see what’s going on inside first.\n- After surgery – Dogs that have undergone surgery will need to be x-rayed to check how the injuries are coming along after surgery.\n- Kidney stones, gallbladder stones, liver issues, etc. – So many growths can occur inside the body, and an x-ray is the fastest way to detect these growths and deposits where they shouldn’t be.\n- Cancer – Some types of tumors show up easily in x-rays.\nWhy Dog X-rays Are Important\nWhen we think we’ve broken anything, we immediately get an x-ray. This is the best way to determine if anything was broken in the first place. The same principle applies when your dog suffers from an accident. Your vet has to see clearly what is going on inside, so the proper treatment can be given. The injury’s position is important, and the actual state of what’s going on in the bones and organs. If you want the most accurate diagnosis and treatment, you need to provide your dog with the right medical imaging.\nA dog x-ray has many benefits. For instance, if your dog suffered from a possible fracture, the actual extent of the fracture will be revealed, as well as any other internal injuries that may have arisen as a result of the break. X-rays can also help track down internal injuries and conditions that you never knew about. For instance, a proper x-ray can reveal if your dog has a spinal injury (either fresh or healing) or if it has any torn ligaments or joints. Dogs tend to ingest garbage and other indigestible things, and an x-ray is the easiest way to determine what was exactly swallowed.\nKeep in mind, however, that an x-ray isn’t the only diagnostic tool available for canines. In other situations, your vet may ask for an x-ray and additional tests, like urine analysis, urine culture, blood chemistry panel, etc. There are also other imaging technologies available for dogs, like ultrasounds and CT scans. When the veterinarian requires live imaging of soft tissue sections, your dog must get a good medical ultrasound. Ultrasound imaging, much like x-rays, are harmless and painless, and this type of image is often done to check if female dogs are pregnant. Gallbladder stones and other anomalies can also be confirmed with ultrasound imaging. Some conditions are just more difficult to diagnose with just an x-ray, which is more or less just one flat image of a particular cross-section of the dog’s body.\nHigh-tech imaging technologies are more expensive – sometimes three times or four times as much as x-rays. This is why it’s not practical to face these medical hurdles without any form of pet insurance. Pet insurance ensures that your dog will get the tests without burdening your bank account too much. Of course, we don’t want to be in a situation where you will have to skip your dog’s medical requirements because it’s too expensive for you. |
Residents Learn the Art of Open Surgery\nLaparoscopy, a surgery performed through a small incision, is changing the way today’s residents experience surgeries. With many more procedures being done laparoscopically, they don’t experience as much open surgery as in the past (despite this being an important skill surgeons need to have). Because of this problem, the Swedish Hospital Surgery Residency program director, Dr. Emmett McGuire contacted RVU to learn more about our Surgery Simulation Center and the cut suit.\nAnthony LaPorta, MD, FACS, Professor of Clinical Surgery, and Michael Tieman, MD, Chair & Professor of Specialty Medicine, welcomed the residents and, along with Dr. McGuire, performed an open appendectomy and a major abdominal case (specifically, a colon injury as the result from a mass casualty event) using cut suits. Dr. Tieman noted, “One of the benefits of working with the cut suit is that surgeons are able to discuss various possible situations and outcomes without being worried about getting the patient out of anesthesia. Another benefit is that the surgeon can allow the residents to make mistakes, which will [ideally] help prevent those mistakes from happening later.” The cut suit is capable of repeated surgeries and, with positive feedback from the program director and residents, it is likely that this collaboration will continue with future events.\nLeave a Reply |
- Do I need to visit the Center before surgery date?\n- May I pre-register for my surgery?\n- What if I cannot make my appointment?\n- What should I wear?\n- Why must I refrain from eating and/or drinking prior to surgery?\n- Should I take my usual daily medication?\n- May I continue my herbal medications?\n- Who may accompany me?\n- Will I receive sedation before going into the operating room?\n- Will I be contacted before my surgery?\n- Should I bathe and wash my hair before leaving home?\n- What should I do if I am not feeling well?\n- What should I do if I started my menstrual cycle?\n- What should I do if I believe that I am pregnant?\n- May I drive home?\n- May I speak to my anesthesiologist before the surgery?\n- What if I have special needs?\n- Should I bring my special needs equipment?\n- What must I bring with me on the day of surgery?\n- How will my pain be managed?\nDo I need to visit the Center before surgery date?\nAll patients will need an up-to-date medical history and physical form. EKGs are done at the Surgery Center. If blood work or x-rays are required, your surgeon will advise where you may have this done.\nSome families may elect to bring their children for a preoperative tour of Matthews Surgery Center. Please call to schedule an appointment.\nSome patients may choose to come to the Center before their surgery date to complete paperwork or make payments. We strongly recommend that you complete all preoperative documentation before the day of surgery.\nMay I pre-register for my surgery?\nYes. We strongly encourage you to have completed all the registration forms before the day of surgery.\nWhat if I cannot make my appointment?\nPlease notify the surgeon and the Matthews Surgery Center at 704-815-7880 as early as possible if you cannot make your scheduled appointment. Early notification can help us better accommodate you and other patients.\nWhat should I wear?\nPlease wear comfortable clothing. Button-down shirts or blouses are best. Wear comfortable shoes. Leave all jewelry at home, including body-piercing jewelry. If you wear contact lenses, you will probably have to remove them for the surgery, so consider bringing your glasses. If you have to wear your contacts, please bring contact solution and contacts case. If you wear eyeglasses, please bring your eyeglass case. Please do not wear any make-up as this can hide certain clinical signs. Please remove all body piercings.\nWhy must I refrain from eating and/or drinking prior to surgery?\nYou refrain from eating and/or drinking prior to surgery in order to prevent the risks of aspirating gastric contents during your surgery. This complication is very serious and you need to strictly abide by our recommendations. This has nothing to do with nausea and vomiting after your surgery as some think.\nWe have very clear policies as to specific times before surgery when you must refrain from eating and/or drinking. These are all based on safety standards. Please note that the standards have been revised recently. We believe that the fasting time should be as short as possible before your surgery. You will not improve your safety by not eating or drinking longer than necessary; in fact, at times you may complicate things a bit.\nChildren have different fasting schedules than adults, so please check in the Children and Special Needs Adults section.\nShould I take my usual daily medication?\nThe Health History nurse will advise which medications you should take before leaving home. Diabetic medications will be individualized. We will usually hold oral diabetic medicines and instruct you on the dosage of insulin. You will be instructed during your pre-operative call as to which medications should be taken. Please bring all your medications with you or a detailed list with medication name, strength, frequency and when the last dose was taken.\nPeople using inhalers must bring them to the Center on the day of surgery.\nSome medications will be stopped for the surgery, particularly diabetes medication and blood thinners. Please call us with any questions you may have.\nMay I continue my herbal medications?\nHerbal medications may have harmful effects on the surgery. Many of these remedies may affect your clotting mechanism and interfere with the anesthetic agents. (The list of drugs and their side effects are too great for this site.) We generally request that you stop these medications two weeks before surgery. Please remember to mention these remedies when being asked about medication.\nWho may accompany me?\nYou are welcome to bring one person with you to the Center. That person will be allowed to be with you before surgery and may sit with you after the surgery if you so choose.\nWhen a patient is a child often two parents and/or guardians will accompany him or her to the Center and will be allowed to sit with the child after surgery.\nPlease refrain from bringing young children to the Center as guests.\nWill I receive sedation before going into the operating room?\nWe will individualize each patient’s care.\nWill I be contacted before my surgery?\nWe call each patient before the surgery to gather information and hopefully answer any of your questions. Preoperative instructions will be given by the nurse who calls you. You can also call the Center directly with any questions.\nShould I bathe and wash my hair before leaving home?\nYes. You can comfortably take a shower, bathe, brush your teeth, etc. Please do not use make up, hair spray, nail polish or toiletries. These may interfere with the anesthesia monitoring and possibly hide clinical signs from the anesthesiologist.\nWhat should I do if I am not feeling well?\nIf you are not feeling well, please contact your surgeon immediately. During normal business hours, you can call the Center for advice. There are some surgeries which are safer if delayed when you are sick. We need to know specific details to make the decision. Please do not delay in contacting your surgeon or the Center.\nWhat should I do if I started my menstrual cycle?\nThis will not affect most surgical procedures. Call us if you have any questions at 704-815-7880 and ask for a pre-op nurse.\nWhat should I do if I believe that I am pregnant?\nIt is very important for us to be aware of this possibility. Only essential surgery is done on pregnant patients. If there is any doubt please contact us immediately.\nMay I drive home?\nAny patient receiving anesthesia should not drive until the next day. A patient receiving sedation for a procedure needs a ride home. The few patients who have procedures performed under local anesthesia alone could possibly drive home. This is determined on a individual basis, depending on the procedure performed.\nWe would strongly recommend that all patients have a ride home and will be received by a responsible adult when they arrive home. Patients will not be allowed to drive, walk or take public transportation after sedation or anesthesia. Please make the appropriate arrangements.\nMay I speak to my anesthesiologist before the surgery?\nAll patients will be seen by the anesthesiologist on the day of surgery prior to entering the operating room. Sufficient time should be spent to answer any questions you may have. If you need to speak to the anesthesiologist before the day of surgery, you are welcome to call the Center and we will arrange for you speak with an anesthesiologist. We can also arrange a preoperative interview if you desire.\nWhat if I have special needs?\nWe will make every effort to accommodate any special need you may have. We strongly encourage you to call the Surgery Center in advance so that we can properly prepare to make you comfortable. Do not hesitate to call and suggest anything that may make your day easier.\nShould I bring my special needs equipment?\nYes. Please bring any walkers, post-op crutches, hearing aids, orthopadeic devices (braces, boots), etc.\nWhat must I bring with me on the day of surgery?\n- Bring case for eyeglasses or contacts.\n- Bring insurance identification cards, driver’s license, completed billing forms, co-payments.\n- Bring all medication.\n- Make sure you have a ride home and someone to care for you at home.\n- Bring a favorite bottle or “sippy cup” for your child; diapers, if appropriate.\n- Wear comfortable, loose fitting clothing.\n- Leave all jewelry and valuables at home.\nHow will my pain be managed?\nThe management of your pain is of great importance to us. We will be assessing your level of pain from the time of admission until you receive our postoperative call at home. We need to inform and prepare you for each step of the process. This education will begin with our first contact. You will be repeatedly asked to rate your pain from a numerical scale called the Visual Analog Pain Scale, or for children, the Faces Pain Scale. Using the results of our communication we will alter the therapy as needed in order to assure your comfort.\nThe management of your pain will be taken very seriously. We will often use a combination of different modalities to help make you comfortable, choosing from oral medications, intravenous medications, nerve blocks, injection of local anesthetic during the surgery, etc. and prior to the surgery, the management of your pain should be discussed with both your anesthesiologist and surgeon. Please feel free to bring up any concerns or fears you may have. Remember that information on pain management gives you the appropriate expectations and hence a smoother, more comfortable recovery.\nMatthews Surgery Center exists to improve the health of communities one person at a time.\nMatthews Surgery Center will deliver the most remarkable patient experience in every dimension, every time.\nThe Matthews Surgery Center values of compassion, diversity, personal excellence, and teamwork guide our actions and behaviors as we work together to achieve our vision and further our mission. |
JACKSON, TN, June 03, 2021 /24-7PressRelease/ -- Toni M. Brice has been included in Marquis Who's Who. As in all Marquis Who's Who biographical volumes, individuals profiled are selected on the basis of current reference value. Factors such as position, noteworthy accomplishments, visibility, and prominence in a field are all taken into account during the selection process.\nMrs. Brice earned a Bachelor of Science from Arkansas State University, a Master's in Nursing from Downstate Health Sciences University, State University of New York, and concluded her education with a Doctor of Nursing from Arkansas State University in Jonesboro in 2020. Since coming of age, she had cultivated a desire to become a nurse specializing in the field of anesthesiology, and consequently became a certified registered nurse anesthetist. Following this accomplishment, Mrs. Brice has practiced in the Memphis area for over 20 years.\nIn collaboration with health care professionals, Mrs. Brice provides preoperative, intraoperative and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care and emergency situations. In addition, she is qualified to provide anesthesia in collaboration with a medical doctor or dentist and assists patients in critical condition. Mrs. Brice has excellently assessed, diagnosed and provided anesthesia for cardiovascular, neurology, gynecology, obstetrics, nephrology, pediatric and dental surgery patients.\nIn the coming years, Mrs. Brice would like to expand her nurse anesthesiology practice and teach students in an educational setting. In accounting for her standout success, she credits her strong dedication to assisting patients and her empathetic attitude, which has manifested within her a keen sense of responsibility to providing excellent care. To remain aware of developments in her field, Mrs. Brice maintains her affiliation with such organizations as the American Association of Nurse Anesthetists.\nAbout Marquis Who's Who®\nSince 1899, when A. N. Marquis printed the First Edition of Who's Who in America®, Marquis Who's Who® has chronicled the lives of the most accomplished individuals and innovators from every significant field of endeavor, including politics, business, medicine, law, education, art, religion and entertainment. Today, Who's Who in America® remains an essential biographical source for thousands of researchers, journalists, librarians and executive search firms around the world. Marquis® now publishes many Who's Who titles, including Who's Who in America®, Who's Who in the World®, Who's Who in American Law®, Who's Who in Medicine and Healthcare®, Who's Who in Science and Engineering®, and Who's Who in Asia®. Marquis® publications may be visited at the official Marquis Who's Who® website at www.marquiswhoswho.com.\n# # # |
Find numerous Dentists in India from the comfort of your home on Lybrate.com. You will find Dentists with more than 31 years of experience on Lybrate.com. You can find Dentists online in Bangalore and from across India. View the profile of medical specialists and their reviews from other patients to make an informed decision.\nBook Clinic Appointment\nTreatment & Management of Braces\nTreatment of Tetracycline Stains\nRoot Canal Treatment\nManagement of Dental Hygiene\nArtificial Teeth Treatment\nBraces Treatment for Adults and Teens\nCeramic Braces Treatment\nTeeth Scaling & Polishing\nDental Extractions Procedure\nOrthosis Fitting Procedure\nFixed Partial Denture Procedure\nSubmit a review for Dr. B. V. Sreenivasa MurthyYour feedback matters!\nHi doc, My questions is for dentists doctors.... I am having gap between wisdom tooth and next to that... Anything that i eat will stuck between that gap...and i started feeling pain.... Is there any way to fill that gap... till now i am maintaining the problem by toothpick but sometimes it wont work and the pain starts again.... doctor recommended me remove the wisdom tooth but i dont want to remove it.... Any other alternative will be appreciated....\nI am a 27 year old male have chipped the edge of my front top tooth due to a fall would like advice, because i've never visited a dentist before.\nI am 32 years old lady. I have a cavity in my wisdom tooth. Can this be filled instead of removing as two of my hind teeth had been already removed and I have heard that removing of teeth makes eye sight weak. My eyes are already weak. So what shall I do?\nMy son teeth is very yellow they do brush a single time in a day what I can do to make my children teeth white and clear.\nI am suffering from ora Mouth problems. I am having cavities and tooth ache. My gums also bleed while brushing.\nMy gums have been paining for the past several weeks and there is irritation during brushing. What can be the probable treatment for this?\nI'm 49 years old, I have removed around 6-7 teeth, and the rest of the teeth needs to be cured, what shall I do and how much it's cost for hollywood smile?\nI am having a gap between my front teeth. Its draining all my confidence to face and talk to someone. I wish to start treatment near dentist in order to reduce gap. How much month should I wear clip on teeth for making my front teeth more close and perfect? Please help me.\nMy mother aged sixty has toothache in her broken teeth at the end of her jaw. Cold / hot water is creating problem while intake it. She wants her teeth to be removed. Kindly advice?\nMy wife is suffering from blister in mouth since last 3 years and we are very worried about her. What should we do? pls help us.\nAny dentist. Please help me. I regularly brush my teeth. In morning & before going to bed also. But still my teeth are not white, they look yellow! please help me.\nA healthy set of teeth is essential for good living. However, teeth problems are widespread and you are susceptible to it at any age, at any time. Though there are medications available for tooth problems, sometimes extraction of the tooth remains the only plausible solution.\nYou may have to undergo tooth extraction for multiple reasons. Some of them are:\n- Unaligned teeth: In case you are suffering from unaligned teeth, chances are that you may suffer from what in technical terms is known as "crowded mouth." In such a situation you have difficulty in eating as there is not enough room for the teeth in the mouth. Extraction of tooth, in this case, is the only way to rectify it and align the teeth in a better fashion.\n- Infection: Sometimes if you suffer from a tooth infection, it tends to quickly spread to the pulp, affecting and damaging the blood vessels and different nerves. Though medications are available, if the intensity of the infection increases, extraction of tooth remains the only option.\nProcedure: There are different steps that are involved in the extraction of teeth. They are:\n- Local anesthesia: Like all other surgeries, administering a local anesthesia is the first step. If you are undergoing a tooth extraction, the dentist or the surgeon will inject anesthesia that will create numbness and soothe you of the ensuing pain.\n- Cutting away gum and bone tissues: After the anesthesia, the dentist will proceed to extract the infected tooth. In order to do this, the doctor cuts away the gum and the tissues covering the tooth. After the root of the infected tooth has been exposed, the dentist would then with the help of forceps, sever it from the jaw.\nAfter the surgery, you must observe certain precautions to expedite the recovery process. Some of them are:\n- Take painkillers: After the tooth extraction, the possibility of suffering from an ensuing pain is incredibly high. Therefore, in most cases the dentist prescribes certain painkillers and you must take them regularly.\n- Change the dressing: The operated area will be covered with bandages to preclude any infection. However, the dressing must be changed from time to time. If the same dressing remains for a long time, chances of an infection increase.\n- Complete rest: After the extraction, you must take complete rest and not engage in any form of physical activity.\n- Avoid certain foods: Just after the surgery, the operated area remains tender. Therefore, you must eat food that requires less effort to chew like soup, pudding, ice cream etc. You must also abstain from smoking and drinking for some time. |
