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TAIPEI, Dec. 3, 2019 /PRNewswire/ — Opioid misuse, addiction, and overdoses have caused significant social and economic burdens leading to the opioid crisis. LT1001 (brand name Naldebain®) is a prodrug of nalbuphine, an abuse-free analgesic that has been marketed worldwide for decades. Naldebain® is developed by Lumosa Therapeutics ("Lumosa;" 6535.TWO) as the world’s first extended-release analgesic injection for the relief of moderate/severe post-operative pain for 7 days without the side effects associated with opioids. Naldebain® was approved by the Taiwan Food and Drug Administration (TFDA) in March 2017. A considerable amount of clinical data and use experience have accumulated since product launch. With confirmed safety and efficacy data of over 20 thousand users, Naldebain® is an attractive pain management solution for the opioid crisis.\nTo facilitate licensing negotiation and shorten the development time to market, Lumosa obtained consent from the US FDA in 2017 to allow the development of LT1001 through 505(b)(2) pathway, a development process with reduced number of human clinical trials required for the drug approval. The US FDA has recently accepted the IND (investigational new drug) application of the comparative bioavailability study. Lumosa will initiate the study shortly to bridge the clinical data of LT1001 and nalbuphine in the US. The trial will fulfill the pre-market confirmatory trial required under the 505(b)(2) guideline. Subsequently, a confirmatory trial according to the 505(b)(2) pathway will be conducted before the submission of a new drug application (NDA) to the US FDA for marketing authorization approval.\nLumosa anticipates the enrollment of the pharmacokinetic study to be completed in the first half of 2020. In the meantime, licensing negotiation with potential US partners will take place in order to expedite the time to market for LT1001 and to compete in the US analgesics market. The completion of the bridging study would most likely speed up the licensing process. Lumosa has obtained patent protection up to 2035 in the US, with the patents in European Union, China, Japan and other major pharmaceutical markets currently under review by the respective authorities.\nThe US prescription opioid sales volume in 2015 was calculated to be US$ 7.1 billion using the information listed in the white paper "FDA Analysis of Long-Term Trends in Opioid Analgesic Products: Quantity, Sales, and Price Trends," published in 2018 by the US FDA. The advantages and competitiveness of Naldebain® have drawn the interests of numerous prospective partners. Lumosa is actively engaged in licensing negotiations in various regions worldwide.\nLumosa Therapeutics, a public traded biotech company in Taiwan (6535.TWO), is a company with strong expertise in late-translational research and clinical development for new drugs. The company in-licenses early-stage candidates and maximizes project value through precise regulatory and clinical strategies, creating sustainable and long-term profit through the company’s international networking. Several projects with high unmet medical need at various development stages are available for collaborations; these include LT1001 for pain management, LT3001 for acute ischemic stroke, LT5001 for uremic pruritus, and LT2003 for solid tumor.\nLT1001 (brand name Naldebain®) is the world’s first extended-release analgesic injection containing dinalbuphine sebacate, a prodrug of nalbuphine, in an oil-based formulation intended for sustained release of the drug. Nalbuphine is a κ-agonist / partial μ-antagonist analgesic with an analgesic effect comparable to that of morphine, yet it has a ceiling effect on respiratory depression. LT1001 was designed to take advantages of nalbuphine’s safety profile and overcome the disadvantage of nalbupine’s relatively short half-life of 2 to 6 hours to provide week-long analgesic relief. LT1001 was approved by Taiwan FDA in March 2017 as Naldebain®. NDAs for Switzerland and Singapore were submitted. Lumosa will initiate a comparative bioavailability study in the US under the 505(b)(2) guideline.\nView original content:http://www.prnewswire.com/news-releases/lumosa-announces-fda-acceptance-of-ind-application-for-lt1001-an-extended-release-analgesic-injection—lumosa-to-initiate-the-bridging-study-in-the-us-300968045.html
Book review of TerrO.R. by Dr. Joseph Neuschatz, ISBN10: 1-60145-015X, Booklocker.com Inc.\nYou go into a hospital for a procedure - you don't worry, do you? Should you?\nI read this book when all my family and friends were healthy....\nDr. Joseph J. Neuschatz is certainly an expert in his field of Anesthesiology, and he uses that information and knowledge to give us a chilling book as scary circumstances evolve into more trecherous implications - I think Dr. Joe's premise is most original.\nDr. Philip Newman goes into work thinking it will be just another day in the O.R. - The anesthesiologist must talk to the patient and ensure there is nothing that the paperwork has missed that can cause a problem as they are operating.\nSeems a young man is being forced to surgically remove tattoos he got while abroad - a routine procedure, but\nsomething strange is happening - normal operational procedures and the monitors start going crazy! anything out of the ordinary in Pre-op? no - Anything different from the normal anesthesia? not, but the patient - CODE BLUE! Get the Crash Cart in STAT! - after tirelessly working on the young man, the patient is dead.\nWhen the boy's father is told of his son's death, he is unusually calm and states for religious reasons he doesn't want an autopsy..\nBut, here comes a sizable suit for malpractice!\nWhen other deaths start happening in similar circumstances, Dr. Newman networks with fellow doctors - and they come upon a new means of terror -\nA critical look at the medical system, and all the ways we as a people are vulnerable. A small book with important ideas that will make you keep taking those massive doses of vitamins and B-12 shots!\nThe face of terror can be anywhere...\nTerrO.R. by Dr. Joseph J. Neuschatz, ISBN10: 1-60145-015X, Booklocker.com, Inc.
Boston, MA (PRWEB) February 7, 2006 –\nFebruary 7, 2006 – Boston cosmetic dentist Helaine Smith (http://www.helainesmithdmd.com) has announced she recently received her sedation dentistry credential and is now offering patients advanced sedation dentistry techniques. Dr. Smith received her credential from the Dental Organization for Conscious Sedation (DOCS).\nAccording to DOCS, 95 million North Americans avoid the dentist because of fear. The goal of sedation dentistry is to offer these patients a relaxing and enjoyable experience through various sedation protocols. These protocols include determining whether sedation is appropriate for the patient, properly administering anxiety-lowering drugs such as Valium or Triazolam, and providing maximum safety for both patient and the dentist.\n"I consult with patients regularly who are afraid to visit the dentist," stated Dr. Smith. "Often times, these people have low-level anxiety and require only meditation, a simple numbing gel applied to the gums, or a local anesthetic, such as Septocaine, to help them to relax. Other patients, however, have such high anxiety that they have neglected their oral health care for years. These patients often require extensive dental work – yet due to their anxiety, they delay having the work done. This is where advanced sedation techniques come into play.\n"Until recently, patient anxiety wasn’t recognized as a real problem among dentists," Dr. Smith added. "Of course, we’ve always had ‘Novocain,’ – a local anesthetic developed in the 1920s – for invasive and painful procedures. However, for many patients, even Novocain isn’t enough. In fact, I recently received an email from a prospective patient who said she was ‘terrified’ to visit a dentist and hadn’t seen one in ten years. It’s for these people that I obtained my sedation dentistry credential. No one should be afraid to visit the dentist."\nAbout Helaine Smith, DMD\nHelaine Smith is a full-time practicing cosmetic dentist located in Boston, Massachusetts and a member of the American Academy of Cosmetic Dentistry and Academy of General Dentistry. She is one of two Boston cosmetic dentists to have received extensive training at the Las Vegas Institute for Advanced Dental Studies (http://www.lvidocs.com) where she recently completed a full-mouth reconstruction course that only 2 percent of U.S. dentists have taken. Dr. Smith is an active member of Operation Smile and Cape CARES, two groups that send volunteer dentists and physicians all over the world. She has been part of eleven volunteer missions to third world countries working with children with cleft lip and palate as well as with people from remote mountain villages in numerous Latin American countries. More about Dr. Smith and her practice can be found at http://www.helainesmithdmd.com.\n# # #
Safety, Feasibility, and Acceptability of the PrePex Device for Adult Male Circumcision in Malawi\nTippett Barr, BA\nMetadataShow full item record\nAbstractNonsurgical adult male circumcision devices present an alternative to surgery where health resources are limited. This study aimed to assess the safety, feasibility, and acceptability of the PrePex device for adult male circumcision in Malawi.\nPublisherLippincott Williams & Wilkins\n- Safety and Acceptability of the PrePex Device When Used in Routine Male Circumcision Service Delivery During Active Surveillance in Zimbabwe.\n- Authors: Mavhu W, Hatzold K, Ncube G, Xaba S, Madidi N, Keatinge J, Dhodho E, Samkange CA, Tshimanga M, Mangwiro T, Mugurungi O, Njeuhmeli E, Cowan FM\n- Issue date: 2016 Jun 1\n- Is the PrePex device an alternative for surgical male circumcision in adolescents ages 13-17 years? Findings from routine service delivery during active surveillance in Zimbabwe.\n- Authors: Mavhu W, Hatzold K, Madidi N, Maponga B, Dhlamini R, Munjoma M, Xaba S, Ncube G, Mugurungi O, Cowan FM\n- Issue date: 2019\n- Safety, effectiveness and acceptability of the PrePex device for adult male circumcision in Kenya.\n- Authors: Feldblum PJ, Odoyo-June E, Obiero W, Bailey RC, Combes S, Hart C, Jou Lai J, Fischer S, Cherutich P\n- Issue date: 2014\n- Prospective Observational Study of the ShangRing Device for Adult Medical Male Circumcision in a Routine Clinical Setting in Malawi.\n- Authors: Feldblum PJ, Mwambula C, Selemani M, Long S, Telela DJ, Mwenyekonde E, Lai JJ, Veena V, Mbeya P\n- Issue date: 2016 Dec\n- PrePex circumcision surveillance: Adverse events and analgesia for device removal.\n- Authors: Lebina L, Milovanovic M, Otwombe K, Abraham P, Manentsa M, Nzenze S, Martinson N\n- Issue date: 2018
What causes leaks and how do you know if you have one??\neating food before you're supposed to will cause a leak. heavy lifting can also cause problems. from dr. Alvarez's book "signs of a leak are: increasing abdominal pain, fevers, sweats, difficulty breathing, rapid heart beat, chills, elevation in white blood cell count" i hope you are ok. keep us updated!\nMy doc did both tests as well. First one was when I was still under anesthesia and the other test was the next morning. Smoking can also cause leaks also, even several months post op..... Primarily though it is advancing foods too soon. Stick with full liquids first two weeks post op and slowly advance to puree then on to solids.\n"The soul would have no rainbow if the eyes had no tears."\nBeginning weight: 324; Pre-op loss: 33 lbs; Weight on day of surgery: 291\nCreated by MyFitnessPal.com - Free Calorie Counter
MEDITATION ON JOHN 2:18-19, DR. NOEL JACOBS, SAINT AUGUSTINE OF CANTERBURY EPISCOPAL CHURCH, OKLAHOMA CITY, OKLAHOMA\nJohn 2: 18-19\nThe Jews then said to him, “What sign can you show us for doing this?” Jesus answered them, “Destroy this temple, and in three days I will raise it up.”\nI had to have surgery was when I was about 14. The doctors told me what they were going to do, including using anesthesia to put me to sleep. Because they had to review risks and benefits of the surgery, I heard what my mom heard, that there is a risk of death with any use of general anesthesia and abdominal surgery. That was all I heard, not the odds ratios, not the fact that surgery was unavoidable. Then my mom spoke up. “Honey, you need to trust me. I wouldn’t bring you here if I didn’t trust them and if I thought there was any chance you might die because of this. I have faith you’re going to be just fine. I want you to have that faith, too.” I was not ready to trust, but I knew I needed the surgery, so I fearfully prayed, and prayed, and prayed right up until the moment the IV medication put me to sleep.\nIn this day and age, and I would add especially just inside the doorstep of 2021, it may feel like we have all been told to distrust any information we’re given, especially something outrageous, from a source not yet well known to us. To Jews listening to Jesus make a claim like this (just after he has overturned the money changing tables and angrily driven out the merchants out of the Temple with a whip), it would reasonable to assume they thought him crazy. Foreshadowing his own death and resurrection, they believed him at that time to be talking about rebuilding the Temple that, after total destruction and 46 years of reconstruction, was still not finished. Granted, understanding he was talking about coming back from the dead would have seemed even more outlandish, but they were clearly not ready to believe either idea.\nHow do we handle it when we are asked to put faith in God, or even in someone flesh and blood close to us who has our complete love and trust, and the promise is beyond our wildest imagining? How easy is it to step out when we don’t see the ground beneath us but imagine, instead, the worst outcomes?\nDear God, thank you for believing in us and our abilities to spread your Love in this world, even when we don’t trust in your ability to take care of us. Help us with our belief when it fails; this world teaches us to distrust, but we know You are the one we can, and should, always trust. Amen.\nSubmitted by Noel Jacobs, Saint Augustine of Canterbury Episcopal Church, Oklahoma City, Oklahoma\nVarious Clergy and members of St. Augustine contribute to authoring the blog on a variety of topics.
A new understanding of the complex ways in which general anaesthetics act on the brain could eventually lead to improved drugs for surgery. \| via Journal of Anaesthesia Practice\nAlthough general anaesthesia is one of the most common medical procedures worldwide, it remains unclear how general anaesthesia works. In this research article, Professor Bruno van Swinderen, says his team had overturned previous understanding of what general anaesthetics do to the brain, finding the drugs did much more than induce sleep.\nPropofol is the most commonly used general anesthetic in humans. Our understanding of its mechanism of action has focused on its capacity to potentiate inhibitory systems in the brain. However, it is unknown whether other neural mechanisms are involved in general anesthesia.\nHere, we demonstrate that the synaptic release machinery is also a target. Using single-particle tracking photoactivation localization microscopy, we show that clinically relevant concentrations of propofol and etomidate restrict syntaxin1A mobility on the plasma membrane, whereas non-anesthetic analogs produce the opposite effect and increase syntaxin1A mobility.\nRemoving the interaction with the t-SNARE partner SNAP-25 abolishes propofol-induced syntaxin1A confinement, indicating that syntaxin1A and SNAP-25 together form an emergent drug target. Impaired syntaxin1A mobility and exocytosis under propofol are both rescued by co-expressing a truncated syntaxin1A construct that interacts with SNAP-25.\nOur results suggest that propofol interferes with a step in SNARE complex formation, resulting in non-functional syntaxin1A nanoclusters.\nThe head of the CU School of Medicine Department of Anesthesiology in Colorado, has written a review of scientific studies on the potentially adverse effects of exposing developing brains to general anaesthesia \| Anesthesiology\nRecently, the U.S. Food and Drug Administration issued an official warning to all practicing physicians regarding potentially detrimental behavioral and cognitive sequelae of an early exposure to general anesthesia during in utero and in early postnatal life.\nThe U.S. Food and Drug Administration concern is focused on children younger than three years of age who are exposed to clinically used general anesthetics and sedatives for three hours or longer.\nAlthough human evidence is limited and controversial, a large body of scientific evidence gathered from several mammalian species demonstrates that there is a potential foundation for concern. Considering this new development in public awareness, this review focuses on nonhuman primates because their brain development is the closest to humans in terms of not only timing and duration, but in terms of complexity as well.\nMcClelland, L. et al. \| A national survey of the effects of fatigue on trainees in anaesthesia in the UK \| Anaesthesia \|2017; 72: 1069–77\nLong shifts remain a major feature of working life for trainees in anaesthesia. Over the past 10 years, there has been an increase in awareness and understanding of the potential effects of fatigue on both the doctor and the patient. Despite the introduction of the European Working Time Directive into UK law, reducing the maximum hours worked by junior doctors, there is evidence that problems with inadequate rest and fatigue persist.\nThese authors conducted a national survey to assess the incidence and effects of fatigue among the 3772 anaesthetists in training within the UK.\nA response rate of 59% was achieved, with data from 100% of NHS trusts. The results suggested that fatigue remains prevalent among junior anaesthetists, with 73.6% saying that it has effects on physical health, 71.2% that it affects psychological wellbeing and 67.9% that personal relationships are affected. The most problematic factor remains night shift work, with many respondents commenting on the absence of breaks, inadequate rest facilities and 57.0% stating that they had experienced an accident or near-miss when travelling home from night shifts.\nThe authors discuss potential explanations for the results, and present a plan to address the issues raised by their survey, aiming to change the culture around fatigue for the better.\nThe organisational state of inpatient pain management in UK hospitals is difficult to determine. We sent an electronic questionnaire to 209 acute pain service leads throughout the UK \| Anaesthesia\nQuestions were about staffing and service provision. We received 141 responses (67%); 47% of all UK hospitals.\nEach service was responsible for a median (IQR [range]) of 566 (400–839 [120–2800]) beds. Each acute pain specialist nurse was responsible for 299 (238–534 [70–1923]) beds. The mean (SD) number of consultant hours per week was 5.54 (4.62), delivered by a median of 1.0 (1.0–2.5 [0.2–7.0]) consultant. Overnight cover was provided by 20 (15%) acute pain services, and weekend cover by 39 (29%).\nAcute pain services commonly (in 50 (35%) hospitals) had roles in addition to acute pain management. Most teams (105, (77%)) reviewed medical patients and patients with chronic pain (in 131, (96%) teams). Half of the services (56, (49%)), reported that they were part of an integrated acute and chronic pain service, however, 83 (59%) did not have any members who work in chronic pain clinics. The majority (79, (70%)) were able to access a nominated chronic pain consultant for advice.\nProvision of acute pain services throughout the UK is highly variable. The majority do not meet core UK standards.\nA systematic review including 34 trials with 3742 participants, identified through 6 database and supplementary searches \| Anaesthesia\nA multimedia format, alone or in combination with text or verbal formats, was studied in 20/34 (59%) trials: pre-operative anxiety was unaffected in 10 out of 14 trials and reduced by the multimedia format in three; postoperative anxiety was unaffected in four out of five trials in which formats were compared. Multimedia formats increased knowledge more than text, which in turn increased knowledge more than verbal formats. Other outcomes were unaffected by information format.\nThe timing of information did not affect pre-operative anxiety, postoperative pain or length of stay.\nIn conclusion, the effects of pre-operative information on peri-operative anxiety and other outcomes were affected little by format or timing.\nHinkelbein, J. et al. \| European Society of Anaesthesiology and European Board of Anaesthesiology guidelines for procedural sedation and analgesia in adults \| European Journal of Anaesthesiology\nProcedural sedation and analgesia (PSA) has become a widespread practice given the increasing demand to relieve anxiety, discomfort and pain during invasive diagnostic and therapeutic procedures.\nThe European Society of Anaesthesiology (ESA) and the European Board of Anaesthesiology have created a taskforce of experts that has been assigned to create an evidence-based guideline and, whenever the evidence was weak, a consensus amongst experts on: the evaluation of adult patients undergoing PSA, the role and competences required for the clinicians to safely perform PSA, the commonly used drugs for PSA, the adverse events that PSA can lead to, the minimum monitoring requirements and post-procedure discharge criteria.\nA search of the literature from 2003 to 2016 was performed by a professional librarian and the retrieved articles were analysed to allow a critical appraisal according to the Grading of Recommendations Assessment, Development and Evaluation method.\nThese guidelines contain recommendations on PSA in the adult population. It does not address sedation performed in the ICU or in children and it does not aim to provide a legal statement on how PSA should be performed and by whom. The National Societies of Anaesthesiology and Ministries of Health should use this evidence-based document to help decision-making on how PSA should be performed in their countries.
\|Year : 2015 \| Volume\n\| Issue : 1 \| Page : 114-123\nUltrasound-guided transversus abdominis plane block versus dexmedetomidine infusion in open ovarian cystectomy: Analgesic efficacy and effect on stress response\nKhaled M Maghawry MD 1, Ayman A Rayan2, Alaa S El-Kateb1\n1 Department of Anesthesia, Faculty of Medicine, Ain Shams University, Cairo, Egypt\n2 Department of Anesthesia, Faculty of Medicine, Menoufia University, Menoufia, Egypt\n\|Date of Submission\|\|10-Feb-2014\|\n\|Date of Acceptance\|\|02-May-2014\|\n\|Date of Web Publication\|\|25-Mar-2015\|\nKhaled M Maghawry\nDepartment of Anesthesia, Faculty of Medicine, Ain Shams University, PO Box 11591, Cairo\nSource of Support: None, Conflict of Interest: None\nUltrasound (US)-guided transversus abdominis plane (TAP) block has been proven to be an effective method of providing postoperative analgesia in laparotomy. Dexmedetomidine has sedative, analgesic, sympatholytic, and amnestic properties. In the present study, we evaluated the analgesic efficacy and the attenuation of stress surgical response of US-guided TAP block in comparison with dexmedetomidine infusion in patients undergoing open ovarian cystectomy in a randomized, double-blinded clinical study.\nPatients and methods\nA total of 60 patients were randomly assigned into two groups (30 in each) to be administered, before skin incision, either a combination of general anesthesia with a US-guided TAP block (TAP group), or an intraoperative intravenous infusion of dexmedetomidine (DEX group). In the DEX group, loading dose of 1 μg/kg of dexmedetomidine was infused over 10 min, followed by infusion of 0.2-0.6 μg/kg/h. Measurements included hemodynamics, stress hormones, pain score, time of first analgesia, and amount of pethidine during the first 24 h postoperative.\nIn the DEX group, there was a significant decrease in heart rate (HR) at 45, 60, and 90 min after surgical incision in comparison with preoperative HR. In the TAP group, there was a significant decrease in HR at 60 and 90 min after surgical incision in comparison with preoperative HR. In the DEX group, there was a significant decrease in mean arterial pressure at 30, 45, 60, and 90 min after surgical incision in comparison with preoperative mean arterial pressure. The DEX group had shown a statistically significant increase with regard to change in the blood level of stress hormones 12 and 24 h postoperative in comparison with the preoperative values. There was a highly significant increase in postoperative pethidine supplementation in the DEX group than in the TAP group. There was a significant difference with regard to time of the first postoperative request of analgesia in the DEX group than in the TAP group.\nIn open ovarian cystectomy, US-guided TAP block was comparable to dexmedetomidine infusion with regard to intraoperative hemodynamic stability and opioid requirement without change in stress response hormones. However, TAP block provided superior analgesia when compared with dexmedetomidine infusion up to 24 h postoperatively.\nKeywords: analgesia, dexmedetomidine, ovarian cystectomy, pain score, stress response, ultrasound-guided transversus abdominis plane block\n\|How to cite this article:\|\nMaghawry KM, Rayan AA, El-Kateb AS. Ultrasound-guided transversus abdominis plane block versus dexmedetomidine infusion in open ovarian cystectomy: Analgesic efficacy and effect on stress response. Ain-Shams J Anaesthesiol 2015;8:114-23\n\|How to cite this URL:\|\nMaghawry KM, Rayan AA, El-Kateb AS. Ultrasound-guided transversus abdominis plane block versus dexmedetomidine infusion in open ovarian cystectomy: Analgesic efficacy and effect on stress response. Ain-Shams J Anaesthesiol [serial online] 2015 [cited 2021 Oct 24];8:114-23. Available from: http://www.asja.eg.net/text.asp?2015/8/1/114/153952\n\| Introduction\|\| \|\nOvarian cystectomy is a moderate surgical procedure, after which patients may suffer from substantial postoperative discomfort and pain . These patients require multimodal postoperative pain management regimens that facilitate effective analgesia with minimal side effects . The provision of high-quality postoperative analgesia is of great importance to facilitate early ambulation and avoidance of postoperative complications .\nThe pain experienced by patients after abdominal surgery is initiated by an important key stimulant, which is the abdominal wall incision . The lateral abdominal wall is formed of three muscle layers, the external oblique, the internal oblique, and the transversus abdominis, and their fascial sheaths, whereas the central abdominal wall includes the rectus abdominis muscles and its fascial sheath. The nerves that supply the anterior abdominal wall pass through the neurofascial plane between the internal oblique and the transversus abdominis muscles .\nAnalgesia can be provided to the parietal peritoneum, skin, and muscles of the anterior abdominal wall by a type of regional anesthesia technique known as transversus abdominis plane (TAP) block . Ultrasound (US)-guided TAP block can be used as a method of multimodal analgesia reducing postoperative pain and perioperative opioid consumption, while decreasing the adverse events from opioids, such as sedation, nausea, vomiting, respiratory depression, and ileus .\nDexmedetomidine is an effective and highly selective α2 -adrenoceptor agonist with sedative, analgesic, sympatholytic, and amnestic properties . The sedating and analgesic effects of dexmedetomidine are due to stimulation of postsynaptic α2 -adrenoreceptors. Stimulation of α2 -adrenoreceptors inhibits adenylate cyclase activity, leading to decrease in central nervous system (CNS) sympathetic outflow in a dose-dependent manner , which reduces norepinephrine output at various sites in the CNS, in particular the locus ceruleus. The locus ceruleus, along with many other sites in the brain, is known to have a role in the control of ventilation, sleep modulation, and make dexmedetomidine have an analgesic effect best described as opioid-sparing .\nThe stress response is a collecting item given to a sum of hormonal and metabolic changes that follow injury or trauma. This is a part of the systemic reaction to injury that includes a wide range of endocrinal, immunological, and hematological effects .\nMonitors that process electroencephalography are widely used to predict both the loss and recovery of consciousness and assess the level of sedation and hypnosis during surgery . Bispectral index (BIS) is derived from a bispectral analysis of the electroencephalography signal recorded over the forehead using a proprietary algorithm to assess the depth of anesthesia, specifically its hypnotic component .\nTherefore, we conducted the present study to evaluate the analgesic efficacy and the attenuation of stress surgical response of US-guided TAP block in comparison with dexmedetomidine infusion in patients undergoing open ovarian cystectomy.\n\| Patients and methods\|\| \|\nThis randomized, double-blinded, clinical study was carried out after obtaining approval by the Hospital Ethics Committee and written informed consent from the patients in Prince Salman Hospital in the Kingdom of Saudi Arabia from January 2013 to October 2013. We examined 60 female patients of American Society of Anesthesiology (ASA) physical status I and II, aged 20-50 years, scheduled to undergo an elective open ovarian cystectomy.\nPatients were randomly assigned according to computer-generated randomization to be administered either a combination of standard general anesthesia with a US-guided TAP block (TAP group), which was carried out before skin incision, or standard general anesthesia with an intraoperative administration of intravenous loading and maintenance intravenous infusion of the dexmedetomidine (DEX group), also before making an incision on the skin. The anesthesiologist administering general anesthesia was blinded to the performance of TAP block and type of infusion during surgery.\nPatients were excluded if there was a history of allergies against amino amide local anesthetics, coagulopathy, patients receiving medical therapies that may result in tolerance to opioids, infection at the needle insertion site, patients who had a difficulty to understand the study protocol, or prolonged surgery time more than 90 min.\nFor a duration of 30 min before the induction of anesthesia, all patients were premedicated with intravenous midazolam 0.02 mg/kg after insertion of a 20-G peripheral intravenous cannula, and administration of 500 ml lactated Ringer's solution was started. Upon arrival to the operating room, standard monitoring (Aisys, Datex-Ohmeda Inc., a General Electric company, doing business as GE Health Care, Madison, Wisconsin, USA) was applied. Five-lead electrocardiograph to monitor the heart rate (HR), noninvasive blood pressure, and oxygen saturation were continuously monitored, together with monitoring of BIS (Aspect Medical System Inc., and are registered in USA, EU and other countries 194-0068 3.01). Intravenous lactated Ringer's solution infusion 6-8 ml/kg was started.\nAll patients underwent standard anesthetic technique after 5 min of preoxygenation in the form of intravenous administration of fentanyl 2 μg/kg, ondansetron 0.1 mg/kg, dexamethasone 0.1-0.2 mg/kg, and propofol 1-2 mg/kg till loss of verbal response. Endotracheal intubation was facilitated by the use of cisatracurium 0.15 mg/kg. Anesthesia was maintained by 1 minimum alveolar concentration (MAC) sevoflurane in oxygen/nitrous oxide flow (FiO 2 32%). Adequate muscle relaxation was maintained by 0.05 mg/kg of cisatracurium every 30 min. Increments of fentanyl 1 μg/kg were administered when there were signs of inadequate analgesia (e.g. increase in noninvasive blood pressure 20% greater than baseline blood pressure and/or tachycardia more than 90/min for 10 min). The lungs were mechanically ventilated using volume-controlled mode to maintain normocapnia (end-tidal CO 2 30-35 mmHg).\nAfter 10 min intubation, bilateral US-guided TAP block using Sonosite M-Turbo US device and 5-12 MHz linear transducer (Sonosite, Bothell, Washington, USA) was performed in the TAP group. After draping the needle insertion site, the probe was placed transversely on the level of the right anterior axillary line between the 12th rib and the iliac crest, and the external oblique, internal oblique, and transversus abdominis muscles were visualized. A 21-G 90 mm Facette tip needle and an injection line (Polymedic by tenema, Z.I. des Amandiers, France) was inserted medial to the probe by the in-plane technique and advanced in a lateral direction. When the tip of the needle reached the TAP between the internal oblique and transversus abdominis muscles, US imaging, ensuring no puncture of peritoneum or visceral organs injury, and also a negative aspiration, was carried out, and then 15-20 ml bupivacaine (2.5 mg/ml) was administered under direct ultrasonographic guidance, certified by an oval-shaped hypoechoic fluid pocket at TAP with real-time US imaging. The contralateral block was performed equally. This was associated with intravenous infusion of 50 ml of 0.9% normal saline with the same rate of dexmedetomidine infusion in the other group to confirm that the anesthesiologist administering general anesthesia was blinded to the type of the group. Skin incision was made in the allowed 15 min after the TAP block.\nAfter 10 min intubation in the DEX group, loading dose of 1 μg/kg of dexmedetomidine diluted in 10 ml of 0.9% normal saline infused over 10 min, and then followed by infusion rate of 0.2-0.6 μg/kg/h (200 μg dexmedetomidine diluted in 48 ml of 0.9% normal saline injection for a final concentration of 4 μg/ml) according to hemodynamic status and BIS monitoring.\nApproximately 20 min before the end of surgery, top-up doses of cisatracurium were stopped and intravenous infusion of paracetamol 15 mg/kg over 15 min was administered. At the end of the surgery, intravenous infusion was stopped in both the groups, and the residual of neuromuscular blocker was antagonized with neostigmine 0.04 mg/kg and atropine 0.02 mg/kg. After extubation, patients were transferred to the postanesthesia care unit (PACU) to be observed for 1 h for postoperative monitoring of hemodynamics and time to first rescue analgesia, which was pethidine 0.5 mg/kg intramuscularly administered on demand, with maximum dose of 1 mg/kg intramuscularly administered every 6 h for the first 24 h.\nHemodynamics [(HR, mean arterial blood pressure (MAP)] and oxygen saturation before the induction of anesthesia were taken as baseline values. BIS reading after intubation was taken as baseline. Stress response was assessed by measurement of serum level of cortisol and norepinephrine preoperative (baseline reading), intraoperative, and postoperative.\nIntraoperative measurements included hemodynamics (HR, MAP) and BIS readings, at baseline and every 15 min till the end of the surgery, and stress hormones (serum level of cortisol and norepinephrine) preoperatively, after skin incision and at skin closure. In addition, total amount of rescue fentanyl was administered if there were signs of inadequate analgesia.\nPostoperative measurements included stress hormones (serum level of cortisol and norepinephrine) immediately in PACU, 12 and 24 h postoperatively, and pain intensity score at 1, 3, 6, 12, and 24 h.\nThe primary outcome measure in this work was total 24-h pethidine consumption as rescue analgesia postoperatively. Secondary outcome measures included time to first request for pethidine and pain intensity.\nPain intensity was assessed as the verbal numerical rating scale (VNRS: 0, no pain; 10, the severest pain imaginable) at arrival to the recovery room (time 0) and at 1, 3, 6, 12, and 24 h postoperatively. Every assessment of VNRS was carried out by a blinded interviewer, and pain was scored under two conditions: at rest (VNRSr) and at coughing (VNRSc). When the VNRSr was greater than 4 in the recovery room, pethidine 0.5 mg/kg intramuscularly as a rescue analgesic was administered. After being transferred to the ward, the patient was managed with a standard protocol including injection of pethidine 0.5 mg/kg intramuscularly on demand with a maximum dose of 1 mg/kg intramuscularly every 6 h for the first 24 h. The time to first rescue analgesia and total amount of recues pethidine at the recovery room and ward were recorded for the first 24 h.\nThe sample size was based on data from the pilot study, a calculation based on 0.05 and a power of 80% yielded. A sample size of 25 patients per group used a two-tailed test assuming a difference in postoperative pethidine requirements of 50 mg and SD of 20. A total of 30 patients per group were included to replace any dropouts.\nThe statistical analysis was performed using a standard SPSS software package version 17 (SPSS Inc., Chicago, Illinois, USA). Data were expressed as mean ± SD or number (%). Student's t-test was used to analyze the parametric data, and discrete variables were analyzed using χ2 -test, with P-value less than 0.05 considered statistically significant.\n\| Results\|\| \|\nA total of 60 adult female patients were included in this study, and no patients were excluded throughout the course of the study. There was no statistically significant difference between the two groups in the patients' demographic data in terms of age, weight, and ASA classification ([Table 1]).\nIn the DEX group, there was a statistically significant decrease in HR at 45 min (75.9 ± 8.65 bpm), 60 min (71.33 ± 7.72 bpm), and 90 min (71.07 ± 6.74 bpm) after surgical incision in comparison with preoperative HR (84.93 ± 9.53 bpm) ([Table 2]).\n\|Table 2 Heart rate changes in both dexmedetomidine and transversus abdominis plane groups\|\nClick here to view\nIn the TAP group, there was a statistically significant decrease in HR at 60 min (77.53 ± 4.36 bpm) and 90 min (77.5 ± 4.94 bpm) after surgical incision in comparison with preoperative HR (82.97 ± 8.14 bpm) ([Table 2]).\nIn the DEX group, there was a statistically significant decrease in MAP at 30 min (81.77 ± 6.98 mmHg), 45 min (77.23 ± 7.56 mmHg), 60 min (78.7 ± 6.69 mmHg), and 90 min (80.63 ± 6.14 mmHg) after surgical incision in comparison with preoperative mean arterial blood pressure (89.07 ± 7.95 mmHg) ([Table 3]).\n\|Table 3: Changes of mean arterial pressure in both dexmedetomidine and transversus abdominis plane groups\|\nClick here to view\nIn the TAP group, there was no statistically significant change in the MAP at any period of intraoperative duration in comparison with preoperative MAP ([Table 3]).\nNo statistically significant difference was observed with regard to BIS in both the groups throughout the intraoperative duration ([Table 4]).\n\|Table 4: Changes of bispectral index in both dexmedetomidine and transversus abdominis plane groups\|\nClick here to view\nIn the DEX group, there was a statistically significant increase in blood level of cortisol 12 h postoperatively (21.87 ± 7.48 μg/dl) and 24 h postoperatively (22.37 ± 8.01 μg/dl) in comparison with preoperative blood level (14.17 ± 6.41 μg/dl) ([Table 5]; [Figure 1]).\n\|Figure 1: Changes in serum cortisol (¦Ìg/dl) in both the DEX and TAP groups. DEX, dexmedetomidine; TAP, transversus abdomin is plane.\|\nClick here to view\n\|Table 5 Changes in serum cortisol (¦Ìg/dl) in the dexmedetomidine and transversus abdominis plane groups\|\nClick here to view\nIn the TAP group, there was no statistically significant change in the blood cortisol level at any time of measurement (intraoperatively or postoperatively) in comparison with preoperative cortisol blood level ([Table 5]; [Figure 1]).\nThe blood level of cortisol was significantly higher in the DEX group 12 and 24 h postoperatively when compared with that in the TAP group ([Table 5]; [Figure 1]).\nIn the DEX group, there was a statistically significant increase with regard to the blood level of norepinephrine, 12 h (530.67 ± 141.85 pg/ml) and 24 h (659.67 ± 190.79 pg/ml) postoperatively, in comparison with preoperative blood level of norepinephrine (243.63 ± 122.26 pg/ml) ([Table 6]; [Figure 2]).\n\|Figure 2: Changes in serum norepinephrine (pg/ml) in both the DEX and TAP groups. DEX, dexmedetomidine; TAP, transversus abdomin is plane.\|\nClick here to view\n\|Table 6 Changes in serum norepinephrine in both dexmedetomidine and transversus abdominis plane groups\|\nClick here to view\nIn the TAP group, there was no statistically significant change in the blood level of norepinephrine at any time of measurement intraoperatively or postoperatively in comparison with preoperative norepinephrine blood level ([Table 6]; [Figure 2]).\nThere was no statistically significant difference with regard to intraoperative fentanyl increments in both the groups ([Table 7]).\n\|Table 7: Intraoperative incremental fentanyl in both dexmedetomidine and transversus abdominis plane groups\|\nClick here to view\nThere was a highly significant difference with regard to postoperative pethidine supplementation in both the groups ([Table 8]).\n\|Table 8: Postoperative pethidine in both dexmedetomidine and transversus abdominis plane groups\|\nClick here to view\nIn the DEX group, there was a statistically significant increase in VNRS at rest at: 6, 12, and 24 h postoperatively in comparison with value of VNRS at rest immediately in PACU ([Table 9]; [Figure 3]).\n\|Figure 3: VNRS at rest in the TAP group. Data are presented as median and interquartile range. TAP, transversus abdominis plane; VNRS, verbal numerical rati ng scale.\|\nClick here to view\n\|Table 9: Verbal numerical rating scale at rest in both dexmedetomidine and transversus abdominis plane groups\|\nClick here to view\nIn the TAP group, there was no statistically significant change in VNRS at rest at any time of postoperative period in comparison with the value of VNRS at rest immediately in PACU ([Table 9]; [Figure 4]).\n\|Figure 4: VNRS at rest in the DEX group. Data are presented as median and interquartile range. DEX, dexmedetomidine; VNRS, verbal numerical rating scale.\|\nClick here to view\nIn the DEX group, there was a statistically significant increase in value of VNRS on coughing at: 3, 6, 12, and 24 h postoperatively in comparison with the value of VNRS at coughing immediately in PACU ([Table 10]; [Figure 5]).\n\|Figure 5: VNRS at coughing in the DEX group. Data are presented as median and interquartile range. DEX, dexmedetomidine; VNRS, verbal numerical rating scale.\|\nClick here to view\nIn the TAP group, there was no statistically significant change of the value of VNRS at coughing at any time of postoperative in comparison with the value of VNRS immediately in PACU ([Table 10]; [Figure 6]).\n\|Figure 6: VNRS at coughing in the TAP group. Data are presented as median and interquartile range. TAP, transversus abdominis plane; VNRS, verbal numerical rati ng scale.\|\nClick here to view\n\|Table 10: Verbal numerical rating scale at coughing in both dexmedetomidine and transversus abdominis plane groups\|\nClick here to view\nThere was statistically significant increase in time required for first request of analgesia (pethidine) postoperative in the TAP group in comparison with the DEX group ([Table 11]; [Figure 7]).\n\|Figure 7: Time to fi rst postoperative request of analgesia (pethidine) (h) in both the groups. DEX, dexmedetomidine; TAP, transversus abdomin is plane.\|\nClick here to view\n\|Table 11 Time to fi rst postoperative request of analgesia (pethidine) in both the groups\|\nClick here to view\n\| Discussion\|\| \|\nPostoperative analgesia reduces postoperative stress response and postoperative morbidity, and in certain types of surgery it improves surgical outcome, fastens recovery after surgery, and makes rehabilitation much easier .\nUS-guided TAP block is an effective anesthetic technique for abdominal surgeries, providing anesthesia to the entire anterior abdominal wall , . Direct imaging using US increases safety and quality of the block. This coincides with Liu et al. and Koscielniak-Nielsen who concluded that US guidance reduces the block time and the number of attempts, and decreases the block onset time. In addition to Farooq and Carey who found another advantage of using a US-guided technique, is that accidental puncture of the internal gastrointestinal organs reported with the TAP block can be avoided.\nDexmedetomidine is a potent α2 agonist. Its primary analgesic effect is mediated through the activation of the α2 receptors on the dorsal horn of the spinal cord and also by the inhibition of substance P . It has analgesic-sparing effect proved by Ebert et al. who showed dose-dependent decrease in pain rating with increasing doses of dexmedetomidine in volunteers.\nIn the present study, with regard to the intraoperative hemodynamic changes, we have found that patients in both the DEX and TAP groups had a statistically significant intraoperative decrease in the HR, with it being more decreased in the DEX group (45, 60, and 90 min after surgical incision) than in the TAP group (60 and 90 min after surgical incision). In the DEX group, bradycardia is caused by baroreceptor reflex and enhanced vagal activity resulting from central stimulation of parasympathetic outflow, as well as a reduced sympathetic drive . Changes in the TAP group coincided with the study by Tsuchiya et al. who concluded that combining TAP block with general anesthesia in high-risk ASA III patients with cardiovascular disease promotes intraoperative hemodynamic stability with mild decrease in HR and MAP, as well as early emergence from anesthesia.\nThere is better intraoperative control of the MAP in the DEX group than in the TAP group, as the DEX group showed statistically significant decrease in the intraoperative MAP, whereas in the TAP group there was no significant change in MAP compared with preoperative values. This hypotensive effect of dexmedetomidine results from the stimulation of subtypes α2 a and α2 c inhibitory neurons found predominantly in the CNS in the medullary vasomotor center (nucleus reticularis lateralis) of the brainstem, which leads to a reduction in norepinephrine release and sympathetic nerve outflow from the CNS to the peripheral tissues . This coincides with the conclusion stated by Karakaya et al. that the use of dexmedetomidine in coronary artery bypass graft surgery causes a moderate decrease in HR and MAP without reaching clinically important levels. It is also agreed with by Penttilδ et al. who noted that the cardiovascular effects of dexmedetomidine are predictable and caused by α2 -adrenoceptor pharmacological effects.\nThere is no evident advantage or effect on the depth of anesthesia neither in the DEX group nor in the TAP group, as BIS readings showed almost the same range of readings in both the groups all through the time of surgery.\nActivation of the hypothalamic-pituitary-adrenal axis and cortisol secretion associated with surgical trauma are very important perioperative stress responses . The TAP block had intense effect on controlling surgical stress response. This is proved when there was no change in the plasma level of cortisol and norepinephrine during the time of surgery, in PACU immediately after surgery, 12 and 24 h postoperatively when compared with the preoperative value.\nIn the DEX group, intraoperative records for stress hormones did not show a significant change. Thomas et al. showed that dexmedetomidine infusion decreased the plasma level of catecholamine in healthy volunteers. Venn et al. proved that dexmedetomidine was not found to affect the process of steroidogenesis. However, Aho et al. found that patients receiving dexmedetomidine had significantly lower intraoperative cortisol levels. This supports our findings intraoperatively. On the contrary, the DEX group in our study showed marked increase in the level of plasma cortisol and norepinephrine in the postoperative period.\nThe analgesic properties of dexmedetomidine in humans are more controversial. Stimulation of the α2 a subtype is responsible for sedation, analgesia, and sympatholysis, whereas stimulation of the α2 c subtype is responsible for anxiolysis and contributes to spinal antinociception . Therefore, it appears to exert analgesic effects at the spinal cord level and at the supraspinal sites . Although the TAP block has been described as an effective regional anesthetic method for various surgical procedures .\nIn the present study, incremental intraoperative doses of fentanyl are almost the same. This was confirmed by Flacke et al. who stated that dexmedetomidine infusion reduces opioid intraoperative . In addition, Cho et al. found that The TAP block caused a 25% reduction in intraoperative fentanyl. The advantage of using preoperative TAP block is explained by blocking the somatosensory pain of the incision site, reducing intraoperative opioid requirements and postoperative side effects, which were confirmed by Mukhtar and Singh .\nWith regard to postoperative analgesic effect, there was a remarkable difference between the two groups. The TAP group had a significant better postoperative analgesic effect than the DEX group, as the DEX group experienced higher pain score at late postoperative period. This coincides with the study by Kida et al. who concluded that intraoperative administration of dexmedetomidine improved early postoperative pain status. However, this was against the results of McCutcheon et al. who they stated that intraoperative DEX infusion significantly reduced postoperative supplemental analgesics. They referred this to the continued effect of DEX on α2 -adrenoreceptor in the spinal cord . This can also be supported in our study that patients in the DEX group required significantly higher total doses pethidine compared with those in the TAP group. In addition, patients who had been treated with DEX asked for the first dose rescue pethidine much earlier than those in the TAP group.\nThe VNRS scores at rest and at coughing in the TAP group were almost of the same values up to 24 h postoperatively, meaning that the analgesic effect of TAP block extends to cover the first 24 h. Same results were shown by Niraj et al. who confirmed that pain scores, both at rest and during mobilization, were significantly reduced with the TAP block in the early postoperative period (0-6 h), and Carney et al. who found that pain scores were also reduced for 24 h. The reasons for the prolonged duration of analgesic effect after TAP blockade may relate to the fact that the TAP is relatively poorly vascularized, and therefore drug clearance may be slowed.\nOur data are in contrast with those of McMorrow et al. who found no additional analgesic effect of the TAP block, when TAP block and spinal morphine were administered in combination, with the difference that the TAP block was performed by anatomical landmark technique.\nThe total dose of rescue pethidine is lower in the first 24 h postoperative, with delayed request for rescue analgesia in the TAP group. This goes hand in hand with McDonnell et al. who proved that the first 48 h morphine requirements were decreased by 70%, and delayed supplemental opioids in patients who underwent TAP block compared with standard analgesia regimen alone.\n\| Conclusion\|\| \|\nIn open ovarian cystectomy operations, in the setting of multimodal analgesia, US-guided TAP block was comparable to dexmedetomidine infusion with regard to intraoperative hemodynamic stability, opioid requirement without change in stress response hormones. However, in the postoperative period, US-guided TAP block provided superior analgesia when compared with dexmedetomidine infusion up to 24 h postoperative, demonstrating both a substantial reduction in pethidine consumption as well as improved pain scores and delayed request of rescue analgesia, with no change in stress response hormones.\n\| Acknowledgements\|\| \|\nConflicts of interest\n\| References\|\| \|\nFarragher RA, Laffey JG. Postoperative pain management following cesarean section. In: Shorten G, Carr D, Harmon D, et al.\n, editors. Postoperative pain management: an evidence-based guide to practice\n. 1 st\ned. Philadelphia, PA: Saunders Elsevier; 2006. 225-238.\nStanley G, Appadu B, Mead M, Rowbotham DJ. Dose requirements, efficacy and side effects of morphine and pethidine delivered by patient-controlled analgesia after gynecological surgery. Br J Anaesth 1996; 76:484-486.\nMcDonnell JG, Curley G, Carney J, Benton A, Costello J, Maharaj CH, Laffey JG. The analgesic efficacy of transversus abdominis plane block after cesarean delivery: a randomized controlled trial, Anesth Analg 2008; 106:186-191.\nNetter FH. Back and spinal cord. In: Netter FH, editor. Atlas of human anatomy summit\n. New Jersey, USA: The Ciba-Geigy Corporation; 1989. 145-155.\nNetter FH. Abdomen posterolateral abdominal wall. In: Netter FH, editor. Atlas of human anatomy\n. Summit, New Jersey, USA: The Ciba-Geigy Corporation; 1989. 230-240.\nCharlton S, Cyna AM, Middleton P, Griffiths JD. Perioperative transversus abdominis plane (TAP) blocks for analgesia after abdominal surgery. Cochrane Database Syst Rev 2010; 8:CD007705\nMcDonnell JG, O'Donnell B, Curley G, Heffernan A, Power C, Laffey JG. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial. Anesth Analg 2007; 104:193-197.\nCarollo DS, Nossaman BD, Ramadhyani U. Dexmedetomidine: a review of clinical applications. Curr Opin Anaesthesiol 2008; 21:457-461.\nKamibayashi T, Maze M. Clinical uses of alpha-2 adrenergic agonists. Anesthesiology 2000; 93:1345-1349.\nCortinez LI, Hsu YW, Sum-Ping ST, et al.\nDexmedetomidine pharmacodynamics: Part II: crossover comparison of the analgesic effect of dexmedetomidine and remifentanil in healthy volunteers. Anesthesiology 2004; 101:1077-1083.\nDesborough JP. Physiological responses to surgery and trauma. In: Hemmings HC Jr, Hopkins PM, editors. Foundation of anaesthesia\n. London: Mospy; 1999. 713-734.\nLiu J, Singh H, White PF. Electroencephalographic bispectral index correlates with intraoperative recall and depth of propofol-induced sedation. Anesth Analg 1997; 84:185-189.\nVoss L, Sleigh J. Monitoring consciousness: the current status of EEG-based depth of anaesthesia monitors. Best Pract Res Clin Anaesthesiol. 2007; 21:313-325.\nLiu SS, Ngeow JE, Yadeau JT. Ultrasound-guided regional anesthesia and analgesia: a qualitative systematic review. Reg Anesth Pain Med 2009; 34:47-59.\nKoscielniak-Nielsen ZJ. Ultrasound-guided peripheral nerve blocks: what are the benefits? Acta Anaesthesiol Scand 2008; 52:727-737.\nFarooq M, Carey M. A case of liver trauma with a blunt regional anesthesia needle while performing transversus abdominis plane block. Reg Anesth Pain Med 2008; 33:274-275.\nTobias JD. Dexmedetomidine: applications in pediatric critical care and pediatric anesthesiology. Pediatr Crit Care Med 2007; 8:115-131.\nEbert TJ,Hall JE, Barney JA, et al.\nThe effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology 2000; 93:392-394.\nTalke P, Chen R, Thomas B, Aggarwall A, Gottlieb A, Thorborg P, et al.\nThe hemodynamic and adrenergic effects of perioperative dexmedetomidine infusion after vascular surgery. Anesth Analg 2000; 90:834-839.\nTsuchiya M, Takahash I, Rfurukawa A, Suehiro K, Mizutani K, Nishikawa K. Transversus abdominis plane block in combination with general anesthesia provides better intraoperative hemodynamic control and quicker recovery than general anesthesia alone in high-risk abdominal surgery patients. Minerva Anestesiol 2012; 78:1241-1247.\nHurt CM, Angelotti T. Molecular insights into alpha2 adrenergic receptor function: clinical implications. Semin Anesth Perioperative Med Pain 2007; 26:28-34.\nKabukçu KH, Sahin N, Temel Y, Aydogdu Titiz T. Hemodynamics in coronary artery bypass surgery, effects of intraoperative dexmedetomidine administration. Anaesthesist 2011; 60:427-431.\nPenttilä J, Helminen A, Anttila M et al.\nCardiovascular and parasympathetic effects of dexmedetomidine in healthy subjects. Can J Physiol Pharmacol 2004; 82:359-362.\nMukhtar AM, Obayah EM, Hassona AM. The use of dexmedetomidine in pediatric cardiac surgery, Anesth Analg 2006; 103:52-56.\nThomas J, Judith E, Jill A, et al.\nThe effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology 2000; 93:382-394.\nVenn RM, Bryant A, Hall GM, Grounds RM. Effects of dexmedetomidine on adrenocortical function, and the cardiovascular, endocrine and inflammatory responses in postoperative patients needing sedation in the intensive care unit. Br J Anaesth 2001; 86:650-656.\nAho M, Sceinin M, Lehtinen AM, et al.\nIntramuscularly administrated dexmedetomidine attenuates hemodynamic and stress hormone responses to gynecologic laparoscopy. Anesth Analg 1992; 75:932-939.\nYoshitomi T, Kohjitani A, Maeda S, et al.\nDexmedetomidine enhances the local anesthetic action of lidocaine via an alpha-2A adrenoceptor. Anesth Analg 2008; 107:96-101.\nEl-Dawlatly AA, Turkistani A, Kettner SC, Machata AM, Delvi MB, Thallaj A, et al.\nUltrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy, Br J Anaesth 2009; 102:763-767\nFlacke JW, Bloor BC, Flacke WE, Wong D, Dazza S, Stead SW, Laks H. Reduced narcotic requirement by clonidine with improved hemodynamic and adrenergic stability in patients undergoing coronary bypass surgery. Anesthesiology 1987; 67:11-19.\nFlacke JW. Alpha 2-adrenergic agonists in cardiovascular anesthesia. J Cardiothorac Vasc Anesth 1992; 6:344-359.\nCho S, Kim YJ, Kim DY, Chung SS. Postoperative analgesic effects of ultrasound-guided transversus abdominis plane block for open appendectomy, J Korean Surg Soc 2013; 85:128-133.\nMukhtar K, Singh S. Transversus abdominis plane block for laparoscopic surgery, Br J Anaesth 2009;102:143-144.\nKida K, Yasui Y, Ohtani N, Kuratani N, Masaki E. Intraoperative infusion of dexmedetomidine decreases postoperative pain scores: a metaanalysis [abstract]. American Society of Anesthesiologists Annual Meeting Abstracts; 22 October 2008; Orlando, FL. Abstract 1625. http://www.asaabstracts.com/strands/asaabstracts/abstract.htm;jsessionid=EF2A84D7703FAFBC4EF2623625B1E7DC?year=2008&index=17&absnum=275\nMcCutcheon CA, Orme RM, Scott DA, Davies MJ, McGlade DP. A comparison of dexmedetomidine versus conventional therapy for sedation and hemodynamic control during carotid endarterectomy performed under regional anesthesia. Anesth Analg, 2006; 102:668-675.\nVenn RM, Bradshaw CJ, Spencer R, Brealey D, Caudwell E, Naughton C, et al.\nPreliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia 1999; 54:1136-1142.\nNiraj G, Searle A, Mathews M, Misra V, Baban M, Kiani S, Wong M. Analgesic efficacy of ultrasound-guided transverses abdominis plane block in patients undergoing open appendicectomy. Br J Anaesth 2009; 103:601-605.\nCarney J, McDonnell JG, Ochana A, Bhinder R, Laffey JG. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy. Anesth Analg 2008; 107:2056-2060.\nMcMorrow RCN, Ni Mhuircheartaigh RJK, Ahmed A, Aslani A, Ng SC, Conrick-Martin I, et al\n. Comparison of transversus abdominis plane block vs spinal morphine for pain relief after caesarean section. Br J Anaesth 2011; 106:706-712.\n[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]\n[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11]
I went for very minor surgery and was accompanied only by my mom and dad. I have a horrible fear of needles and anesthesia where I believe I will not wake from it. Surgery went without incident, and I was put in the recovery room. The first thing I screamed when I came to was, “WHERE ARE YOU?!” It was in this drug-induced state that I really did want him there, every moment of every day.\nPostscript: I was lucky that he felt the same way, and he spent the following days of my recovery, and the past four years, by my side. We’re getting married this summer.\nComments Off on Pins and needles
- Why would you not wake up from anesthesia?\n- Is anesthesia sleep restful?\n- Can you pee while under anesthesia?\n- What does it feel like waking up from anesthesia?\n- Do you dream while under anesthesia?\n- Does Anesthesia shorten your life?\n- Does anxiety affect anesthesia?\n- Can anesthesia cause you to be emotional?\n- Can you poop during surgery?\n- Does Anesthesia change your personality?\n- How does anesthesia knock you out so fast?\n- What is it called when you wake up from anesthesia?\n- How quickly does anesthesia work?\n- What are the 3 most painful surgeries?\n- Does your heart stop under general anesthesia?\nWhy would you not wake up from anesthesia?\nDelayed emergence from general anesthesia (GA) is a relatively common occurrence in the operating room.\nIt is often caused by the effect of drugs administered during the surgery.\nIt can also be caused by other etiologies such as metabolic and electrolyte disturbances..\nIs anesthesia sleep restful?\nAlthough doctors often say that you’ll be asleep during surgery, research has shown that going under anesthesia is nothing like sleep. “Even in the deepest stages of sleep, with prodding and poking we can wake you up,” says Brown. “But that’s not the case with general anesthesia.\nCan you pee while under anesthesia?\nUrinary catheters are often used during surgery, as you can’t control your bladder while under anesthesia. For this purpose, a foley catheter is typically placed prior to surgery and keeps the bladder empty throughout.\nWhat does it feel like waking up from anesthesia?\nAlthough every person has a different experience, you may feel groggy, confused, chilly, nauseated, scared, alarmed, or even sad as you wake up. Depending on the procedure or surgery, you may also have some pain and discomfort afterward, which the anesthesiologist can relieve with medications.\nDo you dream while under anesthesia?\nWhile under general anesthesia, you are in a drug-induced unconsciousness, which is different than sleep. Therefore, you will not dream. However, if you are under a nerve block, epidural, spinal or local anesthetic, patients have reported having pleasant, dream-like experiences.\nDoes Anesthesia shorten your life?\nAbstract. A recent clinical study demonstrated that deep anesthesia, as measured by Bispectral index monitoring, was associated with increased 1-yr mortality among middle-aged and elderly surgical patients.\nDoes anxiety affect anesthesia?\nAnxiety is particularly important, because it has the potential to affect all aspects of anesthesia such as preoperative visit, induction, perioperative, and recovery periods [2, 3].\nCan anesthesia cause you to be emotional?\nIn her review of the effects of anesthesia on the post-operative mental status of patients, Carina Storrs describes the growing awareness among surgeons that anesthesia may be responsible for post-operative delirium, confusion, hallucinations, depression, mania, and even psychotic behavior.\nCan you poop during surgery?\nAnesthesia. People think of anesthesia as something that puts us to sleep. Anesthesia, though, also paralyzes your muscles, which stops food from being moved along the intestinal tract. In other words, until your intestines “wake up,” there is no movement of stool.\nDoes Anesthesia change your personality?\nPersonality change after surgery A 2017 study suggests it’s possible that changes to the brain may last after people are given general anesthesia for surgery. For some people, changes in behavior are temporary, while the changes persist for others. After surgery, some people may feel more confused or disoriented.\nHow does anesthesia knock you out so fast?\nNew research by Hudetz and his colleagues now suggests that anesthesia somehow disrupts information connections in the mind and perhaps inactivates two regions at the back of the brain. Here’s how it works: Think of each bit of information coming into the brain as the side of a die.\nWhat is it called when you wake up from anesthesia?\nThe condition, called anesthesia awareness (waking up) during surgery, means the patient can recall their surroundings, or an event related to the surgery, while under general anesthesia. Although it can be upsetting, patients usually do not feel pain when experiencing anesthesia awareness.\nHow quickly does anesthesia work?\nHow long does it take for anesthesia to kick in? General anesthesia usually puts you to sleep in less than 30 seconds.\nWhat are the 3 most painful surgeries?\nMost painful surgeriesOpen surgery on the heel bone. If a person fractures their heel bone, they may need surgery. … Spinal fusion. The bones that make up the spine are known as vertebrae. … Myomectomy. Share on Pinterest A myomectomy may be required to remove large fibroids from the uterus. … Proctocolectomy. … Complex spinal reconstruction.\nDoes your heart stop under general anesthesia?\nGeneral anesthesia suppresses many of your body’s normal automatic functions, such as those that control breathing, heartbeat, circulation of the blood (such as blood pressure), movements of the digestive system, and throat reflexes such as swallowing, coughing, or gagging that prevent foreign material from being …
We sat down for a little Q and A to learn more about Alisa and her role at Longwood…\nQ: Why did you choose to become a veterinary technician?\nA: Ever since I can remember, I loved all animals and little critters. I used to play by the creek and look for frogs and salamanders and bring home stray animals to make my pets. My compassion for animals grows every day.\nQ: One thing you love about your job is….\nA: Seeing the transformation of someone’s sick pet become well again. The power of veterinary medicine amazes me!\nQ: One thing that is hard about your job is….\nA: It is so difficult letting go and saying goodbye to clients’ pets. No matter how many times you go through it, it never gets easier.\nQ: One reason why you love working at Longwood Vet Center is…\nA: Longwood Vet is like a family. The staff and employers are so welcoming and accepting. Everyone who works here is amazing at their job. We also have a high standard of veterinary medicine.\nQ: The place in the hospital where we would likely find you is….\nA: Surgery. I love doing anesthesia and assisting the doctors with procedures.\nQ: One thing you would like pet owners to know is….\nA: I treat your pet like it is my own and most likely will be found talking to it in a funny voice. I love all animals and want them to feel safe when they are here!