Plastic surgery is a form of surgical treatment that may be becoming increasingly well-liked in our Robert Griffin III Jersey society. As people try to increase their visual appeal and simulate the seems of Hollywood famous people, this is among the several choices they will likely turn to. But precisely what does cosmetic surgery require and how would you make your appropriate decisions when evaluating a plastic surgeon? This article will assistance to response some of those queries.\nLooking at cosmetic surgery to improve or boost your visual appeal is one thing that must not be considered lightly. You will need to experience some physical evaluating to be certain there is no need any disorders that could get you to an increased-risk affected individual. As you are undergoing the testing, make sure to be completely truthful in order to avoid any devastating outcomes once the procedure is comprehensive.\nMake sure out your physician’s qualifications. Have a background Robert Griffin III Jersey check out. Verify his, or her academic, and professional references. Affirm education, accreditation, and sign up by your state’s office of wellness. Also, be on the lookout for disciplinary activities, or complaints registered from them. Even, take a look at how medical doctors using their healthcare school normally do.\nIf you have already decided upon one surgery or yet another, and is particularly approaching shortly, there exists some planning you have to do. One of the most crucial things to consider can be your pre-op diet. You want to avoid achieving or burning off too much weight in this particular time period as it can certainly transform points to your doctor.\nFind out if the process Robert Griffin III Jersey you would like, needs anesthesia. The sorts are generally community, basic, or semi-mindful sedation. Focus on the chance and basic safety of every one together with your physician before getting your method. Many processes allow you to opt for, but general sedation tends to be more costly. Furthermore, make sure you ask simply how much you will require and the things they will do if it’s inadequate for you personally.\nSchedule a decent amount of time to recover adhering to any cosmetic plastic surgery. Recovery time is needed for you after any surgical treatment. So very clear your routine, and provide your body the correct time for you to repair. Don’t attempt to go back to function too soon. You may well be Robert Griffin III Jersey feeling far better now, but after strenuous activity, you might understand your system is not yet prepared to consider the job day.\nRegardless of where you’re owning your cosmetic surgery completed, you can be certain that there are professional skilled demands to the medical doctors who deal with it. Spend some time to validate in case your doctor’s accreditations have a look at. It’s a straightforward approach, and the level of probable damage that it may assist you to avoid it can be tremendous.\nPlastic surgery Robert Griffin III Jersey is a form of surgical procedures that is becoming increasingly well-liked in your community. As people try and enhance their look and simulate the appearance of Hollywood famous people, this is probably the many choices they will choose. But what exactly does aesthetic surgery entail and how do you have the appropriate choices while searching for a cosmetic surgeon? This post will assist to respond to a few of those inquiries.\n105total visits,1visits today |
August 24, 2022\nBy Nomi Health on March 22, 2023\nAs the healthcare industry progresses and expands, women continue to join the field. Today, over 60% of those entering healthcare are women. This is a stronger female representation than in any other corporate industry in the U.S. This level of representation comes as a result of years of women blazing the trail to success.\nLooking back through the history of healthcare women have worked toward critical advancements in newborn care, lifesaving surgery, infectious diseases, and more. We are focusing today on five important women who changed medicine for the modern world.\nA list of influential women in healthcare would not be complete without Elizabeth Blackwell. She was the very first woman in America to receive her medical degree.\nElizabeth was born in 1821. After she moved from England to Ohio in 1832, her father died and left her family in a dire financial predicament. To survive, Blackwell, her sisters, and her mother all began teaching to keep the family afloat. While teaching, a close friend of Blackwell’s died, inspiring her interest in medicine. However, no medical colleges at the time accepted women.\nAfter many rejections, she finally received an acceptance to Geneva College. She endured discrimination throughout her studies, persevered, and graduated in 1849. Despite ongoing difficulty practicing as the first female doctor, Dr. Blackwell went on to open an infirmary for women and children, trained nurses during the Civil War, opened a medical college, became a professor of gynecology in London, and published several books.\nShortly after Dr. Blackwell’s success we find Rebecca Lee Crumpler, the first African American woman to earn her medical degree.\nCrumpler was born in Pennsylvania. She was inspired to go into medicine after watching her aunt take care of those in her community during her childhood. As she grew, she moved to the Boston area and assisted doctors for eight years. Finally, medical education opportunities spread, and in 1860 she attended the New England Female Medical College as the only African American student.\nAfter taking a hiatus to attend to her sick husband, Crumpler graduated with her degree in 1864. Shortly after, Dr. Crumpler moved to Richmond, Virginia to provide critical healthcare to formerly enslaved people. After working in Richmond, Dr. Crumpler moved back to Boston, treating patients in and around her home. She continued to work despite difficulty fulfilling prescriptions and a lack of admitting privileges to hospitals due to her race. She worked generously and dutifully until her passing in 1895.\nWith her time spent serving as a surgeon, spy, and abolitionist, Mary Edwards Walker has quite the resume. However, perhaps her most notable accomplishment is that she is the only woman to receive the Medal of Honor.\nWalker was born in a household that greatly valued education. She attended school to become a teacher. Once she became a teacher, she worked to save money to attend medical school and graduated in 1855.\nWhen the Civil War broke out, Dr. Walker traveled to Washington to be a medical officer. After initially being denied for being a woman, she instead turned to volunteer nursing and surgical work in war camps. During this time, she also created the Women’s Relief Organization with an emphasis on assisting families as they visited their family members in the hospital. Her work was recognized, and she eventually became the first female U.S. Army surgeon.\nHer surgical work began to take her across battle lines, where she was eventually captured by Confederate soldiers as a possible spy. She was held as a prisoner of war for months before eventually being released.\nShe was granted the Medal of Honor for her work by President Andrew Johnson.\nVirginia Apgar blazed a new trail in the mid-1900s. She not only became the first full professor at Columbia University College of Physicians and Surgeons, but she also developed the first standardized testing for newborn health.\nApgar was a thoughtful and determined student. She pushed through the difficulties of the Great Depression to graduate fourth in her class at Columbia in 1933. She continued to advance by training as a surgeon under Dr. Alan Whipple. Dr. Whipple encouraged Apgar to research anesthesiology as he believed it was an area needing vast improvement.\nDr. Apgar spent months training in anesthesiology, specifically obstetrical anesthesia. This is when she developed the Apgar Score, an evaluation method measuring heart rate, respiratory effort, muscle, reflex, and color to determine newborns’ overall health. She also linked this test directly to the effects and usage of anesthesia during labor and birth.\nDr. Apgar went on to earn a master’s degree and pursued research into preventing birth defects. She won multiple awards for her work throughout her career.\nArdis Dee Hoven continues women’s healthcare legacy into the present day. Dr. Hoven has not only served as the president of the American Medical Association (AMA), but she also became the first female chair of the World Medical Association (WMA).\nAfter receiving her MD in 1970, Dr. Hoven became inspired to improve Americans’ access to healthcare during the AIDS epidemic in the 80s. This desire to expand health access and serve her community led her down a path of organized medical leadership. In 1993, she became a dedicated delegate to the AMA and served on a hospital’s foundation board.\nDuring her career, she also established a successful private medical practice and served as an infectious disease consultant in Kentucky. Her ongoing work with the AMA evolved into her becoming President of the AMA and an eventual chairperson of the WMA.\nDr. Hoven works as a professor at the University of Kentucky and as a director of the Harm Reduction Initiative in partnership with Kentucky’s department of public health.\nWith two-thirds of those entering healthcare being female, and no gender gap appearing in promotion rates in healthcare, the trajectory and possibilities for women in medicine are endless. As society continues to support women in healthcare, they will continue to innovate and break new ground. |
Kawartha Credit Union gift supports advanced X-ray technology at RMH\nKAWARTHA LAKES: Kawartha Credit Union has been supporting the health of the community through its gifts to the Ross Memorial Hospital Foundation since 1997. Its contributions have helped the hospital to purchase key equipment such as echocardiogram and dialysis machines, 3D mammography, MRI and CT scanners. Today, Lindsay Branch Manager Michelle Finley visited the Ross Memorial to present a cheque for $5,000 from the Kawartha Credit Union Community Involvement Program, to Erin Coons, RMH Foundation CEO. The gift will support the cost of new advanced X-ray/Fluoroscopy technology in the Diagnostic Imaging (DI) Department. This technology is changing the nature of care at the Ross, offering a wider variety of exams and opening new clinical possibilities including non-sedation Interventional Radiology. This advanced technology features twin robotic arms that can move around the patient, significantly reducing the need to adjust patients’ bodies to achieve the best quality image. It’s the first of its kind in Canada! “After 100 years, X-ray technology remains one of the most trusted tools physicians count upon to diagnose injury and illness,” said Erin Coons. “We’re so grateful for the support of the Kawartha Credit Union. Without the help of our donors in the community, acquisitions such as these wouldn’t be possible.” The provincial government funds the day-to-day operations and administrative costs of the hospital. It does not provide funding for the purchase of all the medical equipment. Support from the community through donations to the RMH Foundation are vital to the hospital’s ability to keep the best tools and technology available to local patients. |
New Grant available for\nNurse Anesthesia education school or program\nApplication Deadline January 31, 2021\nApplications are being accepted for nurse anesthesia schools or programs (programs) interested in applying for IFNA Accreditation. One programs will be selected to complete the accreditation process which requires completion of all steps in the written procedure for accreditation as outlined in the International Federation of Nurse Anesthetists Anesthesia Program Approval Process (APAP) Operational Policies and Procedures (2017). See: https://ifna.site/ifna-accreditation-program/approval-process-for-nurse-anesthesia-programs/\nThe selected program will be required to pledge to meet the IFNA Educational Standards for Preparing Nurse Anesthetists (2016)(https://ifna.site/ifna-accreditation-program/approval-process-for-nurse-anesthesia-programs/)andsubmit the curriculum and related material in a written self -study for review by the IFNA Education Committee. The information will also be evaluated by a team of on-site visitors to determine if it meets the IFNA Education Standards. Guidelines for this international experience will be provided by the APAP manager.\nThere is no cost to the selected program. Approved expenses will be paid by a grant from IFNA. Anesthesia programs interested in participating should submit a written request to participate by January 31, 2021. The completed application should be e-mailed to the IFNA Executive Office at [email protected].\nA nurse anesthesia program must meet the following requirements to be selected to complete the application process for Level #3 IFNA Accreditation.\n- The country where the program/school is located needs to be an IFNA member or become an IFNA member prior to hosting an IFNA onsite visit.\n- Admission requirements include an education in nursing that prepares a student to succeed in the program.\n- There is official evidence from a governmental entity that the program is currently authorized, recognized, chartered, audited, accredited or has some equivalent official status in the country, if available.\n- There is evidence that the program has not been denied approval, recognition or accreditation by a governmental or nongovernmental accreditation or quality assurance entity. (This requires the signature of a program official for confirmation.)\n- The program has graduated at least 5 classes of students from essentially the same curriculum.\n- A completed application, “IFNA Accreditation Grant Application for Nurse Anaesthesia Program Accreditation”, must be submitted\n- A statement that addresses how accreditation will benefit the program is required.\n- A pledge by the program that it will cooperate with the IFNA Education Committee in meeting timelines is required.\nAll nurse anesthesia programs are welcome to apply. We are especially interested in applications from programs located in IFNA member countries that do not currently have a program/school with IFNA accreditation.\nGrant applications and advise concerning the accreditation process will be available from Mrs Madsen APAP Manager: [email protected]\nPlease submit your application by the 31. Jan. 2021 deadline to: [email protected].\nMay 2019 /December 2020/ MR |
You have probably seen the foot with a bunion, a common condition. Toes pointing laterally (in the direction of the little toe), and no bony bump at the base. the lump may be red and tender.\nEven though bunions are obvious from the pain and unusual shape of the big toe, it’s still a good idea to see a certified podiatrist.\nYou’ll probably get X-rays of your bunion. You may also get blood tests if your doctor thinks that a type of arthritis such as gout or an infection may be causing the pain. With the results, your doctor can decide whether you need orthopedic shoes, custom made inserts, medication, surgery, or other treatment.\nFirst, your doctor will check on why you have bunions. The cause will affect what treatment you need.\nYour doctor might recommend a prescription or over-the-counter pain reliever, and medicine to relieve swelling and pain. You may also want to use a heating pad or warm foot bath to ease the immediate pain and discomfort. Some people find that ice packs help.\nSome bunions may need surgery, but only if the symptoms are severe. You shouldn’t get surgery just because you don’t like the way the bunion makes your foot look, because the risks can outweigh the benefits.\nYou’ll want to talk with your doctor about what you can expect, and what the recovery will be like.\nThe surgery is called a bunionectomy. You may get it done in a hospital or a surgery center. You may get local anesthesia, which numbs the area, and sedation. Or you might get general anesthesia so you’re not awake for the procedure. |
A minimally-invasive surgical option for weight loss that gets you back to your life - and your healthy lifestyle changes - as quickly as possible.\nLaparoscopic Sleeve Gastrectomy (LSG) is a new form of laparoscopic (minimally-invasive) surgery that reduces the size of the stomach. With the help of the da Vinci Robot, Your surgeon will staple your stomach so that it takes the shape of a sleeve; this "sleeve" then acts as a new, smaller stomach.\nLSG is performed under general anesthesia. The procedure takes about one hour, and you will stay in the hospital for two to three days. Most patients return to their normal daily activities in two weeks and are fully recovered in three weeks.\nYour new, smaller stomach can only hold a limited amount of food. This means that you will feel full sooner and for longer, contributing to an overall drop in your dietary intake.\nNo. The food you eat travels through your system in the usual order, and your stomach and intestines continue to secrete enzymes and digest your meals as normal. This means that food - and related nutrients - can be fully absorbed by the body.\nTake the First Step\nTo begin the weight loss surgery process at Middlesex Health, all patients attend our Patient Information Seminar. *\n*During the COVID-19 emergency, this seminar is available online. |
Welcome to Anesthesia and Critical Care Reviews and Commentary (ACCRAC)\nWhat is ACCRAC?\nACCRAC stands for Anesthesia and Critical Care Reviews and Commentary. The aim of this podcast is to help trainees who are reviewing for their exams as well as to provide a forum for interesting topics, debates and interviews in the areas of anesthesia and critical care.\nTo get the maximum benefit from the site, sign up for notifications in your email whenever we post a new podcast. We never spam or sell your address.\nSubscribe to our mailing list by clicking here: Mailing List Sign Up\nWho runs ACCRAC?\nMy name is Jed Wolpaw. I am an associate professor of anesthesia and critical care medicine at Johns Hopkins University School of Medicine. I am board certified in anesthesia and in adult critical care medicine. I completed medical school and Anesthesia residency at UCSF in San Francisco. I then did a critical care fellowship at Johns Hopkins and stayed on faculty when I finished my fellowship. I have a master’s degree in education and dedicate a large portion of my time to teaching medical students, residents and fellows. My research interests focus on medical education, communication and physician well-being. My goal in starting this podcast is to provide an accessible way for anyone interested in anesthesia and critical care to review basic topics, ongoing research, and interesting debates while working out or commuting.\nI can be reached at [email protected]\nSocial Media Manager (2019 – 2020)\nNotes Contributor (2020 -)\nHello, fellow podcast-enthusiasts! My name is Kimia, and I am the current ACCRAC social media manager. I have always been a fan of the podcast as a medical student, and I’m very excited to now be a part of the ACCRAC team. To tell you guys a little bit about myself, I am originally from Iran but relocated with my family to rural Maine at a young age. I graduated from Tufts University School of Medicine this year, and I’m looking forward to starting my anesthesiology residency training at the University of Virginia this summer! Apart from listening to ACCRAC in my free time, I enjoy international travel, painting, photography, and heading to the mountains to go backpacking or rock climbing.\nSocial Media Manager (2020 -)\nNotes Contributor (2019 -)\nHi everyone! My name is April and I am in my final year of medical school up in Canada. In my spare time, I absolutely love to run and podcasts are always a great accompaniment on these adventures. I love listening to ACCRAC because it continues to teach me so much about the fascinating world of anesthesia and beyond (shout out to those random recommendations). I am super excited to be ACCRAC’s next social media manager and to continue to contribute to writing show notes for the amazing episodes. Other hobbies that I love include swimming, baking, painting, and exploring the various national parks North America has to offer!\nTech Lead (2020 -)\nNotes Contributor (2017 -)\nHey y’all! I’m currently an anesthesia resident at the Brigham and Women’s Hospital in Boston, MA. I’m originally from Chicago, and am a big fan of their hot dogs (Portillo’s) and deep dish (Lou Malnati’s). Prior to completing medical school at Drexel University COM, I completed a master’s degree at Boston University, and worked at the Massachusetts Dept of Public Health, and a non-profit called Health Leads. Like many medical students interested in anesthesia, I came to enjoy the easy-listening and smooth voice of ACCRAC during medical school. I’m interested in leveraging technology in education, so in 2017 I connected with Dr. Wolpaw to start writing show notes as a way of extending the engagement beyond the podcasts. We’ve grown the team since then, and now I focus on expanding features to improve the learning experience!\nSocial Media Manager (2021 -)\nHi guys! I’m a fourth year medical student at NYCOM who will be applying anesthesiology this coming year. I’ve been an ACCRAC listener for a few years now and it plays a big role in my regular pod rotation. I think it’s a great resource for medical students interested in anesthesia and/or critical care, as well as residents, CRNAs, AAs, and practicing attendings. When I’m not doing school, I’m probably watching the Jacksonville Jaguars or Pittsburgh Penguins, hanging out with friends, or trying to get a pick-up game going. Sometimes I even read. I look forward to contributing to this podcast through the growth of the Facebook and Twitter accounts, as well as creating and expanding the brand new ACCRAC Instagram account.\nSocial Media Manager (2022 -)\nCo- Tech Lead (2022 -)\nHi everyone! I’m a fourth year medical student at NYITCOM. I’m originally from the good ol’ Staten Island, NY (yes I took a ferry from Staten Island to Manhattan everyday in undergrad). Speaking of undergrad, I majored in Biochem & minored in biology — I guess I’m a bit of a bio enthusiast? In my spare time I love checking national parks off my list, baking, doing some freelance writing and teaching my British Shorthair kitten tricks (we have not been successful of yet). I came across ACCRAC when I started my fourth year anesthesia rotations & I am thrilled to become a team member!\nSocial Media Manager (2022 -)\nHey I’m Chris and currently a 4th year medical stu dent at NYITCOM. I’m from Wantagh, NY and went to Marist College for undergraduate. I became interested in anesthesia my third year of medical school during my surgery rotation. The ACCRAC podcast was recommended by a friend and quickly became a favorite listen of mine. During my free time I enjoy surfing, fishing, beach volleyball, and have just started playing golf.\nNotes Contributor (2021 -)\nHello hello, my name is Edison and I am a 4th year medical student at the Medical University of Lublin in Poland. I’m a Canadian who is an addict of both inline skating and podcasts. Sometimes enjoying both at the same time. I love anesthesia and crit care, and have joined ACCRAC to help with show notes and take deep dives on topics that interest me. Lastly and most importantly, I am also a diehard Canucks fan.\nThe information on the website is not meant to replace the advice of a health professional; it is designed to complement, not replace, the relationship between a patient and his/her own physician. For more on this see our disclaimer.\nAny information collected by our website, such as an email address, will never be passed on to any third party, unless required by law. |
Breast Implant Removal Q&A\nComparison + Breast Implant Removal\nFluid build up in my right breast, ultrasound showed there is a thick film of capsular around my implant. Look swollen but no pain. I went to 2... READ MORE\nIf I drain my saline breast implants how long would it take for my breast skin to firm up and my breast tissue to "fluff" per say compared to removing... READ MORE\nI have baker grade IV capsular contracture which is extremely uncomfortable and painful. I was wanting dr's opinion on which procedure is best and... READ MORE\nI believe I have smooth saline under the muscle by Mehgan in June, 2005. 300cc in left 270 right, They are so firm right now, making it difficult to... READ MORE\nHello my surgeon let me know that I would not need to be wrapped after surgery nor would I need to wear a compression bra after my implant removal,... READ MORE\nWhich breast lift would better for me - the lollipop lift or an internal lift combined with benelli lift? (Photo)\nI'm looking into getting my 492 cc silicone gel under muscle removed. I've had two consultations with two board certified plastic surgeons. I'm so... READ MORE\nI saw many picturs about breast implants removed and i noted that after implant removed breast results better when implants are over muscle then... READ MORE\nCan I achieve a feminine, perky silhouette by removing my old saline implants and lifting my natural tissue? (photo)\nThe last surgeon I saw said there could possibly be a leak in my 10 year old saline implants, but wouldn't know until they are removed. I am concerned... READ MORE\nOver implants 26 yrs, explanting (no lift) because of baker 3 cc with up shift right side. One PS said he would remove both capsules, the other said... READ MORE\nHi there, I am getting an explant by an oncologist, not a plastic surgeon. Can you explain if there would be a difference in the way either of them... READ MORE\nBreast explant surgery after 40 years. Which is safer: in office, or in a hospital under general with an anesthesiologist?\nI am afraid of the psychological effect of no breasts, not fitting into clothes, etc. I have always had hard capsule, many immune issues, pain,... READ MORE\nIf the breast implant was done through armpit opening, could the explant operation using again the armpit strategy can perfectly and successfully... READ MORE\nAre there any recovery/risk differences with with Breast Implant Removal through the armpit rather than under the breast fold?\nAll the posts I've read talk about removal of implants from breast underfold. My implants were inserted through my armpit behind breast muscles. I am... READ MORE\nSaline Over the muscle Breast Implant Removal; Are they more difficult or easier less painful to remove?\nI had Brest implants smooth saline put in via tuba method there's 400cc. above the muscle. I've had them for 11 years and not sure if I should have... READ MORE\nDo I have tuberous or constricted breasts? I was told NOT tuberous, but yes constricted. Thoughts? (photos)\nI got implants in 2011. I never knew my natural breasts were "deformed" until my surgeon told me my breasts were constricted. Now I wonder if they... READ MORE\nHow likely will my breasts return to normal after explant surgery? Total Capsulectomy or Capsulotomy? Possible complications?\nI'm in my mid 20s and had silicone implants (250cc and 275cc) placed under the muscle 2 years ago. My right side has grade 2 capsular contracture,... READ MORE\nI have been to 5 PS all which have minimal experience with explant only. I am going with the PS who was recommended by my PCP. He has a lot of... READ MORE\nHi, I was hoping you could tell me if there is a big difference between a compression bra and a sports bra. I'm having explant sugery on September 1st... READ MORE\nI got 300cc saline implants about 5 months ago and have decided to have them removed. There are no issues-i have just decided they are not for me. Is... READ MORE\nIs there a price difference on having breast implants removed with local anesthesia compared to gave them out with general?\nI am looking to have my implants removed. I am looking for a doctor who will remove them with local anesthesia as I am not having any trouble and I... READ MORE |
Crown lengthening can be performed on one or more teeth, most commonly as preparation for a dental crown. A dental crown is a cap that is placed on a broken or decayed tooth in order to restore function and appearance. A crown may also be necessary for completing a more extensive restoration such as a root canal, implant, or dental bridge. Crown lengthening can also be performed as a cosmetic procedure to help you achieve your desired smile by treating what is commonly referred to as a “gummy smile” – excessive gum tissue surrounding the front teeth.\nThis surgery is a relatively simple procedure that can be completed in one sitting while you are under local anesthesia. If you are in need of a crown lengthening procedure, talk to your dentist Family Dental Care of Champaign about treatment. |
Through generous donations by ACVS surgeons, corporations and animal owners, the Foundation promotes learning opportunities at the annual ACVS Surgery Summit. These sessions allow ACVS surgeons, surgeons in training and general practitioner veterinarians to keep their knowledge current about topics such as limb sparing (alternatives to amputation of a leg) and gastrointestinal surgery. Additionally, the Foundation partners with Wiley-Blackwell to publish the Advances in Veterinary Surgery book series, which provides state-of-the-art information for veterinarians to use in their practices.\nThe Foundation provides funds for ACVS surgeons and surgeons in training to investigate a wide variety of topics that lead to better surgical care for the animals that are important to you. Grants awarded have examined and reported on subjects including anesthesia, arthritis, joint issues in horses, fractures in cats and lameness in dogs. |
Magnetoencephalography (MEG) is a non-invasive medical test that measures the magnetic fields produced by your brain's electrical currents. It is performed to map brain function and to identify the exact location of the source of epileptic seizures.\nOn the day of your exam, tell your doctor if you have any medical devices or implants you have. Your doctor will advise you on any eating and drinking restrictions and whether you may take your regular medications as usual. Leave jewelry at home and wear loose, comfortable clothing. You may be asked to wear a gown or allowed to wear your own clothing, provided it is loose-fitting and has no metal fasteners. Patients undergoing MEG do not typically experience claustrophobia. However, if you are feeling anxious, you may want to ask your doctor for a mild sedative prior to your scheduled exam.\n- What is Magnetoencephalography?\n- What are some common uses of the procedure?\n- How should I prepare?\n- What does the equipment look like?\n- How does the procedure work?\n- How is the procedure performed?\n- What will I experience during and after the procedure?\n- Who interprets the results and how do I get them?\n- What are the benefits vs. risks?\n- What are the limitations of Magnetoencephalography?\nWhat is Magnetoencephalography (MEG)?\nMagnetoencphalography is a non-invasive medical test that uses a superconducting quantum interference device (SQUID) and a computer to measure neuromagnetic activity within the brain.\nMEG detects, records and analyzes the magnetic fields produced by electrical currents in the brain. The distribution of these magnetic fields is superimposed with an anatomical image of the brain to help identify the source of activity in the brain.\nAn MEG study is a direct measure of brain function and the most advanced method of recording and evaluating the brain while it is actively functioning.\nWhat are some common uses of the procedure?\nMEG is used to identify or map:\n- the functional areas of the brain, including centers of sensory, motor, language and memory activities\n- the precise location of the source of epileptic seizures\nMEG creates a roadmap of the brain that is useful for preoperative and treatment planning for individuals with epilepsy and for patients undergoing surgery to remove a brain tumor or other lesion. MEG is also used as a research tool to help scientists better understand human brain function and to study neurological and psychiatric disorders.\nHow should I prepare?\nYou may be asked to wear a gown during the exam or you may be allowed to wear your own clothing if it is loose-fitting and has no metal fasteners.\nYour physician will advise you on eating and drinking before your exam and whether you may take medications as usual.\nPatients undergoing MEG do not typically experience claustrophobia (fear of enclosed spaces). However, if you are feeling anxious about your exam, you may want to ask your physician to prescribe a mild sedative prior to your scheduled examination.\nInfants and young children may require sedation or anesthesia to complete an MEG exam without moving. Whether a child requires sedation depends on the child's age and the type of exam. Moderate and conscious sedation can be provided at many facilities. A physician or nurse specializing in sedation or anesthesia for children should be available during the exam for your child's safety. You will be given special instructions for how to prepare your child for the sedation or anesthesia.\nJewelry and other accessories should be left at home or removed prior to the MEG exam. You should not wear makeup (which could include metallic substances) or hair products on the day of your procedure. Because they can interfere with the detection of magnetic fields, metal and electronic items are not allowed in the shielded exam room. These items include:\n- jewelry, watches, credit cards and hearing aids, all of which can be damaged\n- pins, hairpins, metal zippers and similar metallic items\n- removable dental work\n- pens, pocket knives and eyeglasses\n- body piercings\n- underwire bras\n- some types of heavily applied facial make-up, especially around the eyes\nPeople with the following implants may not be able to have a MEG exam:\n- cochlear (ear) implant\n- some types of clips used for brain aneurysms\n- some types of metal coils placed within blood vessels\n- nearly all cardiac defibrillators and pacemakers\n- artificial heart valves\n- implanted drug infusion ports\n- artificial limbs or metallic joint prostheses\n- implanted nerve stimulators\n- metal pins, screws, plates, stents or surgical staples\nWhat does the equipment look like?\nAn MEG study is performed in a special room that is shielded from outside magnetic and electric noise. A helmet-shaped container is placed on the patient's head. Tiny magnetic sensors line the inside of this specially designed helmet, which looks similar to a large hair dryer. The computer workstation that helps detect and record the signals from the MEG helmet is located in a separate room.\nHow does the procedure work?\nBrain cells interact by generating tiny electrical voltages that create electrical currents throughout the brain. This electrical flow produces magnetic fields that can be detected and recorded using sensitive magnetic sensors. Several hundred of these specialized sensors are built into the MEG helmet, which is placed on the patient's head. This sophisticated instrument and computer software work together to detect and record the activity of neurons as the patient lies still or completes a series of tasks, such as listening to a series of words or looking at pictures. An analysis of the recording, which collects both normal and abnormal brain signals every millisecond of the study, helps determine where specific activities in the brain originate.\nHow is the procedure performed?\nMEG examinations are usually performed on an outpatient basis.\nTypically, three to four positioning coils may be attached to your head with temporary tape to help precisely determine the location of your head relative to the MEG detectors.\nAn electroencephalogram (EEG), another type of test used to detect abnormalities related to the electrical activity of the brain, may be performed at the same time as the MEG exam. If so, small electrical conductors called electrodes will also be attached to your head with temporary tape, or on a cap that resembles a swimming-cap.\nThe exact positions of the coils and electrodes are measured using a special wand-like device called a digitizer.\nThe patient may be positioned on a moveable examination table or seated in a comfortable chair within a room that shields out any electric and magnetic noise that could interfere with the exam. You will be positioned within the stationary helmet that contains the MEG detectors placed on your head.\nDepending on the type of study you are having, you may lie quietly or even go to sleep. If you are having an MEG exam to identify the sensory areas of your brain, you will be given ear phones and presented with sounds or images on a screen and asked to respond. To identify areas of the brain involved in movement, you may be asked to repeatedly push a button. For identifying language areas of the brain, you may be asked to read.\nThroughout these tasks, you will be asked to hold relatively still and keep your head and eye movements to a minimum.\nAfter your exam is finished, the recording will be analyzed.\nMEG exams generally include multiple recording sequences, some of which may last several minutes.\nThe entire examination usually takes between one to two hours, depending on the extent of functional mapping.\nWhat will I experience during and after the procedure?\nMost MEG exams are painless.\nPatients do not typically feel claustrophobic when wearing the MEG helmet because it fits loosely on the head and does not cover your face or body.\nYou will be alone in the exam room during much of the MEG procedure. At all times during your exam, the technologist will be able to see, hear and speak with you using a two-way intercom. Many MEG centers allow a friend or parent to stay in the room as long as they are also screened for safety in the magnetic environment.\nIf you or your child have been sedated or anesthetized for an MEG exam, recovery time ranges from approximately 30 minutes to two hours after the exam is completed.\nIf you have not been sedated, no recovery period is necessary. You may resume your usual activities and normal diet immediately after the exam.\nWho interprets the results and how do I get them?\nA radiologist, a physician specially trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care or referring physician, who will share the results with you.\nWhat are the benefits vs. risks?\n- MEG is a noninvasive imaging technique that does not involve exposure to ionizing radiation.\n- MEG is a highly precise, real-time study of brain activity.\n- MEG improves the surgical outcomes of epilepsy patients.\n- The MEG examination poses no known risk to the average patient when appropriate safety guidelines are followed.\nWhat are the limitations of MEG?\nPatients need to remain relatively still during an MEG exam. Patients with a vagus nerve stimulator (VNS), pacemaker or similar device may not be able to undergo an MEG study.\nThis page was reviewed on March 18, 2020 |
Dental anxiety can make even minor dental work feel overwhelming or even terrifying. Sedation dentistry makes it possible to get the dental work you need in a comfortable and relaxing setting. There are four levels of sedation dentistry, ranging from light sedation to full anesthesia.\nIf you’re worried about getting dental work or experience anxiety, we can help. Our dentist Dr. Ramin Mahallati and our dentistry team at the Center for Implant & Esthetic Dentistry offer sedation dentistry services at our office in Beverly Hills, California.\nFour levels of sedation dentistry\nThe four levels of sedation dentistry include:\n- Mild/minimal sedation\n- Moderate sedation\n- Deep sedation\n- General anesthesia\nThe type of sedation that you’ll need depends on several factors, including the procedure, your level of anxiety, and your health. Before your appointment, Dr. Mahallati and our team will discuss your options and recommend the best type of sedation for your needs.\nMild sedation with nitrous oxide\nMost people are familiar with nitrous oxide — also known as “laughing gas.” The nitrous oxide gas is mixed with oxygen. You’ll remain awake and alert throughout the procedure but relaxed enough to feel comfortable and less anxious. The effects wear off fairly quickly, and it’s safe for use on both children and adults.\nSome of the most common dental procedures where nitrous oxide is used include:\nNitrous oxide is inhaled through a mask.\nModerate dental sedation\nModerate sedation is a little stronger than laughing gas and is administered orally in pill form. While you’ll still be awake and conscious during the procedure, moderate dental sedation has a stronger effect and offers deeper relaxation, so you may not entirely remember the details of the procedure.\nDeep sedation is administered intravenously (IV), and while you remain awake throughout the procedure, it produces what’s known as “twilight sleep” or an amnesic state where you’re just on the edge of consciousness and less sensitive to pain.\nIV sedation is commonly used for oral surgery procedures like wisdom teeth extractions, dental implants, and gum surgery.\nGeneral anesthesia is the strongest form of sedation. Under general anesthesia, you are fully unconscious throughout the procedure.\nDepending on your dental procedure and the type of sedation required, we generally recommend that you bring someone to the appointment with you to drive you home afterward while the effects of the sedation fully wear off.\nSedation dentistry is a safe and effective way to manage dental anxiety and to deal with issues like lower pain tolerance and tooth and gum sensitivity. If you’re taking any medication or have underlying health issues, let us know before your procedure, and Dr. Mahallati will recommend the best options for you.\nFor more information about the different types of sedation dentistry, contact us today to schedule an appointment with Dr. Mahallati at our office in Beverly Hills. |