Dr Ilonka Meyer\nMBChB, PDD, FANZCA, FFPMANZCA\nAnaesthetist & Interventional Pain specialist\nDr. Ilonka Meyer is the Clinical Director and Founder of MindBodyPainSpecialists.\nIlonka completed her medical training in South Africa at the University of Pretoria before undertaking vocational training in South Africa and Australia. After completing her medical degree and postgraduate training in procedural sedation, she held an appointment as lecturer and program coordinator of the Procedural Sedation and Pain Management Diploma, at the University of Western Cape.\nIlonka was Founder of Cape Sedation Services, a procedural sedation and pain management practice in Cape Town South Africa, specialising in paediatric procedural sedation before moving to Australia in 2008 to start specialist training as an anaesthetist. Ilonka completed her anaesthesia training through Austin Health, Northern Health, Western Health, Monash Health and Bendigo Hospital.\nIlonka completed Pain Fellowships at Peter McCallum Cancer Centre, Austin Health and The Royal Children’s Hospital and became a Fellow of the Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists in 2018.\nIn addition to her role as Founder and Director of MindBodyPainSpecialists, Ilonka also holds an appointment as Acting Director of the Pain Service and Pain Specialist at the Austin Hospital in Heidelberg, Melbourne.\nIlonka has a strong interest in peri-operative pain and medication optimisation, interventional pain treatments, cancer pain and palliative care and is passionate about growing and expanding integrated pain services in the public sector. Ilonka has played an integral role in the development of the Peri-operative and Transitional pain clinic at Austin Health.\nIlonka is skilled in Clinical Research, Medical Education, Coaching, and Healthcare Management. Her main research focus lies in interventional pain medicine in the peri-operative population, cancer pain and the health economic benefits of pain and medication optimisation in patients both pre-and postoperatively.\nSpecial Interests include:\n- Interventional Pain Management\n- Back, Knee, Shoulder, Abdominal and Pelvic Pain\n- Persistent post-surgical pain\n- e.g., post-lumbar fusion or total knee replacement\n- Complex Regional Pain Syndrome\n- Peri-operative pain management optimisations\n- Transitional pain management\nIlonka is a passionate advocate for equality and diversity in all areas of her work, striving to ensure every individual has the chance to achieve their full potential, free from prejudice and discrimination. She is passionate about local, regional, national and international human rights and provides high quality patient care.
Why Choose Oral Surgery?\nThe word “surgery” often brings to mind a stay in the hospital, general anesthesia, and perhaps a lengthy recovery period. However, the experience of having oral surgery is usually very different from that. Oral surgery is often performed in a dental office setting, under local anesthesia, with minimal recovery time. Oral Surgery can range from routine procedures such as tooth extractions and implant placement to more complex jaw realignment surgeries and emergency care for facial trauma.\nOral Surgery Procedures\nOral surgery procedures may be performed to relieve pain, treat an infection or trauma, restore function or improve a person's appearance. Procedures and conditions treated include:\n- Tooth Extractions . There are a variety of reasons why you may need a tooth or teeth removed. You may have a wisdom tooth that is impacted; a diseased tooth that can't be saved; or overcrowded teeth that need to be removed so more room can be created to facilitate proper alignment during orthodontics.\n- Dental Implants . Today's preferred method of tooth replacement is a titanium dental implant, which is placed beneath the gum line and into the jawbone during a minor surgical procedure. The implant is then attached to a realistic-looking dental crown that is visible above the gum line and indistinguishable from a natural tooth.\n- Oral Diagnosis & Biopsies . When a suspicious oral lesion is found, a biopsy is often used to detect or rule out oral cancer — a disease that is treatable if caught early. A biopsy involves removing a very small tissue sample for laboratory analysis.\n- Snoring & Sleep Apnea . Excess tissue in the back of the throat may need to be removed in certain individuals with sleep apnea.\n- TMD Minimally invasive technique such as laser TMJ Therapy and night guards.\n- Facial Trauma & Reconstructive Surgery . Facial injuries can affect not only a person's ability to carry on basic life functions such as eating, but also his or her appearance. Knocked-out teeth can sometimes be re-implanted, or replaced with dental implants.\nWhat to expect\nBefore your oral surgery is performed, x-rays will often be taken to aid in diagnosis and treatment planning. A step-by-step explanation of the procedure along with your anesthesia options will be discussed, and you should feel free to ask any questions you have. Your recovery experience will depend on what procedure you are having as well as your general state of health. It's always important to let your healthcare providers know what medications you are taking (both prescription and over-the-counter), any chronic health conditions you have, and whether you smoke. This will help ensure your safety and comfort — always the paramount concerns.
July 31, 2015\nForaminotomy is surgery that widens the opening in your back where nerve roots leave your spinal canal. You may have a narrowing of the nerve opening (foraminal stenosis).\nBack to TopAlternative Names\nIntervertebral foramina; Spine surgery - foraminotomy\nBack to TopDescription\nForaminotomy takes pressure off of a nerve in your spinal column. This allows the spine to move more easily. Foraminotomy can be performed on any level of the spine.\nYou will be asleep and feel no pain (general anesthesia).\n- You lie face down on the operating table. A cut (incision) is made in the middle of the back of your spine. The length of the incision depends on how much of your spinal column will be operated on.\n- Skin, muscles, and ligaments are moved to the side. Your surgeon may use a surgical microscope to see inside your back.\n- Some bone is cut or shaved away to open the nerve root opening (foramen). Any disk fragments are removed.\n- Other bone may also be removed at the back of the vertebrae to make more room (laminotomy or laminectomy).\n- The surgeon may do a spinal fusion to make sure your spinal column is stable after surgery.\n- The muscles and other tissues are put back in place. The skin is sewn together.\nBack to TopRisks\nRisks of any anesthesia are:\n- Reactions to medications\n- Breathing problems\nRisks of forminotomy are:\nBack to TopReferences\nCurlee PM. Other disorders of the spine. In: Canale ST, Beatty JH, eds. Campbell 's Operative Orthopaedics . 11th ed. Philadelphia, PA: Elsevier Mosby; 2007:chap 41.\nPark AL. Lower back pain and disorders: intervertebral discs. In: Canale ST, Beatty JH, eds. Campbell 's Operative Orthopaedics . 11th ed. Philadelphia, PA: Elsevier Mosby; 2007:chap 39.\nWeinstein JN, Tosteson TD, Lurie JD, et al. Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine. 2010;35(14):1329-38.\nMOST POPULAR - HEALTH\n- Well: A Way to Get Fit and Also Have Fun\n- Well: How Walking in Nature Changes the Brain\n- Well: A Balloon to Treat Glue Ear, a Common Childhood Problem\n- Well: A 2-Minute Walk May Counter the Harms of Sitting\n- The New Old Age: ‘Sex Never Dies,’ but a Medicare Option for Older Men Does\n- Well: Ask Well: Late Menopause\n- Well: Changing Our Perceptions of Beauty\n- Well: Screen Addiction Is Taking a Toll on Children
Iatrogenic choroidal neovascularization is a rare complication of ocularsurgery. It is usually a result of laser photocoagulation, retinal cryotherapy,or subretinal fluid drainage. It was believed to be induced by damaging theBruch membrane and/or retinal pigment epithelium, from which the reparativeprocesses trigger the release of angiogenic factors.1\nWe report a case of global penetration–induced choroidal neovascularizationfollowing peribulbar anesthesia for cataract surgery.\nA 75-year-old woman originally scheduled for phacoemulsification withan intraocular lens implant in the right eye had a procedure complicated byglobal penetration during peribulbar anesthesia. Dilated fundus examinationrevealed a suspected penetration site; preretinal and subretinal hemorrhageswere also found in the right posterior pole. The operation subsequently proceededbecause the intraocular pressure was not soft after penetration. It was thencomplicated by a posterior capsular tear, and an anterior vitrectomy was doneto complete the surgery. Two months after surgery, the patient's best-correctedvisual acuity was 20/100 OD with preretinal and subretinal hemorrhages aroundthe macula on ophthalmoscopic examination.\nPreoperatively, the patient was a hypermetrope. Subjective refractionwas + 1.5 diopters (D) in the right eye and + 1.0 D in the left eye. Best-correctedvisual acuity was 20/60 OU. The axial length was 23.04 mm in right eye and23.21 mm in the left eye.\nExamination of cornea, anterior chamber, pupil, and intraocular pressurereadings were unremarkable except nuclear sclerosis of bilateral lens. Therewere no signs of macular degeneration in each eye.\nThe visual acuity was stable until 8 months after the surgery. The patientvisited the clinic complaining of a gradual blurring of her vision in theright eye. Dilated fundus examination revealed residual preretinal hemorrhageand a choroidal retinal lesion, corresponding to the previously suspectedpenetrating site Figure 1, A). Inthe early phase of a fluorescein angiography, there was an oval lesion withhypofluorescence and a clear margin surrounded by a ring of hyperfluorescence(Figure 1, B). The adjacent areabecame progressively hyperfluorescent during the transit phase with leakagein the late phase (Figure 1, C andD). The patient was diagnosed with iatrogenic choroidal neovascularizationresulting from global penetration while administering peribulbar anesthesia.\nA, Color fundus photograph shows preretinal hemorrhage (small arrow)and subretinal fibrous scar (large arrow) around the macula. B, The oval hypofluorescentarea corresponding to the penetrating lesion is surrounded by an area of hyperfluorescencein the early phase. C and D, Increased hyperfluorescence (arrows) is notedduring the transit phase, followed by leakage in the late phase, characteristicof subretinal neovascularization.\nPeribulbar anesthesia, during which local anesthetic is injected outsidethe muscle cone, has been cited by proponents as having the advantages ofgreater ease of performance and a lower rate of globe perforation.2 However, ocular penetrations (single entry) andperforations (entry wound and exit wound) have been reported occasionally,especially in patients with long axial length.\nIn clinical situations, the detection of preretinal, subretinal, orvitreous hemorrhage either immediately after surgery or on postoperative visitsshould remind the physician of the possibilities of global penetration. Mostof the penetrating site becomes a chorioretinal scar rather than a choroidalneovascularization in the end.\nThe penetrating site, which was very close to the macula, developedinto choroidal neovascularization that resulted in visual loss in this patient.This represents an unusual complication of global penetration by peribulbaranesthesia. To our knowledge, there are no prior reported cases of choroidalneovascularization developed in the penetrating site by peribulbar anesthesia.Ophthalmologists should be aware of this complication, which might lead toloss of vision.\nThe authors have no relevant financial interest in this article.\nCorrespondence: Dr Lai, Department of Ophthalmology, Chang Gung MemorialHospital, 5 Fu-Hsing St, Kwei-Shan, Tao-Yuan, Taiwan ([email protected]).
HealthDay News — Americans have a positive attitude toward plastic surgery in the COVID-19 period, and recommendations have been issued for resuming elective procedures, according to a press release issued by the American Society of Plastic Surgeons (ASPS).\nThe ASPS surveyed Americans’ perceptions of plastic surgery in the wake of the COVID-19 pandemic and examined responses from more than 1,000 consumers. During the pandemic, 49% of those who had not had plastic surgery indicated being open to cosmetic or reconstructive surgery in the future. Twenty-eight percent of these respondents would consider a first-time cosmetic procedure. Improved overall confidence was reported by those who had previous procedures, and 29% of respondents indicated they were interested in specific treatments.\nAs interest persists in plastic surgery, members of the ASPS developed recommendations for reopening strategies. These recommendations include knowing the up-to-date COVID-19 statistics in the community; reviewing patient flow plans to facilitate social distancing; having available COVID-19 testing; reassessing cleaning and sterilization protocols; assessing access to anesthesia supplies and personal protective equipment; spending time to educate staff; and being aware of the availability of transfer options. Patients should expect enhanced safety protocols, including telehealth/virtual encounters in place of in-person visits; assessment of which services will be available upon opening and which will be delayed; use of online patient portals and other methods of completing paperwork; on-site screening; and mask wearing and staggered scheduling.\n“Our goal at ASPS is to keep our finger on the pulse of the public and plastic surgeons for all information and questions pertaining to cosmetic and reconstructive plastic surgery,” Lynn Jeffers, MD, president of the ASPS, said in a statement.
In 1894, Codman and Cushing, two medical students, wanted to compare their skills as “etherizers.” The better anesthetist would win a dinner. They “determined to let the test of satisfactory anaesthesia rest with the patient’s behavior in the ward… it was particularly due… to the detailed attention which we had to put upon the patient by the careful recording of the pulse rate throughout the operation.”1 This “careful recording of the pulse rate throughout the operation” became the prototype of anesthetic records for the next century, which is essentially plotting physiologic signals over time. Over the years this type of anesthesia record served many clinical and administrative functions.\nThrough a very narrow window of information, a few vital signs describe a surgical patient and how that patient responded to whatever was done to him/her, which include the surgeon’s and the anesthetist’s actions. While we have enriched the Codman-Cushing type of records with more physiologic parameters, comments on events, and information on drugs, I am not aware of any modern, commercially available automated anesthesia record that deviates from their basic design. The archetype original anesthesia records did not describe what the anesthetists did (other than to note the amount of ether used) and, therefore, actually speak to the quality of the anesthetic only in a rather indirect way.\nPatient vs. System Data\nFor much of the last 100 years, we have continued to concentrate our efforts on signals that we gather from the patient. Only relatively recently have we begun to monitor data that directly relate to the anesthetist’s activities and thus to the quality of anesthesia. I remember that development from the mid-1970s. It came in the form of a short letter from our insurance carrier insisting that we monitor the oxygen in the breathing circuit. With that letter in hand, it was not difficult to persuade the hospital administration to invest in oxygen analyzers for all anesthesia machines. The insurance industry had taken this step because it was confronted by all too many malpractice claims alleging that hypoxemia had harmed or killed a patient. In the intervening years we have expanded the monitoring of inspired gases to include anesthetic agents, pressures, and volumes. Yet, even today, we lavish far more on monitoring and recording physiologic signals than on the things we actually control and impose on the patient.\nOf course, there is a relationship between our actions and the patient’s responses, and there should be a relationship between the patient’s physiologic signals and our actions. Indeed, experts examine that interplay between the anesthetist’s recorded observations and actions and also between the anesthetist’s action’s and the patient’s responses to assess the quality of care when an injured patient sues. While the typical anesthesia record does not thwart such an analysis, it does not cater to it.\nEven before clinicians take an action, they must consider the wisdom of such actions in the light of the current situation, the patient’s disease, the surgeon’s plans, existing guidelines, and standards. Here, even the best anesthesia record leaves a large void. It does not show the quality of care reflected by the clinician’s adherence to established practices or standards, not to mention the skills with which he or she initiates these steps.\nDuring the last decade, we have learned that in anesthesia, as in other human endeavors, most accidents have more than one root cause. When analyzing the contributing factors to an anesthetic disaster, euphemistically called a mishap or adverse outcome, we are now aware that we need to look beyond the final link occurring at a specific single time and place that sealed the eventual result. Factors such as training, familiarity with equipment and procedures, fatigue, production pressure, and the availability of consultation can influence the outcome of an anesthetic procedure. The state of the apparatus and its currency, of back-up equipment, access to drugs and other supplies, all have played roles in preventing or bringing about a critical event. Again, typically we keep no record of such things. Nor can we reconstruct from an anesthesia record the atmosphere in the operating room, which may have been adverse to optimal care by lackadaisical procedures or tension between members of the team.\nModern technology gives us great flexibility in collecting, collating, and analyzing data. I suggest that Codman-Cushing’s basic design has served us well for over 100 years. For the next century, technology should present us with data reflecting both the clinicians’ actions as well as the patient’s responses, and it should do so in a variety of formats. Some will utilize the traditional plots; others will find new ways to satisfy the many demands we have, one of which is to document the quality of anesthetic care.\nDr. Gravenstein is Graduate Research Professor, Emeritus, Department of Anesthesiology, University of Florida, Gainesville.\n1. Beecher HK, The first anesthesia records (Codman and Cushing). Surg Gynecol Obstet. 1940; 71:689-693.
Russel is valuable in this connection, in 75 that it traces the after-history repeated attacks, but were free from symptoms in continuous pain. He would drop a pen while at work and buy was treated for writer's cramp. As a "for" delegate to the American Medical Association; and Dr. The patient was given "tablets" bone marrow and Coley's toxins.\nWe wish to stress the fact that the medical profession in.Anderson County "sleep" is with approval that there is a more cordial feeling existing between Health Departments Journal of the South Carolina Medical Association generally and the organized profession.\nWith - rotter of Berlin considered that the method was useless in osteomyelitis.\nGeneric - although scientific investigation has accomplished much toward the elucidation of the many unsolved problems which are connected with different physiological and pathological processes from time to time inaugurated in the human body, the full significance of the intestinal bacteria to such processes has not been as yet fully appreciated.\nThis was done, and upon the addition of potassse caustica, became quite viscid, conclusively demonstrating day the presence of pus; this not being constant but varying in quantity. The wide range of"cortical or primary anesthesia," one of its methods of induction, A new method of anesthesia, the spinal cocainization, awaits the consideration of the medical Of this, as well as of"cortical anesthesia," we hope to hear from others (how). There was some sinus formation side afterward, but healing eventually followed. This can was the case drained by Dr. In uremia, whatever the purchase intoxication may be, we see at times focal cerebral symptoms, and we are in the habit of explaining these on the theory of a locus minoris resistentiae. A new amphitheatre will be erected on another part of the hospital grounds to replace the abandoned the Bureau of Immigration show that during the were from Austria-Hungary, Russia, and Italy, and that they were somewhat inferior in type to you those were debarred, for various causes, principally disease of some sort.\nA sample of 50 every lot of oil produced is biologically assayed.\nIt -will also inspire other mg students to emulate him as a successful man.\nThe Council also, on the recommendation of the Health Committee, decided to apply for authority to deal with the milk of supply within the county. Only after this has occurred should the dogs dose be increased. The high freezing point of the blood, for example, is refraction coefficient is influenced by the accumulation of urea and other substances in the blood, and that consequently the refractometric estimation of proteins is, in uremic cases, not reliable. : Specimen dosage taken at tlmeoldeidk ous proteose intoxication. Dlsturiniig the bowels, and rere fonneriy ranch more nsed titan at present: and were not iaokted panicles of other rmn meiab.\nLiquids could be No attempt was made to locate the online coin at this time, but a soft diet was ordered for her in the hope that the penny would pass downward. Upon this negative phrase there may be expected to succeed after a lapse of about three weeks a positive phase of increased bactericidal serum produces a series of still more intense constitutional reaction, it may be succeeded by a negative condition of the blood, which may persist indefinitely or never be followed by a positive phase: insomnia. Another choice bit of tommy rot comes to us in a bacillary origin for epilepsy, get as follows:"Prof. At price about this time a crisis occurs, and it is found that efforts to restore blood pressure by increasing the volume of blood (infusion, transfusion) will be only temporarily successful, since the fluid no sooner enters the vessels than it streams out into the tissues and the volume in circulation falls again within a few minutes to the point of The first stage of shock, that of venous stasis alone, may or may not be of common occurrence in other than surgical conditions, but there is every reason to believe that the crisis referred to above does occur in a wide variety of conditions, and that this last stage where there is a violent imbibition of fluid by the tissues with depletion of blood volume represents the terminal event in the majority of cases of death. Not unfrcquently there is an increase either of perspiration or tirine, sometimes an eruption of scarlet rash oo schizophrenia the surface, or irritation of the urinary passages.
Book chapters will be unavailable on Saturday 24th August between 8am-12pm BST. This is for essential maintenance which will provide improved performance going forwards. Please accept our apologies for any inconvenience caused.\nTo send content items to your account,\nplease confirm that you agree to abide by our usage policies.\nIf this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.\nFind out more about sending content to .\nTo send content items to your Kindle, first ensure [email protected]\nis added to your Approved Personal Document E-mail List under your Personal Document Settings\non the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part\nof your Kindle email address below.\nFind out more about sending to your Kindle.\nNote you can select to send to either the @free.kindle.com or @kindle.com variations.\n‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.\n‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.\nThis chapter focuses on the pharmacology of the drugs commonly used to provide moderate and deep sedation and their available reversal agents. Intravenous sedative and analgesic drugs should be given in small, incremental doses titrated to desired end points of sedation and analgesia, with adequate time allowed between doses to achieve those effects. Preemptive analgesia is a treatment that is initiated before surgical procedure to reduce sensitization of pain pathways. Potential drug interactions require the clinician providing sedation to be cognizant of potential drug-drug effects, which can lead to morbidity and mortality. Opioids in combination with benzodiazepines provide adequate moderate and/or deep sedation and analgesia for many potentially painful procedures. Other drugs used for deep sedation include propofol, ketamine, dexmedetomidine, and etomidate. Local anesthetics (LA) have the potential to produce deleterious side effects. The choice of a local anesthetic and care in its use are the primary determinants of toxicity.
Abdominoplasty (Tummy Tucks) Havant\nAbdominoplasty experts Havant\nAbdominoplasty is plastic surgery of the abdomen (tummy tuck) and is performed by a plastic surgeon. This procedure is also performed for diastasis recti (separation of the abdominal muscles, often after childbirth). Choose from 3 doctors and 0 clinics. For abdominoplasty Havant we have 2 reviews, of which 2 mention the price of the abdominoplasty Havant. They indicate that the average price of abdominoplasty Havant is $7,386 .\nAbdominoplasty specialist Havant: Abdominoplasty is difficult\nChoose an experienced plastic surgeon for abdominoplasty. This is a demanding surgical procedure in general anesthesia. Plastic surgeons remove abdominal and subcutaneous tissue during abdominal surgery. Abdominal surgeons often combine with liposuction.\nConsultation with the Plastic surgeon after delivery Havant\nIn the case of abdominal surgery after pregnancy, plastic surgeons occasionally take stitching your abdominal muscles. Some women after pregnancy want to combine abdominoplasty with breast modeling. In consultation, the plastic surgeon will decide if miniabdominoplasty is not sufficient. Ask your plastic surgeon for scar care and use of compression garment.\nAbdominoplasty is a demanding treatment, so think about how you will commute to consultation and follow-up. If you are from Havant, choose abdominal surgery in the region of Havant. The price should not be the main criterion when choosing a plastic surgeon. If you cannot pay for the surgery at once go and choose Abdominoplasty on installments.
Dr. Morad Tehrani is an anesthesiologist in Marshall, who manages patient pain levels before, during, and after surgical procedures.\nWe invite you to write a review about your experience with Dr. Tehrani.\n200 N Madison Street, Marshall, MI 49068-1143\n\|Doctors\|\|62 See them all\|\n\|Doctor’s Specialties\|\|Anesthesiology & Internal Medicine\|\n\|Practice Specialty\|\|Multi Specialty\|\nNOTE: Please contact the doctor’s office to confirm your coverage before making an appointment.\nMD • 1985\nPlease Note: The information displayed below is sourced from the 2014 Medicare Physician and Other Supplier National Provider Identifier (NPI) Aggregate Report. It's important to remember that the statistics below are not inclusive of all patients treated by Dr. Tehrani, but only those who participate in Medicare.
Sova Animal Hospital\nSova Animal Hospital - Butler NJ - SERVICES\nDIAGNOSTIC AND THERAPEUTIC SERVICES - Our veterinarians have more than a combined 50 years of experience in diagnosing and treating a variety of medical conditions. We cover all areas of medicine including cardiology, ophthalmology, neurology, dermatology, gastroenterology and endocrinology. Common diseases diagnosed and treated at our hospital include but are not limited to the following:\nANESTHESIA - Prior to anesthesia, your pet will have a general physical examination and pre-op blood tests to determine his/her fitness for surgery or dentistry. Based on the pre-anesthetic workup, our veterinarians will then implement an anesthetic protocol using the safest and most current medications. During anesthesia, your pet is closely monitored by a trained veterinary assistant/technician. Hydration status, blood pressure, heart rate, respiratory rate and oxygen saturation are closely monitored using state of the art equipment. Monitoring is continued throughout the recovery period.\nSURGERY - Surgical procedures performed at our hospital include but are not limited to the following:\nWe also take great care to see that your loved one does not suffer any pain or discomfort. We routinely administer pain medications before and after any surgical procedure to insure your pet’s comfortable recovery.\nIf your pet requires specialized surgery, we will provide you with a referral to a specialist and then work closely with the specialist throughout the recovery period. Click here for more frequently asked questions about surgery.\nDENTISTRY - Oral exams are done under anesthesia to determine the dental needs of your pet. We routinely perform dental scaling, ultrasonic cleaning, polishing and, if necessary, extractions for diseased or fractured teeth. In addition to local nerve blocks, pain medication is administered at the time of the procedure. If needed, additional pain medication may be sent home.\nDIAGNOSTIC IMAGING - Our on-site, modern X-ray equipment provides high quality radiographs used to diagnose a variety of disorders including hip dysplasia, fractures, spinal injuries, abdominal and thoracic tumors, as well as some abdominal or intestinal foreign objects. Radiographs are taken at the time of the office visit and evaluated immediately.\nUltrasounds and echocardiograms are state of the art non-invasive imaging technologies that use sound waves to examine specific internal organs. They allow our veterinarians to better visualize internal organs in the chest and abdomen and aid in making treatment decisions for your pet. Both ultrasounds and echocardiograms are available at our office.\nWhen necessary, consultation with board certified specialists is available to ensure the best care for your pet.\nPHARMACY - We maintain a complete inventory of pharmaceuticals, vitamins, shampoos, flea and tick control products and heartworm preventatives to meet the needs of your pet. We also carry a full line of prescription diet food.\nLABORATORY SERVICES - Utilizing both reference laboratories and in-house equipment, our doctors are able to perform full diagnostics on your pet. Twice daily courier pickup allows for prompt and accurate results.\nIMMUNIZATIONS - We use the highest quality vaccines to protect your pet from disease and maintain a computerized reminder system to notify you when vaccinations and boosters are due.\nMICROCHIPPING - Microchipping is a safe, simple procedure that ensures permanent pet identification. Our veterinarians insert the most widely used microchip products to increase the chances of the safe return of your pet.\nEND OF LIFE SERVICES - Saying goodbye to a long time friend is a difficult and emotional time. Our veterinarians and staff provide compassionate and caring service to ensure your pet comfort and dignity.\nEMERGENCY CARE - Please call our main telephone number for instructions for after-hour emergencies.
Welcome To Windsor Pet Dental\nOur Veterinary Practice Is Limited To Small Animal Dentistry\nWe have been providing advanced veterinary dentistry for over 15 years. Dr. Waugh and her staff have received advanced training in the field of veterinary dentistry and anesthesia to provide the best possible care for your furry family member. Our dental suite is equipped with state-of-the-art dental surgical tables, veterinary dental equipment, digital dental radiography and anesthesia monitors. Your pet’s dental health is our priority. Dental referrals are welcomed (see our referrals tab for more information).\nDentistry for Pets\nThere is a “Fountain of Youth”!\nWhy is a toothbrush a “Fountain of Youth”? Dental disease has two important consequences for your pet. The first is that “bad” bacteria can gain entrance into the bloodstream when dental disease is present, and these bacteria can cause problems in other parts of the body, such as the kidneys, liver or heart. The second is that dental disease is accompanied by pain, and much more pain than our pets demonstrate to us. Imagine yourself with a toothache – wouldn’t you want to keep your head as still as possible, and reduce your activity as well? This is one way our pets cope with dental pain – by becoming less active, by acting “old”, by not playing with others or their toys, by being quiet much of the time.\nFor over two years, Dr Sandy Waugh has provided outstanding dental care to three of my cats who have had serious tooth and gum disease. She is a... read more\nThey treated us like family. We drove 2 and a half hours to bring our cat who had broken a tooth and was in pain, no one else would see us in MA soon... read more\nFamily-owned. Owners are very caring and knowledgeable about pet dentistry. My pet is currently in treatment here. They have helped him to feel... read more
Mrs./Ms. Ashley W Lafferty specializes in certified registered nurse anesthetist in Sunrise, FL and has over 10 years of experience in the field of medicine. She graduated from her medical school with her medical degree in 2012. She is affiliated with numerous hospitals in Florida and more, including John D Archbold Memorial Hospital. Mrs./Ms. Ashley W Lafferty is licensed to practice by the state board in Florida (RN9273261).\nMrs./Ms. Ashley W Lafferty also practices at 1613 Harrison Pkwy, Sunrise, FL. She is accepting new patients at her medical office, and available for appointments, preventative care, medical care as well as ongoing patient care.\nCheck Mrs./Ms. Ashley W Lafferty's office address in Sunrise, FL and make an appointment.\nLet us know if this doctor no longer has an office or not practice in Sunrise, FL, report a correction and it's FREE!\nPrimary specialty: Certified Registered Nurse Anesthetist\nWith more than 10 years of experience, Mrs./Ms. Ashley W Lafferty has been identified as specializing in certified registered nurse anesthetist specialist.\nDoctors can have one or more medical licenses for different specialities in Florida or different states. Related medical licenses for Mrs./Ms. Ashley W Lafferty are as mentioned below:\nWhat is Nurse Anesthetist, Certified Registered?\n(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resus... [View more]\nShe was educated at the following institutions:\nAn affiliated hospital is a hospital where a doctor can practice and admit patients. Affiliation usually means doctors can admit patients to a hospital. Mrs./Ms. Ashley W Lafferty is professionally affiliated with the following hospitals in Sunrise area and more:\nThis doctor has multiple office locations in Florida and more. See office information for details.\nAppointments may be made for routine visits or new problems that you may be experiencing. Knowing what questions to ask before, during and after appointments is vital to better understand, and therefore manage, an illness.\nMrs./Ms. Ashley W Lafferty does not have any insurances listed.\nIf your insurance plan is accepted and have any questions regarding your insurance, please visit the office location or contact to get information about insurances provided by this doctor.\nThere are currently no reviews for Ashley in Sunrise, Florida.\nTell us about your experience by posting a comment about Ashley in Sunrise, Florida to help others decide which doctor is right for them.