THE ANTI-AGING TRINITY OF MORPHEUS8, FACETITE AND BODYTITE\nWhile a healthy diet and exercise routine will help increase your longevity and elevate your mood, they don’t always go far enough in trimming the body of excess stubborn fat. In addition, aging and weight loss can result in sagging skin that further compromises the physique.\nAt Aesthetic MdR, we understand the value of thinking strategically. That is why we have created a triple threat combination procedure to address both fat loss and skin tightening simultaneously. The anti-aging trinity of Morpheus8, FaceTite and BodyTite works to rejuvenate you from head to toe, replenishing your self-confidence while rejuvenating the face and streamlining the figure. Treatment is less invasive than surgery and comes with much less downtime and discomfort as well.\nLISTEN TO DR. LUIS MACIAS FEATURED ON THE BIG BUTTS NO LIES PODCAST FOR SURGICAL AND NON-SURGICAL FACIAL REJUVENATION OPTIONS\nListen here to Dr. Luis Macias being interviewed by the Big Butts No Lies podcast host for "When Should I Have a Facelift?" This podcast episode covers the following topics:\n- What are non-surgical options if not ready for a Facelift (Morpheus8, Facetite and Renuvion)?\n- When do most patients get a facelift?\n- Where are the scars hidden for a facelift?\n- Are neck lifts part of a facelift procedure?\n- Is fat grafting done during a facelift?\n- Is a mini facelift worth it?\n- Can a facelift be done under local anesthesia?\n- How can lips be augmented as we age?\n- What lasers do you recommend for facial rejuvenation?\nWhat are the benefits of FaceTite and BodyTite?\n- Safe, non-invasive and non-surgical\n- No anesthesia, incisions or scarring\n- See results right away\n- Short treatment time\n- No downtime or discomfort\n- Helps address skin laxity, wrinkles and lines\n- Reduces stubborn fat\n- Stimulates collagen and elastin renewal\n- Streamlines the physique\n- Rolls back the clock on aging\n- Enhances self-confidence\nWhy choose Aesthetic MdR?\nAll treatments at Aesthetic MdR are overseen by Dr. Macias, a board-certified plastic surgeon who previously served his country as a sergeant in the US Marine Corps. After receiving his medical degree from UCLA, Dr. Macias pursued a demanding residency in plastic and reconstructive surgery at the world-renowned Mayo Clinic, followed by a microvascular reconstructive surgery fellowship at the University of Pennsylvania. Dr. Macias was appointed as the Aesthetic Program Director at the University of Southern California (USC) Keck School of Medicine Division of Plastic and Reconstructive Surgery, where he helps new residents and fellows to hone their talents and perfect advanced techniques.\nTo take your next step in cosmetic enhancement, your next step is a consultation with one of our providers. Please call our office to schedule an appointment.Schedule a Consultation\nRSVP TO THE PARTY OF THE SEASON |
Why You Might Need Neuroma Surgery\nNeuroma surgery involves the removal of the abnormal nerve segments that runs between two adjacent metatarsal (forefoot) bones and their respective toes. Thus, there will be some numbness of the adjacent toes after the surgery that may be permanent.\n- Reduce or eliminate pain associated with the neuroma.\nPossible Alternatives to Surgery\n- Orthotics or padded insoles, with/without metatarsal pad\n- Wider shoes, low heels, or orthopedic shoes.\n- Medications – oral or injected\n- Physical Therapy – Ice Massages\nPotential Complications / Risks\nRecurrent neuroma (amputation neuroma); Recurrent pain; Numbness; Stiffness; Prolonged post-operative swelling; Prolonged post-operative pain; Incomplete relief of pain; Delayed healing or non-healing of skin / soft tissue; Unsightly or painful scar; Circulation disturbance of skin / soft tissue; Infection of soft tissue or bone; Tendon injury or tendonitis; Toe deformity; Weakness of the toe; Poor toe to ground contact; Thinned fat pad on bottom of foot; Change in shoe size; Hematoma or bleeding complication; Phlebitis; Mild to life threatening reaction to medications and/or anesthesia.\nUsual Post-Operative Care / Recovery\nWalk in a special surgical shoe immediately after surgery with crutches or other assistive device; Use elevation, rest, water-tight ice packs, and prescribed medications for pain and swelling control; keep bandages dry and in place for approximately two weeks; sutures are removed in approximately two weeks; utilize anti-swelling and anti-stiffness physical therapy for one to six months; return to loose shoes or sneakers in approximately two to six weeks; return to fashionable shoes in one to four months; return to sedentary activities in two weeks to four months; possible use of orthoses long-term. |
This week’s Monday Mission – on a Tuesday because Promo was in the hospital yesterday for a colonoscopy.\n- When was the last time you were in the hospital as a patient? As a visitor?\nNever as a visitor. Last October as a patient for my cyst removal.\n- Have you ever been put under anesthesia or sedation? For what reason? Did it mess with your mind?\nYep, see above. I didn’t have any real trouble with the anesthesia, although I came out of it before my morphine was hooked up and was in a world of pain until they got me set with my drugs. sigh.\n- Have you (or someone close to you) ever had any major surgery? How did it go?\nWell, I think the cyst removal counts as major. Read all about it on my site on the subject. :)\n- How about the emergency room? Have you ever had to be taken there, or had to accompany someone else? What happened?\nNope and nope.\n- Have you ever donated blood (or other fluids)?\nYep! I was a regular blood donor until the new Mad Cow Disease rules made it against the rules for them to accept my blood. Stoopid semester abroad.\n- Are you an Organ Donor? How do you feel about having your organs being donated to those in need once you die? Have you or someone you know ever been the recipient of donated organs?\nYep, I am. I think it’d be great to live on that way. Never known ab\nybody who received organs, though.\n- Do you know any men who refuse, or are too afraid, to go to see a Doctor? Why are so many men like that?\nWell, I know men who are reluctant (for whatever reason) to go to the doctor. I suspect it’s related to that “not wanting to show weakness” thing that also manifests in a refusal to ask for directions. It irks me when it’s a man I really care about doing it because I worry that if there is, God forbid, really something wrong, it won’t be caught in time… but at the same time I don’t want to be a horrible and annoying nag. You know? |
Position Type: Full Time\nDate Posted: 1/8/2014\nCompany: Somnia Anesthesia\nDescription: Somnia is searching for CRNAs for Mercy Hospital Grayling, a 94-bed regional care facility in Northern Michigan. The target start date is January 1, 2014.\nEducation: Diploma/Certificate in Anesthesia\nOur new anesthesia team will be comprised of 3 MDs and 3 CRNAs. CRNAs will be medically directed by MDs in a variety of specialties, including obstetrics/gynecology, orthopedics, cardiology, urology, and ophthalmology.\nThe anesthesia team will be responsible for covering 3 ORs, with an annual surgical case volume of 3,000, 800 endoscopy procedures, and 300 births in the labor and delivery suite.\n• Active Michigan State License\n• ACLS Certification\n• Regional Anesthesia Experience\nA comprehensive benefits package is available. Somnia offers employee (W2) or independent contractor (1099) options.\nThe county seat of Crawford County, Grayling is a town of approximately 2,000 residents located on the banks of the AuSauble River. Just miles from the only national forest in Lower Michigan and 90 minutes from Lake Huron and Lake Michigan, Grayling and Crawford County are a scenic, idyllic representation of the beauty and wonder of northern Lower Michigan. Although a town of only 2,000 residents, Grayling is an outdoor enthusiasts’ paradise. Activities range from biking and hiking, to boating and sailing, to golfing, where 30 minutes north in Gaylord is one of the nation’s densest regions of world-class, championship courses. An area with a rich and proud history, Grayling is home to several museums, cultural attractions, and historical landmarks, including the AuSable Artisan Village Art Center.\nNumber of Openings: 3\nJob Reference: AANA\nWill Hire From: US Residents Only\nReply To E-mail: [email protected]\nHow To Apply: For your consideration, please send your CV to:\[email protected] or Phone: 877-476-6642, ext. 3548\nCompany Web Site: |
Citation: Au AHY, Choi SW, Cheung CW, Leung YY (2015) The Efficacy and Clinical Safety of Various Analgesic Combinations for Post-Operative Pain after Third Molar Surgery: A Systematic Review and Meta-Analysis. PLoS ONE 10(6): e0127611. https://doi.org/10.1371/journal.pone.0127611\nAcademic Editor: Francesco Staffieri, University of Bari, ITALY\nReceived: December 17, 2014; Accepted: April 17, 2015; Published: June 8, 2015\nCopyright: © 2015 Au et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited\nData Availability: All relevant data are within the paper and its Supporting Information files.\nFunding: The authors have no support or funding to report.\nCompeting interests: The authors have declared that no competing interests exist.\nThe combination of analgesics from different classes may provide additive analgesic effects with lesser side effects than when a single drug is used [1, 2]. It has also been suggested that the combination of analgesics can provide different mechanisms of action and therefore multimodal coverage of a wider spectrum of pain, thus enable the drug components to provide potential synergistic effect . Moreover, in terms of safety, analgesic combinations may allow a lower dose of single drug component, which may result in a lower incidence of adverse effects. As multiple pathways of human body’s nociception were suggested , analgesic combinations are appropriate for pain management and has been recommended by World Health Organization (WHO) , the American Pain Society (APS) and the American College of Rheumatology (ACR) .\nAcute post-operative dental pain model has been suggested as an excellent analgesic model because the pain can be debilitating . Wisdom tooth surgery has been commonly used in studies to investigate the efficacy of single or combination analgesics [9–11]. Review of the literature demonstrated that analgesic combinations of NSAIDs or acetaminophen and opioids were superior to single drug in terms of analgesic effect and/ or side-effect for acute post-operative pain .\nHowever, among the enormous number of possible combinations, there is a lack of knowledge regarding which therapeutic analgesic combination and the respective drug dosages is more superior in terms of analgesic efficacy and its clinical safety. Therefore the purpose of the study was to conduct a systematic review and meta-analysis to answer a clinical question “which analgesic combination and dosage is potentially the most effective and safe for acute post-operative pain control after third molar surgery?”\nMaterials and Methods\nA systematic review and meta-analysis was designed to perform two rounds of comprehensive searches of literature with relevance to the clinical question and a round of critical evaluation to identify relevant articles that could be included in the final review. Two authors (A.H.Y. and L.Y.Y.) were judges in the two rounds of search and the evaluation round, and worked independently according to the protocol and were blinded to each other’s choice. Disagreements between two judges were discussed and solved by consent. A third party (N.S.) was consulted if any consensus to a disagreement could not be reached.\nFirst round search\nThree databases (Pubmed, Embase and the Cochrane Library) were searched. There were no restriction criteria set on language or publication date. The last date of the search was 1st March, 2013. The electronic search was performed using the keywords:\n- third molar;\n- wisdom tooth;\n- dentoalveolar surgery\n- acute dental pain\nA search was performed by (1 or 2 or 3) AND (4 or 5 or 6 or 7)\nA list of articles with the search strategy was generated. Each abstract of the articles was reviewed. The full articles were retrieved if there was inadequate information in the abstracts or the abstracts were missing. Articles relevant to the study of analgesics combination and third molar surgery were selected and included in the next round.\nSecond round search and selection\nTo expand the search for possible articles that were relevant to the topic, a manual search was performed on three international oral and maxillofacial surgery journals (Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology; International Journal of Oral and Maxillofacial Surgery; and Journal of Oral and Maxillofacial Surgery). The manual search of these 3 journals was limited to the period from March 2003 to Feb 2013. Articles relevant to the treatment of post-operative dental pain and uses of combination analgesia were selected in this round.\nA reference list search was performed from the manual search articles and the selected articles of the first round articles. Articles that were relevant to the study of post-operative dental pain and combination of analgesic efficacy and clinical safety were selected.\nIn addition to the articles from the first round, all articles were evaluated. Two independent judges (A.H.Y and L.Y.Y) carried out independent selection of the articles entered this round, according to the following selection criteria:\n- Articles must be limited to third molar surgery;\n- Articles must be limited for assessing the combination of analgesic;\n- Articles must be randomized clinical trials.\nArticles had to fulfill all these three criteria to be selected to enter the third round evaluation.\nThird round evaluation\nArticles entering the third round were evaluated by two independent judges (A.H.Y and L.Y.Y) based on the following criteria.\n- The study must contain one or more of the following information about the patients who underwent wisdom tooth surgery: basic demographic data (mean age, gender of patients); number of wisdom teeth removed; and baseline pain intensity.\n- The study must contain a placebo group.\n- The articles must consist of the following two objective pain measurements that were commonly used in analgesic studies:\n- Sum of pain intensity difference in 6 hours (SPID6);\n- Total pain relief in 6 hours (TOTPAR6).\n- The articles must include the adequate description on the side effect, patient tolerability and safety of the drugs.\nArticles had to fulfill all criteria to be included in the final review. Table 1 summarized the eligibility criteria for articles included in the final review. Table 2 listed the excluded studies and the reasons for exclusion.\nArticles entering the final review were being assessed of the efficacies and the adverse effects of the analgesic combinations reported in the studies. Drug efficacy was reported by the two objective pain measurements, SPID6 and TOTPAR6 (See Objective pain measurements). Single drug analgesics reported in the included studies were not assessed. The reported SPID6 and TOTPAR6 value of the placebos in the included articles reported and compared with the analgesic combinations. When there were multiple studies reporting the same analgesic combination and same dosage, the mean SPID6 and mean TOTPAR6 of the analgesic combination and the respective placebo was calculated according to the formula:\nThe adjusted effect of an analgesic combination reported in each included study was calculated by offsetting the placebo effect within the same study to report its actual effect. The formulae to calculate the adjusted SPID6 and TOTPAR6 were as follows:\n- Adjusted SPID6 = SPID6 of drug—SPID6 of placebo\n- Adjusted TOTPAR6 = TOTPAR6 of drug—TOTPAR6 of placebo\nThe adverse effects of the analgesic combinations of the included studies were reported. The proportion of subjects complaining of an adverse effect of the analgesic combination were reported and compared. When there were multiple studies reporting the same analgesic combination of the same dosage, the mean proportion of subjects presenting with the adverse effect were reported.\nObjective pain measurements\n- 1. Sum of pain intensity difference in 6 hours (SPID6). SPID6 measured the difference of the sum of pain intensity score in the first 6 hours post-operatively. Pain intensity score was reported subjectively by the subject on a four-point scale (0 = none; 1 = slight; 2 = moderate; 3 = severe). The baseline pain intensity score was recorded after third molar surgery and local anaesthesic effect was subsided. Analgesics were administered afterwards.\nThe Pain Intensity Difference (PID) was measured by the pain intensity score at baseline minus the pain intensity score at a given observation time point, which was recorded hourly in the first 6 hours. The sum of Pain Intensity Difference (SPID) for the 0 to 6-hour observation period was reported as SPID6. The higher score represents more effective analgesia.\n- 2. Total pain relief in 6 hours (TOTPAR6). Pain relief was measured by a categorical rating scale (0 = none; 1 = slight; 2 = moderate; 3 = good; 4 = complete). Pain relief after analgesic consumption was recorded at different post-operative time points, which was recorded hourly in the first 6 hours. The summation of pain relief score on each hour in the first 6 hours resulted in TOTPAR 6. It was defined as the area under the curve of the pain relief scores against the corresponding time interval. For example if a patient had complete pain relief immediately after taken the analgesic, and sustained it for the full 6 hours of observation period, the maximum TOTPAR6 would be (6 hours x 4) 24. The higher the score represented the analgesic was more effective.\nMeta-analysis of the data was performed by first looking at the heterogeneity of the studies included in this paper. Cochrane Q and quantification of dispersion between studies using I2, values were calculated using Comprehensive Meta-Analysis (version 2.2.064, Englewood, New Jersey). The random effects model was chosen and significance level was set at 0.05.\nThe manuscript was based on a master thesis of the first author, which was submitted in September 2013 to the University of Hong Kong. The meta-analysis of the study was performed by the second author. A re-search was performed in September 2014 using the keywords and found no new studies to be included. The authors therefore prefer to use the original search date for the systematic review and meta-analysis.\nA flow diagram of the three rounds of search and evaluation was presented in Fig 1. The first round search of the computer base, covering the period from the earliest available date to 1st March 2013, yielded 896 hits from PubMed, 137 hits from Medline and 82 hits from the Cochrane Library. One hundred and eighty three hits were duplications and were removed. The abstracts of 932 articles were screened, 365 articles were considered relevant to the study of the efficacy and clinical safety of analgesic combination of post-operative acute dental pain, with 567 articles were considered irrelevant and were excluded. The second round search yielded 4 additional articles from manual search and 4 additional articles from reference search. After selection, 71 articles met the three criteria and entered the third round for evaluation. Fifty-eight studies failed to meet one or more of the criteria in the evaluation round and were excluded. Fourteen studies fulfilled the eligibility criteria and entered the final review.\nThe 14 included studies [13–25] of the final review were all randomized clinical trial with placebo control. These articles were published between 1986 and 2012. Two were multi-center studies [21, 25], thirteen were double blinded single oral dose studies [13, 14, 16–25] and one study was double blinded with repeated doses . All studies reported the basic demographic data.\nThere were a total of 3521 subjects included the 14 included studies. Of these, 1748 subjects received different combinations and dosages of analgesics and 629 subjects received placebo. The remaining 1144 subjects of these studies had single drug analgesics and were excluded from the review.\nTen groups of drug combinations were identified in the final review according to the type of drug combined. They were 1) acetaminophen + codeine phosphate; 2) acetaminophen + hydrocodone bitartrate; 3) acetaminophen + oxycodone HCL; 4) acetaminophen + ibuprofen 5) aspirin + caffeine; 6) aspirin + codeine phosphate; 7) aspirin + caffeine + butalbital + codeine phosphate; 8) ibuprofen + oxycodone HCL; and 9) ibuprofen + caffeine; 10) ibuprofen + codeine phosphate\nThere were 17 drug combinations with different dosages and were listed below.\n- Acetaminophen 650mg + codeine phosphate 60mg\n- Acetaminophen 600mg + codeine phosphate 60mg\n- Acetaminophen 300mg + codeine phosphate 30mg\n- Acetaminophen 1g + codeine phosphate 30mg\n- Acetaminophen 1g + hydrocodone bitartrate 10mg\n- Acetaminophen 500mg + hydrocodone bitartrate 7.5mg\n- Acetaminophen 325mg + oxycodone HCL 5mg\n- Acetaminophen 500mg + ibuprofen 200mg\n- Acetaminophen 1g + ibuprofen 400mg\n- Aspirin 650mg + caffeine 65mg\n- Aspirin 650mg + codeine phosphate 60mg\n- Aspirin 325mg + caffeine 40mg + butalbital 50mg + codeine phosphate 15mg\n- Ibuprofen 400mg + oxycodone HCL 5mg\n- Ibuprofen 200mg + caffeine 200mg\n- Ibuprofen 200mg + caffeine 100mg\n- Ibuprofen 200mg + caffeine 50mg\n- Ibuprofen 400mg + codeine phosphate 25.6mg\nEfficacy of analgesic combinations\nThe efficacies of the analgesic combinations in terms of SPID6 and TOTPAR6 were reported in Table 3.\nSeven of the 17 different analgesic combinations with different dosages described in the included studies involved acetaminophen combining with an opioid (codeine phosphate, hydrocodone bitartrate or oxycodone HCL), with the adjusted SPID6 and adjusted TOTPAR6 of ranged from 1.46–3.7 and 3.24–7.2 respectively. Four of these combinations involved different dosages of acetaminophen combined with codeine phosphate. There was no obvious difference of efficacy in terms of SPID6 and TOTPAR6 between acetaminophen 650mg + codeine phosphate 60mg and acetaminophen 600mg + codeine phosphate 60mg. But these two combinations were more effective than acetaminophen 300mg + codeine phosphate 30mg, with adjusted SPID6 and adjusted TOTPAR6 at least 2.1 and 1.6 times higher, respectively, than the lower dosage combination.\nThree of the analgesic combinations from the included studies involved aspirin as a major analgesic component, with the adjusted SPID6 and adjusted TOTPAR6 were ranged from 1.8–3.09 and 4.4–6.7, respectively. The four drugs combination of aspirin 325mg+caffeine 40mg + butalbital 50mg + codeine phosphate 15mg showed the highest efficacy in terms of adjusted SPID6 (3.09) and TOTPAR6 (6.7) among the three, followed by aspirin 650mg + caffeine 65mg and aspirin 650mg + codeine phosphate 60mg.\nSeven of the analgesic combinations reported in the included studies had ibuprofen as a major analgesic component, with the adjusted SPID6 and adjusted TOTPAR6 were ranged from 1.5–6.44 and 7.0–10.3, respectively. Ibuprofen 400mg + oxycodone HCL 5mg showed the highest adjusted SPID6 then the other three combinations of ibuprofen with caffeine in different dosages, which was at least 1.84 times better in adjusted SPID6. For the analgesic combinations of ibuprofen with caffeine, it seemed that the analgesic efficacy did not drastically increase when the dosage of caffeine was increase from 100mg to 200mg, which was interpreted by similar adjusted SPID6 and TOTPAR6 findings. However, ibuprofen 200mg + caffeine 50mg was obviously less effective when compared to the two combinations of ibuprofen 200mg and caffeine in higher dosages.\nAmong the 17 different analgesic combinations reported in the included studies, ibuprofen 400mg + oxycodone HCL 5mg had the highest adjusted SPID6 (6.44), and a very higher adjusted TOTPAR6 (9.31), representing its efficacy could be the superior than the other different analgesic combinations reported in this study.\nMeta-analysis and Forest plots\nStudies were analyzed separately both according to the SPID6, and then according to the TOTPAR6 scores obtained. The observed between study dispersion, (Cochrane Q value) calculated according to SPID6 and TOTPAR were both p<0.0001, with 17 degrees of freedom (18 studies being included in this analysis) which shows homogenous treatment according to the random effects model. The I2 value calculated according to SPID6 and TOTPAR was both 0.0%, which represents less than moderate heterogeneity. Forest plots were presented according to either SPID6, or TOTPAR (Figs 2 and 3). Both figures confirmed all analgesic combinations were better than the placebo, and showed Ibuprofen 400mg with oxycodone 5mg offered the highest analgesic effect after lower third molar surgery.\nSafety of analgesic combinations\nThe summary of the adverse effects of the various analgesic combinations from the included studies was listed in Table 4. The common adverse effects were mostly related to the side effects of opioids, including drowsiness, dizziness, headache and nausea. Nausea was the most common adverse effect in opioids containing combinations, ranging from 2.4% to 55%. Other rarer adverse effects (e.g. leg numbness, chills, itchy, dry mouth, sweating) were also reported in most of the analgesic combinations but in general the prevalence was low.\nAmong the 7 combinations of acetaminophen and an opioids (codeine phosphate, hydrocodone bitartrate or oxycodone HCL), it was noted acetaminophen 1g + hydrocodone bitartrate 10mg had the highest incidence of adverse effects, with 55% of the subjects complaining of nausea or vomiting, 22.4% of the subjects with dizziness, 15% with headache and 10.5% with drowsiness. Acetaminophen 500mg + hydrocodone bitartrate 7.5mg was reported to have fewer subjects with adverse effect, which was likely to be related to the reduced dosage of hydrocodone bitartrate, with only 15.25% of the subjects experienced nausea and 8.47% with drowsiness. There were also 41% of the subjects who took the combination of acetaminophen 325mg and oxycodone HCL 5mg experienced nausea. The combinations of acetaminophen and codeine phosphate had fewer adverse effects reported when compared to the combinations of acetaminophen and hydrocodone bitartrate or oxycodone HCL. From the included studies, it seemed that reduced dosages of acetaminophen and codeine phosphate did not result in a reduced incidence of the side effects of the opioids.\nThe adverse effects of the two studies reported the use of ibuprofen 400mg + oxycodone HCL 5mg were pooled. The prevalence of the subjects who experienced drowsiness was 13.25%. The other adverse effects were related to the side effect of the opioid oxycodone HCL but the prevalences were low (0.4–2.4%).\nIn contrast to the analgesic combinations containing opioids, combinations of an NSAID with caffeine were reported to have much fewer adverse effects. In the same study reporting combinations of ibuprofen 200mg and 3 different dosages of caffeine, there seemed to have no obvious difference in terms of prevalence of adverse effect with the increased dosage (up to caffeine 200mg).\nSystematic reviews and meta-analyses have become increasingly popular in medicine [26, 27]. It helps clinicians to keep up-to-date clinical practice guideline and facilitate researchers to use them as a starting point for new guideline formation and future research [28, 29]. It can also provide a high-level overview of a particular research or clinical question by the process of identify, select, synthesize and appraise all high quality research evidence . According to the oxford levels of evidence, systematic review of randomized controlled trials (RCT) is considerate to be level 1 evidence . This study tried to summarize objectively the efficacy and clinical safety of various analgesic combination of post-operative acute dental pain. There were only randomized controlled trials (RCT) with placebo were selected into the final round for analysis, the protocol was straightly followed the PRISMA statement (Preferred Reporting Items for Systematic reviews and Meta-Analyses) and it helps to ensure the clarity and transparency of the systematic reviews conducted.\nPost-operative pain after third molar surgery has become a frequently used model in the studies of acute pain clinical trials. This is because third molar surgery is one of the commonest procedure with sufficient numbers of patients to make studies relatively easy to perform . It is also a sensitive method for demonstrating the efficacy of oral analgesic agents . It is because the patient sample in dental pain model is homogenous in pain stimulus, and the post-operative pain is frequently moderate or severe in intensity. Moreover, absence of multiple surgical complication factors comparing to other major surgical procedures, trauma, or other pain stimuli reduced to variables of the surgical procedure and outcome. In addition, third molar surgical procedures can be easily categorized, and the obtained data in dental pain model can substantiate the assay sensitivity of the clinical trials, and therefore it is useful in predicting the general analgesic efficacy of NSAIDs [33, 34].\nPooling of data in a systematic review were occasionally criticized to be “mixing apples and oranges”, especially if there were obvious heterogeneity of the included studies. In this study, the heterogeneity of the included studies in the Final Review has been tested to be less than moderate (I2 = 0.0%), which enabled a representable meta-analysis to be performed.\nThe measurement of analgesic efficacy is usually performed by comparing patient’s subjective evaluation of pain before and after administration of the analgesics . For a long time, SPID and TOTPAR are the most commonly used methods to measure the efficacy of an analgesic and were well validated [36–38]. They were used in the research context for comparisons between the efficacies of different analgesics , and now routinely used in analgesic studies [40–42]. In this systematic review, formulae of adjusted SPID and adjusted TOTPAR were developed by correction of the placebo effect of the respective studies of the analgesics. This may allow direct cross-studies comparison of the analgesic combination efficacies and to reduce the heterogeneity of the placebo effects in different studies.\nAnalgesic combinations have been proved to be more effective in pain control when compared to single drug [43, 44]. The concurrent use of ibuprofen and paracetamol was the most widely studied analgesic combination. It was shown in a Cochrane Review that 400mg ibuprofen / 1000mg paracetamol combination has superior analgesic effect when compared to ibuprofen or paracetamol alone or the combination of the two of lower dosage . However, there were no other meta-analysis in the literature comparing the effectiveness and side effects of different analgesic combinations.\nThis systematic review and meta-analysis of analgesic combinations reported the objective analgesic efficacy and the adverse effects of various analgesic combinations studied in the literature. One of the key findings of this study was ibuprofen 400mg + oxycodone HCL 5mg was found to have the most effective analgesic effects in acute dental pain as measured by the objective efficacy measurements of SPID6 and TOTPAR6. It was reported in the literature that ibuprofen 400mg have a stronger analgesic efficacy than acetaminophen 1g [45, 46]. Post-operative inflammation may magnify the process of acute pain signals which potentially lead to greater pain nociception [47–50]. The anti-inflammatory action may therefore provide a higher analgesic efficacy. Moreover, oxycodone HCL is a stronger opioid when compared to codeine phosphate and hydrocodone bitartrate. According the equianalgesia chart [51, 52], the analgesic potency of oxycodone HCL is around 1.5–2.0 times stronger than hydrocodone bitartrate and 15–20 times stronger than codeine phosphate. The combination of the two analgesics therefore was found to be superior in terms of analgesic efficacy when compared to the other combinations.\nAcetaminophen and codeine phosphate combination is a common analgesic combination in clinical practice. Acetaminophen mechanism of action is not fully understood . It was suggested that the mechanism of acetaminophen may be related to inhibition of the nitric oxide synthase , reduction of spinal prostaglandin E2 release , or reversal of the hyperalgesia induced by N-methyl-D-aspartate (NMDA) [54, 55]. The side-effects of acetaminophen are minimal. Unlike NSAIDs, acetaminophen is not likely to cause gastrointestinal irritation. The prevalence of allergic reaction to acetaminophen is rarer when compared to the NSAIDs counterpart. We noted the efficacy of acetaminophen 600mg + codeine phosphate 60mg was doubled when compared to acetaminophen 300mg + codeine phosphate 30mg. We therefore concluded for post-operative pain control after third molar surgery, a higher dosage of acetaminophen and codeine phosphate combination would be better in terms of analgesic efficacy. However, it was also noted the raised dosage of codeine phosphate was related to an elevated prevalence of drowsiness, which might not favorable especially to drivers or machine operators. Taking all these factors into considerations, we recommend the combination of acetaminophen 600mg and codeine phosphate 60mg is effective for post-operative pain after third molar surgery, and may be useful when the patient is allergic to NSAIDs.\nWe noted most of the adverse effects of the combined analgesics from the included studies were mostly contributed by centrally acting analgesic i.e. codeine phosphate, hydrocodone bitartrate or oxycodone HCL. Their common side effects include drowsiness, dizziness, headache and nausea and vomiting [56, 57]. Other possible adverse effects of opioids described in literature e.g. itching, dry mouth, flashes, sweating and chills were also reported in our study but in a low prevalence [3, 58]. Severe adverse reactions of opioids in patients including tolerance, dependence, confusion, hallucinations, delirium, hypothermia, bradycardia/tachycardia, orthostatic hypotension and urinary retention were not found in our study [56, 57]. We believed those uncommon adverse effects were more likely found in prolonged use of opioids in chronic pain patients [59–61]. It was therefore very unlikely that a short-course use of analgesic for acute dental post-operative pain would lead to these major adverse effects or severe complications. Clinicians have an important role to prescribe appropriate dosing such that patients could gain the analgesic effects with the least adverse effects. Under suitable dosage, central acting analgesic could be an effective and safe medication for the treatment of acute dental post-operative pain.\nOne of the randomized clinical trials included in the final review compared 3 different dosages of the combination of ibuprofen and caffeine. Caffeine is the central-nervous-system stimulant which is an antagonist of adenosine receptors in the brain . High dose of caffeine may cause tolerance, insomnia, hallucination, reduced control of fine motor movements [52, 63–65]. We reported the adverse effects of the combinations of ibuprofen and caffeine was minimal when compared to other combinations containing opioids. We also found the analgesic efficacies of ibuprofen 200mg with caffeine 100mg or 200mg were similar, with both much superior than with caffeine 50mg. We presumed that the caffeine ceiling dose may be approximately at around 100mg and the combination of ibuprofen 200mg with caffeine 200mg might not have an extra benefit in its analgesic effect.\nThe limitations of this systematic review and meta-analysis included the possibilities of reporting bias. Some pharmacological studies were sponsored by pharmaceutical companies, which might only report favourable outcomes if a drug combination was shown to be superior. Furthermore, our group did not request centers and companies to report if they had unpublished data on this topic, which might not find all related studies or data about the clinical question we defined.\nIn this study, the commonly reported adverse effects of NSAIDs (e.g. dyspepsia, gastric ulceration/bleeding, diarrhea) were not found in the drug combinations. Non-selective NSAIDs inhibit both cyclooxygenases (COX): COX-1 and COX-2 which reduce the levels of protective prostaglandins, leading to increase in gastric acid secretion and diminish bicarbonate secretion and mucus secretion [66, 67]. The included studies reported the use of analgesic combinations containing NSAIDs only in a very short course for the acute dental pain. The dosages and the duration of taking NSAIDs might not be sufficient to induce an obvious adverse effect in most patients. The introduction of COX-2 selective inhibitors was reported to have a strong analgesic effect with less adverse effect on the gastrointestinal tract when compared to the non-selective NSAIDs. Stichtenoth DO and Frölich JC have suggested that selective COX-2 inhibitors have significantly less gastric events and no effects on platelet aggregation . However, a COX 2 selective inhibitor was found to increase cardiovascular risks and was withdrawn from the market [69, 70]. There are several COX-2 selective inhibitors still in the market and are found to be safe to use. In this study, there was no well conducted RCT on the efficacy and safety of analgesic combinations with a COX-2 selective inhibitor included in the final review. We therefore recommend future research to investigate the efficacy and side effects on the combination of COX-2 to another group of analgesic, which may potentially be a good analgesic choice for post-operative pain after third molar surgery.\nThis systematic review and meta-analysis of randomized clinical trials has presented the efficacy and adverse effects of the various analgesic combinations for acute post-operative dental pain control. We have identified ibuprofen 400mg with oxycodone 5mg was more effective when compared to the other 16 combinations. Nausea was the most common adverse effects in an analgesic combination containing an opioid. Ibuprofen 200mg with caffeine 100mg or 200mg has a reasonable analgesic effect with fewer side effects when compared to the other analgesic combinations.\nConceived and designed the experiments: AHYA YYL. Performed the experiments: AHYA YYL. Analyzed the data: AHYA SWC CWC YYL. Contributed reagents/materials/analysis tools: AHYA LYY. Wrote the paper: AHYA SWC CWC YYL.\n- 1. A M, I P. Perioperative NSAIDs: towards greater safety. Pain Rev. 1995;2:268–91.\n- 2. Romsing J, Moiniche S, Dahl JB. Rectal and parenteral paracetamol, and paracetamol in combination with NSAIDs, for postoperative analgesia. British journal of anaesthesia. 2002;88(2):215–26. Epub 2002/03/07. pmid:11878655.\n- 3. Raffa RB. Pharmacology of oral combination analgesics: rational therapy of pain. Journal of Clinical Pharmacy and Therapeutics. 2001;26:257–64. pmid:11493367\n- 4. Besson JM. The neurobiology of pain. Lancet. 1999;353(9164):1610–5. Epub 1999/05/20. pmid:10334274.\n- 5. Schug SA, Zech D, Dorr U. Cancer pain management according to WHO analgesic guidelines. Journal of pain and symptom management. 1990;5(1):27–32. Epub 1990/02/01. pmid:2324558.\n- 6. I G. Principles of Analgesic Use in the Treatment of Acute pain and Cancer pain: American Pain Society.; 1999.\n- 7. Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthritis and rheumatism. 2000;43(9):1905–15. Epub 2000/10/03. pmid:11014340.\n- 8. Cheung CW, Choi WS, Leung YY, Lui F, Ng JK, Hei-Ho AM, et al. A double-blind randomized crossover study to evaluate the timing of pregabalin for third molar surgery under local anesthesia. Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons. 2012;70(1):25–30. Epub 2011/08/09. pmid:21820233.\n- 9. Qi DS, May LG, Zimmerman B, Peng P, Atillasoy E, Brown JD, et al. A randomized, double-blind, placebo-controlled study of acetaminophen 1000 mg versus acetaminophen 650 mg for the treatment of postsurgical dental pain. Clinical therapeutics. 2012;34(12):2247–58.e3. Epub 2012/12/04. pmid:23200183.\n- 10. Hassan SS, Ahmed A, Rai M, Kalappa TM. Analgesic efficacy of tramadol and butorphanol in mandibular third molar surgery: a comparative study. The journal of contemporary dental practice. 2012;13(3):364–70. Epub 2012/08/25. pmid:22918011.\n- 11. Moll R, Derry S, Moore RA, McQuay HJ. Single dose oral mefenamic acid for acute postoperative pain in adults. The Cochrane database of systematic reviews. 2011;(3):Cd007553. Epub 2011/03/18. pmid:21412904; PubMed Central PMCID: PMCPmc4170999.\n- 12. Curatolo M, Sveticic G. Drug combinations in pain treatment: a review of the published evidence and a method for finding the optimal combination. Best practice & research Clinical anaesthesiology. 2002;16(4):507–19. Epub 2003/01/09. pmid:12516888.\n- 13. Cooper SA, Firestein A, Cohn P. Double-blind comparison of meclofenamate sodium with acetaminophen, acetaminophen with codeine and placebo for relief of postsurgical dental pain. The Journal of clinical dentistry. 1988;1(2):31–4. Epub 1988/01/01. pmid:3254707.\n- 14. Forbes JA, Bates JA, Edquist IA, Burchfield WH, Smith FG, Schwartz MK, et al. Evaluation of two opioid-acetaminophen combinations and placebo in postoperative oral surgery pain. Pharmacotherapy. 1994;14(2):139–46. Epub 1994/03/01. pmid:8197031.\n- 15. Forbes JA, Butterworth GA, Burchfield WH, Beaver WT. Evaluation of ketorolac, aspirin, and an acetaminophen-codeine combination in postoperative oral surgery pain. Pharmacotherapy. 1990;10(6 (Pt 2)):77s–93s. Epub 1990/01/01. pmid:2082317.\n- 16. Forbes JA, Butterworth GA, Burchfield WH, Yorio CC, Selinger LR, Rosenmertz SK, et al. Evaluation of flurbiprofen, acetaminophen, an acetaminophen-codeine combination, and placebo in postoperative oral surgery pain. Pharmacotherapy. 