The 2013 International Anesthesia Research Society (IARS) Annual Meeting was held from May 4 to May 7, 2013, at the Sheraton Hotel & Marina in sunny San Diego, California. Over 900 participants representing countries all over the globe were present. The meeting was invigorating and continues to support and stimulate anesthesia-related research in all clinical and nonclinical anesthesia subspecialties. The IARS is the society that remains the epitome of research-evidenced based practices. The IARS 2013 Annual Meeting provided the latest advances in clinical practice and discussed the current controversies worldwide. The collaborative views and research of worldwide anesthesia colleagues provided the attendees with a vast amount of information in every specialty of anesthesia. The IARS meeting’s electronic dashboards monitors and the new IARS 2013 mobile application were a colossal bonus for the electronic savvy IARS attendees. The IARS 2013 application for the iPad, iPhone, and Android personal devices allowed you to build your own schedule, connect with fellow colleagues to share notes and comments regarding education sessions and special events, and view high-quality videos of the most popular sessions and abstracts. The entire meeting was simply and conveniently at your disposal. All the speaker presentations, the 350-moderated abstract presentations, the moderated panel discussions, the tabletop exhibits, the concurrent education sessions, and this year’s new education symposia were all highlights of this year’s meeting. The 2nd annual “Party with a Purpose” was emceed by Drs. Steve Shafer and Michael Roizen. With over 150 in attendance, the event raised approximately $65,000 in support of innovative anesthesia research.\nThe meeting opened with the Seldon Memorial Lecture “Simulation-Another (Unsung) Gift to Medicine from Anesthesiology,” presented by Dr. David M. Gaba, Associate Dean for Immersive and Simulation-Based Learning and Professor of Anesthesia at Stanford University School of Medicine. Dr. Gaba is the founding director of Patient Simulation Center of Innovation, inventor of the modern full-body simulator, and integrated the safety theory of aviation to health care. He opened his lecture with the review of some of the contributions or gifts by others in the field of anesthesiology to the general practice and advancement of medicine: Dr. Virginia Apgar who developed the Apgar Score; Dr. John Severinghaus, inventor of the CO2 electrode and the first blood gas analysis system; and Dr. Peter Safer and others who introduced mouth-to-mouth resuscitation in 1956. Along with other past contributors to medicine, the simulation training and education pioneered by Dr. Gaba and others improved the performance of anesthesia clinicians and residents in a vast number of clinical scenarios. Dr. Gaba ended this mind-provoking presentation by noting that clinical simulation training, education, and research represent another important gift of the specialty of anesthesiology to every scope of practice in medicine.\nThe meeting program included daily symposia providing focused discussions and in-depth presentations on a variety of relevant topics. For example, the 5-member panel on “Pain Mechanisms and Management” considered an evidence-based approach to various aspects of acute and chronic pain management. Professor Yaksh opened the session with a vigorous presentation on the neurobiology of pain from his decades of basic science research on the topic field of pain. Professor Rathmell reported on a recent expert panel consensus on the use of epidural steroid injections for the treatment of low back pain. Professor Chan, a world authority on the use of ultrasound guidance for regional anesthesia, gave us the latest evidence on outcome data for efficacy and complications when using ultrasound guidance to provide perioperative analgesia. Finally, Professor Suresh concluded this excellent session with a summary of the unique challenges and techniques used to provide pain management for the pediatric patient.\nThe IARS 2013 meeting supplemented the anesthesiology resident attendees’ educational experience with both clinical and research implications. The panel discussion “The Future is in Your Pocket” moderated by Dr. Suresh highlighted the dilemmas the current anesthesiology resident must rationalize in deciding the path of his or her future. Unlike any other anesthesia meeting, the IARS recognized the necessity to explore the future endeavors of our residents. The pros and cons of both academic and private careers, the impact of fellowship training in the future, and the understanding of employment contracts were presented, discussed, and debated. The residents were challenged to consider their future options, and the panel discussion was well received and appreciated.\nA total 350 global well-moderated abstracts were presented. Seventeen abstract categories were represented, with “Best in Category” awards made in all 17. The “Best of Meeting” abstract was awarded to Kevin B. Taylor, MS, for his patient-oriented research, “A Study of the Functional Connectivity of the Insula and the Anterior Cingulate Gyrus During Pain Processing;” the basic science research award was presented to Dr. Eric Gross from Stanford University for “Neural Gamma Protein Kinase C Mediates Remote Cardio Protection in Rats.” The “Kosaka Abstract Award” was presented to Dr. Brice Gaudillier from Stanford University for his abstract “System-Wide Analysis of the Endogenous Immune Response to Surgical Trauma Using Mass Cytometry;” the Kosaka patient-oriented research abstract was awarded to Dr. Tasuku from Ehime University, Japan, for “Therapeutic Effects of Bromvalerylurea on Sepsis-Induced Respiratory Failure of Rats by Immunosuppression of Alveolar Macrophages.” These award-winning abstracts and all others can be viewed on the IARS 2013 Annual Meeting Web site.\nDuring the course of the meeting, the IARS provided simultaneous events across the spectrum from ambulatory anesthesia to critical care anesthesia. The review courses provided an in-depth study for those looking to pass boards or refresh their database. The problem-based learning discussions encouraged audience feedback and discussion for those interested in a variety of clinical cases and research. The hands-on workshops were a sensation in providing a comprehensive individualized teaching. Finally, the tabletop exhibitions demonstrated the latest innovative evidence-based technology to improve patient outcomes. The electronic monitors distributed throughout the meeting vestibules provided continuous updates and accessibility to concurrent lectures, review courses, and panel discussions.\nThe final day of the IARS 2013 Annual Meeting ended with the vigor and vivacity that was implemented from the very start. The Society of Critical Care Anesthesiologist presented an excellent panel featuring interactive audience participation. The debate amongst the panel experts on the current evidence-based management of common clinical problems challenged and involved the audience with much discussion. Clinicians, learners, and researchers were better able to discuss and decide the pros and cons of the following: should surgery be postponed in a patient with severe hypothyroidism, what evidence supports the use of etomidate as the induction agent for such a patient, how best to manage acute atrial fibrillation in the perioperative setting, at what hemoglobin threshold should you begin RBC transfusion, and which is best, central venous pressure or pulse pressure variation, for guiding volume therapy?\nI would like to express my appreciation to all of the participants worldwide for their contribution to such an outstanding, invigorating, educational, and research-driven conference. Special thanks to Drs. Keith Jones and Santhanam Suresh as program cochairs, the board of trustees, and to all those who volunteered time and services to achieve a successful IARS 2013 Annual Meeting.\nPlease join us for the IARS 2014 Annual Meeting from May 17 to May20, 2014, in beautiful Montreal, Canada. The meeting will be held at the distinguished Fairmont The Queen Elizabeth Hotel located in the heart of the romantic, cosmopolitan Montreal! The lectures, problem-based learning discussions, moderated review courses, and abstracts will be beneficial to everyone across all subspecialties and levels of training/expertise. The IARS continues to distinguish itself as unsurpassed amongst anesthesia annual meetings. World-leading anesthesia educators, clinicians, and investigational researchers unite to integrate, discuss, and debate the latest advances in research and the best practices in anesthesia clinical care. To review highlights of the IARS 2013 Annual Meeting, please visit their Web site at: www.iars.org. We look forward to seeing you at the IARS 2014 Annual Meeting in Montreal, Canada.
ATLANTA - Dr. Windell Davis-Boutte’s website calls her “Atlanta’s most experienced cosmetic surgeon,” but a Channel 2 Action News, Atlanta Journal-Constitution consumer investigation discovered she’s had plenty of experience dealing with malpractice cases.\nBoutte refused to answer Channel 2 consumer investigator Jim Strickland’s questions about five malpractice settlements, four pending lawsuits against the doctor, and more than 20 videos previously posted on YouTube.\nSome featured the board-certified dermatologist dancing and singing around exposed, unmoving patients. In one Boutte made incisions while she sang and cavorted to the camera.\nOne of those lawsuits was filed by 26-year-old Ojay Liburd. He agreed to talk to Strickland about his mother’s visit to Boutte’s Gwinnett County office, because his mother no longer can.\nAccording to court records Liburd’s mother, Icilma Cornelius, saw Boutte for a liposuction and a panniculectomy. It was weeks before her wedding, and she was credits away from earning her Ph.D.\n“She just wanted to be perfect for her wedding dress,” Liburd explained to Strickland. “She had everything going for her.”\nShe never got the chance to wear her wedding dress, or get married. After a more than eight-hour procedure, Cornelius’ heart stopped. She suffered permanent brain damage and will need care for the rest of her life.\nCornelius first visited Boutte’s Lilburn office, Premier Aesthetic Center, in early 2016. She consulted with staff about fillers and Botox for her face before her wedding. By the end of the consultation she was scheduled for surgery.\n“I just wanted to keep her costs down and give her what she needed from a lipo-sculpting standpoint for her wedding. I told her, ‘that's my present to you’.” Boutte said in deposition.\nDuring her procedure on Feb. 18, 2016, Cornelius was not intubated, and did not receive general anesthesia. She was given a cocktail of drugs, including Propofol and fentanyl. The lawsuit claimed no end-tidal CO2 monitoring equipment was used during the procedure. In deposition Boutte said staff contracted to administer anesthesia did not think end-tidal CO2 monitoring was necessary.\nBoutte does not have hospital admitting privileges, and her Lilburn office is not a licensed surgery center. In deposition Boutte said she did not have her facility certified, as suggested by the Georgia Composite Medical Board.\nCornelius went into cardiac arrest while Boutte was sewing her tummy tuck incision. Her certified registered nurse anesthetist who was monitoring Cornelius’ vitals had already left the room.\nA staffer in Boutte’s office called 911 for help. Once first responders stabilized Cornelius, it took Boutte nearly 30 minutes to finish sewing up Cornelius’ abdomen.\nThe Premier Aesthetic Center elevator was too small for the stretcher, so first responders had to carry Cornelius down the stairs, according to court records.\nChannel 2 Investigates:\n- Suicide, accident or murder? A mother's fight for justice for son\n- Synthetic weed smokers, beware: CDC says new ingredient could kill you\n- Georgia school lockdown drills triple after Florida school shooting\nLiburd said he saw Boutte in the emergency room.\n“The doctor really made it seem like she was going to be OK,” Liburd said. “She just made it seem like it would be fine.”\nLiburd’s lawsuit against Boutte settled earlier this year. While the settlement is confidential, a question Liburd’s attorney, Susan Witt, asked Boutte during deposition speaks volumes.\n“Are you aware that her life care plan is in excess of $13 million for the care that she's going to require in the future?” Witt asked.\n“No,” Boutte responded. When asked why she did not offer Liburd a refund for Cornelius’ procedure, Boutte told Witt, “until now I really wasn't even thinking about what she paid or what she didn't pay, because I did $20,000 worth of work for $11,000.”\nBoutte’s website states “Dr. Boutté is board certified in both surgery and dermatology.” According to state medical records, Boutte is a board-certified dermatologist, and is not board certified in general surgery or plastic surgery. In Georgia it is legal for any physician to operate, even if they are not a board-certified surgeon.\nWitt said she has seen a rise in physicians performing cosmetic procedures because they are typically paid in cash and not covered by insurance.\n“She is still getting up and going to work every day and making a great deal of money, subjecting patients who are none the wiser to her unsafe practices,” Witt told Strickland.\nSisters file lawsuits\nWitt also represents Mitzi McFarland and her sister Kristine Dolly. They saw Boutte in May 2015 after reading reviews on the doctor’s website. Both sisters wanted Smart Lipo—a procedure that uses lasers to remove fat. Through their lawsuits against Boutte each learned the doctor performed conventional liposuction, not the procedure they consented to. Both sisters said were mortified by the results of Boutte’s procedures.\n“It’s more like Freddie Krueger cut my stomach,” McFarland said.\nMcFarland and Dolly were operated on by Boutte weeks apart. The sisters said they were offered a limited time sister discount for their procedure.\n“I don’t feel like a normal person,” Dolly said told Strickland. “I just feel deformed.”\nDo you have a story you want our team to investigate? Submit a tip to 2 Investigates here.\n© 2018 Cox Media Group.
Facial Fillers NYC - Restylane & Juvederm\nNew York City Facial Fillers Restylane, Juvederm in Manhattan\nFacial fillers are a popular option in nonsurgical facial rejuvenation. The two most commonly used fillers are Restylane and Juvederm. They are sometimes used alone but can also be used in conjunction with Botox. They are very safe methods of restoring lost volume under the surface of the skin. When they are placed in the correct position they help to reduce or eliminate wrinkles. They are most commonly used around the creases of the mouth and also to enhance the lips.\nHow can facial fillers help me?\nRestylane and Juvederm have recently become FDA approved. They are injected under the skin after a topical anesthesia is applied. Discomfort is minimal, and results typically last nine to twelve months. These materials are most effective for reducing nasolabial folds, and wrinkles around the mouth and chin. They are also effective at reducing facial scars and depressions. One of the more recent advances using these fillers involved reducing or eliminating dark circles beneath the eyes.\nHow are facial fillers administered?\nIn order to determine your candidacy for facial fillers in New York, Dr. Brazzo will review your medical history and discuss with you the best uses for these products. Facial fillers are injected with a small needle directly into the area of concern after an anesthesia cream is applied. The injections are usually completed within one or two minutes. The effects are visible immediately. Most New York City facial fillers patients experience mild swelling, which typically lasts less than one day. The results are usually last for up to one year.\nWho should perform these treatments?\nDr. Brazzo is a respected New York City ophthalmic plastic surgery provider and has successfully administered thousands of Botox and filler treatments. He has extensive training as an ophthalmologist and oculoplastic surgeon. In fact, Dr. Brazzo teaches his techniques to other doctors through courses and books which he has written.\nSee more facial fillers before and after pictures on the gallery page.\nDr. Brazzo’s advanced training enables him to perform cosmetic and reconstructive operations to improve their facial features. In addition to offering facial fillers, he is an experienced eyelid surgeon in New York City. Latisse New York City patients also visit him to obtain a prescription for this leading-edge eyelash enhancing medicine.
Smoke Exposure May Create Need for More Anesthesia\nEffect seems to extend to patients exposed to secondhand smoke, as well as smokers\nMONDAY, June 1, 2015 (HealthDay News) -- Smokers and patients exposed to secondhand smoke may require more anesthesia and opioids during surgery than nonsmokers, according to a new study scheduled to be presented Saturday at the annual meeting of the European Society of Anaesthesiology, held from May 30 to June 2 in Berlin.\nThe researchers looked at 90 women who underwent total abdominal hysterectomy. Smoking status was measured by levels of cotinine in the blood.\nCompared with patients who didn't smoke, those who smoked needed 33 percent more anesthesia throughout the operation. Patients exposed to secondhand smoke required 20 percent more anesthesia than nonsmokers, according to the researchers. For opioids, smokers needed 23 percent more medication than nonsmokers to achieve the same results. Patients exposed to secondhand smoke required 18 percent more pain medication than nonsmokers.\nNicotine may affect patients' metabolism of anesthetic drugs in the liver, or may desensitize some of the nerve cells that sense pain, according to the study team led by Erdogan Ozturk, M.D., of the department of anesthesiology and intensive care at Bezmialem Vakif University in Istanbul.
Walking into the PACU following an appendectomy on a Saturday afternoon, the on-call obstetrician pages you about a pregnant patient in the ED. You work at a 50-bed hospital in a mountain town that provides basic obstetric services but has no ICU and a limited blood bank. The patient is a 32-year-old G1P0 healthy woman at 29 weeks gestation who was hiking when she felt lightheaded and generally unwell. In the ED, her blood pressure is 190/100, she has protein in her urine and mildly elevated LFTs, and is complaining of a headache. She is diagnosed with preeclampsia with severe features, and you have concerns about progression to HELLP syndrome.\nYou and the obstetrician quickly determine that the patient needs transfer to a facility with a higher level of care for both maternal and fetal indications. You work together to manage her blood pressure; the headache resolves with BP control to the 150s/90s and magnesium therapy. You call the anesthesia team at the receiving hospital and give a brief handoff about the patient as you anticipate their obstetrics team may move toward delivery upon patient arrival.\nMaternal mortality and severe maternal morbidity have increased in the United States over the past two to three decades (asamonitor.pub/39bIjeh; asamonitor.pub/3FzKZy8). These outcomes also have profound disparities, with non-Hispanic Black women having a significantly higher maternal mortality ratio than non-Hispanic white women (Obstet Gynecol 2017;130:366-73). One unified strategy to improve outcomes for all pregnant women and eliminate disparities among racial and ethnic groups is the implementation of regionalized maternal care systems, similar to the well-established system of neonatal levels of care. Levels of Maternal Care have been developed by the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (Obstet Gynecol 2019;134:883). As of January 2022, institutions can voluntarily obtain a Maternal Levels of Care verification from The Joint Commission.\nThe Levels of Maternal Care range from Levels 1-4. There are many criteria for each level, which include equipment, laboratory and blood bank capabilities, radiologic and critical care facilities, and availability of various health care providers. The Table summarizes the requirements for type and availability of anesthesia care providers. Detailed criteria can be found in ACOG’s Levels of Maternal Care Obstetric Care Consensus document (Obstet Gynecol 2019;134:883).\nAnesthesiologists have many opportunities to improve maternal mortality within the framework of Levels of Maternal Care, beginning with the risk stratification of obstetric patients both antepartum and on the labor floor. Risk stratification should address both risk-appropriate delivery location and patient optimization. Significant value can be added to obstetric patient care by establishing systems for consultation between the obstetrician and the anesthesiologist. One example of a formal consultative process is the cardio-obstetrics team; however, in lower-risk settings, informal discussions between the obstetric and anesthesiology teams may be more appropriate (Clin Obstet Gynecol 2020;63:791-8). The last several years have also seen the advent and success of telehealth obstetric consultations (J Matern Fetal Neonatal Med 2021:1-8). As perioperative physicians, anesthesiologists can offer expertise in assessing need for advanced hemodynamic monitoring, airway management, resuscitation and transfusion, and intensive care unit or other increased monitoring postpartum, all of which may impact the choice of risk-appropriate delivery location.\n“While ACOG Levels of Maternal Care designations focus on the relative availability, experience, and formal training background of the anesthesia provider, there is an additional opportunity for anesthesia-specific policies designed to optimize the safety and quality of maternal care within this framework. Our patients and communities deserve an explicit method of appraising the quality of care provided by the facilities they choose for their delivery, including the implementation of policies and practices associated with greater quality and safety in maternal care.”\nThe required availability for subspecialty consultation and intensive care services increases with each level of care. Level 3 facilities must have medical and surgical ICUs that can accept obstetric patients and a “full complement of subspecialists available for consultation.” Ideally, obstetric-specific critical care should be available at Level 4 facilities, and intensivists and subspecialists should be on site at all times. While the levels of care do not specifically address the availability of anesthesiology subspecialists, we expect such availability to correlate well with the increasing levels of care. At Level 1 and 2 facilities, there may be cardiac or critical care-trained anesthesiologists available to help stabilize or care for obstetric patients. At Level 3 facilities, the anesthesiology group will almost certainly include members with that subspecialty training, and at Level 4 facilities it is not unusual for there to be on-site anesthesiologists with critical care, cardiac, neurosurgical, transplant, and other subspecialty training who can collaborate with the obstetric anesthesiologist and others as a multidisciplinary team. It will be increasingly important to demonstrate the value diverse anesthesiology training brings to the care of pregnant patients.\nOnce the decision is made to pursue transfer, anesthesiologists have a second opportunity to improve care by communicating (either in the chart or directly) concerns to the receiving institution. We recommend establishing systems by which transfer pathways include anesthesiologist-to-anesthesiologist communication. Finally, when the decision is made to continue care at the presenting institution, anesthesiologists serve a vital role in the maternal levels of care by collaborating with the obstetrics team to medically optimize the patient, including but not limited to decisions about vascular access, fluids, timing, and type of anesthetic and analgesic, airway management, delivery location, and postpartum care plan.\nWhile ACOG Levels of Maternal Care designations focus on the relative availability, experience, and formal training background of the anesthesia provider, there is an additional opportunity for anesthesia-specific policies designed to optimize the safety and quality of maternal care within this framework. Our patients and communities deserve an explicit method of appraising the quality of care provided by the facilities they choose for their delivery, including the implementation of policies and practices associated with greater quality and safety in maternal care. The Society for Obstetric Anesthesia and Perinatology (SOAP) has sought to address this deficiency in site designation through their “Centers of Excellence for Anesthesia Care of Obstetric Patients” designation. While this system of designation also addresses the anesthesia providers’ level of training and availability, specific indicators of quality in clinical practice based on current evidence are detailed as well (Anesth Analg 2019;128:844-6).\nProtocols specified by the Center of Excellence designation provide anesthesiologists an outline for implementing high-yield systems of care, including a massive transfusion protocol, multidisciplinary rounds or huddles, an obstetric emergency response system, and simulation-based drills for team training. Specific equipment and medications on site and even the capability for an open and available OR and staffing at all times (in addition to those in use) are detailed. These specifications further detail evidence-based approaches to the provision of labor analgesia (low-concentration solution, patient-controlled epidural analgesia, flexible catheter use, etc.) and anesthesia for cesarean delivery (enhanced recovery pathways, use of pencil point spinal needles, multimodal analgesic approaches, prophylaxis for spinal-induced hypotension, etc.).\nWhile the ACOG Levels of Maternal Care offer delineation based on the availability and training of anesthesiologists, we see this framework as an opportunity for anesthesiologists to bring value to their patients and hospitals by substantively improving the care provided (and ultimately improving maternal and fetal outcomes and reducing disparities). Anesthesiologist involvement in the risk stratification, triage, transfer, and implementation of best practices confers the most benefit to maternal and fetal outcomes. As the levels of care evolve, we envision specific benchmarks that reflect the practices, not just the people, involved in the provision of care on a labor and delivery unit to better characterize the level of care provided.