1989;9(5):322–30. Epub 1989/01/01. pmid:2813153.\n- 17. Forbes JA, Jones KF, Kehm CJ, Smith WK, Gongloff CM, Zeleznock JR, et al. Evaluation of Aspirin, Caffeine, and Their Combination in Postoperative Oral Surgery Pain. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 1990;10(6):387–94.\n1. A M, I P. Perioperative NSAIDs: towards greater safety. Pain Rev. 1995;2:268–91.\n2. Romsing J, Moiniche S, Dahl JB. Rectal and parenteral paracetamol, and paracetamol in combination with NSAIDs, for postoperative analgesia. British journal of anaesthesia. 2002;88(2):215–26. Epub 2002/03/07. . [PubMed]\n3. Raffa RB. Pharmacology of oral combination analgesics: rational therapy of pain. Journal of Clinical Pharmacy and Therapeutics. 2001;26:257–64. [PubMed]\n4. Besson JM. The neurobiology of pain. Lancet. 1999;353(9164):1610–5. Epub 1999/05/20. . [PubMed]\n5. Schug SA, Zech D, Dorr U. Cancer pain management according to WHO analgesic guidelines. Journal of pain and symptom management. 1990;5(1):27–32. Epub 1990/02/01. . [PubMed]\n6. I G. Principles of Analgesic Use in the Treatment of Acute pain and Cancer pain: American Pain Society; 1999. [PubMed]\n7. Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthritis and rheumatism. 2000;43(9):1905–15. Epub 2000/10/03. doi: 10.1002/1529-0131(200009)43:9<1905::aid-anr1>3.0.co;2-p . [PubMed]\n8. Cheung CW, Choi WS, Leung YY, Lui F, Ng JK, Hei-Ho AM, et al. A double-blind randomized crossover study to evaluate the timing of pregabalin for third molar surgery under local anesthesia. Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons. 2012;70(1):25–30. Epub 2011/08/09. doi: 10.1016/j.joms.2011.03.056 . [PubMed]\n9. Qi DS, May LG, Zimmerman B, Peng P, Atillasoy E, Brown JD, et al. A randomized, double-blind, placebo-controlled study of acetaminophen 1000 mg versus acetaminophen 650 mg for the treatment of postsurgical dental pain. Clinical therapeutics. 2012;34(12):2247–58.e3. Epub 2012/12/04. doi: 10.1016/j.clinthera.2012.11.003 . [PubMed]\n10. Hassan SS, Ahmed A, Rai M, Kalappa TM. Analgesic efficacy of tramadol and butorphanol in mandibular third molar surgery: a comparative study. The journal of contemporary dental practice. 2012;13(3):364–70. Epub 2012/08/25. . [PubMed]\n11. Moll R, Derry S, Moore RA, McQuay HJ. Single dose oral mefenamic acid for acute postoperative pain in adults. The Cochrane database of systematic reviews. 2011;(3):Cd007553 Epub 2011/03/18. doi: 10.1002/14651858.CD007553.pub2 ; PubMed Central PMCID: PMCPmc4170999. [PMC free article][PubMed]\n12. Curatolo M, Sveticic G. Drug combinations in pain treatment: a review of the published evidence and a method for finding the optimal combination. Best practice & research Clinical anaesthesiology. 2002;16(4):507–19. Epub 2003/01/09. . [PubMed]\n13. Cooper SA, Firestein A, Cohn P. Double-blind comparison of meclofenamate sodium with acetaminophen, acetaminophen with codeine and placebo for relief of postsurgical dental pain. The Journal of clinical dentistry. 1988;1(2):31–4. Epub 1988/01/01. . [PubMed]\n14. Forbes JA, Bates JA, Edquist IA, Burchfield WH, Smith FG, Schwartz MK, et al. Evaluation of two opioid-acetaminophen combinations and placebo in postoperative oral surgery pain. Pharmacotherapy. 1994;14(2):139–46. Epub 1994/03/01. . [PubMed]\n15. Forbes JA, Butterworth GA, Burchfield WH, Beaver WT. Evaluation of ketorolac, aspirin, and an acetaminophen-codeine combination in postoperative oral surgery pain. Pharmacotherapy. 1990;10(6 (Pt 2)):77s–93s. Epub 1990/01/01. . [PubMed]\n16. Forbes JA, Butterworth GA, Burchfield WH, Yorio CC, Selinger LR, Rosenmertz SK, et al. Evaluation of flurbiprofen, acetaminophen, an acetaminophen-codeine combination, and placebo in postoperative oral surgery pain. Pharmacotherapy. 1989;9(5):322–30. Epub 1989/01/01. . [PubMed]\n17. Forbes JA, Jones KF, Kehm CJ, Smith WK, Gongloff CM, Zeleznock JR, et al. Evaluation of Aspirin, Caffeine, and Their Combination in Postoperative Oral Surgery Pain. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 1990;10(6):387–94. doi: 10.1002/j.1875-9114.1990.tb03568.x\n18. Forbes JA, Jones KF, Smith WK, Gongloff CM. Analgesic effect of an aspirin-codeine-butalbital-caffeine combination and an acetaminophen-codeine combination in postoperative oral surgery pain. Pharmacotherapy. 1986;6(5):240–7. Epub 1986/09/01. . [PubMed]\n19. Fricke J, Halladay SC, Bynum L, Francisco CA. Pain relief after dental impaction surgery using ketorolac, hydrocodone plus acetaminophen, or placebo. Clinical therapeutics. 1993;15(3):500–9. Epub 1993/05/01. . [PubMed]\n20. Gatoulis SC, Voelker M, Fisher M. Assessment of the efficacy and safety profiles of aspirin and acetaminophen with codeine: results from 2 randomized, controlled trials in individuals with tension-type headache and postoperative dental pain. Clinical therapeutics. 2012;34(1):138–48. Epub 2011/12/16. doi: 10.1016/j.clinthera.2011.11.018 . [PubMed]\n21. Litkowski LJ, Christensen SE, Adamson DN, Van Dyke T, Han SH, Newman KB. Analgesic efficacy and tolerability of oxycodone 5 mg/ibuprofen 400 mg compared with those of oxycodone 5 mg/acetaminophen 325 mg and hydrocodone 7.5 mg/acetaminophen 500 mg in patients with moderate to severe postoperative pain: a randomized, double-blind, placebo-controlled, single-dose, parallel-group study in a dental pain model. Clinical therapeutics. 2005;27(4):418–29. Epub 2005/06/01. doi: 10.1016/j.clinthera.2005.04.010 . [PubMed]\n22. McQuay HJ, Angell K, Carroll D, Moore RA, Juniper RP. Ibuprofen compared with ibuprofen plus caffeine after third molar surgery. Pain. 1996;66(2–3):247–51. Epub 1996/08/01. . [PubMed]\n23. Moore PA, Crout RJ, Jackson DL, Schneider LG, Graves RW, Bakos L. Tramadol hydrochloride: analgesic efficacy compared with codeine, aspirin with codeine, and placebo after dental extraction. Journal of clinical pharmacology. 1998;38(6):554–60. Epub 1998/07/03. . [PubMed]\n24. Sunshine A, Marrero I, Olson N, McCormick N, Laska EM. Comparative study of flurbiprofen, zomepirac sodium, acetaminophen plus codeine, and acetaminophen for the relief of postsurgical dental pain. The American journal of medicine. 1986;80(3a):50–4. Epub 1986/03/24. . [PubMed]\n25. Van Dyke T, Litkowski LJ, Kiersch TA, Zarringhalam NM, Zheng H, Newman K. Combination oxycodone 5 mg/ibuprofen 400 mg for the treatment of postoperative pain: a double-blind, placebo- and active-controlled parallel-group study. Clinical therapeutics. 2004;26(12):2003–14. Epub 2005/04/13. doi: 10.1016/j.clinthera.2004.12.002 . [PubMed]\n26. Moher D, Tetzlaff J, Tricco AC, Sampson M, Altman DG. Epidemiology and reporting characteristics of systematic reviews. PLoS medicine. 2007;4(3):e78 Epub 2007/03/29. doi: 10.1371/journal.pmed.0040078 ; PubMed Central PMCID: PMCPmc1831728. [PMC free article][PubMed]\n27. Medicine OCfE-B. 2011. Available from: http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/.\n28. Young C, Horton R. Putting clinical trials into context. Lancet. 2005;366(9480):107–8. Epub 2005/07/12. doi: 10.1016/s0140-6736(05)66846-8 . [PubMed]\n29. Stevens A, Shamseer L, Weinstein E, Yazdi F, Turner L, Thielman J, et al. Relation of completeness of reporting of health research to journals' endorsement of reporting guidelines: systematic review. BMJ (Clinical research ed). 2014;348:g3804 Epub 2014/06/27. doi: 10.1136/bmj.g3804 ; PubMed Central PMCID: PMCPmc4070413. [PMC free article][PubMed]\n30. Library C. About Cochrane Systematic Reviews. Available from: http://www.thecochranelibrary.com/view/0/AboutCochraneSystematicReviews.html.\n31. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Journal of clinical epidemiology. 2009;62(10):e1–34. Epub 2009/07/28. doi: 10.1016/j.jclinepi.2009.06.006 . [PubMed]\n32. Barden J, Edwards JE, McQuay HJ, Andrew Moore R. Pain and analgesic response after third molar extraction and other postsurgical pain. Pain. 2004;107(1–2):86–90. Epub 2004/01/13. . [PubMed]\n33. Cooper SA. Models for clinical assessment of oral analgesics. The American journal of medicine. 1983;75(5a):24–9. Epub 1983/11/14. . [PubMed]\n34. Cooper SA, Beaver WT. A model to evaluate mild analgesics in oral surgery outpatients. Clinical pharmacology and therapeutics. 1976;20(2):241–50. Epub 1976/08/01. . [PubMed]\n35. McMahon S, Koltzenburg M, Tracey I. Wall DC & Melzack's Textbook of Pain.\n36. Laska EM, Meisner M, Takeuchi K, Wanderling JA, Siegel C, Sunshine A. An analytic approach to quantifying pain scores. Pharmacotherapy. 1986;6(5):276–82. Epub 1986/09/01. . [PubMed]\n37. Bloomfield SS, Mitchell J, Cissell G, Barden TP. Analgesic sensitivity of two post-partum pain models. Pain. 1986;27(2):171–9. Epub 1986/11/01. . [PubMed]\n38. Sriwatanakul K, Lasagna L, Cox C. Evaluation of current clinical trial methodology in analgesimetry based on experts' opinions and analysis of several analgesic studies. Clinical pharmacology and therapeutics. 1983;34(3):277–83. Epub 1983/09/01. . [PubMed]\n39. CR B, JY T. Statistics in the Pharmaceutical Industry. 3rd Edition ed: Raton: Chapman & Hall/CRC; 2006.\n40. Barden J, Edwards J, Moore RA, McQuay HJ. Single dose oral rofecoxib for postoperative pain. The Cochrane database of systematic reviews. 2005;(1):Cd004604 Epub 2005/01/28. doi: 10.1002/14651858.CD004604.pub2 . [PubMed]\n41. Traa MX, Derry S, Moore RA. Single dose oral fenoprofen for acute postoperative pain in adults. The Cochrane database of systematic reviews. 2011;(2):Cd007556 Epub 2011/02/18. doi: 10.1002/14651858.CD007556.pub2 ; PubMed Central PMCID: PMCPmc4171001. [PMC free article][PubMed]\n42. Derry S, Moore RA. Single dose oral celecoxib for acute postoperative pain in adults. The Cochrane database of systematic reviews. 2012;3:Cd004233 Epub 2012/03/16. doi: 10.1002/14651858.CD004233.pub3 ; PubMed Central PMCID: PMCPmc4161494. [PMC free article][PubMed]\n43. Moore RA, Straube S, Paine J, Derry S, McQuay HJ. Minimum efficacy criteria for comparisons between treatments using individual patient meta-analysis of acute pain trials: examples of etoricoxib, paracetamol, ibuprofen, and ibuprofen/paracetamol combinations after third molar extraction. Pain. 2011;152(5):982–9. Epub 2011/03/19. doi: 10.1016/j.pain.2010.11.030 . [PubMed]\n44. Bailey E, Worthington H, Coulthard P. Ibuprofen and/or paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth, a Cochrane systematic review. British dental journal. 2014;216(8):451–5. Epub 2014/04/26. doi: 10.1038/sj.bdj.2014.330 . [PubMed] |
|Publication number||US5269290 A|\n|Application number||US 07/870,354|\n|Publication date||Dec 14, 1993|\n|Filing date||Apr 17, 1992|\n|Priority date||Apr 17, 1992|\n|Publication number||07870354, 870354, US 5269290 A, US 5269290A, US-A-5269290, US5269290 A, US5269290A|\n|Inventors||Stephen L. Barrett, Stephen V. Day|\n|Original Assignee||Barrett Stephen L, Day Stephen V|\n|Export Citation||BiBTeX, EndNote, RefMan|\n|Patent Citations (7), Non-Patent Citations (42), Referenced by (26), Classifications (9), Legal Events (7)|\n|External Links: USPTO, USPTO Assignment, Espacenet|\nThe present invention relates generally to a new podiatric surgical procedure. More particularly, the present invention relates to an endoscopic plantar fasciotomy surgical procedure.\nHeel spur syndrome, or plantar fasciitis, is one of the most common foot pathologies for which a patient will seek treatment. Heel spur syndrome occurs approximately equally in both men and women, and can effect persons of all ages. It can effect persons who are regularly active as well as those who are relatively sedentary. This condition, often described by patients as a "stone bruise" in the heel of the foot, is usually worse in the morning, or when first standing after periods of rest. As the condition worsens, the heel can hurt even when not weight-bearing.\nHeel spur syndrome is usually caused by a mechanical problem involving the structural alignment of the foot. There is a dense, fibrous band of tissue in the bottom of the foot known as the plantar fascia, which is connected to the heel bone and fans out toward the ball of the foot. The plantar fascia includes a medial band, a central band and a lateral band. Because of misalignment of the foot, excessive tension is placed on this band of tissue, causing inflammation and pain where the plantar fascia connects to the heel bone.\nThe inflammation of the plantar fascia can cause a spur or sediment to grow adjacent the heel bone. The patient can detect the spur, or "stone bruise" in the heel of the foot, and typically assumes that it is the cause of the pain. However, it has been known for many years that the pain is actually a result of the excessive tension placed on the plantar fascia, and not because of pressure placed on the spur.\nWhile it is possible that heel spur syndrome will subside without treatment, in most cases the longer the patient waits to seek treatment the more chronic the condition becomes. Heel spur syndrome can be successfully treated without surgery in many cases. However, if pain and discomfort are still present after nonsurgical treatment, surgery is normally recommended.\nThere are generally two prior surgical techniques known which are used to relieve the tension on the plantar fascia and relieve the pain of heel spur syndrome. Perhaps the most common is a procedure where the spur is removed from the foot. A large incision, several centimeters in length, is made on the inside of the heel, which allows the surgeon access to the spur and the connection of the plantar fascia to the heel bone. In removing the spur from the heel, the plantar fascia is cut and released from its connection to the heel bone. This releases the tension in the plantar fascia, thus relieving the patient's pain.\nThis technique has several drawbacks. First, it has long been known that the resultant pain from heel spur syndrome is not caused by the spur, but by the tension in the plantar fascia. Thus, removing the spur is an unnecessary procedure. Furthermore, the spur is a deposit formed on the heel bone itself, and surgery on the bone can be more traumatic to the patient than surgery on tissue. Additionally, because of the large incision made in the heel and the cutting of the spur from the bone, patients are usually unable to bear any weight on the heel for 2-4 weeks after the surgery. This precludes an early return to work or recreational activity.\nA second known technique for relieving the symptoms of heel spur syndrome is an operation whereby the plantar fascia is released from the heel bone, thus relieving the tension on the plantar fascia. However, in this technique, a large incision is made in the heel, allowing the surgeon to view the plantar fascia and its connection to the heel bone. Making such a large incision into the heel precludes the patient from bearing any weight on the foot for 2-4 weeks.\nFurther, techniques which limit the patient's ability to bear weight on the heel may also minimize the effectiveness of the operation. Once the plantar fascia is released from the heel bone, the tension in the fascia releases, easing the patient's pain. Bearing weight on the foot after the operation causes the plantar fascia to fan out, into an expanded configuration. This increases the gap between the plantar fascia and the heel bone. Scar tissue will then grow to reconnect the plantar fascia to the heel bone across the gap. If the patient is able to bear weight on the foot immediately after the operation, the scar tissue will grow from the expanded state, thus creating a longer plantar fascia, which is less subject to tension. If the patient must experience several weeks of post-operative immobility, the plantar fascia remains in a contracted state. Thus, when the scar tissue grows to reconnect the plantar fascia to the heel bone, the plantar fascia may be subject to the same tension as previously experienced.\nAccordingly, it is an object of the present invention is to provide a heel spur syndrome surgical procedure which minimizes the length of time necessary for patient recovery and resumption of normal activities.\nAnother object of the present invention is to provide a heel spur syndrome surgical procedure which reduces the tension experienced by the plantar fascia.\nA further object of the present invention is to provide a heel spur syndrome surgical procedure which minimizes the cost of treating the condition.\nYet another object of the present invention is to provide a heel spur syndrome surgical procedure which minimizes the surgical trauma incident to treatment of heel spur syndrome.\nA still further object of the present invention is to provide a heel spur syndrome surgical procedure which can be readily performed using commercially available equipment and conventional medical techniques.\nThese and other objects of the present invention are attained by the provision of an endoscopic plantar fasciotomy surgical procedure which utilizes a small incision, normally approximately 4 millimeters in length, in the heel of the patient's foot. Generally, this procedure can be performed in an office comfortably under a local anesthetic. A first incision, preferably cut in a vertical direction, approximately 4 millimeter in length, is made in the medial side of the foot. Adipose tissue is removed, and a fascial elevator is inserted into the first incision to create a channel laterally in the foot. Next, a canula and trocar are inserted into the first incision. A second incision is made on the lateral side of the foot so that the trocar and canula can substantially pierce the foot. The trocar is then removed and an endoscope is placed into the canula through the medial portal. A cutting instrument is placed into the canula from the lateral portal, and the plantar fascia is cut thereby adjacent its connection to the heel bone. To assure that a proper release of the plantar fascia has been achieved, a hook probe is inserted into the canula and moved laterally across the plantar fascia along the area where the fascia has been severed. The instruments are then removed from the canula, and the canula is removed from the foot. A bandage is placed on the foot, and the patient is usually immediately able to bear weight on the foot. In most cases, minimal, if any, pain medication is required.\nOther objects, advantages and novel features of the present invention will become apparent from the following detailed description of the invention when considered in conjunction with the accompanying drawings.\nFIG. 1 is a side view of the heel portion of a foot showing the plantar fascia connected to the heel bone.\nFIG. 2 is a side view of the heel portion of a foot showing the plantar fascia released from the heel bone.\nFIG. 3 is a bottom view of a foot showing the plantar fascia released from the heel bone.\nFIG. 4 is a side view of a foot showing the positioning of the tibial nerve.\nFIG. 5 is a side view of a foot showing the positioning of the sural nerve.\nFIG. 6 is a side view of a foot having a tourniquet and a bandage thereon.\nFIG. 7 is a side view of a foot showing the approximate location of the first incision and a metric ruler.\nFIG. 8 is a side view of a foot showing a fascial elevator inserted into the first incision and the location of the spiral septa.\nFIG. 9 shows a bottom view of a foot showing the trocar and canula substantially piercing the foot.\nFIG. 10 is a rear view of a foot showing an endoscope and cutting instrument inserted into the canula.\nFIG. 11 is a rear view of a foot showing an endoscope and a hook probe inserted into the canula.\nFIG. 12 is a rear view of a foot showing rotation of the canula and endoscope.\nReferring now to the drawings, in which like-referenced characters indicate corresponding elements throughout the several views, attention is first directed to FIG. 1 which illustrates a side view of the heel portion of a foot, generally identified by the reference numeral 10. Foot 10 includes a number of connected bones including heel bone 12 which is located rearward and downward in foot 10. Heel bone 12 is connected to plantar fascia 14, which is a dense band of tissue extending forwardly and spreading out toward the toes.\nUtilizing the preferred endoscopic plantar fasciotomy procedure, the operation may be conducted in-office, on an out-patient basis. The patient is weight-bearing immediately after the procedure is performed, thus allowing for expansion of plantar 14 fascia and proper growth of scar tissue between plantar fascia 14 and heel bone 12. This technique also allows the patient to return home immediately after the operation, and return to normal activities within several days.\nWhile other similar instrumentation may be used to effectively perform this surgical technique, the applicants have found particular instrumentation to be preferable. For example, to determine the placement of the medial incision in the foot, metric steel ruler 26 is used rather than the calibrations on a standard blade handle. Preferably, a thin surgical marker is used to mark the position of the medial incision, and a standard #15 blade and handle is used to make the medial incision and the lateral incision. Other small instrumentation used to perform the surgical procedure include a small pair of blunt tipped dissecting scissors with a slight curve, a fascial elevator, a slotted canula and trocar, a pair of Adson forceps and a small needle holder.