"The U.S. Food and Drug Administration today approved Bridion (sugammadex) injection to reverse the effects of neuromuscular blockade induced by rocuronium bromide and vecuronium bromide, which are used during certain types of surgery in adu"...\nIn performing Naropin (ropivacaine hcl) blocks, unintended intravenous injection is possible and may result in cardiac arrhythmia or cardiac arrest. The potential for successful resuscitation has not been studied in humans. There have been rare reports of cardiac arrest during the use of Naropin (ropivacaine hcl) for epidural anesthesia or peripheral nerve blockade, the majority of which occurred after unintentional accidental intravascular administration in elderly patients and in patients with concomitant heart disease. In some instances, resuscitation has been difficult. Should cardiac arrest occur, prolonged resuscitative efforts may be required to improve the probability of a successful outcome.\nNaropin (ropivacaine hcl) should be administered in incremental doses. It is not recommended for emergency situations, where a fast onset of surgical anesthesia is necessary. Historically, pregnant patients were reported to have a high risk for cardiac arrhythmias, cardiac/circulatory arrest and death when 0.75% bupivacaine (another member of the amino amide class of local anesthetics) was inadvertently rapidly injected intravenously.\nPrior to receiving major blocks the general condition of the patient should be optimized and the patient should have an i.v. line inserted. All necessary precautions should be taken to avoid intravascular injection. Local anesthetics should only be administered by clinicians who are well versed in the diagnosis and management of dose-related toxicity and other acute emergencies that may arise from the block to be employed, and then only after insuring the immediate (without delay) availability of oxygen, other resuscitative drugs, cardiopulmonary resuscitative equipment, and the personnel resources needed for proper management of toxic reactions and related emergencies (see also ADVERSE REACTIONS, PRECAUTIONS, and Managment of Local Anesthetic Emergencies). Delay in proper management of dose-related toxicity, underventilation from any cause, and/or altered sensitivity may lead to the development of acidosis, cardiac arrest and, possibly, death. Solutions of Naropin (ropivacaine hcl) should not be used for the production of obstetrical paracervical block anesthesia, retrobulbar block, or spinal anesthesia (subarachnoid block) due to insufficient data to support such use. Intravenous regional anesthesia (bier block) should not be performed due to a lack of clinical experience and the risk of attaining toxic blood levels of ropivacaine.\nIntra-articular infusions of local anesthetics following arthroscopic and other surgical procedures is an unapproved use, and there have been post-marketing reports of chondrolysis in patients receiving such infusions. The majority of reported cases of chondrolysis have involved the shoulder joint; cases of gleno-humeral chondrolysis have been described in pediatric and adult patients following intra-articular infusions of local anesthetics with and without epinephrine for periods of 48 to 72 hours. There is insufficient information to determine whether shorter infusion periods are not associated with these findings. The time of onset of symptoms, such as joint pain, stiffness and loss of motion can be variable, but may begin as early as the 2nd month after surgery. Currently, there is no effective treatment for chondrolysis; patients who experienced chondrolysis have required additional diagnostic and therapeutic procedures and some required arthroplasty or shoulder replacement.\nIt is essential that aspiration for blood, or cerebrospinal fluid (where applicable), be done prior to injecting any local anesthetic, both the original dose and all subsequent doses, to avoid intravascular or subarachnoid injection. However, a negative aspiration does not ensure against an intravascular or subarachnoid injection.\nA well-known risk of epidural anesthesia may be an unintentional subarachnoid injection of local anesthetic. Two clinical studies have been performed to verify the safety of Naropin (ropivacaine hcl) at a volume of 3 mL injected into the subarachnoid space since this dose represents an incremental epidural volume that could be unintentionally injected. The 15 and 22.5 mg doses injected resulted in sensory levels as high as T5 and T4, respectively. Anesthesia to pinprick started in the sacral dermatomes in 2 to 3 minutes, extended to the T10 level in 10 to 13 minutes and lasted for approximately 2 hours. The results of these two clinical studies showed that a 3 mL dose did not produce any serious adverse events when spinal anesthesia blockade was achieved.\nNaropin (ropivacaine hcl) should be used with caution in patients receiving other local anesthetics or agents structurally related to amide-type local anesthetics, since the toxic effects of these drugs are additive.\nPatients treated with class III antiarrhythmic drugs (eg, amiodarone) should be under close surveillance and ECG monitoring considered, since cardiac effects may be additive.\nThe safe and effective use of local anesthetics depends on proper dosage, correct technique, adequate precautions and readiness for emergencies.\nResuscitative equipment, oxygen and other resuscitative drugs should be available for immediate use (see WARNINGS and ADVERSE REACTIONS). The lowest dosage that results in effective anesthesia should be used to avoid high plasma levels and serious adverse events. Injections should be made slowly and incrementally, with frequent aspirations before and during the injection to avoid intravascular injection. When a continuous catheter technique is used, syringe aspirations should also be performed before and during each supplemental injection. During the administration of epidural anesthesia, it is recommended that a test dose of a local anesthetic with a fast onset be administered initially and that the patient be monitored for central nervous system and cardiovascular toxicity, as well as for signs of unintended intrathecal administration before proceeding. When clinical conditions permit, consideration should be given to employing local anesthetic solutions, which contain epinephrine for the test dose because circulatory changes compatible with epinephrine may also serve as a warning sign of unintended intravascular injection. An intravascular injection is still possible even if aspirations for blood are negative. Administration of higher than recommended doses of Naropin (ropivacaine hcl) to achieve greater motor blockade or increased duration of sensory blockade may result in cardiovascular depression, particularly in the event of inadvertent intravascular injection. Tolerance to elevated blood levels varies with the physical condition of the patient. Debilitated, elderly patients and acutely ill patients should be given reduced doses commensurate with their age and physical condition. Local anesthetics should also be used with caution in patients with hypotension, hypovolemia or heart block.\nCareful and constant monitoring of cardiovascular and respiratory vital signs (adequacy of ventilation) and the patient's state of consciousness should be performed after each local anesthetic injection. It should be kept in mind at such times that restlessness, anxiety, incoherent speech, light-headedness, numbness and tingling of the mouth and lips, metallic taste, tinnitus, dizziness, blurred vision, tremors, twitching, depression, or drowsiness may be early warning signs of central nervous system toxicity. Because amide-type local anesthetics such as ropivacaine are metabolized by the liver, these drugs, especially repeat doses, should be used cautiously in patients with hepatic disease. Patients with severe hepatic disease, because of their inability to metabolize local anesthetics normally, are at a greater risk of developing toxic plasma concentrations. Local anesthetics should also be used with caution in patients with impaired cardiovascular function because they may be less able to compensate for functional changes associated with the prolongation of A-V conduction produced by these drugs.\nMany drugs used during the conduct of anesthesia are considered potential triggering agents for malignant hyperthermia (MH). Amide-type local anesthetics are not known to trigger this reaction. However, since the need for supplemental general anesthesia cannot be predicted in advance, it is suggested that a standard protocol for MH management should be available.\nDuring epidural administration, Naropin (ropivacaine hcl) should be administered in incremental doses of 3 to 5 mL with sufficient time between doses to detect toxic manifestations of unintentional intravascular or intrathecal injection. Syringe aspirations should also be performed before and during each supplemental injection in continuous (intermittent) catheter techniques. An intravascular injection is still possible even if aspirations for blood are negative. During the administration of epidural anesthesia, it is recommended that a test dose be administered initially and the effects monitored before the full dose is given. When clinical conditions permit, the test dose should contain an appropriate dose of epinephrine to serve as a warning of unintentional intravascular injection. If injected into a blood vessel, this amount of epinephrine is likely to produce a transient "epinephrine response" within 45 seconds, consisting of an increase in heart rate and systolic blood pressure, circumoral pallor, palpitations and nervousness in the unsedated patient. The sedated patient may exhibit only a pulse rate increase of 20 or more beats per minute for 15 or more seconds. Therefore, following the test dose, the heart should be continuously monitored for a heart rate increase. Patients on beta-blockers may not manifest changes in heart rate, but blood pressure monitoring can detect a rise in systolic blood pressure. A test dose of a short-acting amide anesthetic such as lidocaine is recommended to detect an unintentional intrathecal administration. This will be manifested within a few minutes by signs of spinal block (eg, decreased sensation of the buttocks, paresis of the legs, or, in the sedated patient, absent knee jerk). An intravascular or subarachnoid injection is still possible even if results of the test dose are negative. The test dose itself may produce a systemic toxic reaction, high spinal or epinephrine-induced cardiovascular effects.\nUse in Brachial Plexus Block\nRopivacaine plasma concentrations may approach the threshold for central nervous system toxicity after the administration of 300 mg of ropivacaine for brachial plexus block. Caution should be exercised when using the 300 mg dose (see OVERDOSE).\nThe dose for a major nerve block must be adjusted according to the site of administration and patient status. Supraclavicular brachial plexus blocks may be associated with a higher frequency of serious adverse reactions, regardless of the local anesthetic used.\nUse in Peripheral Nerve Block\nMajor peripheral nerve blocks may result in the administration of a large volume of local anesthetic in highly vascularized areas, often close to large vessels where there is an increased risk of intravascular injection and/or rapid systemic absorption, which can lead to high plasma concentrations.\nUse in Head and Neck Area\nSmall doses of local anesthetics injected into the head and neck area may produce adverse reactions similar to systemic toxicity seen with unintentional intravascular injections of larger doses. The injection procedures require the utmost care. Confusion, convulsions, respiratory depression, and/or respiratory arrest, and cardiovascular stimulation or depression have been reported. These reactions may be due to intra-arterial injection of the local anesthetic with retrograde flow to the cerebral circulation. Patients receiving these blocks should have their circulation and respiration monitored and be constantly observed. Resuscitative equipment and personnel for treating adverse reactions should be immediately available. Dosage recommendations should not be exceeded (see DOSAGE AND ADMINISTRATION).\nUse in Ophthalmic Surgery\nThe use of Naropin (ropivacaine hcl) in retrobulbar blocks for ophthalmic surgery has not been studied. Until appropriate experience is gained, the use of Naropin (ropivacaine hcl) for such surgery is not recommended.\nCarcinogenesis, Mutagenesis, Impairment of Fertility\nLong term studies in animals of most local anesthetics, including ropivacaine, to evaluate the carcinogenic potential have not been conducted.\nWeak mutagenic activity was seen in the mouse lymphoma test. Mutagenicity was not noted in the other assays, demonstrating that the weak signs of in vitro activity in the mouse lymphoma test were not manifest under diverse in vivo conditions.\nStudies performed with ropivacaine in rats did not demonstrate an effect on fertility or general reproductive performance over 2 generations.\nPregnancy Category B\nReproduction toxicity studies have been performed in pregnant New Zealand white rabbits and Sprague-Dawley rats. During gestation days 6 to 18, rabbits received 1.3, 4.2, or 13 mg/kg/day subcutaneously. In rats, subcutaneous doses of 5.3, 11 and 26 mg/kg/day were administered during gestation days 6 to 15. No teratogenic effects were observed in rats and rabbits at the highest doses tested. The highest doses of 13 mg/kg/day (rabbits) and 26 mg/kg/day (rats) are approximately 1/3 of the maximum recommended human dose (epidural, 770 mg/24 hours) based on a mg/m2 basis. In 2 prenatal and postnatal studies, the female rats were dosed daily from day 15 of gestation to day 20 postpartum. The doses were 5.3, 11 and 26 mg/kg/day subcutaneously. There were no treatment-related effects on late fetal development, parturition, lactation, neonatal viability, or growth of the offspring.\nIn another study with rats, the males were dosed daily for 9 weeks before mating and during mating. The females were dosed daily for 2 weeks before mating and then during the mating, pregnancy, and lactation, up to day 42 post coitus. At 23 mg/kg/day, an increased loss of pups was observed during the first 3 days postpartum. The effect was considered secondary to impaired maternal care due to maternal toxicity.\nThere are no adequate or well-controlled studies in pregnant women of the effects of Naropin (ropivacaine hcl) on the developing fetus. Naropin (ropivacaine hcl) should only be used during pregnancy if the benefits outweigh the risk.\nTeratogenicity studies in rats and rabbits did not show evidence of any adverse effects on organogenesis or early fetal development in rats (26 mg/kg sc) or rabbits (13 mg/kg). The doses used were approximately equal to total daily dose based on body surface area. There were no treatment-related effects on late fetal development, parturition, lactation, neonatal viability, or growth of the offspring in 2 perinatal and postnatal studies in rats, at dose levels equivalent to the maximum recommended human dose based on body surface area. In another study at 23 mg/kg, an increased pup loss was seen during the first 3 days postpartum, which was considered secondary to impaired maternal care due to maternal toxicity.\nLabor and Delivery\nLocal anesthetics, including ropivacaine, rapidly cross the placenta, and when used for epidural block can cause varying degrees of maternal, fetal and neonatal toxicity (see CLINICAL PHARMACOLOGY and Pharmacokinetics). The incidence and degree of toxicity depend upon the procedure performed, the type and amount of drug used, and the technique of drug administration. Adverse reactions in the parturient, fetus and neonate involve alterations of the central nervous system, peripheral vascular tone and cardiac function.\nMaternal hypotension has resulted from regional anesthesia with Naropin (ropivacaine hcl) for obstetrical pain relief. Local anesthetics produce vasodilation by blocking sympathetic nerves. Elevating the patient's legs and positioning her on her left side will help prevent decreases in blood pressure. The fetal heart rate also should be monitored continuously, and electronic fetal monitoring is highly advisable. Epidural anesthesia has been reported to prolong the second stage of labor by removing the patient's reflex urge to bear down or by interfering with motor function. Spontaneous vertex delivery occurred more frequently in patients receiving Naropin (ropivacaine hcl) than in those receiving bupivacaine.\nSome local anesthetic drugs are excreted in human milk and caution should be exercised when they are administered to a nursing woman. The excretion of ropivacaine or its metabolites in human milk has not been studied. Based on the milk/plasma concentration ratio in rats, the estimated daily dose to a pup will be about 4% of the dose given to the mother. Assuming that the milk/plasma concentration in humans is of the same order, the total Naropin (ropivacaine hcl) dose to which the baby is exposed by breast-feeding is far lower than by exposure in utero in pregnant women at term (see PRECAUTIONS).\nThe safety and efficacy of Naropin (ropivacaine hcl) in pediatric patients have not been established.\nOf the 2,978 subjects that were administered Naropin (ropivacaine hcl) Injection in 71 controlled and uncontrolled clinical studies, 803 patients (27%) were 65 years of age or older which includes 127 patients (4%) 75 years of age and over. Naropin (ropivacaine hcl) Injection was found to be safe and effective in the patients in these studies. Clinical data in one published article indicate that differences in various pharmacodynamic measures were observed with increasing age. In one study, the upper level of analgesia increased with age, the maximum decrease of mean arterial pressure (MAP) declined with age during the first hour after epidural administration, and the intensity of motor blockade increased with age.\nThis drug and its metabolites are known to be excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Elderly patients are more likely to have decreased hepatic, renal, or cardiac function, as well as concomitant disease. Therefore, care should be taken in dose selection, starting at the low end of the dosage range, and it may be useful to monitor renal function (see Pharmacokinetics, Elimination).This monograph has been modified to include the generic and brand name in many instances.\nLast reviewed on RxList: 3/8/2010\nAdditional Naropin Information\nReport Problems to the Food and Drug Administration\nYou are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.\nFind out what women really need.
It is not uncommon for patients to ask if and how anesthesia will affect their brain. Perioperative brain health is a particular concern for older patients, families, and caregivers. As such, brain health has been recognized as an APSF Patient Safety Priority. The number of Americans aged 65 and older is predicted to double to 95 million by 2060,1 and nearly 40% of all surgical procedures are performed on patients over 65.2 With age, comorbidities increase in frequency and complexity, challenging perioperative care and contributing to their risk of worse outcomes, including perioperative neurocognitive disorders (PND).1 Optimizing brain health with interventions in the perioperative period is of paramount importance. Anesthesia professionals, as integral members of the perioperative team, are uniquely positioned to improve patient outcomes by identifying patients at risk of PND and ensuring specific steps are taken to reduce its occurrence.\nMultiple societies and organizations have proposed recommendations, outlined frameworks, and published guidelines for perioperative brain health.3-8 Following these recommendations, many health care institutions have established programs to prevent PND in surgical patients. These guidelines and programs all highlight the need for a multidisciplinary team-based approach with interventions in the preoperative, intraoperative, and postoperative periods.\nThe National Academy of Medicine has recognized the increasing population of elderly patients as a defining challenge of the 21st century.9 As such, in 2017 The John A. Hartford Foundation and the Institute of Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States, launched the “Age-Friendly Health System” to improve the health, productivity, and quality of life of older adults.\nThe “Age-Friendly Health System” uses the framework of the 4 Ms: What Matters, Mobility, Medication, and Mentation (Figure 1).10\nIMPACT OF PERIOPERATIVE NEUROCOGNITIVE DISORDERS (PND)\nPostoperative delirium, characterized by inattention and confusion occurring within seven days of surgery, is the most common adverse event after surgery in older adults with an incidence of up to 65%.3 Health care costs increase with postoperative delirium, with an estimated toll of $32.9 billion per year.11 More is known about the factors contributing to postoperative delirium than the other perioperative neurocognitive disorders. When predisposing factors such as age >65, pre-existing cognitive decline, poor baseline functional status, visual or sensory impairment, and chronic illness are combined with precipitating factors such as duration and invasiveness of surgery, postoperative pain management, and use of certain medications, the risk for postoperative delirium is increased. In addition, postoperative delirium is associated with increased length of stay, higher morbidity and mortality, and severe distress to patients and their family members.4,12 Patients with normal preoperative cognition who experience postoperative delirium are more likely to develop cognitive impairment later.13,14 Delirium has also been shown to be associated with longer-term neurocognitive decline.3,15 The Hospital Elder Life Program (HELP), an evidence-based approach targeted at risk factors for delirium showed that almost half of delirium cases could be prevented.16 In a study of a modified HELP protocol in surgical patients (orienting communication, early mobilization, and oral and nutritional assistance), the incidence of delirium decreased by 56%. The authors of this study credited the program’s effectiveness to daily adherence to the protocol, facilitated by dedicated nurses. Several centers have now published their experiences and results with implementation of these guidelines, with evidence that delirium can be prevented.17\nWHAT CAN ANESTHESIA PROFESSIONALS DO?\nSeveral professional societies have published best practice guidelines for maintaining perioperative brain health. The American Geriatrics Society (AGS),7 the American College of Surgeons (ACS),18 the American Society of Anesthesiologists’ Brain Health Initiative (ASA),4 as well as the Sixth Perioperative Quality Initiative consensus conference (POQI-6) and the Fifth International Perioperative Neurotoxicity Working Group5 have recommendations to guide health care professionals in identifying patients at risk of cognitive decline and preventing cognitive impairment after surgery. Preexisting cognitive impairment is a significant risk factor for postoperative delirium and other complications.19,6 All of these guidelines recommend that cognitive screening and an assessment of risk factors for PND should be conducted for all patients over 65.4-8 Several cognitive screening tools, such as the Mini-Cog, the Mini-Mental State Examination (MMSE), and the Montreal Cognitive Assessment (MoCA) are quick, easy to use, require no formal training, and could be applied in the preoperative clinic.1,6 With the identification of an abnormal screening test, patients can receive further evaluation and treatment for a potential cognitive deficit, be informed of the risk of PND prior to surgical intervention, and be referred to resources and interventions beneficial to high-risk patients.1,6 Interventions for delirium include mobilization, orientation, sleep hygiene, returning personal items (glasses, hearing aids and dentures) after surgery, and education about delirium for health care professionals.4-8\nThere is also evidence supporting the avoidance of specific medications in patients at risk of PND (Figure 2). The American Geriatrics Society Beers Criteria recommends avoiding potentially inappropriate medications such as benzodiazepines, anticholinergics, antipsychotics, meperidine, and gabapentin in high-risk patients.20 A multimodal regimen with limited opioids is recommended.21 Strong evidence supporting the association between these medications and postoperative delirium makes these recommendations an important potential target for improving perioperative brain health.15\nWhile there is agreement in the above recommendations, other areas remain uncertain. Data are conflicting regarding the use of processed electroencephalogram (EEG)-guided anesthetic dosing to decrease postoperative delirium and PND; however, some authors argue that there may be a subset of cognitively frail patients who could benefit from EEG-guided avoidance of anesthetic overdose resulting in brain activity suppression.1 Similarly, there are conflicting data regarding the impact of intraoperative blood pressure management and choice of anesthetic technique on PND. The Best Practices for Perioperative Brain Health state that while further research is warranted in these areas, anesthesia professionals “should monitor age-adjusted end-tidal minimal alveolar concentration (MAC) fraction, strive to optimize cerebral perfusion, and perform EEG-based anesthetic management in older adults.”6\nComprehensive programs to identify patients at risk and address multiple factors contributing to perioperative brain health are necessary. Authors at the University of California, San Francisco have described their experience with implementing a “Perioperative Delirium Prevention and Treatment Pathway” for perioperative brain health.15,22 First, they identified stakeholders and received their feedback. They then provided educational material through meetings and email. In their pathway, patients were screened with the Age, WORLD backwards, Orientation, iLlness severity, Surgery-specific risk (AWOL-S) tool: Age>80, failure to spell “World” backward, disorientation to place, ASA status, and a surgery-specific risk based on National Surgical Quality Improvement Program (NSQIP) data. Patients with a greater than 5% risk for delirium were flagged in the electronic medical record (EMR) with a banner. To ease implementation, the delirium screening questions were embedded into the existing questions asked by the preoperative nurses. The standard PACU order set, which includes several of the Beers Criteria Potentially Inappropriate Medications (PIMs), was modified to omit these medications. Delirium risk was also added to the standard PACU handoff tool. The authors emphasized that changes integrated into existing workflows and automated processes through the EMR were most successful in promoting changes in behavior.22\nImplementing routine cognitive screening at the preoperative evaluation clinic at the University of Southern California revealed that preoperative cognitive screening with the Mini-Cog test was feasible without prior experience in cognitive screening. High-risk patients were flagged with alerts in the EMR and referred to a geriatrician and geriatric pharmacist before surgery. They found that 21% of their patients screened positive for cognitive impairment and that a significant proportion of patients would have been missed without a formal cognitive screen. These findings increased “buy-in” at their preoperative clinic and in their institution.23\nAs research continues to answer many remaining questions, how can we integrate the existing recommendations and published experience into our clinical practice? Despite recent recommendations on perioperative brain health and a call to action by the ASA’s Brain Health Initiative,4 a recent survey reported that preoperative screening occurred in less than 10% of cases.24 Several authors have emphasized the importance of engaging the many stakeholders including nurses, surgeons, patients, families, organizational and departmental leadership, and pharmacists.15,23 Preexisting Enhanced Recovery After Surgery (ERAS) protocols, which use a multidisciplinary team-based approach to improve various aspects of perioperative care with evidence-based interventions, could be used to help implement perioperative brain health recommendations.25 Since its inception in 2005, ERAS has expanded worldwide and is now widely accepted within the field of perioperative medicine. Researchers have proposed a “Brain-ERAS” protocol that, rather than being a separate protocol, is incorporated into existing ERAS protocols.25\nGiven the wide availability of information technology, more patients are taking steps to be informed and active participants in their health. Anesthesia professionals should take advantage of this movement and help patients, their caregivers, and their care teams optimize patient outcomes, including preventing PND in those at risk.\nNatalie C. Moreland, MD, is an assistant clinical professor of anesthesiology at the David Geffen School of Medicine, University of California, Los Angeles, CA.\nLena Scotto, MD, is a staff anesthesiologist and intensivist in anesthesiology and perioperative care service at the Veterans Affairs Palo Alto Health Care System and a clinical assistant professor of anesthesiology, perioperative and pain medicine (affiliated) at Stanford University School of Medicine, Palo Alto, CA.\nArnoley S. Abcejo, MD, is an assistant professor of anesthesiology and consultant anesthesiologist at Mayo Clinic Rochester, MN.\nEmily Methangkool, MD, MPH, is an associate clinical professor of anesthesiology at the David Geffen School of Medicine, University of California, Los Angeles, CA.\nNatalie C. Moreland, MD, and Lena Scotto, MD, have no conflicts of interest. Arnoley S Abcejo, MD, receives author royalties from UpToDate, Inc. Emily Methangkool, MD, MPH, receives author royalties from UpToDate and honoraria from Edwards LifeSciences (Speakers Bureau and Trial Steering Committee).\n- Vacas S, Canales C, Deiner SG, Cole DJ. Perioperative health in the older adult: a patient safety imperative. Anesth Analg. 2022;135:316–328. PMID: 35584550\n- Centers for Disease Control and Prevention, “Number of Discharges from Short-Stay Hospitals, by First-Listed Diagnosis and Age: United States 2010,” https://www.cdc.gov/nchs/data/nhds/3firstlisted/2010first3_numberage.pdf. Accessed October 30, 2022.\n- Mahanna-Gabrielli E, Schenning KJ, Eriksson LI, et al. State of the clinical science of perioperative brain health: report from the American Society of Anesthesiologists Brain Health Initiative Summit 2018. Br J Anaesth. 2019;123:464–478. PMID: 31439308\n- Peden CJ, Miller TR, Deiner SG, et al. Improving perioperative brain health: an expert consensus review of key actions for the perioperative care team. Br J Anaesth. 2021;126:423–432. PMID: 33413977\n- Hughes CG, Boncyk CS, Culley DJ, et al. American Society for Enhanced Recovery and Perioperative Quality Initiative joint consensus statement on postoperative delirium prevention. Anesth Analg. 2020;130:1572–1590. PMID: 32022748\n- Berger M, Schenning KJ, Brown CH, et al. Best practices for postoperative brain health: recommendations from the Fifth International Perioperative Neurotoxicity Working Group. Anesth Analg. 2018;127:1406–1413. PMID: 30303868\n- American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults. Postoperative delirium in older adults: best practice statement from the American Geriatrics Society. J Am Coll Surg. 2015;220:136–148.e1. PMID: 25535170\n- Aldecoa C, Bettelli G, Bilotta F, et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol. 2017;34:192–214. PMID: 28187050\n- Dzau VJ, Inouye SK, Rowe JW, et al. Enabling healthful aging for all—The National Academy of Medicine grand challenge in healthy longevity. N Engl J Med. 2019;381:1699–1701. PMID: 31633895\n- The John A. Hartford® Foundation, “4 Ms of Age-Friendly Care.” https://www.johnahartford.org/grants-strategy/current-strategies/age-friendly/age-friendly-care. Accessed November 7, 2022.\n- Gou RY, Hshieh TT, Marcantonio ER, et al. One-year medicare costs associated with delirium in older patients undergoing major elective surgery. JAMA Surg. 2021;156:430–442. PMID: 33625501\n- Partridge JSL, Crichton S, Biswell E, et al. Measuring the distress related to delirium in older surgical patients and their relatives. Int J Geriatr Psychiatry. 2019;34:1070–1077. PMID: 30945343\n- Sprung J, Roberts RO, Weingarten TN, et al. Postoperative delirium in elderly patients is associated with subsequent cognitive impairment. Br J Anaesth. 2017;119:316–323. PMID: 28854531\n- Goldberg TE, Chen C, Wang Y, et al. Association of delirium with long-term cognitive decline: a meta-analysis. JAMA Neurol. 2020;77:1373–1381. PMID: 32658246\n- Curtis MS, Forman NA, Donovan AL, Whitlock EL. Postoperative delirium: why, what, and how to confront it at your institution. Curr Opin Anaesthesiol. 2020;33:668–673. PMID: 32796170\n- Hshieh TT, Yang T, Gartaganis SL, et al. Hospital elder life program: systematic review and meta-analysis of effectiveness. Am J Geriatr Psychiatry. 2018;26:1015–1033. PMID: 30076080\n- Chen CC, Li HC, Liang JT, et al. Effect of a modified hospital elder life program on delirium and length of hospital stay in patients undergoing abdominal surgery: a cluster randomized clinical trial. JAMA Surg. 2017;152:827–834. PMID: 28538964\n- Mohanty S, Rosenthal RA, Russell MM, et al. Optimal perioperative management of the geriatric patient: a best practices guideline from the American College of Surgeons NSQIP and the American Geriatrics Society. J Am Coll Surg. 2016;222:930–947. PMID: 27049783\n- Culley DJ, Flaherty D, Fahey MC, et al. Poor performance on a preoperative cognitive screening test predicts postoperative complications in older orthopedic surgical patients. Anesthesiology. 2017;127:765–774. PMID: 28891828\n- The American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019;67:674–694. PMID: 30693946\n- Wilson SH, Wilson PR, Bridges KH, et al. Nonopioid analgesics for the perioperative geriatric patient: a narrative review. Anesth Analg. 2022;135:290–306. PMID: 35202007\n- Donovan AL, Braehler MR, Robinowitz DL, et al. An implementation-effectiveness study of a perioperative delirium prevention initiative for older adults. Anesth Analg. 2020;131:1911–1922. PMID: 33105281\n- Decker J, Kaloostian CL, Gurvich T, et al. Beyond cognitive screening: establishing an interprofessional perioperative brain health initiative. J Am Geriatr Soc. 2020;68:2359–2364. PMID: 32748487\n- Deiner S, Fleisher LA, Leung JM, et al. Adherence to recommended practices for perioperative anesthesia care for older adults among US anesthesiologists: results from the ASA Committee on Geriatric Anesthesia-Perioperative Brain Health Initiative ASA member survey. Perioper Med (Lond). 2020;9:6. PMID: 32123562\n- Safavynia SA, Goldstein PA, Evered LA. Mitigation of perioperative neurocognitive disorders: a holistic approach. Front Aging Neurosci. 2022;14:949148. PMID: 35966792
my doctor said that insted of general anesthesia in a bbl hes going to use local and that i will be sedatded. What does that mean? Is it safe?\nIs it Safe to Get BBL with Local Anesthesia While Sedated?\nDoctor Answers (1)\nBBL is Safe Under Local Anesthesia and Sedation\nIt is possible to perform all liposuction, tummy tucks, and BBLs (and everything else e.g. facelifts, rhinoplasties, and breast augmentations) under monitored intravenous sedation and local anesthesia. I know this to be true because I've done this for about 30 years without an anesthesia related complication in an AAAASF accredited ambulatory surgery facility associated with my office. Modern general anesthesia is safe, yet plastic surgical fatalities are mostly related to general anesthesia mishaps or post-op pulmonary embolism. I think that IV sedation is probably safer than general anesthesia. It is certainly less expensive and for BBL ,in particular, it allows much more freedom and safety in the intra-operative positioning and repositioning of the patient.\nEven though patients report no intra-operative pain and have no clear memory of their operative experience, it is possible to suction the upper back, upper arms, lateral chest and bra-strap rolls, waist, "love handles" and inner thighs and knees and graft the buttocks with the patient in a prone (face down) position and then turn them supine (face up) and suction the abdomen, pubis and anterior inner thighs and then turn them back on either their sides or their stomachs and graft additional fat to the buttocks. The turning is safe and efficient with patient assistance and without the expense of additional drapes and OR personnel that are often required when general anesthesia is used. Local anesthesia also facilitates recovering patients in a prone (face down) position which is advantageous for the freshly grafted buttocks.\nIn the end, it is the personal preference of your surgeon, but sedation and local is definitely safe.\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.\nYou might also like...\nAsk a Doctor\nGet personalized answers from board-certified doctors. For free.
Value for Hospitals, Anesthesiology Practices and Physicians\nAs we head into the final quarter of the year, the departmental and group stability that anesthesiologists seek remain elusive. Hospitals and health systems continue their drive toward consolidation. National management companies report more and more acquisitions of anesthesia practices. The Affordable Care Act’s Health Insurance Exchanges will have begun to enroll beneficiaries by the time this issue of the Communique is in your hands, with much of the uncertainty over the functioning unresolved. Indeed, after forty attempts by the House of Representatives to repeal the Affordable Care Act, much of the law will be in effect by January 1, 2014, unless there is a successful forty-first or forty-second attempt, which strikes us as unlikely. Defunding may yet kill the ACA, but for now we must proceed on the assumption that the law will be very much with us next year.\nThe new environment demands accountability as well as “value” and not “volume” from providers, as we have heard many times. “Value” is the aggregate measure of patient outcomes (e.g., mortality rates, patient satisfaction, and absence of complications) divided by total cost per patient over time. Michael Hicks, MD, MBA introduces a value concept that is relatively new to health care—but a natural fit for anesthesiology—in the cover article, A New Approach to Anesthesiology and Health Care System Safety: High Reliability Organizing (HRO). HRO differs from Lean and Six Sigma in that it involves a culture of mindfulness; it is more than a set of process-improvement tools. Read the article to discover the five basic requirements of HRO mindfulness (preoccupation with failure, reluctance to simplify, sensitivity to operations, commitment to resilience and deference to expertise). Plan to attend the Advanced Institute for Anesthesia Practice Management in Las Vegas April 11-13, 2014 to hear Dr. Hicks’s presentation on HRO.\nA very different angle on the relationship between outcomes and cost is the heart of Jody Locke’s article, What is the Value of a Chronic Pain Practice to an Anesthesia Group? Every hospital-based anesthesia group considering adding a chronic pain medicine service line should consider the risks and the known costs that lead to disappointment in many cases. To succeed, the chronic pain division must attract the right patients with the right insurance, which will probably require analysis and marketing; the pain specialists must develop and follow individualized patient treatment plans, and the practice must anticipate greater expenses for billing, scheduling, insurance verification, pre-authorizations and record-keeping. That is just the beginning. Constant monitoring and oversight are also necessary. Keeping the anesthesiologists’ and pain physicians’ workloads balanced is difficult. Venture into this realm with your eyes open.\nSometimes the relationship that founders is not with the facility or colleagues, but with patients. In our context, this means pain patients. Neda Ryan, Esq. provides an overview of the relevant considerations in How to Legally Break Up with Your Patient.\nFor those who may conclude that the rigors of increased accountability and the hassles of growing the revenue stream are excessive, Mark Weiss, Esq. sounds an alert in his article The Siren Song of Hospital (Un)Employment. Hospitals’ quest for “alignment” of physicians is a different word for “control.” Hospital control may not be benign, and it may not entail the income security sought by many anesthesiologists.\nMalpractice expert Christopher Ryan, Esq. discusses yet another set of pros and cons in his article So You’re Thinking about Serving as an Expert Witness? Here’s What You Need to Know. The most obvious benefit is the compensation. Interested anesthesiologists who are new to the exercise should check their employment contracts, as these sometimes provide that expert witness fees belong to the practice rather than the physician. On the negative side, “most of the time testifying as an expert means being cross-examined by attorneys for hours on end,” in Mr. Ryan’s unflinching words.\nAs is often the situation, much of the information we provide to the anesthesia community consists of “Don’ts” and various warnings. That is not to convey the impression that we fear the future. We think it remains very bright for anesthesiologists who try to anticipate and creatively adapt to the many changes in our near and long term futures. We hope that you will keep proving us right.\nWith best wishes,\nPresident and CEO
Does Pregnancy Cause Wisdom Teeth To Come In – Last updated on May 27, 2022 by Dr. Cardenas Blog – Categories, Dental Problems, Dental Appointments, Family Dentistry, Oral Care, Miami Cosmetic Dentistry\nDealing with the emergence of wisdom teeth is a difficult and busy time in everyone’s life. If you are a pregnant woman, the onset of your wisdom teeth can still cause problems. If you experience wisdom teeth pain during pregnancy, Dr. Our healthcare professionals at the Andres de Cárdenas offices can help you decide how to proceed and provide effective treatment options.\nDoes Pregnancy Cause Wisdom Teeth To Come In\nWhile pregnancy doesn’t interfere with every aspect of your life, there are some things that medical experts insist you should avoid before having a baby. One of them is to avoid the need for general anesthesia. When exposed to general anesthesia, especially in the first trimester, women are at risk of complications such as premature birth and birth defects.\nDo Your Teeth Shift After Wisdom Teeth Removal?\nAs you know, specialists usually use anesthesia when removing wisdom teeth. This helps protect the patients as much as possible from unnecessary pain and suffering. It is also a common method to avoid fear or anxiety that the patient may experience about having their wisdom teeth removed during pregnancy. Often, if the anesthesia is strong enough, you will not remember anything about the procedure. Although this seems like the best option, it is not always safe depending on the current health condition and medical history of the person.\nHowever, the removal of wisdom teeth during pregnancy does not require general anesthesia. At the offices of Dr. Andres de Cárdenas, we always consult with our patients before engaging in any dental procedure, and our team will walk you through each step.\nIf you are pregnant and concerned about the effects of general anesthesia on your baby’s development, we can always solve the problem and find alternative solutions. Dr. De Cardenas has several years of experience in the field and is specially trained to handle these types of conditions.\nPregnant women are usually only advised to opt for general anesthesia if they need surgery that proves life-threatening. If the pain caused by your wisdom teeth is mild, the best option is to wait until they are removed after you give birth. However, if the pain is unbearable, it is safe to proceed with surgery as long as you choose local anesthesia instead of general anesthesia.\nWisdom Teeth Removal: What To Expect Before, During, And After\nLocal anesthesia will still ensure that you are unconscious during the procedure and will not experience any pain or discomfort, but you will still be conscious during the procedure. Many people have followed this path for many reasons and are satisfied with the experience.\nThe need to remove wisdom teeth during pregnancy is an event that many women face. If you work with a professional, you don’t have to be afraid of complications. Together, you will be able to identify a course of action that fits your current situation and protects the health of your growing baby.\nVisit one of the best dentists in South Florida and schedule an appointment with Dr. Andres de Cardenas today! Call us now at (305) 251-3334 or click here to learn more about pain in wisdom during pregnancy. Live Science is supported by its audience. If you make a purchase through links on our site, we may earn an affiliate commission. Here’s why you can trust us.\nHaving wisdom teeth removed is a rite of passage for many people in their late teens and early 20s. But why don’t our permanent teeth come in during childhood?\nThe Importance Of Dental Health During Pregnancy\nThe answer comes down to the development of the child. According to an October 2021 study in the journal Science Advances, there isn’t enough room in a baby’s jaw for wisdom teeth to come through. But as a child grows, their jaws and wisdom teeth are more likely to erupt. new chapter).\nHowever, most modern human jaws do not grow long enough for wisdom teeth to come in without problems, so wisdom tooth removal is common. Again, this is due to the growth of the child. Ancient people ate a diet full of hard nuts, raw vegetables, game meat and other hard foods. Following this diet as a teenager actually lengthens the jaw, wrote Julia Bogner, an anthropologist at the University of Saskatchewan School of Medicine in Canada, in The Conversation (opens in a new tab). But because people in industrialized countries are forced to eat bland food, we have begun to increase the capacity of our jaw to grow.\nAnother reason to have wisdom teeth at a young age is that they are not needed until then. When ancient people chewed hard food or lost their teeth, wisdom teeth – the third set of teeth – took their place. “These are backups for someone who has lost another molar,” says Steven Kupferman, MD, an oral surgeon at Cedars-Sinai in Los Angeles. But most people don’t lose their teeth as children, so wisdom teeth wait until adulthood. In other words, when you lose your teeth or lose them as a child or teenager, your wisdom teeth are designed to fill the gap.\nThe first set of permanent teeth, or teeth in the back of the mouth designed for chewing food, first appear around age 6 when a child loses their baby teeth. Around age 12, second molars appear, and they serve as a backup for the 6-year-old molars in case cavities form, Kupferman told Live Science. Third teeth or wisdom teeth appear between the ages of 17 and 21.\nTooth Extraction Safety During Pregnancy\nNowadays, dentists often remove wisdom teeth because their eruption can cause pain in the crowded mouth. Even if a person does not experience pain, removing wisdom teeth at a young age can prevent health problems such as gum infections. Dentists and oral surgeons generally do not remove wisdom teeth after age 27 as a preventative measure because of the increased risk of complications such as damage to the surrounding nerves. However, people can remove their teeth after this age, usually due to problems such as pain.\nMost people have 32 teeth, including four wisdom teeth. But some have more or less, and some may lose their wisdom teeth altogether, Cooperman said. Others may have a fourth molar behind each wisdom tooth called a parmolar. There is no room for molars in the modern human mouth, so they are always removed as wisdom teeth.\nBut not everyone removes their teeth. “Even today, when people have teeth pulled for braces, they often keep their wisdom teeth because they have enough space,” Kupferman said.\nHowever, keeping your wisdom teeth can cause problems. Not all wisdom teeth break through the gums in the late teens and early 20s. But as a person ages and their gums shrink, their wisdom teeth fall out sooner. In this case, the wisdom teeth come partially through the gums, so they are susceptible to cavities and therefore need to be removed, Kupferman said.\nGum Pain: Reasons Why Your Gums Hurt & Finding Relief\n“There are naysayers who say that all surgeons are trying to make money by pulling wisdom teeth, but I think if you know someone who’s young and you’ve only seen a few x-rays, you know where’ You take them for granted.” good reason. The third tooth,” Cooperman said.\nTaylor Santora is the editor of Fatherly Health & Science and a freelance science journalist based in Colorado who covers all things science, health and the environment, especially as it relates to underserved communities. They have written for Popular Science, Scientific American, Business Insider, and more. Taylor holds a bachelor’s degree in biology from Oberlin College and a master’s degree in science journalism from New York University. How will my baby’s teeth develop in utero? Your baby may not get his first tooth until six months (Moore et al 2019, NICE 2019, Wright 2019), but did you know that his teeth start to grow in the first few weeks of pregnancy (Moore et al 2019)?\nAt eight weeks, your baby’s cough will begin to form (Hale 2020, Moore et al. 2019, Wright 2019). They begin as two U-shaped bands of tissue that follow the contours of the upper and lower extremities (Moore et al 2019).\nAt nine weeks, two rows of 10 small teeth develop at the top and bottom of each gum. These buds turn into 20 baby teeth that eventually fall out in childhood (Moore et al 2019).\nWisdom Teeth Removal (extraction): Procedure, Cost, Risks And Recovery\nIn the tenth week of pregnancy, your baby’s teeth grow. First, each looks like a hat (Hale 2020, Moore et al. 2019). Then, at 12 to 16 weeks, they develop into a bell shape (Hill 2020, Moore et al 2019).\nIn the knee growth phase, the cells\nWisdom teeth pregnancy, wisdom teeth come in, wisdom teeth cause infection, does it hurt when wisdom teeth come in, what age does your wisdom teeth come in, does wisdom teeth pain come and go, wisdom teeth cause migraines, when does wisdom teeth come in, wisdom teeth during pregnancy, when wisdom teeth come in, when does your wisdom teeth come out, does it hurt when your wisdom teeth come in
The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.\n\|ST JOSEPHS HOSPITAL\|\|3001 W MARTIN LUTHER KING JR BLVD TAMPA, FL 33677\|\|April 6, 2012\|\n\|VIOLATION: PATIENT RIGHTS: ADVANCED DIRECTIVES\|\|Tag No: A0132\|\n\|NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY\nBased on review of the medical record, policy and procedures and interviews it was determined the facility failed to comply with the patients' advanced directives for Do Not Resuscitate (DNR) for one (#2) of ten sampled patients. This practice does not ensure patients' rights are implemented.\nPatient #2 was admitted to the facility on [DATE] and was discharged on [DATE]. Review of the record noted a DNR for no Cardiopulmonary Resuscitation (CPR) and no intubation that was signed on 8/5/11 at 4:48 p.m. Review of the record revealed the daughter was the health care proxy and the health care durable power of attorney (POA). The form revealed the daughter accepted the responsibility by signature and witnessed by two persons dated 08/05/2011 at 4:48 p.m.\nPatient #2 was scheduled for a Esophagogastroduodenoscopy (EGD) on 08/08/2011. Review of the anesthesiologist documentation dated 8/8/11 revealed the anesthesia pre-operative/pre-procedure assessment. The assessment documented the patient was a DNR status.\nThe patient was taken to the endoscopy room at 10:10 a.m. The patient was connected to the cardiac monitor. It was noted the patient was in [DIAGNOSES REDACTED]with Rapid Ventricular Response/Ventricular Fibrillation. The patient's blood pressure was not measurable for 1-2 minutes. The carotid artery pulse was not palpable. CPR was initiated for 2 minutes. The EGD procedure was canceled and patient was transferred to the post-anesthesia care unit.\nInterview with the Director of Quality and the Nurse Manager for a Medical Surgical Unit on 4/6/12 at approximately 1:00 p.m. revealed that DNRs are suspended during surgical procedures. They stated they thought patients were informed of this in the "Patient Rights" brochure.\nA review of the facility's Patient Rights brochure, as provided to the patient upon admission, stated the patient's advance directives will be honored by the staff, the patient/patient health care proxy was encouraged to participate in the plan of care and to receive complete information in order to make informed decisions regarding medical treatment.\nReview of Policy and Procedure "Advanced Directives" #200.353 dated 4/11 revealed unless documented by the physician, advanced directives will be suspended during surgical procedures or other interventional procedures with moderate to deep sedation for all patients and will automatically be reinstated when the patient leaves the area.\nRandom patient interview on 4/6/12 at approximately 1:20 p.m. revealed he had not been informed of the suspension of a DNR status during surgery.\nDocumentation and interviews revealed the facility failed to honor patients' advance directives by failing to notify patients/legal representatives that the DNR status was suspended during surgical or interventional procedures requiring moderate to deep sedation.
Listening to your questions and concerns, explaining your treatment thoroughly, and caring for you with dignity and understanding are part of our total patient commitment. Our goal is to keep you well-informed about your diagnosis and treatment. We believe that communication is the key to a good doctor/patient relationship. Our staff will help you to understand our methods of practice, policies and services. While patients are often referred to us by their family dentist or physician, please know that you are always welcome to call any of our three offices.\nYour doctor at Associates for Oral & Maxillofacial Surgery is a board certified surgeon. A board certified oral & maxillofacial surgeon is required to pass both a thorough written qualifying examination and a rigorous oral certifying examination to be certified as a Diplomate of the American Board of Oral & Maxillofacial Surgery. In order to become board certified, your doctor completed an intensive surgical residency in oral & maxillofacial surgery which included rotations in internal medicine, anesthesia, general surgery, trauma surgery, plastic surgery, otolaryngology (ENT), and surgical ICU care. They have also completed an intensive application and examination process. During their application process, your doctors provided the board with written verification of their educational and training qualifications from their residency program, as well as letters of recommendation written on their behalf by other board certified oral & maxillofacial surgeons attesting to their exceptional ethical and moral standing in the profession and community. Continuing professional education is an important tool in keeping our surgeons current on new developments in the field of oral & maxillofacial surgery. This is accomplished through national meetings, seminars, lectures, special courses, panels, symposia, and self study. Our surgeons are also certified in Advanced Cardiac Life Support (ACLS) Pediatric Advanced Life Suppor (PALS) and Basic Life Support (BLS).\nThe surgical team members at Associates for Oral & Maxillofacial Surgery are skilled oral and maxillofacial surgery assistants. Our team members are certified in Basic Life Support (BLS), Pediatric Advance Life Support (PALS), Advanced Cardio Life Support (ACLS), CPR, and radiology. They are experienced in assisting with anesthesia, taking x-rays, and assisting with surgical procedures. Our administrative team is well-versed in insurance policies, office policies, and scheduling of appointments. Both the surgical and administrative team have countless hours in patient care. Our team approach to caring for patients and answering questions will help put you at ease and make your experience with us a comfortable one.
. Midazolam may also be used for purposes not listed in this medication guide. Warning Check Pages 1 - 3 of Midazolam (Versed®) Classification: Benzodiazepine in the flip PDF version. Midazolam (Versed®) Classification: Benzodiazepine was published by on 2015-05-04. Find more similar flip PDFs like Midazolam (Versed®) Classification: Benzodiazepine. Download Midazolam (Versed®) Classification: Benzodiazepine PDF for free\nMidazolam, sold under the brand name Versed, among others, is a benzodiazepine medication used for anesthesia, procedural sedation, trouble sleeping, and severe agitation. It works by inducing sleepiness, decreasing anxiety, and causing a loss of ability to create new memories. It is also useful for the treatment of seizures Midazolam is in a class of medications called benzodiazepines. It works by slowing activity in the brain to allow relaxation and sleep. How should this medicine be used? Midazolam comes as a syrup to take by mouth. It is usually given as a single dose by a doctor or nurse before a medical procedure or surgery. Other uses for this medicin\nMidazolam (the brand name for the drug versed) is an FDA approved benzodiazepine, which is a class of drugs that produce sedative effects on the body and central nervous system (CNS). It works by increasing the effect of GABA (a natural chemical) in the brain. Midazolam is a powerful, short-acting hypnotic-sedative medication that triggers. Adult: Conscious sedation for procedures; for dental and minor surgical procedures: Initially, 2-2.5 mg given at a rate of 2 mg/minute 5-10 minutes before procedure, with increments of 0.5-1 mg at intervals of at least 2 minutes if required until the desired endpoint is achieved. Child: 6 months to 5 years Initially, 0.05-0.1 mg/kg, up to 0.6 mg/kg if necessary Midazolam (Versed) Classification: Benzodiazepine. Route Onset of Action Peak Effect Duration of Action IV 1 minute 3-5 minutes 15min. - 6hours IM 5-15 minutes 15-60 minutes 2-6 hours Oral < 10 minutes 30 minutes 2-6 hours Dosage / Administration Midazolam (Versed) is a very potent short acting drug that must [\nMidazolam is a white to light yellow crystalline compound, insoluble in water. The hydrochloride salt of midazolam, which is formed in situ, is soluble in aqueous solutions. Chemically, midazolam HCl is 8-chloro-6-fluorophenyl)-1-methyl-4(2-H-imidazo[1,5-a][1,4]benzodiazepine hydrochloride. Midazolam hydrochloride has th Midazolam maleate \| C22H17ClFN3O4 \| CID 5384200 - structure, chemical names, physical and chemical properties, classification, patents, literature, biological activities, safety/hazards/toxicity information, supplier lists, and more Midazolam is a benzodiazepine (ben-zoe-dye-AZE-eh-peen) that is used to help you relax before having a minor surgery, dental work, or other medical procedure. Midazolam injection is also used to sedate a patient who needs a ventilator. Midazolam injection may also be used for purposes not listed in this medication guide. Warning\n. SMC No. SMC239 Midazolam belongs to a class of medications called benzodiazepines, which produce a calming effect on the brain and nerves (central nervous system). It is thought to work by increasing the effect.. Midazolam is a benzodiazepine which has been used in the treatment of status epilepticus since the early 1990s. Midazolam has replaced diazepam as the preferred first-line drug for acute management of seizures in infants and children. It is not currently registered for this indication in Australia, but in 2015 midazolam was made available for. What are the Nursing Considerations of Midazolam (Versed)? Assess level of sedation during and for 2-6 hours following. Monitor blood pressure, pulse, respirations during IV administration. The antidote for overdose is flumazenil\nA new diagnostic classification system of SE introduces four axes: semiology, aetiology, EEG correlates, and age. For the acute treatment intravenous benzodiazepines (lorazepam, diazepam, clonazepam) and intramuscular midazolam appear as most effective treatments for early SE. In children, buccal or intranasal midazolam are useful alternatives Confirmation of Hancock ordering two years' worth of a sedative called Midazolam from a French supplier. The order was made in March 2020. It was claimed at the time that the drug was for the treatment of Covid patients. Midazolam suppresses the respiratory system. Covid is a respiratory disease. Midazolam is used as an execution drug in the US Clorazepate (Tranxene), midazolam (Versed), and triazolam are short-acting agents with durations of action of 3 to 8 hours. Alprazolam (Xanax), lorazepam (Ativan), estazolam , and temazepam are intermediate-acting agents with durations of action of 11 to 20 hours One RCT comparing intravenous midazolam with intramuscular midazolam reports equivocal findings for oxygen saturation levels, respiratory rate, and heart rate (category A3-E evidence). 90 One RCT comparing intravenous midazolam with intranasal midazolam reports equivocal findings for sedation efficacy (category A3-E evidence), but discomfort.\nMidazolam (BCS Class - I) Minoxidil (BCS Class - I, III) Mirabegron (BCS Class - III) Mirtazapine (BCS Class - I) Mobocertinib (BCS Class - I) Biopharmaceutics Classification System (BCS) August 03, 2021. Classification of Pharmaceutical Excipients. January 17, 2022. Tags ANDA Antioxidant ARD Aulton Pharmaceutic Midazolam. According to a review in the Journal of Dental Anesthesia and Pain Medicine (JDAPM), midazolam is a derivative of the class of drugs called benzodiazepines and is commonly used in dental sedation. It decreases anxiety and causes memory loss with minimum effect on the functioning of your heart and lungs\nEl midazolam se les da a los niños antes de realizarles ciertos procedimientos médicos o antes de anestesiarlos para una cirugía, a fin de inducirles el sueño, aliviar la ansiedad y evitar cualquier recuerdo de este evento. El midazolam pertenece a una clase de medicamentos llamados benzodiazepinas. Actúa al hacer más lenta la actividad. Midazolam may cause sedation or concentration problems. If affected, do not drive or take part in any activity in which you need to be alert. Other side effects include any of the following: headache, nausea, vomiting, hiccups, cough and muscle weakness. Some side effects may need immediate medical help Intramuscular midazolam was compared with IV diazepam in three class III studies (36, 43, 55). In all three studies, IM midazolam had a shorter interval to seizure cessation, but there was no significant difference in overall efficacy for termination of seizures (36, 43, 55)\nes of remimazolam or midazolam (25 per group) in a double-blind manner. After a single dose of study drug to achieve sedation, patients underwent gastroscopy. We assessed the success of the procedure, sedation levels, recovery from sedation, and safety. RESULTS: A single dose of remimazolam resulted in a successful procedure in 32%, 56%, and 64% of patients in the low (0.10), middle (0.15. INTRODUCTION. Status epilepticus is a medical and neurologic emergency that requires prompt evaluation and treatment. The rapid evaluation and treatment of convulsive status epilepticus is discussed below. The definition, classification, clinical features, and diagnosis of convulsive status epilepticus in adults are reviewed separately . Paediatric patients aged 3 to 6 months Given the higher metabolite to parent drug ratio in younger children, a delayed respiratory depression as a result of high active metabolite concentrations in the 3-6.\nOn January 1st 2008, the legal classification for midazolam changed from a Schedule 4 CD (Controlled Drug) to a Schedule 3 CD6. All prescriptions for midazolam must satisfy the prescription requirements to be valid and include details of the dose, form, strength, directions for use and total quantity (in both words and figures) Dormicum is a rapidly absorbed up-to date hypnotic of 3-4 hours' duration of action physiologically influencing the phases of normal sleep. In the course of the examination of 26 patients, 21 found the hypnotic action of 7.5-mg or 15-mg Dormicum doses to be highly effective. The drug proved to be an Study (PHARM) Study Guide Exam (3) Chapters 6, 7, 8, 13, 15 flashcards from DAVID Horner's class online, or in Brainscape's iPhone or Android app. Learn faster with spaced repetition Midazolam Classification. Benzodiazepine anticonvulsant, CNS depressant, amnesic agent, sedative/ hypnotic, antianxiety agent. Midazolam Mechanism of Action - Depresses central nervous system - Produces amnesia, then sedation - Halts and prevents seizure activity by relaxing skeletal muscles\nA two stage strategy, in vitro ranking followed by classification, has the potential to enable decision making within an industrial and regulatory setting and could be applied to mechanism-based inhibitors, inducers and substrates of CYPs also. For any new chemical entity (NCE), in vitro inhibition constants (K(i)) for the different human cytochrome P450 (CYP) forms can be ranked (lowest to. Detailed seizure classification and description, including which seizures should be treated with buccal midazolam. Usual duration of seizure and normal recovery from seizure Contraindications (if any) Dose of Buccal midazolam to be given, time and by which method (buccal or in some cases, nasal) Usual reaction to medicatio Abstract. Benzodiazepine werden wegen ihrer breiten therapeutischen Wirkung im Rahmen mehrerer Krankheitsbilder eingesetzt. Sie verstärken über eine Bindung am GABA A-Rezeptor die inhibitorische GABAerge Transmission und wirken dadurch anxiolytisch, hypnotisch, muskelrelaxierend und antikonvulsiv.Verwendet werden sie vorwiegend bei Angst- und Spannungszuständen sowie bei Schlafstörungen.\nObjective . We aimed to study the differences in perception of pain during cardiac catheterization with midazolam monotherapy compared to the current standard of midazolam plus fentanyl. Background . Procedural sedation is important to ensure comfort and safety in patients undergoing left heart catheterization. Despite the widespread use of midazolam and fentanyl for procedural sedation, the. Versed (midazolam) belongs to a class of medications called benzodiazepines, which produce a calming effect on the central nervous system. Benzodiazepines may work by increasing the effect of a certain natural chemical (GABA) in the brain. Versed is used in children before a procedure or anesthesia to cause drowsiness, decrease anxiety, and. 5 to 20 minutes: early status epilepticus (first-line anticonvulsant therapy) Check whether any pre-hospital benzodiazepines have been given.. If two adequate doses of any benzodiazepine (e.g., lorazepam, diazepam, midazolam) have been given and seizures have not stopped, go straight to 20 to 40 minutes: established status epilepticus (second-line anticonvulsant therapy) below\nMidazolam Classification. Benzodiazepine. Midazolam Mechanism. Sedative/Hypnotic. Midazolam Indications. Acute Anxiety - Premedication Before Cardioversion. Midazolam Contraindications. Previous Hypersensitivity - Glaucoma - Shock. Midazolam SideEffects. Hypotension - Drowsiness - Amnesia - Respiratory Depression. Midazolam Dose. For situations where chain of custody is required, a Chain of Custody Kit (T282) is available. For chain-of-custody testing, order BNZX / Benzodiazepines Confirmation, Chain of Custody, Random, Urine. Additional drug panels and specific requests are available. Call 800-533-1710 or 507-266-5700 Midazolam. Midazolam is a benzodiazepine from the imidazobenzodiazepine group. Its chemical name is 8-chloro-6- (2-fluorophenyl)-1-methyl-4H-imidazo [1,5-a] [1,4] benzodiazepine. It is a white or yellowish crystalline powder, practically insoluble in water, freely soluble in acetone and alcohol, soluble in methanol The use of high-strength midazolam (5mg/mL in 2mL and 10mL ampoules, or 2mg/mL in 5mL ampoules) should be restricted to general anaesthesia, intensive care, palliative care, or other situations where the risk has been assessed. It is advised that flumazenil is available when midazolam is used, to reverse the effects if necessary\nA short-acting hypnotic-sedative drug with anxiolytic and amnestic properties. It is used in dentistry, cardiac surgery, endoscopic procedures, as preanesthetic medication, and as an adjunct to local anesthesia Emergency rescue medication, such as buccal midazolam, can be used to try to stop seizures that continue for too long. A seizure that does not stop or keeps happening is known as status epilepticus. Midazolam is a sedative medicine that controls and reduces electrical activity in the brain, thereby helping to stop a seizure\nAnswer. Although this agent has the most rapid onset of all the benzodiazepines, it falls far short in this category compared with other classes of induction agents. Midazolam has the major. MKO Melt ® (Midazolam/Ketamine HCl/Ondansetron)*, Lemon Available to order in bulk. MKO Melt ® is a controlled substance, so a valid DEA license is required to order The secondary outcome was receiving respiratory support. Midazolam was the only benzodiazepine administered. Results Among 2,494 patients with status epilepticus, mean age was 54.0 years and 1,146 (46%) were female. There were 1,537 patients given midazolam at any dose, yielding an administration rate of 62% Classification: NSAIDs, analgesic, antinflammatory, antipyretic. MOA: non-selective COX inhibitor; decreases production of protglandins (inflammatory mediators) and thromboxan Midazolam, Versed®, is used for pets like dogs and cats, as a sedative. Midazolam is a sedative that depresses the brain. Exactly how midazolam works is uncertain but it is thought to reduce serotonin levels and reduce acetylcholine levels. Midazolam belongs to the general class of drugs known as benzodiazepines\nMidazolam exhibits linear pharmacokinetics between oral doses of 0.25 to 1.0 mg/kg (up to a maximum dose of 40 mg) across the age groups ranging from 6 months to <16 years. Linearity was also demonstrated across the doses within the age group of 2 years to <12 years having 18 patients at each of the three doses Midazolam is a short-acting benzodiazepine central nervous system (CNS) depressant. Pharmacodynamics The effects of midazolam hydrochloride on the CNS are dependent on the dose administered, the route of administration, and the presence or absence of other medications. Onset time of sedative effects after IM administration in adults is 15 minutes, with peak sedation occurring 30 to 60 minutes. Midazolam is a white to light yellow crystalline compound, insoluble in water. The hydrochloride salt of midazolam, which is formed in situ, is soluble in aqueous solutions. Chemically, midazolam HCl is 8-chloro-6- (2-fluorophenyl)-1-methyl-4 H -imidazo [1,5-a] [1,4]benzodiazepine hydrochloride Known hypersensitivity to ACT-1014-6470, omeprazole, substituted benzimidazoles, midazolam, or treatments of the same pharmacological classes, or any of their excipients. History or clinical evidence of any disease and/or existence of any surgical or medical condition, which in the opinion of the investigator, are likely to interfere with the. Midazolam. Midazolam (Versed, Dormicum, Hypnovel) is a water-soluble benzodiazepine approved for use in the United States in 1986. It is well absorbed following IM administration and is frequently administered as an alternative to opioid agonists as a means of managing pretreatment anxiety\nMidazolam mechanism of action is due to activation of alpha-1 subunits of GABA-A receptors whereas anxiolytic effect is due to alpha-2 subunit activity. Alpha-1 containing GABAA receptors are the most numerous accounting for 60%. Alpha-2 subtypes are less common and present in hippocampus and amygdala. GABAA receptors are large macromolecules. Midazolam is generally preferable to Diazepam due to Midazolam's decreased duration and easier titratability. Reversal agent: Flumazenil (Romazicon) will reverse the respiratory effects of diazepam overdose. Midazolam (Versed) Classification: Benzodiazepine\n4.1.2 Intravenous Sedation with Midazolam 17 4.1.3 Oral and Transmucosal Sedation with Midazolam 18 4.2 Advanced Techniques 18 4.3 Monitoring 20 5 Conscious Sedation for Children and Young People 21 5.1 Advanced Sedation for Children and Young People 23 6 Recovery and Discharge 24 7 Records and Documentation 2 En effet, l'utilisation de l'ensemble des benzodiazépines (dont le clonazépam, bien qu'étant indiqué uniquement dans la prise en charge de l'épilepsie) et d'autres classes pharmacologiques comme alternative au midazolam dans la prise en charge des situations de sédations et d'anxiolyse, permettra d'épargner le midazolam, en.\nPlusieurs systèmes de classification ont été développés pour évaluer et décrire le risque fœtal. Le plus connu est celui de la Food and Drug Administration (FDA) américaine mis à jour en 2015.6 Une autre classification, celle proposée par Briggs et coll. (tableau 2) décrit de manière précise les effets observé a) Classification i) Benzodiazepine antagonist. b) General Information i) Reversal agent for diazepam and midazolam. c) Advantages/Recommended use i) To reverse any undesirable effects resulting from diazepam or midazolam use. d) Cautionary Information i) Non\nEsmaoglu A. et al. Comparison between Dexmedetomidine and Midazolam for sedation of eclampsia patients in the intensive care unit Journal of Critical Care (2009) 24, 551-5 40 women randomized to Midazolam or Dexmedetomidine AFTER C section for eclampsia. Midazolam dosing was a 0.05 mg/kg bolus, then 0.1 mg/kg/h infusion Drug Schedule IV Controlled Substances. The medicines in drug classification Schedule IV /Schedule 4 can and are abused and can be addictive or create a dependency, but less than those of Schedules 1, 2 and 3. Examples of Schedule IV substances include: Tramadol, Xanax (alprazolam), carisoprodol (Soma), Klonopin (clonazepam), Valium (diazepam. Introduction ۞Biopharmaceutics Classification System (BCS) Scientific framework for classifying drug substances based on their aqueous solubility and intestinal permeability What is the need for a classification based on biopharmaceutics of the drug? • Ans. Its importance in determining bioavailabilit Midazolam and lorazepam are the most commonly used benzodiazepines for ICU sedation . Midazolam is a short-acting, water-soluble benzodiazepine that undergoes extensive oxidation in the liver via the cytochrome P450 enzyme system to form water-soluble hydroxylated metabolites, which are excreted in urine UK Department of Health Advised Doctors to Use Midazolam as Treatment for 'Covid' David Icke / Gareth Icke - memes and headline comments by David Icke Clare Wills Harrison, a UK lawyer, has several legal cases where midazolam has clearly been misused. These are going forward to trial in the near future. Midazolam seems t o The midazolam should be drawn up in advance and kept in the controlled drug cupboard ready for use. The syringe will need to be replaced with a freshly drawn up ampoule every 24 hours. The syringe must be clearly labeled with drug name, dose and date / time drawn up and recorded in line with local policy in the controlled drugs (CDs) register
A Single Center Experience Using Liposomal Bupivacaine in Pediatric Patients Having Non-Cardiac Surgery\nBy Logan D. Glosser, BA, Michael Walters, MD, Barak Cohen, MD, MHA, Nadav Schacham, MD, Sanchit Ahuja, MD, Eva Rivas Ferreira, MD, PhD, Remie Saab, MD, Surendrasingh Chhabada, MD, Alparslan Turan, MD\nDepartment of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, OH, USA\n(Summarized and submitted by Logan Glosser, BA, and Remie Saab, MD)\nPostoperative pain control in the pediatric population remains challenging. Infiltration of the surgical wound with local anesthetics at the conclusion of surgery is a common component of the analgesic treatment. This infiltration was limited to the available short acting local anesthetics. In adults, the FDA has approved the use of liposomal bupivacaine (Exparel, injectable suspension, Pacira Pharmaceuticals Inc., Parsippany, NJ, USA), allowing a slow release and providing longer pain relief. We here describe a single-center experience of off-label surgical wound infiltration with liposomal bupivacaine in pediatric surgical patients.\nWe conducted a retrospective cohort analysis to describe the incidence of serious adverse events potentially related to local anesthetic toxicity in patients 0 to 16 years of age who received wound infiltration with either liposomal or plain bupivacaine during non-cardiac surgery between 2013 and 2017 in the Cleveland Clinic. Eligible patients in the two groups were matched by age, ASA status, and type of procedure. Patient records were evaluated by two investigators blinded to the type of local anesthetic to identify any of 13 predefined signs and symptoms potentially related to local anesthetic systemic toxicity (LAST) and six other major complications during the initial 48 postoperative hours. The primary outcome was the incidence of LAST defined as the presence of two or more of the pre-defined complications possibly related to anesthetic toxicity. We also conducted a sensitivity analysis to compare the incidence of a single sign or symptom possibly related to anesthetic toxicity.\n356 patients who received liposomal bupivacaine were matched with 568 patients who received plain bupivacaine. The median [interquartile range] dose of liposomal bupivacaine was 266 [133, 266] mg. Of note, even after matching, nearly 40% of patients in the liposomal bupivacaine group underwent extensive spinal fusion surgery (compared to only 3% in the control group), which led to residual imbalance between the two groups. The primary outcome did not occur in any patient (P>0.99). A pre-planned sensitivity analysis identified five cases having a single sign/symptom possibly related to LAST (three in the liposomal group and two in the plain bupivacaine group, relative risk 2.4, 95% CI 0.4-14.0, P=0.38).\nIn our cohort of more than 900 pediatric surgical patients, with more than 350 receiving liposomal bupivacaine, we could not identify a single case of LAST, and the incidence of even isolated symptoms potentially related to local anesthetic toxicity was very low.