\nTo perform this procedure, the applicants prefer using a 30 degree angled 2.7 millimeter×67 millimeter focusing video arthroscope with a 35 millimeter focal length. This scope is coupled to a two-camera system with compatible light source, thus providing an image on a high resolution medical grade television monitor such as the 25-inch resolution medical grade television monitor manufactured by Sony Corporation. In addition, a quality VHS format video recorder can provide hard copy, real time documentation of the procedure.\nLocal anesthesia is preferred, due to the minimal invasiveness of the surgical technique. The use of local anesthesia is also beneficial in that it allows the patient to bear weight on the foot immediately after the operation. This benefit is not always available with other forms of anesthesia. Furthermore, because the endoscopic plantar fasciotomy surgical procedure is a minimally traumatic procedure, the exposure to higher risks associated with other anesthetics is not needed. Furthermore, local anesthesia can be much more cost effective than other forms of anesthesia.\nA preferred method of anesthetizing the foot includes infiltrating approximately 3-6 cubic centimeters with a 1:1 ratio of 0.5% bupivicaine plain with 2% lidocaine plain into the area of posterior tibial nerve 16 and sural nerve 18. The applicants have found that it is preferable to allow 30-45 minutes to achieve local blockage of the heel, before the patient is moved into the operating room.\nOccasionally, some superficial branches coming medially off the superficial peroneal nerve or the saphenous nerve may also need to be blocked. Before attempting to block the latter, the applicants have found it beneficial to initially perform the sural and posterior tibial nerve block and allow several minutes before ascertaining anesthesia. By blocking these two nerves completely, adequate anesthesia is normally attained for the patient. If, however, there are still areas that are not to an acceptable level of anesthesia, the applicants would not recommend infiltration of local anesthetic into the area where the surgical procedure is to be performed unless absolutely necessary. Such local infiltration of anesthesia has been found to cause serious visual impairment during the endoscopy procedure. Instead, the sural and posterior tibial nerves should be further anesthetized.\nAfter anesthetizing the patient, the endoscopic plantar fasciotomy surgical procedure of the present invention continues with the pre-operative planning of the operation. First, the location of plantar fascia 14 is determined. It is preferable to determine the actual position of plantar fascia 14 using a non weight-bearing lateral projection radiograph taken a short period of time before surgery. The radio-opaque line of plantar fascia 14 should be apparent in such a radiograph. The shadow, or grey line, that corresponds to the plantar fascia should be followed from anterior to posterior as it inserts into the medial calcaneal tubercle. It is at this point that a reference position is delineated approximately two to three millimeters below the insertion of the fascia into the tubercle. If a large inferior calcaneal exostosis is present, this reference position should be placed on the same vertical level, but just anterior to the distal aspect of the calcaneal exostosis.\nOnce this reference position has been established, a measurement is made from the posterior skin surface of the heel to the reference position anteriorly, and another measurement is made from the reference position vertically and inferiorly to the plantar skin surface. With these measurements, the corresponding placement of the reference position can be mapped out on the patient in the operating room.\nThe placement of first incision 20 should allow for the trocar to be placed inferiorly to plantar fascia 14. If the reference position is placed too high, an adequate fascial release may not be achieved laterally. Conversely, if the placement of the incision is too low, adequate release of the plantar fascia may not be achieved.\nOnce these measurements are completed, the patient is placed onto the operating room table in a supine position, and prepared and draped in the usual aseptic manner. The anesthesia is ascertained by use of Adson forceps with teeth to provide a noxious stimulus in the area of the surgery. The anesthesia should be checked medially, laterally and plantarly. Exsanguination of the foot is then achieved, preferably with Esmark bandage 22, followed by inflation of ankle tourniquet 24 to a pressure of approximately 250 millimeters of mercury.\nOnce the anesthetic blockage is confirmed, and exsanguination is achieved, first incision 20 is made into the skin. While any blade or cutting mechanism may be used, the applicants have found that a #15 blade is preferred. The placement of first incision 20 corresponds to the reference mapped out on the patient. It is preferred that first incision 20 be approximately 4 millimeters in length. It is further preferred that the incision be made substantially vertically; that is, substantially transverse to the longitudinal direction of the foot and plantar fascia 14. It is also preferred that first incision 20 be made in the medial side of the foot. Next, the adipose tissue is spread. This can be accomplished by introducing blunt dissecting scissors into first incision 20, and spreading the tissue. Once this is accomplished, the medial aspect of plantar fascia 14 can be palpated with the tips of the scissors. The dissecting scissors can then be introduced deeper, along the inferior surface of plantar fascia 14. At this point of the procedure the inferior plantar convexity of plantar fascia 14 can be appreciated. This use of the dissecting scissors creates a channel into which canula 34 will be introduced.\nAfter using the dissecting scissors the channel can be completed by use of fascial elevator 28. At this point, the full convexity of plantar fascia 14 can be appreciated. It is sometimes necessary to release some of the fibrous spiral septa 30 extending into the heel fat pad inferiorly at the lateral aspect of the fascia. To do this, the end of fascial elevator 28 is palpated laterally through the skin before trocar 32 is placed into the heel. If this is not accomplished, then during the placement of trocar 32 an incomplete channel may cause inferior placement of canula 34 at the lateral aspect of plantar fascia 14 and a complete lateral release will be more difficult to accomplish.\nTrocar 32 and canula 34 are then placed into the channel along the inferior surface of plantar fascia 14 extending toward the lateral aspect of the heel. Care should be taken to avoid splitting the fascia at either the junction of the medial and central bands or at the junction of the central and lateral bands with trocar 32. If this occurs an incomplete release may occur if the improper placement is not recognized by the surgeon. In addition, incorrect placement may also cause additional, unnecessary tissue trauma.\nOnce the tip of trocar 32 can be palpated through the skin, a second incision is made on the lateral side of the foot, approximately opposite the first incision, allowing trocar 32 and canula 34 to be placed completely through the heel. Preferably, this second incision is also made with a #15 blade, and is made vertically, approximately 4 millimeters in length. Trocar 32 is then withdrawn from canula 34. Several sterile cotton tipped applicators can then be run through canula 34 to remove any adipose tissue that remains in the tube.\nEndoscope 36 is then placed into canula 34, preferably from the medial portal. At this time, the entire width of plantar fascia 14 can be viewed from medial to lateral. If there is any visual impairment due to unwanted adipose tissue, this can be removed with suction biting forceps. Two anatomical locations should then be identified, the medial plantar fascial investment and the lateral plantar fascial investment.\nWith endoscope 36 focused at the medial plantar fascial investment, retrograde knife 38 is introduced into the lateral portal of canula 34 extending across the fascia medially until it is brought into view. By placing dorsal pressure on retrograde knife 38, the medial investment is then "hooked." Gentle retrograde pressure is used to bring retrograde knife 38 laterally, and begin the severance, or incision, of plantar fascia 14 from heel bone 12. An assistant surgeon should monitor the fascial separation with the endoscope by moving endoscope 36 from medial to lateral.\nThe surgeons should closely observe the monitor in order to ensure a complete fascial release. In most cases, a complete fascial release will not be achieved with one pass of retrograde knife 38. If complete release is not achieved in a single pass, several passes may be made. A complete release will allow the muscle belly below plantar fascia 14 to be viewed on the monitor. Thus, the red or violaceous muscle belly will be positioned between the two brilliant white ends of the released fascia. The intermuscular septa should be viewed and identified during the procedure. Then, from medial to lateral, across the inferior surface of plantar fascia 14, the two severed ends of the fascia should be observed to ensure a complete fascial release. If this is difficult to distinguish, probe 40 can be used to tease the tissue so the muscle belly can be observed. If an area of incomplete release is identified, a knife can be used to release any remaining fibers of plantar fascia 14 through use of gentle dorsal pressure.\nOnce the surgeon has accomplished a "complete" release, endoscope 3 is placed into the lateral portal of canula 34 and the blade 38 is inserted into the medial portal of canula 34 and the severing process is repeated. This helps the surgeon verify that a complete release has in fact been performed and also provides the surgeon with a different visual perspective. This different perspective is particularly helpful in regard to viewing the medial plantar fascial investment. The medial band is the thickest band of the three bands of the plantar fascia, and medially it curves superiorly to invest the abductor hallucis muscle. From the lateral perspective this can be appreciated and any remaining fibers can be appropriately released.\nOnce the surgeon is assured that a complete release has been performed, canula 34 should be rotated approximately 180° to allow the surgeon to view plantarly if plantar fascia 14 has been penetrated and split. This is shown in FIG. 12. Canula 34 should then be rotated another approximately 180° to its original placement and probe 40 can be inserted into canula 34 to separate the cut ends of plantar fascia 14.\nAt this time the procedure is complete and the instrumentation is then removed from canula 34. A sterile lavage through canula 34 is performed, and the canula removed. Preferably two to three interrupted 5-0 prolene sutures are then used to close the skin incisions. Three cubic centimeters of 0.5% bupivicaine plain, and one cubic centimeter of dexamethasone phosphate is infiltrated into the area. A small compression gauze bandage is then placed over the incisions, and ankle tourniquet 24 is deflated.\nAlthough the present invention has been described above in detail, the same is by way of illustration and example only and is not to be taken as a limitation on the present invention. The scope and content of the present invention are defined only by the terms of the appended claims.\n|Cited Patent||Filing date||Publication date||Applicant||Title|\n|US4461281 *||Jun 15, 1977||Jul 24, 1984||Carson Robert W||Arthroscopic surgical apparatus and method|\n|US4607621 *||Oct 7, 1983||Aug 26, 1986||Welch Allyn Inc.||Endoscopic apparatus|\n|US4815464 *||Mar 23, 1987||Mar 28, 1989||Bruce Sanders||Methods for temporomandibular joint small incision surgery|\n|US4819620 *||Aug 13, 1987||Apr 11, 1989||Ichiro Okutsu||Endoscope guide pipe|\n|US4946642 *||Oct 20, 1988||Aug 7, 1990||Mitsubishi Denki Kabushiki Kaisha||Apparatus for handling a measuring instrument for the inside of a nuclear reactor|\n|US4962770 *||Jul 14, 1989||Oct 16, 1990||John M. Agee||Surgical method|\n|US5029573 *||Mar 30, 1990||Jul 9, 1991||Chow James C||System for endoscopic surgery|\n|1||*||Amis, Jennings, Graham and Graham, Painful Heel Syndrome: Radiographic and Treatment Assessment, Foot & Ankle, 1988.|\n|2||*||Anderson and Foster, Operative Treatment of Subcalcaneal Pain, Foot & Ankle, Jun., 1989.|\n|3||*||Baerg, Calcaneal Decompression for Heel Pain, Clinics in Podiatric Medicine and Surgery, Jan., 1991.|\n|4||*||Baxter and Thigpen, Heel Pain Operative Results, Foot & Ankle, 1984.|\n|5||Baxter and Thigpen, Heel Pain--Operative Results, Foot & Ankle, 1984.|\n|6||*||Beito, Krych and Harkless, Recalcitrant Heel Pain Traumatic Fibrosis versus Heel Neuroma, Journal of the American Podiatric Medical Association, Jul., 1989.|\n|7||*||Bergmann, History and Mechanical Control of Heel Spur Pain, Clinics in Podiatric Medicine and Surgery, Apr., 1990.|\n|8||*||Berkowitz, Kier and Rudicel, Plantar Fasciitis: MR Imaging, Radiology, 1991.|\n|9||*||Contompasis, The Management of Heel Pain in the Athlete, Clinics in Podiatric Medicine and Surgery, Oct., 1986.|\n|10||*||Correspondence Treatable Causes of a Painful Heel.|\n|11||Correspondence--Treatable Causes of a Painful Heel.|\n|12||*||Dailey, Differential Diagnosis and Treatment of Heel Pain, Clinics in Podiatric Medicine and Surgery, Jan., 1991.|\n|13||*||Davidson and Copoloff, Neuromas of the Heel, Clinics in Podiatric Medicine and Surgery, Apr., 1990.|\n|14||*||Forman and Green, The Role of Intrinsic Musculature in the Formation of Inferior Calcaneal Exostoses, Clinics in Podiatric Medicine and Surgery, Apr., 1990.|\n|15||*||Furey, Plantar Fasciitis, The Journal of Bone and Joint Surgery, Jul., 1975.|\n|16||*||Goulet, Role of Soft Orthosis in Treating Plantar Fasciitis, Physical Therapy, Apr., 1984.|\n|17||*||Hepford, Minimal Incision Surgical Approach to Mechanical Heel Pain, Clinics in Podiatric Medicine and Surgery, Jan., 1991.|\n|18||*||Hill and Cutting, Heel Pain and Body Weight, Foot & Ankle, 1989.|\n|19||*||Hoffman and Thul, Fractures of the Calcaneus Secondary to Heel Spur Surgery, Journal of the American Podiatric Medical Association, May, 1985.|\n|20||*||Intenzo, Wapner, Park and Kim, Evaluation of Plantar Fasciitis by Three phase Bone Scintigraphy, Clinical Nuclear Medicine, May, 1991.|\n|21||Intenzo, Wapner, Park and Kim, Evaluation of Plantar Fasciitis by Three-phase Bone Scintigraphy, Clinical Nuclear Medicine, May, 1991.|\n|22||*||Jacoby and Wolfe, Surgical Management of Recalcitrant Heel Pain, Clinics in Podiatric Medicine and Surgery, Jan., 1991.|\n|23||*||Jay, Davis, Schoenhaus and Beckett, Calcaneal Decompression for Chronic Heel Pain, Journal of the American Podiatric Medical Association, Oct., 1985.|\n|24||*||Kenzora, The Painful Heel Syndrome: All Entrapment Neuropathy, Bulletin of the Hospital for Joint Diseases Orthopaedic Institute, 1987.|\n|25||*||LaMelle, Kisilewicz and Janis, Chronic Plantar Fascial Inflammation and Fibrosis, Clinics in Podiatric Medicine and Surgery, Apr., 1990.|\n|26||*||Lapidus and Guidotti, Painful Heel: Report of 323 Patients with 364 Painful Heels.|\n|27||*||Leach, Seavey and Salter, Results of Surgery in Athletes with Plantar Fasciitis, Foot & Ankle, 1986.|\n|28||*||Lester and Buchanan, Surgical Treatment of Plantar Fasciitis, Clinical Orthopaedics and Related Research, Jun., 1984.|\n|29||*||Lutter, Surgical Decisions in Athletes Subcalcaneal Pain, The American Journal of Sports Medicine, 1986.|\n|30||Lutter, Surgical Decisions in Athletes' Subcalcaneal Pain, The American Journal of Sports Medicine, 1986.|\n|31||*||Meltzer, A Rational Approach to the Management of Heel Pain, Journal of the American Podiatric Medical Association, Feb., 1989.|\n|32||*||O Brien and Martin, A Retrospective Analysis of Heel Pain, Journal of the American Podiatric Medical Association, Aug., 1985.|\n|33||O'Brien and Martin, A Retrospective Analysis of Heel Pain, Journal of the American Podiatric Medical Association, Aug., 1985.|\n|34||*||Onuba and Ireland, Plantar Fasciitis, Italian Journal of Orthopaedics and Traumatology, Dec., 1986.|\n|35||*||Polisner, Early Ambulation After Minimal Incision Surgery for Calcaneal Spurs, Clinics in Podiatry, Jul., 1985.|\n|36||*||Schepsis, Leach and Gorzyca, Plantar Fasciitis, Clinical Orthopaedics and Related Research, May, 1991.|\n|37||*||Schwartz, Inferior Heel Spur Surgery, Clinics in Podiatric Medicine and Surgery, Apr. 1990.|\n|38||*||Sebes, The Significance of Calcaneal Spurs in Rheumatic Diseases, Arthritis and Rheumatism, Mar., 1989.|\n|39||*||Shmokler, Bravo, Lynch and Newman, A New Use of Instrumentation in Fluoroscopy Controlled Heel Spur Surgery, Journal of the American Podiatric Medical Association, Apr., 1988.|\n|40||*||Snider, Clancy and McBeath, Plantar Fascia Release for Chronic Plantar Fasciitis in Runners, The American Journal of Sports Medicine, 1983.|\n|41||*||Turlik, Seronegative Arthritis as a Cause of Heel Pain, Clinics in Podiatric Medicine and Surgery, Apr., 1990.|\n|42||*||Ward and Clippiner, Proximal Medial Longitudinal Arch Incision for Plantar Fascia Release, Foot & Ankle, 1987.|\n|Citing Patent||Filing date||Publication date||Applicant||Title|\n|US5400768 *||Apr 2, 1993||Mar 28, 1995||Endoscopic Heel Systems, Inc.||Method and system for performing endoscopic surgery at locations where tissue inserts into bone|\n|US5429117 *||Jun 29, 1993||Jul 4, 1995||Endoscopic Heel Systems, Inc.||Method and system for performing endoscopic surgery at locations where tissue inserts into bone|\n|US5586564 *||Feb 4, 1994||Dec 24, 1996||Instratek, Inc.||Instrumentation and surgical procedure for decompression for Morton's neuroma|\n|US5620446 *||Jun 7, 1995||Apr 15, 1997||Endoscopic Heel Systems, Inc.||Surgical apparatus for performing endoscopic surgery at locations where tissue inserts into bone|\n|US5651790 *||May 19, 1995||Jul 29, 1997||Milres Corporation||Method and apparatus for subligamentous endoscopic transverse carpal ligament release surgery|\n|US5827312 *||Aug 12, 1997||Oct 27, 1998||Instratek Incorporated||Marked cannula|\n|US6083244 *||Sep 12, 1997||Jul 4, 2000||Tendon Technology, Ltd.||Apparatus and method for tendon or ligament repair|\n|US6801801 *||May 3, 2000||Oct 5, 2004||Synthes (U.S.A.)||System and method for virtual representation of bones or a bone joint|\n|US6984241||Oct 3, 2001||Jan 10, 2006||Tendon Technology, Ltd.||Apparatus and methods for tendon or ligament repair|\n|US7462268||Aug 16, 2005||Dec 9, 2008||Allan Mishra||Particle/cell separation device and compositions|\n|US7608258||Mar 22, 2005||Oct 27, 2009||Allan Mishra||Method for treatment of tendinosis using platelet rich plasma|\n|US7611521||Apr 2, 2004||Nov 3, 2009||Tendon Technology, Ltd.||Apparatus and methods for tendon or ligament repair|\n|US7708759||Jul 16, 2003||May 4, 2010||Tendon Technology, Ltd.||Apparatus and methods for securing tendons or ligaments to bone|\n|US8142993||Dec 16, 2011||Mar 27, 2012||Allan Mishra||Method of preparing neutrophil-depleted platelet-rich plasma|\n|US8252011||Sep 29, 2006||Aug 28, 2012||Osteomed Llc||Minimally invasive technique for performing plantar fasciotomies and surgical instrument for use in such a technique|\n|US9050004||Dec 4, 2008||Jun 9, 2015||Socorro Medical, Inc.||Endoscopic system for accessing constrained surgical spaces|\n|US9259343||Mar 15, 2013||Feb 16, 2016||Newman Technologies LLC||Device for mitigating plantar fasciitis|\n|US9320762||Jul 13, 2007||Apr 26, 2016||Allan Mishra||Compositions and minimally invasive methods for treating incomplete tissue repair|\n|US9351999||Aug 29, 2014||May 31, 2016||Bioparadox, Llc||Use of platelet rich plasma composition in the treatment of cardiac conduction abnormalities|\n|US20030088270 *||Nov 20, 2002||May 8, 2003||Tendon Technology, Ltd.||Implantable tissue fixation devices and methods of tissue approximation|\n|US20050186193 *||Mar 22, 2005||Aug 25, 2005||Allan Mishra||Method and kit for treatment of tissue injury|\n|US20060127382 *||Aug 16, 2005||Jun 15, 2006||Allan Mishra||Particle/cell separation device and compositions|\n|US20090092679 *||Nov 5, 2008||Apr 9, 2009||Allan Mishra||Particle/cell separation device and compositions|\n|US20090149716 *||Dec 4, 2008||Jun 11, 2009||Socorro Medical, Inc.||Endoscopic system for accessing constrained surgical spaces|\n|US20090203975 *||Feb 13, 2008||Aug 13, 2009||Barrett Stephen L||Method and device for treating heel pain of a patient|\n|WO2000010642A1 *||Aug 9, 1999||Mar 2, 2000||Vaughan Thomas F||Portal acquisition tool|\n|U.S. Classification||600/183, 600/201, 128/898, 600/101|\n|Cooperative Classification||A61B17/320036, A61B17/320016|\n|European Classification||A61B17/32E4, A61B17/32E|\n|Jun 20, 1994||AS||Assignment|\nOwner name: INSTRATEK INCORPORATED, TEXAS\nFree format text: ASSIGNMENT TO 6/30/05 WITH OPTIONAL EXTENSIONS THEREAFTER, AFTER WHICH RIGHTS REVERT TO CONVEYING PARTY;ASSIGNOR:BARRETT, STEPHEN;REEL/FRAME:007034/0956\nEffective date: 19930723\nOwner name: INSTRATEK INCORPORATED, TEXAS\nFree format text: ASSIGNMENT TO 6/30/02 WITH OPTIONAL EXTENSION TO 6/30/07 , AFTER WHICH RIGHTS REVERT TO CONVEYING PARTY.;ASSIGNOR:DAY, STEPHEN V.;REEL/FRAME:007034/0961\nEffective date: 19930830\n|Dec 27, 1994||RR||Request for reexamination filed|\nEffective date: 19941107\n|Jun 11, 1996||B1||Reexamination certificate first reexamination|\n|Jun 3, 1997||FPAY||Fee payment|\nYear of fee payment: 4\n|Dec 4, 2000||AS||Assignment|\nOwner name: INSTRATEK, INC., TEXAS\nFree format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:DAY, STEPHEN V.;REEL/FRAME:011347/0750\nEffective date: 20001117\n|Jun 6, 2001||FPAY||Fee payment|\nYear of fee payment: 8\n|Jun 14, 2005||FPAY||Fee payment|\nYear of fee payment: 12 |