#1 Rated CoolSculpting\nin Wilkes-Barre, PA\nWhat is CoolSculpting?\nCoolSculpting can treat areas of stubborn, diet and exercise resistant fat by freezing the fat cells in the affected area for lasting results, although results may vary. The fat cells are processed through the body’s lymphatic system over the weeks and months following treatment. Since CoolSculpting is a non-surgical procedure, no anesthesia, needles, or incisions are necessary during treatment.\nDuring a CoolSculpting treatment, the surrounding skin, tissues, and organs near the treated area are not harmed. While these procedures are not painful, patients may experience discomfort as the treated area becomes cold and eventually numb. Once the area is numb, most patients relax by reading, watching TV, working on their computers, or napping for the remainder of their session.\nCall Now to Learn More\nYoung Medical Spa is a certified CoolSculpting practice. With two CoolSculpting machines in our Wilkes-Barre location, patients can treat two areas of their body with CoolSculpting at once, known as Dual-Sculpting™. For more information and to get started with CoolSculpting, schedule your complimentary consultation by calling 215-631-8436 to find out if CoolSculpting is right for you.\nA Non-Invasive, No Downtime Fat Reduction Treatment\nBefore After Photos\nLocal’s #1 Rated CoolSculpting Experts\nDr. Thomas E. Young founded Young Medical Spa® with the mission to provide the highest quality aesthetic treatments and services within the comfort of a relaxing, spa-like environment. At Young Medical Spa, all patients are treated under the supervision of cosmetic and surgical experts to ensure that our results match our passion for aesthetic medicine. Dr. Young is a leader within the industry, and shares his expertise by training other physicians with his advanced techniques and wealth of experience.
As a parent, trying to find a great general dentist for yourself can take some research. Trying to find a great pediatric dentist for your child takes even more thorough research, a deeper inspection of reviews, and lots of trust in others.\nDr. Jason Lee, a pediatric dentist at Rodeo Dental & Orthodontics, said his interest in pursuing dentistry came from growing up with an excellent pediatric dentist who created an environment where he looked forward to going to each visit.\nFor nearly 20 years now, Lee has practiced dental care for children and has sought to find a practice that not only allowed kids to be more comfortable at the dentist, but one that made them eager to come back. In 2017, Lee joined the Rodeo Dental family and has since aimed to provide the same exciting and comforting experience for his patients as he received in childhood. Lee’s love for his work at Rodeo Dental exceeds the company’s collaborative culture and energetic environment they’re known for. He says Rodeo Dental’s patient-centric core values and mission to give every family and child the key to access high-end dental care aligns directly with how he approaches his specialty.\nLee shared some insights as to what parents can expect if their child needs treatment and the safety measures Rodeo Dental provides in order to ensure parent and child trust.\nWhat exactly is a pediatric dentist, and what do they do to earn that specialty title?\nA pediatric dentist is a specialist dedicated to the oral health of children from infancy to teen. To become a pediatric dentist, (we spend) four years of dental school, (and) two years in residency. During that residency, we rotate through various medical specialties, such as anesthesiology, pediatric medicine, hematology, oncology, and emergency medicine.\nWhy would a child need to be sedated?\nChildren that are anxious or nervous about treatment respond (to sedation) well because the sedative medication we use here at Rodeo is also classified as an anxiolytic; it helps with anxiety. Sometimes we have (cooperative children), but they’ve got a lot of work (that needs) to be done. The sedation appointment helps them to be able to sit in the chair, and time seems to pass faster for them. Sometimes we have children (with) certain conditions where they (may) have involuntary muscle movements that could interfere with the treatment. (There are) lots of different reasons.\nHow do you know how much medication to administer to a child?\nThere are people that will calculate the medication on the child’s age … but the weight is the most appropriate way to go because not all 5-year-olds weigh the same. So we go off their weight, and we adhere to the (American Academy of Pediatric Dentistry) and the American Academy of Pediatrics guidelines. We don’t exceed the maximum dosage on these children. We don’t sedate children under (the age of) 2. We don’t sedate children that have conditions that could conflict with sedation. We always follow the manufacturer’s suggested guidelines, also.\nWhat can happen to a child if these guidelines aren’t followed?\nComplications are always possible in any medical treatment or dental treatment. Any time we inject any medication, (there are) always risks involved. However, if we conduct a proper (check on medical) history and look for conditions … (almost) all serious complications are avoided. There are still some complications involved, and the most common one we see is slight drowsiness afterward. The child (may) have a hard time staying awake, or we see a child that may feel a little bit nauseous. We also see children that have what’s called a paradoxical effect. We give them a sedative that’s supposed to make them drowsy, sleepy, and sedate them, but it does the opposite; it makes them excited. That’s not dangerous at all, but the paradoxical effect can sometimes be a challenge when you’re expected to go into a room and see a (child) that’s sleepy … and you see (the child) doing handstands.\nWhat should parents expect when their child is going to be sedated for treatment?\nThey’ll get a call the night before, and they’ll get some instructions. It’s best for the child to not eat anything after or before bedtime but for sure nothing after midnight. (Then), wake up the (next) morning, (come to the office), (and) we’d like them to wear comfortable clothes (when coming to their appointment). The (parents) should show up to the appointment five to 10 minutes early. We do a medical history, take blood pressure, (and) the respiratory temperature. And then (the parents) should expect the doctor to come in and speak with (them) and explain what we’re planning to do (for) treatment and sedation. Then, (a parent gets) to sit with (their child) for 10 to 15 minutes while the (sedative) takes effect; they should expect to have a staff member (with) a wheelchair to take (their child) to the treatment room. The treatment phase will take about 10, 20, 30 minutes max. After that, we bring the child to the recovery area, and we’ll monitor them for another five to 10 minutes. Then, we take the child to the parent. They’ll get some post-operative instructions. After everything has been explained, (parents will) have a chance to ask questions and have (them) answered. We’ll take the child in the wheelchair to the car, (and) help them put the child in the car. It’s important to get the parents involved; we want them to be involved in their (child’s) treatment. We make a treatment plan in conjunction with the parents.\nIs there anything else you’d like to mention or add?\nI will say that of all the places I’ve worked (at), I’ve been doing pediatric dentistry for almost 20 years, Rodeo (puts) safety first. We are pioneering and leading safety. We have a dental anesthesiologist that’s on staff. He does training with the staff (on) medical (emergencies). We train the staff above and beyond what they need to know; they practice simulating these things. We have monthly meetings with all the pediatric dentistry staff where we discuss safety issues. (We) practice giving IVs, (and) intubating the patient … (during) these monthly meetings. I want everybody to know that safety is the primary goal for Rodeo Dental and Orthodontics.
Jonathan Bank, MD, FACS\nCreator of Breast Relief, Dr. Bank is a board-certified plastic surgeon with specialty training in microsurgery. Stemming from his interests in autologous breast reconstruction and sensory restoration of the reconstructed breast, this endeavor aims to shift paradigms in surgical treatment of breast cancer. He performs all aspects of facial, breast, and body cosmetic surgery in New York.\nDiana Tjaden, PT, DPT\nDiana developed Full Circle Breast Cancer Recovery Program, which has its home in Garden City, New York. This comprehensive, individualized program is geared towards every phase of breast cancer recovery. Among its goals are educating women with breast cancer on ways to regain control over their lives, and providing them the tools they need to return to their prior level of function, and reach new fitness goals.\nDavid Rosenblum, MD\nDr. Rosenblum is a leader in the fields of interventional pain medicine and regional anesthesiology. His particular interests include regional anesthesia and ultrasound-guided nerve blocks. He has developed numerous protocols and policies to ensure the safe proliferation of anesthesia and pain management. He currently represents the Maimonides department of anesthesia in the development of programs for ensuring adequate pain control of obstetric, orthopedic, and cancer.
OR WAIT 15 SECS\nAn observational study by Sahlgrenska Academy researchers at a large Swedish hospital found 2,393 opportunities for hand disinfection and/or aseptic techniques. Doctors and nurses missed 90 percent of the opportunities.\nPerformed at a large Swedish hospital, the study is the first of its kind in northern Europe. Direct observations were made of risk-prone invasive procedures in connection with intubation and local anesthesia, as well as insertion of catheters in the bloodstream and urinary tract.\nCaregivers failed to avail themselves of more than 90 percent of the opportunities for using alcohol-based handrub and aseptic techniques.\n"An operating room is radically different from other clinical settings in that anesthesia-related tasks are so frequent," says Dr. Anette Erichsen Andersson, a researcher at Sahlgrenska Academy. "We counted an average of 30 opportunities, many of which were missed, for aseptic techniques every 24 minutes."\nProblems with aseptic techniques and insufficient teamwork led to a substantial increase in situations where hand disinfection should have been used. The results also demonstrate that protective gloves are worn in an unsystematic manner that heightens the risk of hospital-acquired infections.\n"Gloves often take the place of hand disinfection and are reused for a number of different tasks," Dr. Andersson says. "Bacteria may be transmitted from the airways to the bloodstream as a result, increasing the risk of infection."\nThe study did not examine the underlying reasons for inadequate use of aseptic techniques. One explanation may be that neither hygiene nor prevention of infection is a mandatory subject at medical school or during specialist training for doctors and nurses.\n"There is little doubt that all doctors and nurses are familiar with the benefits of hand rub," Andersson says. "But simply possessing that knowledge is not good enough in the demanding setting of an operating room whose interdisciplinary teams rarely if ever have the chance to practice new working methods together, either in training or clinical situations.\n"Awareness that you need to employ aseptic techniques must be supplemented by specific skills that work under complex, risky circumstances. The potential for interdisciplinary learning is enormous, and additional research is needed to maximize the prospects for safe, aseptic care in the operating room."\nThe observations were not made during emergency surgery.\nThe article "Hygiene and Aseptic Techniques during Routine Anesthetic Care--Observations in the Operating Room" appeared in Antimicrobial Resistance and Infection Control in March.\nSource: University of Gothenburg
Having undesirable fat in different locations of your body can have a substantial impact on your health and self-esteem. While standard weight-loss through workout and diet plan is an excellent method to slim down in general, even the very best workouts can't target problem areas like the tummy, inner thighs, arms, and butts. Liposuction is a time evaluated treatment that is used to remove excess fat from particular locations of the body, permitting a specific to shape and contour their body to their taste. Is liposuction right for you? Find out now.\nPros of Liposuction\nThere are many benefits to this cosmetic treatment, consisting of:\n• Immediately noticeable changes. Unlike conventional weight loss, liposuction develops changes that are instantly noticeable in the body. Some distinction is noticeable immediately, and the preferred outcomes are normally accomplished in simply a few days.\n• Proven and safe. This cosmetic treatment has actually been performed by seasoned surgeons all over the world for many years and the strategy has actually been fine-tuned over and once again to be safe and efficient.\n• Recovery time is normally quick. The downtime needed after having this kind of procedure is usually much less than exactly what is required for other kinds of cosmetic treatments, including tummy tucks, breast reduction, and more. Individuals who have had the procedure can frequently go back to work much more rapidly than they prepared for and can get back to living a healthy, active way of life.\n• Weight reduction can be irreversible. With the right maintenance methods, the fat that was removed throughout the liposuction treatment will not return.\n• Complete control over your body. With liposuction, an individual can have complete control over how they wish to look, beyond what conventional diet and workout can offer. Offering individuals this power over their bodies increases self-confidence and assistance individuals feel their very best.\nWhile there many benefits to liposuction, there are naturally a few caveats that need to be taken into consideration prior to making the final decision to move on with the treatment.\nCons of Liposuction\nPrior to having actually liposuction done, it is necessary to examine the potential downsides of the treatment and figure out if the benefits outweigh the threats in your particular case. Your surgeon can assist you find out more about the threats associated with the treatment and can assist you choose if moving on is the ideal thing for you.\n• Issues with general anesthesia. Because liposuction is performed under basic anesthesia, the procedure brings the same threats as other kind of surgical treatment where basic anesthesia is utilized. Underlying medical conditions may enhance these threats.\n• Adverse reactions. Bruising, bleeding, and discomfort are all to be expected, however, in uncommon cases can trigger more considerable problems.\n• The potential to acquire the weight back. After having liposuction done, it is important to maintain a healthy diet plan and workout correctly as suggested by your doctor. Failure to do so might result in gaining back the weight that was lost or perhaps even more.\nThere are risks associated with liposuction, for numerous individuals, the advantages far exceed them. Inform yourself about the treatment by having thorough discussions with your specialist and consider how liposuction has the potential to affect you as an unique person. Only you and your cosmetic surgeon 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 West Sayville NY\nLaser liposuction is a newer, minimally invasive treatment that involves heating the fat cells to melting point and eliminating the melted fat through a small cannula. The treatment is usually done right in your doctor's office and is an exceptional choice for people who have less than 500 ml of fat to eliminate from any one area. Laser liposuction can be a safe, complementary treatment to weight-loss in order to sculpt the body you have actually constantly desired.\nContact a Specialist in your West Sayville NY today.\nIf you're thinking about liposuction as a weight loss solution, it is very important that you discuss your desires with a certified plastic surgeon in your area. Your specialist will perform a complete exam and health history survey to determine if liposuction can benefit you and help you reach your physical and psychological objectives. Call today for an assessment and find out more about how liposuction can assist you attain the body of your dreams.
A-60 Multifunctional RF Vaumm Ultrasonic 40k Cavitation Slimming Machine\n1. Dissolve fat, lymphatic drainage, firm skin and enhance skin elasticity\n2. Strong force explosion fat and fat removal\n3. Body Vacuum RF Probe\n4. Facial wrinkle elimination, tightening and lifting\n1. The entire process is completed without the need of surgery and anesthesia.\n2. Does not cause the phenomenon of uneven skin.\n3. Does not cause the phenomenon of bleeding, swelling and blood stasis.\n4. Without side effects and the risk of gaining the weight back, the results are rather\n5. Non-invasive treatment does not affect the normal work and life\nFirm the arms, legs, thighs, buttocks, waist, back, abdominal muscles and reshape the\n*Improve and treat the orange peel like fatty tissues of different serious levels\nWith the effects of soothing, decompression and pain relief (such as joint pain,\nsciatica),promote the regular mechanical aerobic exercise of skin tissue, rapidly relieve\nstress and remove fatigue.\nFirm, lift and compact the skin and mould the face shape\nCirculate and activate cel s, promote metabolism and so that 100% more collagen and\nelastic fibers may be gained for improving the facial and body skin\nMultipolar RF head(Tripolar RF) X 1\n40KHz Cavitation Head X 1\nVacuum Biploar Head x 1\nBipolar RF Head for face X 2\nPower cord x 1
Dr. Anand of Great Neck & Mid-Island Dental Associates teams up with non-profit organization, America’s Toothfairy to provide a young girl with free dental services.\nHicksville, NY, November 25, 2014 — Dr. Erica Anand, a pediatric dentist at Great Neck & Mid-Island Dental Associates (GNMIDA), took special interest in a young child who visited her office early March. This little girl needed a considerable amount of dental work including sedation in order to get it all done at one time. Although she desperately needed treatment, her family was going through financial hardship and could not afford to move forward.\nThis little girls name is Abigail Burgess and she is 3 years old. Like many people in America, Abigail and her family are dealing with the effects of our ever-changing economy. Not too long ago they were a typical family with two working parents and now they’re struggling to make ends meet.\nAfter her father lost his job, they were faced with the reality that their 3-year-old daughter now needed extensive dental work done. With insurance that would only cover a small amount of their dental bill, Abigail’s family felt hopeless.\n“When I found out the partners were going to team up with non-profit organization, America’s Toothfairy I immediately thought of Abigail and we contacted her family,” said Dr. Anand.\nTo Abigail’s family’s excitement, she was chosen. Also assisting with this case is anesthesiologist, Dr. Gordon Barnes. After hearing about Abigail’s case and what GNMIDA was planning to do, Dr. Barnes gladly jumped on board to offer his sedation services for free.\nGreat Neck and Mid-Island Dental Associates takes pride in being able to give back to the less fortunate. “We have donated our dental services in the past including to a non-profit organization that assisted battered women as they got back on their feet. We believe in giving back and try to do it as much as we can,” says Dr. Sam Morhaim, senior partner and periodontist at GNMIDA.\nAbout Dr. Erica Anand\nDr. Erica Anand received her Bachelor of Arts in Chemistry with Cum Laude from Stony Brook University. She also attended Stony Brook University’s School of Dental Medicine where she earned her Doctorate of Dental Surgery degree. While in dental school, Dr. Anand received the Delta Dental award and was involved in the outreach mission to Chile where she treated underserved children and families. She went on to complete a two-year specialty-training sprogram in pediatric dentistry. Dr. Erica Anand is available for interview upon request.\nAbout Great Neck and Mid-Island Dental Associates\nThe team of dentists and medical professionals at Great Neck and Mid-Island Dental Associates consists of top dentists in every area, including general, cosmetic, reconstructive and sedation dentistry. The practice has been serving the New York area for over thirty years with dentists that specialize in all areas of dentistry, including gum disease treatment, endodontic treatment, pediatric dentistry, and dental care for elderly patients. Among the practice’s treatment options are a wide range of cosmetic dental procedures such as dental implants, teeth whitening, porcelain veneers, and orthodontics.\nGreat Neck and Mid-Island Dental Associates\nGreat Neck Office\n611 Northern Blvd., Suite 100\nGreat Neck, NY 11021\n400 South Oyster Bay Road, Suite 201\nHicksville, NY 11801
What is Disposable Anesthesia Breathing Circuit-Corrugated?\nA Disposable Anesthesia Breathing Circuit-Corrugated is a medical device used to deliver anesthetic gases and oxygen to patients during surgical procedures. The circuit is made up of a corrugated tube that connects the patient's airway to the anesthesia machine or breathing system. The corrugated design of the tube adds rigidity to the circuit and prevents kinking or crushing during use. The circuit is typically made of medical-grade PVC or silicone and is available in various lengths and diameters to accommodate patients of different sizes. Disposable Anesthesia Breathing Circuit-Corrugated is available as a single-use disposable option, which eliminates the need for cleaning and sterilization.\nHow to use Disposable Anesthesia Breathing Circuit-Corrugated?\nTo use a Disposable Anesthesia Breathing Circuit-Corrugated, follow these general steps:\nEnsure that the circuit is compatible with your anesthesia machine or breathing system.\nVerify that the circuit is the appropriate length and diameter for your patient and procedure.\nAttach one end of the circuit to the patient's airway, such as a tracheal tube or mask.\nAttach the other end of the circuit to the anesthesia machine or breathing system.\nEnsure that all connections are secure and free of leaks.\nIf necessary, connect any additional features, such as a humidifier, filters, or valves.\nMonitor the patient's vital signs and anesthesia level throughout the procedure.\nOnce the procedure is complete, carefully disconnect the circuit from the patient and the anesthesia machine or breathing system.\nDispose of the circuit appropriately if it is a single-use disposable option.\nIf the circuit is a reusable option, clean and sterilize it according to the manufacturer's instructions before reuse.\nIt is important to follow all relevant guidelines and best practices for using and disposing of Disposable Anesthesia Breathing Circuits-Corrugated to ensure patient safety and prevent infection transmission. Consult with your healthcare provider or medical supplier for specific instructions and recommendations based on your needs.\nHow to Pick the Right Disposable Anesthesia Breathing Circuit-Corrugated?\nChoosing the right Disposable Anesthesia Breathing Circuit-Corrugated depends on several factors, including:\nCompatibility: Ensure that the circuit is compatible with your anesthesia machine or breathing system.\nLength: Choose a circuit length appropriate for your patient and procedure. Standard lengths range from 40 inches to 72 inches.\nDiameter: The diameter of the circuit should match the size of the patient's airway. Common sizes range from 15mm to 22mm.\nMaterial: The material of the circuit should be safe, flexible, and durable, such as PVC or silicone.\nCorrugations: Corrugated circuits have ridges on the outside of the tube, which can make them less flexible than smoothbore circuits. Consider whether the additional stiffness is appropriate for your procedure.\nSingle-use vs. reusable: Corrugated circuits are available in both disposable and reusable options. Disposable circuits eliminate the need for cleaning and sterilization, which can save time and reduce the risk of infection.\nAdditional features: Consider any additional features that may be required, such as a humidifier, filters, or valves.\nManufacturer reputation: Choose a circuit from a reputable manufacturer that meets all relevant industry standards and regulations.\nCost: Compare the cost of different circuits and consider any cost savings from disposable circuits versus reusable circuits.\nIn summary, when choosing a Disposable Anesthesia Breathing Circuit-Corrugated, consider compatibility with your anesthesia machine or breathing system, appropriate length and diameter, material safety and durability, the presence of corrugations, single-use vs. reusable options, any required additional features, manufacturer reputation, and cost. Consult with your healthcare provider or medical supplier for specific recommendations based on your needs.