When an individual seeks medical care, he or she assumes a high level of professionalism and expertise will be applied to their specific medical concern. The same level of care is expected in dental procedures, as well. Massachusetts residents place their trust in the competence and skill of the medical professionals who serve them and in many cases, place their lives in the hands of these individuals. When that trust is violated, a medical malpractice suit becomes an avenue of legal recourse.\nOne family filed such a suit after the tragic death of their 17-year-old daughter. The teen went in for a routine wisdom teeth surgery, but emerged in a coma. She lost her life just 10 days later. Her autopsy report indicated that her death was caused by a lack of oxygen to the brain during the course of the surgery.\nWithin the medical malpractice suit filed by the girl's parents, the claim was made that the surgical team was negligent in not reviving their patient when her heart rate slowed to a dangerous level. As a result, the flow of oxygen to her brain was greatly reduced, leading to the brain injury that ultimately killed her. The suit named the oral surgeon, anesthesiologist, and other doctor, as well as the business entities associated with those professionals.\nDetails of the settlement are not public, which is not uncommon in cases brought in Massachusetts and across the nation. However, the girl's mother released a statement to say that the settlement was satisfactory to all parties. The mother had previously expressed the hope that the suit would lead to an increased awareness of the dangers of dental surgery. It is hoped that the end of the medical malpractice suit will give the family some sense of closure over two years after the loss of their daughter.\nSource: The Baltimore Sun, "Malpractice claim in teen's wisdom teeth death settled out of court," Kevin Rector, April 3, 2013 |
|Adapted from Special Feature on Pulse Oximeters: The invention that changed the paradigm of patient safety around the world. (LiSA (1340-8836) vol28 No3 Page237-308, 2021.03 (in Japanese)\nDisclaimer: The information provided is for safety-related educational purposes only, and does not constitute medical or legal advice. Individual or group responses are only commentary, provided for purposes of education or discussion, and are neither statements of advice nor the opinions of APSF. It is not the intention of APSF to provide specific medical or legal advice or to endorse any specific views or recommendations in response to the inquiries posted. In no event shall APSF be responsible or liable, directly or indirectly, for any damage or loss caused or alleged to be caused by or in connection with the reliance on any such information.\nWhen the concept of anesthesia for surgery was first introduced half a century ago, only one cardiograph was available at the operating theater, and we were checking for signs of crisis using this device in combination with visual inspection, palpation, percussion, auscultation, intermittent manual measurement of the blood pressure, and also clinical intuition. After pulse oximetry was introduced, it became possible to evaluate the status of oxygenation, ventilation, circulation, body temperature and muscle relaxation using scientific indicators, on the basis of the principle of vigilance. For example, it became possible to detect imminent cardiac arrest about 1 minute before its occurrence if arterial blood oxygen saturation (SpO2) monitoring was performed, and several minutes before its occurrence if end-tidal carbon dioxide (ETCO2) monitoring was performed, whereas the time from the detection of signs of cardiac arrest to the occurrence of cardiac arrest was only 10 seconds when electrocardiogram (ECG) monitoring was performed.\nFor us anesthesiologists whose mission is to protect the life of patients under conditions of body invasion, in which there may be only seconds or minutes left until the onset of a critical condition, introduction of the pulse oximeter enabling non-invasive measurement of SpO2 was a great relief, as if we had met Buddha in hell. This was a brilliant achievement which later triggered advances in the monitoring of vital signs as well. Discovery by Dr. Takuo Aoyagi, in 1974, of the principle of measurement of the arterial oxygen saturation using cardiac pulsations by pulse oximetry has contributed greatly to mankind. At first, an ear oximeter was manufactured on a trial basis for clinical application of this principle, but the device was not commercialized, and research for its commercialization suffered a setback and delay.\nNearly 10 years later, pulse oximeters with fingertip sensors were developed in the USA, followed by the rapid spread of these devices. Japan hastily introduced the devices made in the USA without laying claim to the fact that the pulse oximeter principle was first invented in Japan (by Dr. Aoyagi), until Prof. Severinghaus (University of California, San Francisco [UCSF]) publicized the fact in 1986.\nI was shocked when I was informed by Prof. Michiaki Yamakage (Chief Secretary, Japan Association for Clinical Monitoring) of the death of Dr. Takuo Aoyagi on April 18, 2020. At that time, my memory of him ran like a revolving lantern, including my seeing Dr. Aoyagi while he was alive, and events related to him during the days when I was involved in spreading the clinical application of pulse oximeters. On this occasion, I would like to present some of those scenes in memory of Dr. Aoyagi, while dedicating my deep respect and gratitude to him.\nBefore Creation of Guidance on Monitoring for Safe Anesthesia\nTragedy of accidental erroneous inhalation of pure nitrous oxide\nSurgeon: “Now, skin suturing has started. The operation will be completed in 5 minutes.”\nAnesthesiologist: “So, I will initiate procedures to let the patient emerge from anesthesia.”\nNurse: “Blood pressure is 120/80, pulse rate 80, good tension.”\nSurgeon: “Doctor, the patient looks a little pale —?”\nAnesthesiologist: “Is that so? Isn’t it an effect of the light? How about the vital signs?”\nNurse: “Blood pressure is 180/100, pulse rate is 110.”\nAnesthesiologist: “It’s strange. Is the patient feeling pain while emerging from anesthesia?”\nSurgeon: “Finished. — Is the patient OK?”\nNurse: “Blood pressure 200/120, pulse rate 130.”\nAnesthesiologist: “The patient is cyanotic! Chest motions are normal and no abnormality heard on auscultation. Strange, something is abnormal.”\nNurse: “Blood pressure is dropping – it is 60/30. Pulse rate is 40.”\nAnesthesiologist: “Vasopressors! Ephedrine 1 ampule intravenous injection, also atropine – Hurry up!”\nNurse: “ECG pattern is abnormal.”\nNurse: “Doctor, no pulse palpable.”\nAnesthesiologist: “Pupils are dilated. Why? Cardiac massage! Infuse adrenaline! All anesthetic lines have been turned off and only oxygen is being supplied. It’s strange! Is oxygen really being supplied? — Ach!!!”\nThis is a conversation during a simulation of a miserable accident involving nitrous oxide. This served as a driving force for the creation of guidance on monitoring for safe anesthesia.\nOperating Room Safety Management Committee (Japanese Society of Anesthesiologists)\nIt was in 1976 that the Operating Room Safety Management Committee was constituted within the Japanese Society of Anesthesiologists. Prof. Hideo Yamamura (University of Tokyo) served as the first chairman of this committee. Later, the role of the chairman was passed on to Professors Toyohisa Arai, Keizo Takahashi, Keninchi Kobayashi and Masahiro Suzuki in that order, and the baton was also handed at one time to the author. In those days, anesthesia was viewed unfavorably by people, and there prevailed a negative attitude about anesthesia itself being a risk factor for operation. For example, when the patient died as a result of a poor operative outcome, explanation like the following was often offered without hesitation: “The operative procedure itself was successful, but the patient failed to wake from anesthesia,” etc.\nOn the occasion of the 31st Conference of the Japanese Society of Anesthesiologists in 1984, a symposium titled “Towards Safer Anesthesia” was organized. This was the first meeting focusing on the safety of anesthesia in the setting of an academic conference. Around that time, I began to place great importance to the activities within the framework of the Operating Room Safety Management Committee, which eventually led to the publication of “Guidance on Monitoring for Safe Anesthesia” on April 21, 1993. The process until preparation of this guidance is described in the published monograph “Guidebook – Guidance on Monitoring for Safe Anesthesia by the Japanese Society of Anesthesiologists” (edited by Masahiro Suzuki and Toyohisa Arai, published by Kokuseido Co., Ltd., 1995). This guidance has been revised 4 times and provides easily understandable guidance while avoiding ambiguous expressions.\nA survey of accident cases related to anesthesia was conducted in parallel with the creation of this guidance. At some point of time, some of the survey staff proposed that the survey be discontinued, because data collection and entry were labor-intensive. However, our definitive determination to continue with the survey was understood by successive members of the committee and the staff in charge of the survey at each leader hospital, so that the survey has been continued to date, without interruption. Analysis of the data collected during this survey have yielded significant outcomes, such as the creation of the guidance for countermeasures against massive bleeding and guidance for prevention of pulmonary embolism.\nWhy Was the Guidance Created So Rapidly?\nDevelopment of a concrete guidance was started at a time when standards on intraoperative monitoring were being published one after another in European countries, modeled after the standard published in 1986 by the American Society of Anesthesiologists (ASA). Needless to say, the introduction of pulse oximetry served as a driving force for these actions.\nAnother factor which prompted rapid creation of the guidance was the death of 2 patients caused by accidental erroneous inhalation of pure nitrous oxide at an influential national hospital in Kyushu in 1987. The episode was attributed to an error in the arrangement of the supply pipes for oxygen and nitrous oxide made during the construction of the hospital. Although the anesthesiologists involved in the care of the victims were exempted from legal responsibility, a tense atmosphere prevailed in those days at the mention of anesthesia, and we resolved to never have such accidents recur.\nPreparation for Wiping out the Demon: Monitored Anesthesia Care (MAC)\nIn recent years, it has become mandatory for the guidance on monitoring to be followed if a test or treatment requiring anesthesia is undertaken even outside the operating room. Introduction of such a regulation is also being debated now in Japan, under the so-called MAC. If anesthesia provided without the MAC results in an adverse event, the healthcare provider concerned will be judged as “having been negligent, i.e., there is a default obligation on experts to predict the possible risks associated with a given medical act and to take steps to avoid the risks.” Simply said, invasive medical acts under environments that lack preparation for risk management are unacceptable. MAC is “a preparatory step for wiping out the demon” hidden behind medical acts. In Japan, however, reimbursement for MAC is not provided by the national health insurance system to the physicians in charge of vigilance, putting a considerably heavy burden on the healthcare providers.\nJapan Association for Clinical Monitoring\nWhen talking about Dr. Aoyagi, I cannot omit to referring to the Japan Association for Clinical Monitoring founded under the initiative of Prof. Akira Okuaki (Fukushima Prefectural Medical University). At the meetings of this association, Dr. Aoyagi often presented research data aimed at improving the precision of pulse oximeters and optimizing the cost of this device. He also made a presentation at the 7th conference of this association held in Fukuoka and was awarded the Okuaki Memorial Prize in the following year. In those days, Prof. Katsuyuki Miyasaka (National Children’s Hospital) was also actively involved as a co-researcher in the research conducted by Dr. Aoyagi. Prof. Okuaki invited researchers from varied specialties to this association to allow multidisciplinary wisdoms to debate an issue, and Dr. Aoyagi was a very valuable asset for this association. It was also impressive that Prof. Kunio Suwa (University of Tokyo), who was the best speaker on oxygen-related topics among Japanese researchers, enthusiastically suggested that the performance of Dr. Aoyagi was worthy of a Nobel Prize.\nTalk of Nobel Prize\nAwarded to the research on hypoxia-inducible factor (HIF)\nThe year 2001 was the 100th anniversary of awards of the Nobel Prize. In those days, Prof. Lindahl (Department of Anesthesiology, Karolinska Institute) was the chairman of the Nobel Committee for Physiology or Medicine. I became acquainted with him in those days and we became reasonably good friends as we were around the same age (born in 1943). Prof. Lindahl always talked passionately about the beauty and novelty of science.\nWe asked him to deliver a special speech at the 49th Conference of the Japanese Society of Anesthesiologists in 2002. We asked him to refer to the (1) criteria for selection of a Nobel Prize winner and (2) introduction of the research in our field that would be the worthiest of this prize, when delivering the special speech. He immediately responded to this request, saying that the answer to (1) was “good for mankind” i.e., great contribution to mankind, and to (2) was the research on biological reactions to hypoxia from the standpoint of molecular genetics. On that day at the Conference, his audience was fascinated by his smart and appealing special speech.\nThe Nobel Prize in Physiology or Medicine 2019 was awarded to 3 researchers, including Prof. Semenza (Johns Hopkins University), for their contribution to elucidation of the mechanism of cellular sensing and responses related to oxygen utilization. We were excited much by the Nobel Prize having been awarded for a field of research that was of interest to us. According to the special article by Prof. Kiichi Hirota (Kansai Medical University), published in the November issue of LiSA, 2019 in Japanese, these three researchers were awarded the prize for their detection and isolation of HIF as a factor, a component of the molecular mechanism involved in the induction and maintenance of erythropoietin expression, as well as elucidation of the molecular mechanism for oxygen tension-dependent HIF activity modulation. I hear that Prof. Hirota was involved in isolating the gene encoding the HIF molecule as a member of the laboratory led by Prof. Semenza.\nVery broadly speaking perhaps, the connection between SpO2 and HIF can be viewed as a dialogue between oxygen and the living body during the course of external and internal respiration closely involved in homeostasis and evolution.\nCriteria for Award of the Nobel Prize\nDuring the 75 years after World War II, slightly more than 25 Japanese have been awarded the Nobel Prize. Why was Dr. Aoyagi not awarded the Nobel Prize? Prof. Kunio Suwa had pointed out on several occasions that Dr. Aoyagi deserved this prize, and Prof. Katsuyuki Miyasaka had also provided strong support for the awarding of this prize to Dr. Aoyagi. I also tried to use the best of my limited abilities for this purpose, advising Prof. Lindahl (Chairman of the Nobel Committee) that the performance of Dr. Aoyagi satisfied the criterion “good for mankind” for award of the Nobel Prize. At that time, I thought the chairman subtly told me that while his work was great, it was still some distance from deserving the Nobel Prize. However, because of my poor language abilities, I am not confident that I understood his response completely. He did seem, though, to suggest the weak points of Dr. Aoyagi, i.e., the fact that his first paper was written in Japanese and that the intellectual proprietorship of the outcome of his research had not been established by a globally valid method. It has been pointed out for many years that the basis for the protection of intellectual proprietorship is weak in Japan and that Japanese enterprises show poor capability for translating advanced technologies. I think that these shortcomings remain open issues even until date.\nDespite such limitations, the greatness of Dr. Aoyagi’s performance has been steadily enriched. His research has led to submission of many applications for patent registration (linked to US patent registration), publication of papers in journals, such as Anesthesiology and Anesth Analg, and awards of many professional society prizes such as the Patent Agency Director’s Encouraging Prize, the Science and Technology Director Award, the Medal with Purple Ribbon, Gravenstein Lifetime Achievement Award of the Society for Technology in Anesthesia (USA), the Institute of Electrical and Electronic Engineers (IEEE) Medal For Innovations In Healthcare Technology, and so on. Thus, global recognition of the performance of Dr. Aoyagi has been deepening. Although not satisfying the criteria for the Nobel Prize, the intellectual relics left by Dr. Aoyagi will remain brilliant forever.\nI immediately accepted the offer for writing on this topic from the LiSA Editorial Office, because I have been paying close attention to this journal since its Issue No. 0 in 1994, and because Prof. Miyasaka advised me to accept it. Soon, however, I became aware that I had disposed of the documents needed for writing on this topic during a previous attempt at decluttering that I was engaged in, in preparation for the end of my life. Nevertheless, I made efforts to delve deep into my memory, which has become somewhat unreliable, and to refer to the documents kept at Nihon Kohden Corporation, to make up for my inadequate memory, and managed this piece in memory of Dr. Aoyagi. Under these circumstances, please bear in mind that memory of some of the events may be slightly skewed. I regret that I could not refer to the activities of the Pulse Oximeter Study Group and the Vital Sign Discussion Group, both of which I had been involved with closely. However, when I completed the writing, I was confident that the magnitude of respect and gratitude that I had for Dr. Takuo Aoyagi was second to none. Although this topic deals with a short history spanning only half a century, I would be happy if young readers can learn at least something through “taking lessons from history.”\nJoining my hands together in prayer for late Dr. Aoyagi\nShosuke Takahashi, MD\nProfessor Emeritus, Kyushu University\nMedical corporation, Soseikai\n|Read more articles from this special collection hosted by the APSF on Pulse Oximetry and the Legacy of Dr. Takuo Aoyagi.| |
AboutDr. Ronald Banister, MD is a Doctor primarily located in Lubbock, TX. He has 19 years of experience. His specialties include Anesthesiology. Dr. Banister is affiliated with University Medical Center and Littlefield Hospital. He speaks English.\nDr. Ronald Banister has the following 1 specialty\nAnesthesiologists are physicians who are trained to administer anesthetics, which are medicines used to block nerve sensation. Anesthesia can be either local to one specific part of a body, like a tooth, or regional to block feeling to a larger portion of the body, such as during an epidural for child birth. It can also be more general to block sensation to the entire body, resulting in unconsciousness.\nAnesthesiologists assist in surgery by determining how much anesthesia is necessary and by monitoring the patient's level of responsiveness and vital signs throughout the procedure. The anesthesia specialist will also bring the patient out of anesthesia and then continue to monitor his or her vital signs post-operation.\nBesides assisting in surgeries, anesthesiologists may also treat patients suffering from chronic pain.\nSee the board certifications this doctor has received. Board certifications provide confidence that this doctor meets the nationally recognized standards for education, knowledge and experience.\nDr. Banister is affiliated (can practice and admit patients) with the following hospital(s).\n19 Years Experience\nTulane University School Of Medicine\nGraduated in 1998\nTexas Tech University Health Sciences Center\nDr. Ronald Banister is similar to the following 3 Doctors near Lubbock, TX. |
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