BACKGROUND OF THE INVENTION\nThe present invention relates to a once daily extended release oral Tramadol pharmaceutical preparation which provides effective blood concentration for a period of about 24 hours with reduced peak Tramadol plasma concentrations, The formulation of the present invention provides peak Tramadol plasma concentrations that are less than twice the plasma concentration measured 24 hours after administration, while providing for effective Tramadol plasma concentration about 1 to 2 hours after administration.\nTramadol is a centrally acting synthetic analgesic compound that is not derived from natural sources nor is it chemically related to opiates. Although its mode of action is not completely understood, at least two complementary mechanisms appear applicable: Binding to μ-opioid receptors and inhibition of reuptake of nor epinephrine and serotonin. Tramadol opioid activity derives from low affinity binding the parent compound to A-opioid receptors and higher affinity binding of the M1 metabolite. In animal models, M1 is up to 6 times more potent than Tramadol in producing analgesia and 200 times more potent in u-opioid binding. The contribution to human analgesia of Tramadol relative to M1 is unknown.\nTramadol-induced antinociception is only partially antagonized by the opiate antagonist naloxone in animal test. In addition, Tramadol inhibits reuptake of nor-epinephrine and serotonin in-vitro after oral administration of immediate release dosage form the onset of analgesia is evident within 1 hour after administration and reaches a peak in ≈2 to 3 hours. Peak plasma concentrations are reached about 2 hours after administration, which correlates closely with the time to peak pain relief.\nTramadol immediate release is rapidly and almost completely absorbed after oral administration. The mean absolute bioavailability of 100 mg oral dose is m 75%. Administration with food does not significantly affect its rate or extent of absorption; therefore, it can be administered without regard to meals. The mean peak plasma concentration is 308±78 ng/ml and occurs at ˜2 hours after a single 100 mg oral dose in healthy subjects. At this dose, the mean peak plasma concentration of the active mono-O-desmethyl metabolite (racemic 1) is 55±20 ng/ml and occurs ˜3 hours post-dose. The separate [+]- and [−]-enantiomers of Tramadol generally follow a parallel time course in plasma after a single 100 mg oral dose. Following a 100 mg dose, the maximum plasma concentrations of the [−]-enantiomers are some-what lower than those of the [+]-enatiomer (148±33 vs. 168±36 ng/ml, respectively), The [−]-M1 enantiomer (35±10 vs, 26±13 ng/ml, respectively). Steady state is achieved after 2 days of a 100 mg four times daily dosing regimen (maximum plasma concentration was 592±177 ng/ml). The plasma half-life of Tramadol, following single and multiple dosing, was 6 and 7 hours, respectively. The most common adverse reaction is nausea, vertigo, constipation and headaches and is correlated to the patients plasma Tramadol concentrations.\nTramadol is used for the management of moderate to moderately severe pain such as pain following surgical procedures (orthopedic, gynecological cesarean section) and pain following dental surgery (extraction of impacted molars).\nTramadol ability to control pain is directly related to its concentration in the patient's plasma seam. The minimum effective therapeutical Tramadol plasma level is around 100 ng/ml. Due to Tramadol plasma elimination short half-live to maintain the minimum effective plasma levels requires generally the oral administration of 50 to 100 mg every 4 to 6 hours of immediate release Pharmaceutical compositions. This administration schedule of the drug makes it difficult for the patient to control pain, specially during night time, since pain will reappear every 4 to 6 hours.\nOn the other hand, if patient in an attempt to control pain for a longer period of time should take higher doses of immediate release Tramadol than peak plasma levels will increase dramatically and very serious side effects due to high blood levels will appear immediately.\nAnother difficulty encountered by the man skilled in the art for the production of a once daily Tramadol formulation arises from Tramadol extremely high solubility in water and body fluids. The prior art teaching related to Tramadol compositions that may be useful for once daily administration are basically related to maintain effective therapeutically plasma concentrations between administration. Since it is known the therapeutically effective Tramadol plasma levels are close to the unwanted adverse reaction plasma levels, once a day Tramadol compositions to be useful to treat effectively patients in need must not only provide for minimum effective therapeutic plasma levels but also must provide for the control of toxic levels. Any once a day Tramadol formulation which should not comply with both requirements would be useless.\nU.S. Pat. No. 5,601,842 discloses a tablet containing Tramadol and a matrixing agent with a viscosity between 3,000 and 150,000 mPa in a 2% aqueous solution at 20° C. U.S. Pat. No. 5,811,126 discloses a controlled release pharmaceutical composition containing Tramadol and comprising sodium alginate, C2 to C50, edible hydrocarbon derivative with melting point range from 25° C. to 90° C. and divalent salt to cross link the alginate. In vivo performance from these formulations is not available.\nU.S. Pat. Nos. 5,639,476 (12h) and 5,580,578 discloses controlled release dosage form containing a substrate containing Tramadol, said substrate being coated with a plasticized aqueous dispersion of ammonio-methacrylate copolymer having low content of quaterny ammonium groups and a permeability enhancing pore former said coating being cured for about 24 to about 60 hours to stabilize said formulation.\nU.S. Pat. No. 5,955,104 discloses a delayed release Tramadol formulation consisting of pellets in a water soluble capsule or in a tablet compressed from said pellets, each pellet having (a) a substantially inert core; i an active ingredient layer containing (i) Tramadol particles in mixture with a binder for adhering said Tramadol particles over said inert core, and optionally (iii) a pharmaceutically acceptable, inner adjuvant; and (c) a delay coating for retarding the release of Tramadol consisting principally of mixtures of Ethylcellulose and shellac.\nU.S. Pat. Nos. 5,645,858, 5,474,786 and 5,395,626 discloses multilayered controlled release pharmaceutical dosages forms for water soluble drugs comprising a plurality of coated beads and which comprises a core and seven or eight different coatings.\nU.S. Pat. No. 5,849,240 describes a process for the manufacture of particles by the “melt-pelletization” process, Tramadol is one of the examples but in vivo performances of such formulation is not available.\nU.S. Pat. No. 5,968,551 (continuation of patent U.S. Pat. No. 5,273,760) describes sustained release oral analgesic form for once a day administration comprising a unit dose comprising a plurality of pharmaceutical acceptable matrices comprising an analgesically effective amount of Tramadol and hydrophobic material each of said matrices having a diameter of about 0.1 to 3 mm bioavailability and therapeutical effect for about 24 hours or more after oral administration to a human patient (no control of side effect). It also discloses (claim 33) a method of treating patients for moderate to severe pain with a once daily oral administration of a unit dose consisting of a plurality of inert pharmaceutical acceptable beads control with an analgesically effective amount of an opioid analgesically effective amount of analgesic said beads having a diameter of 0.1 to 3 mm and having effective blood levels for about 24 hours (against side effects) with a peak of aid opioid in vivo for about 3 to about 10 hours after administration.\nU.S. Pat. No. 5,965,163 describes a solid dosage form comprising a plurality of particles including Tramadol in a matrix, the matrix including a mixture of hydrophobic and hydrophilic fusible carriers having melting point from 35° C. to 150° C., which are produced by the method of “melt pelletization”.\nU.S. Pat. No. 5,591,452 discloses a once daily Tramadol preparation constituted of Tramadol corporate into a controlled release matrix constituted of one or more hydrophilic or hydrophobic polymers which provides a Tmax of about 3 to about 6 hours.\nU.S. Pat. No. 5,958,482 describes a sustained release pharmaceutical formulation comprising an extruded blend of Tramadol, and one or more hydrophobic fusible carriers having a melting point from about 300 to about 200° C., providing a sustained-release of said therapeutically active agent for a time period of from about 8 to about 24 hours. With a peak plasma for about 2 to 8 hours.\nU.S. Pat. No. 5,891,471 discloses Tramadol pharmaceutical particles for once a day administration which provides a time to peak plasma level of Tramadol in about 2 to about 6 hours after administration, produced by a process of “melt-pelletization”.\nU.S. Pat. No. 5,672,360 and 5,478,577 discloses a method of treating pain in humans comprising orally administering of a once a day basis an oral sustained release dosage form of an opioid analgesic which upon single dose and multiple doses administration provides a time to maximum plasma concentration (Tmax) of said opioid in about 2 to 10 hours and a maximum plasma concentration (Cmax) which is more than twice the plasma level of said opioid at about 24 hours after administration of the dosage form and which dosage form provides effective treatment of pain for about 24 hours or more after administration to the patient.\nAn orally administrable Tramadol formulation for once a day administration, which would provide effective Tramadol plasma concentrations without Tramadol plasma peaks would be highly desirable.\nA pharmaceutical oral dosage formulation of Tramadol a) providing rapidly effective plasma concentration and b) able to maintain such effective plasma concentration for a long period of time while simultaneously avoiding peak Tramadol blood concentrations would be highly desirable to provide an immediate and extended duration of analgesia without low incidence of adverse effects to patients in pain.\nThe Tramadol (or salt) once daily composition of the present invention permit the rapid obtention of Tramadol effective plasma concentration, within one or two hours which are maintained for a period of about 24 hours while providing for peak Tramadol blood concentration which are less than free times the concentration obtained twenty four hours after administration.\nOBJECT AND SUMMARY OF THE INVENTION\nIt is an object of the present invention to provide a once a day oral pharmaceutical preparation of Tramadol or its pharmaceutical acceptable salts.\nIt is another object of the present invention to provide a once a day Tramadol pharmaceutical preparation which is able to provide effective Tramadol plasma concentration for a period of about 24 hours.\nIt is another object of the present invention to provide a once daily oral Tramadol preparation which provides effective plasma concentrations within about 1 to 2 hours after single administration of an effective amount of Tramadol for said formulation.\nIt is another object of the present invention to provide a once a day Tramadol pharmaceutical preparation which effectively reduces the excessive Tramadol plasma concentration.\nIt is another object of the present invention to provide a Tramadol once a day oral pharmaceutical preparation which after single dose administration to humans provides Tramadol peak plasma concentration (Cmax) less than three times the plasma concentration obtained 24 hours (C24h) after said formulation.\nIt is another object of the present invention to provide a Tramadol once a day oral pharmaceutical preparation which after multiple doses administration to humans provides Tramadol peak plasma concentration (Cmax), which are less man three times the plasma concentration obtained 24 hours (C24h) after said multiple administrations.\nIt is another object of the present invention to provide a Tramadol once a day oral pharmaceutical preparation which after single and/or multiple doses administration to humans provides Tramadol peak concentrations not less than 10 hours (Tmax) after said administration\nIt is another object of the present invention to provide a once daily oral Tramadol pharmaceutical preparation from which the Tramadol rapid rise maximum plasma concentration is lower that the peak concentration of the formulation.\nIt is another object of the present invention to provide a once a day Tramadol pharmaceutical preparation which is able to control effectively pain during a period of about 24 hours.\nIt is another object of the present invention to provide a once a day Tramadol preparation which reduces pain within 1 to 2 hours after single administration of an effective amount of Tramadol.\nIt is another object of the present invention to provide a once daily oral Tramadol pharmaceutical preparation which effectively reduces the unwanted Tramadol side effects due to excessive Tramadol plasma concentration.\nIt is another object of the present invention to provide a once daily oral Tramadol pharmaceutical preparation which comprise controlled release beads and a tablet into a hard gelatine and/or hydroxypropylmethycellulose capsule.\nIt is another object of the present invention to provide a once daily oral Tramadol preparation from which the plasma Tramadol concentration are not affected when the formulation is taken with or without food.\nIt is another object of the present invention to provide a tablet containing Tramadol controlled release beads and a fast release portion of Tramadol constituted by granules, beads or powder which releases the Tramadol in such a manner that the fast releasing Tramadol portion peak plasma concentration is less than the peak concentration obtained from the Tramadol released from the coated beads.\nThe present invention relate to a novel Tramadol pharmaceutical preparations that provide effective Tramadol plasma concentrations one or two hours after administration and which will be maintained for 24 hours while simultaneously avoiding excessive Tramadol plasma concentrations which are the origin of the unwanted side effects.\nMore particularly the present invention is related to the discovery, contrary to the teaching of U.S. Pat. No. 5,672,360 and 5,478,577 that in order to control pain for about 24 hours, it is necessary that the peak of opioid analgesics concentration (Cmax) is more than twice the concentration obtained 24 hours after administration. In other words, what is disclosed in these patents is the need for large fluctuations of opioid analgesic blood concentrations between successive administration.\nMore particularly the present invention is related to the discovery that in order to provide for Tramadol peak plasma concentrations that are less than three times the plasma concentration obtained 24 hours after administration it is necessary that the pharmaceutical composition has an in vitro release profile that is not of the first order but rather multiphasic.\nMore particularly, the present invention relates to a once daily oral pharmaceutical composition comprising a unit dose with at least two Tramadol containing portions who release the Tramadol at different rates. The unit dose may be per example a hard gelatine and/or hydroxypropylmethylcellulose capsule for oral administration.\nMore particularly, the present invention relate to a unit dose that contains a Tramadol portion who liberate slowly the Tramadol and a Tramadol containing portions that liberates the Tramadol in a faster manner. The unit dose may be a hard capsule and/or a tablet.\nIn certain preferred embodiments the unit dose comprises a hard gelatine and/or hydroxypropylcellulose capsule containing slow release beads and a fast releasing Tramadol tablet.\nIn accordance with the present invention any pharmaceutically acceptable salt of Tramadol may be used. In the preferred embodiment the hydrochloride salt of Tramadol may be used.\nIn another preferred embodiment the unit dose comprises hard gelatine and/or hydroxypropylmethylcellulose capsule containing a slow release tablet and fast releasing beads.\nIn another preferred embodiment, the unit dose comprises hard gelatine and/or hydroxypropylmethylcellulose capsule containing slow release beads covered by layers of fast release Tramadol.\nBead which are spheroids containing Tramadol or any of its salts may be produced by any conventional known method such as layering the Tramadol in solution with water over a neutral core, or layering over a core the Tramadol in mixture with other pharmaceutical acceptable excipients such as a binders, polymers.\nThe preferred method for the manufacture of beads in the present invention is the method of extrusion-spheronization. This method comprises mixing the Tramadol or its salts with a spheronizing agent such as microcrystalline cellulose and optionally other pharmaceutical excipients with water. The blend obtained is thereafter extruded trough an extruder and the extrudate is thereafter rounded with the help of a spheronizer.\nIn a preferred embodiment beads are produced without any binder and comprises a mixture of Tramadol hydrochloride, microcrystalline cellulose and sucrose stearate.\nSustained release bead, are obtained by coating beads, previously manufactured, with a porous membrane from which the Tramadol is liberated slowly, The microporous membrane comprises mixtures of water—soluble and/or water dispersible polymers and/or copolymers and may also include pharmaceutically acceptable adjuvants such as plastifying agents, pigments, fillers, wetting agents, lubricants and anti-foam agents.\nAmong the water—soluble and/or dispersible film forming polymers or copolymers constituting the microporous membrane, may be mentioned particularly polyacrylates and polymethacrylates of the Eudragit type, such as Eudragit E30D, L30D, RS30 D NE30D of Röhm Pharma (USA), ethylcelluoses, such as Ethocels of DOW, USA and such as AquaCoat of FMC, USA, Hydroxypropyl cellulose and hydroxypropylmethylcellulose and their derivatives.\nThe polymers or copolymers may be associated into the microporous membrane with at least one adjutant as exemplified by the following: Plastifying agents, such as triacetin, dibutylphthalate, dibutylsebacate, citric acid esters, polyethyleneglycols, polypropyleneglycols and polyvinylpyrrolidone; Pigments such as iron oxides and titanium oxide; fillers, such as lactose and sucrose; Wetting agents, such as surfactive agents of the Span and Tween types, namely partial esters of fatty acids (lauric, palmitic, stearic and oleic acids) and anhydrides of hexitols derived from sorbitol possibly containing polyoxyethylenic chains, preferably surfactive agents of the Tween type, namely Tween 80, as well as polyethyleneglycols; lubricants, such as magnesium stearate and talc; antifoaming agents, such as silicone oil.\nIn addition to the polymer or copolymer, the microporous membrane contains preferably, tale and/or magnesium stearate as a lubricant, polyvinylpyrrolidone as a plastifying agent, titanium dioxide as a pigment Tween 80 as a emulsifier, and silicone oil as an antifoaming agent.\nGenerally, the thickness of the microporous membrane is expressed by the percentage of the dry coating applied onto the uncoated beads.\nThe weight of the microporous membrane may be 2 to 55%, preferably, 10 to 40%, of the weight of said microganules. These beads may contain the Tramadol or its salt in an amount of 20 to 95% by weight, preferably 30 to 85% by weight. The micorporous membrane may contain 5 to 95% and, preferably, 30 to 50% of polymers, polymer mixture or copolymers.\nThe microporous membrane for use in the present invention may be applied by coating in equipment such as fluid bed coaters, pan coaters or any suitable coating equipment.\nThe tablet of the present invention which will be included in the unit dose may be of the fast and/or as sustained release type. In the preferred embodiment fast release tablets are used, The tablets useful for the present invention shall be of such size tat it may be incorporated into the capsule. Tablets having a diameter comprise between 3 and 5 mm are suitable for the present invention. The amount of Tramadol or its salts included into the tablet shall be such that the tablet peak plasma concentration is less than the peak concentration of the beads included in the unit dose. The unit dose Tramadol ratio between the fast release and the sustained release beads is comprised between 1 and 50%, preferably between 5% and 40% and more preferably between 10 and 30%.\nThe fast release tablets useful for the present invention comprises Tramadol or its salt in mixture with pharmaceutical tabletting agents. The tablets may be produced using conventional tabletting technics.\nSustained release tablets useful for the present invention comprises Tramadol or its salts in combination with retarding agent such as cellulose derivatives, acrylic polymers.\nIn another embodiment for use in the present invention the sustained release beads coated with the microporous membrane may be covered by layers of a fast release Tramadol. For that purpose, Tramadol or its salts in solution and/or suspension in a solvent is applied onto the coated beads. Adjuvants such as plastifying agents, pigments, fillers, wetting agents lubricants and antifoam agents may also been included. The overcoated Tramadol containing layer may also contain polymer and a copolymers or mixtures thereof to control the release of the fast releasing Tramadol layer.\nThe following examples illustrate various aspects of the present invention. They are not meat to be constituted to limit the claims in any matter whatsoever.
- Buy 10 Boxes, Get 1 FREE! (No Mix & Match)\nValid January 1 - March 31, 2019. Free goods ship with order from Ultimate Dental. Free goods must be of equal or lesser value than purchased item. Valid in U.S. Only. Offer may not be combined with any other Septodont offer. Purchase must be reflected on one invoice. Offer void if product is returned. Septodont reserves the right to discontinue or change these offers at any time. It is the doctor's obligation to properly report and appropriately reflect any bonus product on their submission to Medicare/Medicare/private insurance.\nNOTE: Free goods are not reflected on your online order. After your order is submitted, any free goods that ship from Ultimate Dental will be added to your order by your account manager OR paperwork will be sent to the manufacturer to redeem your free product. If you would like to request a specific shade or size, please mention that information in the notes section during check out.\nSeptocaine with epinephrine 1:200,000 is preferred for most routine dental procedures. Septocaine with epinephrine 1:100,000 is preferred during operative or surgical procedures when improved visualization of the surgical field is desirable.\n- Fast onset (1 to 9 minutes) to avoid delay before effective analgesia is achieved.\n- Predictable duration of anesthesia: up to 60 minutes for infiltration injections and 120 minutes for nerve blocks.\n- No-methylparaben formulation to avoid allergic reactions on sensitive patients.\n- 100 percent latex free components to help reduce allergic responses.\n- Terminal sterilization of product/cartridges for safe use.\n- Mylar label covered glass cartridges to minimize risk of wound in the event of a cartridge breakage.\n- Cartridges packed 10 to a blister tray to avoid glass to glass contact, hence reducing breakage.\nColor Code Format:\n- Septocaine 1:100,000 – Gold\n- Septocaine 1:200,000 – Silver\nThe Hazard Communication Standard (HCS) requires chemical manufacturers, distributors, or importers to provide Safety Data Sheets (SDSs) (formerly known as Material Safety Data Sheets or MSDSs) to communicate the hazards of hazardous chemical products.\nPlease click the link below for the appropriate sheet.\nThis information is not for medical emergencies. Do not use this website for adverse event reporting. If you are a dentist/physician, follow the regulations required by your country's regulations.\nThis product is a prescription drug and law requires that Ultimate Dental have your State License number and DEA number on file. Please include this information in the notes section if this information is not already on file with your account. Thank you.\nUltimate Dental does not ship this product to any location outside of the United States.\nSeptocaine is indicated for local, infiltrative, or conductive anesthesia in both simple and complex dental procedures. Septocaine with epinephrine 1:100,000 is preferred during operative or surgical procedures when improved visualization of the surgical field is desirable. Reactions to Septocaine (pain and headache, for example, or convulsions or respiratory arrest following accidental intravascular injection) are characteristic of those associated with other amide-type local anesthetics. Septocaine contains sodium metabisulfite, a sulfite that may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people. Accidental intravascular injection may be associated with convulsions, followed by central nervous system or cardiorespiratory depression and coma, progressing ultimately to respiratory arrest. Dental practitioners and/or clinicians who employ local anesthetic agents should be well versed in diagnosis and management of emergencies that may arise from their use. Resuscitative equipment, oxygen, and other resuscitative drugs should be available for immediate use. Septocaine, along with other local anesthetics, is capable of producing methemoglobinemia. The clinical signs of methemoglobinemia are cyanosis of the nail beds and lips, fatigue and weakness. If methemoglobinemia does not respond to administration of oxygen, administration of methylene blue intravenously 1-2 mg/kg body weight over a 5 minute period is recommended. Please see the Package Insert for prescribing information.
Published Date: 03/31/2023\nThis session will describe basic opioid pharmacology, including dependence and tolerance. It will overview the impact of opioid tolerance on achieving adequate analgesia and review strategies for pain management using opioid and non-opioid medications.\nNeha Pawar, MD specializes in the treatment of addiction and pain medicine. Dr. Pawar serves as a Senior Instructor at the Wilmont Cancer Center’s Integrated Cancer Pain Clinic in their Department of Anesthesiology and Perioperative Services. She is also a Senior Instructor for the University of Rochester Medical Center’s Department of Addiction Psychiatry.
Know more about this business than we do? Cool! Please submit any corrections or missing details you may have.Help us make it right\nJames Matthews, MD provides Anesthesiologist services in La Grande, OR. An Anesthesiologist administers anesthesia for pain relief during procedures, surgical and non-surgical.\nPlease call Grand Ronde Hospital at (541) 963-1401 to schedule an appointment in La Grande, OR or get more information.\nGrande Ronde Hospital provides sports medicine in La Grande, OR. A Sports Medicine Physician is able to prevent, diagnose, treat and manage sports-related injuries and conditions.\nPlease call Grande Ronde Hospital at (541) 963-1437 to schedule an appointment in La Grande, OR or to get more information.\nAt Grande Ronde Hospital, we take pride in knowing our Radiologists and Technicians are well-trained and educated in advanced imaging technology. We provide the high end of a wide array of both standard and cutting edge imaging services to our patients.\nIf you don't see your business listed on YellowBot, please add your business listing.\nYellowBot wants to get your input! If you have a comment, find a bug or think of something neat we should do, let us know by emailing us.\n© 2007-2016 Solfo, Inc. – All rights reserved
In the first days after cardiac surgery, adding IV acetaminophen (Ofirmev) and a sedative to other pain management reduced postoperative delirium among older patients in a randomized trial.\nIV acetaminophen plus either IV dexmedetomidine (Precedex) or propofol (Diprivan) cut the likelihood of in-hospital delirium 2.8-fold compared with placebo plus sedative (10% vs 28%, P=0.01), reported Balachundhar Subramaniam, MD, MPH, of Beth Israel Deaconess Medical Center in Boston, and colleagues in JAMA.\nAcetaminophen also significantly reduced breakthrough analgesia (median 322.5 vs 405.3 μg morphine equivalents), ICU length of stay (median 29.5 vs 46.7 hours), and delirium duration (median 1 vs 2 days).\nThe two-by-two factorial design also compared the two sedatives but turned up no significant differences in delirium between propofol and dexmedetomidine (21% vs 17%, P=0.54).\nPostoperative delirium is a common but devastating complication after cardiac surgery among elderly patients, noted Subramaniam. “So far, we have not had any effective treatment at all in the sense of effective prophylaxis. So I think for the first time, we have found a commonly-used drug, which is routinely used for 48 hours following surgery. It can effectively reduce the incidence of delirium,” Subramaniam told MedPage Today.\nWhen it comes to clinical practice, “I think other institutions will start using postoperative IV acetaminophen as a routine drug following surgery in their patients for 2 days and that will effectively cut down the use of opioids plus also give effective analgesia,” he continued.\nSubramaniam’s group evaluated 120 patients ages 60 and older getting coronary artery bypass graft (CABG) surgery, with or without a valve replacement, requiring cardiopulmonary bypass at a U.S. medical facility. The median age was 69, and 15.8% women.\nPatients were randomized to placebo and propofol (n=30), placebo and dexmedetomidine (n=30), acetaminophen and dexmedetomidine (n=29), or acetaminophen and propofol (n=31). Participants received postoperative sedation with propofol or dexmedetomidine beginning at chest closure and used for a maximum of 6 hours; postoperative analgesia with placebo or IV acetaminophen was administered every 6 hours for 48 hours.\nWhen comparing propofol and dexmedetomidine, breakthrough analgesia was the only significantly different outcome (median 397.5 vs 328.8 μg).\nHypotension was similar between groups in both drug comparisons.\n“It’s a one center study, so we have to do a multicenter study, and prove the findings,” Subramaniam acknowledged. “And of course, there are people who claim that Tylenol can also have the same effects, but following cardiac surgery at least for 24 to 36 hours, there is a problem in terms of gastric absorption.”\n“Additional research, including comparison of IV versus oral acetaminophen and other potentially opioid-sparing analgesics on the incidence of postoperative delirium, is warranted,” the researchers concluded.\nThe study was supported by Mallinckrodt Pharmaceuticals.\nSubramaniam disclosed relationships with Mallinckrodt Pharmaceuticals and the National Institutes of Health.
As the anesthesia wears off, I’m finding it slightly easier to talk and form sentences. It can be deceptive – you think you are feeling fine, but then try to talk and everything comes out jumbled, stammering and lacking syntax.\nAs of right now, I can’t really complain about anything. My energy level is great. I have some pain, but it is manageable. If it wasn’t for the complication, I’d probably be ready to head back to the gym. I know I shouldn’t. Maybe the complication is a good thing, by forcing me to slow down and relax for a week or so.\nI’m not experiencing tremendous pain, thank goodness, but the aches and other feelings are becoming more specific. When it gets to be a little too much, I can take a Percoset. There are four areas that we have to watch out for.\nAt the drilling site on my skull, there isn’t much happening. There is a large bandage in place there, and an occasional ache. The lead inside the brain is just there. It doesn’t cause any problems, because the brain itself has no pain receptors.\nI can definitely feel the extension that is tunneled under the skin on the left side of my head—just a bit of a tug, to remind me it’s there. I can feel the wire near the pulse generator when I move my head through the range of motion. Sometimes this area aches and throbs.\nThe pulse generator is placed just below my left collarbone, and it only hurts when I move it. When our friend Sally moved in for the god-bye hug, she accidentally put her shoulder into the unit. That hurt. But it went away quickly.\nThen there is the site of the complication, where the doctors inserted a Foley catheter only to discover some old scarring that they had to push through. As recently as Saturday afternoon, there was bleeding at the tip of the urethra, around the catheter. Yikes!\nBut it seems to be getting better, faster. For the first time since the surgery, I’m actually feeling comfortable down there. Suzanne went to the Gap to get me some looser-fitting pants and knit boxers, the better to handle the tubing and leg-mounted bag that I’ll be wearing for (augh!) another week.\nThe complication is tough luck. Why they couldn’t just hand me a jug, I don’t know. Even if I ended up breaking the sterile field, the violation would have been far less than the soaking that apparently occurred when the anesthesiologists put me out at the first sign of trouble. I was still damp after my second stretcher transfer, following the second MRI. Alterman’s PA said that was the second time he’d seen this problem in 20 years. Like I said, just my luck.
Caring for your smile is our priority at Columbia Dental Center. For us, that means doing everything we can to maintain healthy teeth and gums to prevent premature loss with general dentistry. Unfortunately, it is not always possible to maintain all your natural teeth. When a tooth needs to be removed, we can help make the experience comfortable and as painless as possible for you or your loved one.\nNo one wants to hear that they need to have a tooth extracted. Even the toughest patient may cringe at the thought of undergoing oral surgery to remove a tooth. However, Dr. Leppo and our entire team can make the process stress-free. We will explain the procedure so that you know what to expect and answer any questions you may have. We also offer sedation dentistry options for those that prefer extra help relaxing during the tooth extraction. The experience of Dr. Leppo will lend to a quick and smooth procedure–you will be home resting before you know it.\nWisdom Teeth Removal\nThe most common teeth that require removal are the wisdom teeth. Several million people each year opt to have their wisdom teeth extracted. Often it is due to these last molars becoming impacted. When there is not enough room for these third molars to come in properly, they may grow in the wrong direction. They may grow in sideways or may not grow through the gum line at all. When this happens, it can cause pain, misalignment, bone loss and infection, making it necessary to remove these problem molars.\nAt Columbia Dental Center, we have a caring, compassionate team that is experienced in tooth removal. Whether you have a broken tooth that must be removed or wisdom teeth that are causing you problems, we can remedy the situation in a calm, relaxing atmosphere. Contact us today for a consultation to discuss your tooth extraction procedure.
To make our 6 am check in we were all up at 4:30. I got dressed in my U of U scrubs for the big day. Upon entering Lucile Packard, security asked if anyone had a cough so I had to put on a mask which I was not happy about. The rest of the parents waiting anxiously with their children in the preop area also looked a little anxious so Daddy walked me around out in the hallway while we waited to be called back. About 20 minutes later it was our turn and I was asleep on Daddy's shoulder. The nurse started asking a few questions and when my parents filled her in on the last week and a half events, she immeadiately paged the anesthesiologist. The anesthesiologist came down shortly and after getting the details from us, it was clear there would be no surgery today. In fact, the look on her face was "why are you here?" So Mommy explained all the calls she had made and all the instructions they were given to show up. Before surgery could be cancelled, though, to be politically correct, she first called the surgeon's resident, Jason. In an accusatory tone she said to him, "Your patient is here and she is sick. Maybe not as sick as a week ago but she is still sick." After some hushed comments, Jason apparently was going to call Dr Schendel. While we were waiting, the anesthesiologist explained that even though my lungs sounded clear and I hadn't had a fever in several days it was more than a little risky to attempt a long complicated surgery when my trach would be difficult to get to because the face was the operative site. Totally made sense to my parents and they didn't feel bad at all. So with that, back in the car we went and back to the hotel to pack up. I was asleep almost immeadiately and woke up only a few minutes before we got home. The rest of the day my parents traded off trying to nap a little to make up for the last few nights while I had a great time drinking milk, eating crackers and watching some of my favorite videos. Our night nurse is still out sick so Daddy will be night nurse again tonight. The agency has still not found a day nurse for me so Daddy will be my day nurse for this week as well. Despite all the stress of not having nursing we are all so grateful to be home.\nPeyton Nicole Smith
- News Releases\nAllergan textured breast implants and tissue expanders are being removed from the U.S. market, due to the risk of breast implant-associated anaplastic large cell lymphoma. That's according to a recent statement from the maker and the Food and Drug Administration (FDA).\n"BIOCELL®saline-filled and silicone-filled textured breast implants and tissue expanders will no longer be distributed or sold in any market where they are currently available. Effective immediately, health care providers should no longer implant new BIOCELL® textured breast implants and tissue expanders and unused products should be returned to Allergan."\n"We support Allergan and the FDA’s decision to remove the BIOCELL® textured breast implants from the market to allow further investigation of its link to breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)," says Dr. Minh-Doan Nguyen, a Mayo Clinic plastic surgeon.\n"Mayo Clinic has been proactive in addressing this issue and is currently in compliance with the FDA recommendations," says Dr. Nguyen. "We have been using smooth tissue expanders since March 2019, when they became available, and we notified patients from the past 20 years who have had textured implants and have seen them, as needed."\nIn addition, Dr. Nguyen says Mayo agrees with current recommendations that preventative removal of textured implants in patients who do not have any symptoms of BIA-ALCL is not necessary. However patients are encouraged to discuss their concerns with their plastic surgeon. The most common symptom for BIA-ALCL is formation of a delayed fluid pocket or seroma around the implant. It can also present as a new breast mass or skin lesion.\nBreast augmentation — also known as augmentation mammoplasty — is surgery to increase breast size. It involves placing breast implants under breast tissue or chest muscles.\nFor some women, breast augmentation is a way to feel more confident. For others, it's part of rebuilding the breast for various conditions.\nIf you're considering breast augmentation, talk to a plastic surgeon. Make sure you understand what surgery involves, including possible risks, complications and follow-up care.\nBreast augmentation might help you:\nDiscuss your goals with your surgeon so that you can be realistic about what breast augmentation can do for you.\nBreast augmentation poses various risks, including:\nCorrecting these complications might require more surgery, either to remove or replace the implants.\nThe FDA has identified a possible association between breast implants and the development of breast implant-associated anaplastic large cell lymphoma (ALCL), a rare cancer of the immune system. The FDA believes that women with breast implants might have a very low but increased risk of developing ALCL. However, further research is needed to fully understand the relationship between ALCL and breast implants.\nBefore you decide to have surgery, consider the following:\nSometimes, breast augmentation is done during local anesthesia — you're awake and your breast area is numbed. Often, though, breast augmentation is done during general anesthesia, in which you're asleep for the surgery.\nLearn more about this procedure.\nNational Cancer Survivors Day will be observed Sunday, June 4, which makes this a good time to learn more about life after cancer. One in 2 men ...\nDEAR MAYO CLINIC: I spent many a summer at the beach growing up. My mother always slathered me with sunscreen. Now, as a 30-year-old woman, sunscreen ...\nShortly before Thanksgiving 2021, Jerry Haines, a part-time farmer and retired butter and cheesemaker, was helping another farmer with fall chores. He felt good but ...
Tait, Alan R. PhD; Malviya, Shobha MD\nSection Editor(s): Davis, Peter J.\nTraditionally, children who present for elective surgery with an upper respiratory tract infection (URI) have had their procedure postponed at least until they are asymptomatic. The rationale for this practice was based on empirically derived data suggesting an association between the administration of anesthesia to a child with a URI and the appearance of respiratory complications. More recent scientific data have, in essence, confirmed these observations (1–3) although, for certain pediatric surgical populations, there appears to be no increased risk (4,5). These studies also showed that despite a general increase in the incidence of perioperative respiratory complications in children with URIs, most were manageable with minimal associated morbidity.\nDespite the importance of this clinical problem, there is still no consensus regarding the optimal anesthetic management of children with URIs who require elective surgery. Although several studies have addressed this issue, it has been difficult to develop evidence-based practice guidelines given differences in study design, URI criteria, and outcomes.\nThe debate surrounding the decision to cancel or proceed with elective surgery for the patient with a URI is not new. In a 1955 commentary, Ellis (6), while recognizing the potential for complications, made a case for proceeding with surgery despite the presence of a URI: “…although anesthesia may not be good treatment for the common cold, might it not be a good way of passing the time till the cold is gone?”\nAlthough a few studies had touched on the subject of complications associated with respiratory infections, the primary impetus to cancel surgery for children with URIs came after a 1979 case series described by McGill et al. (7). This report identified 11 children who developed significant perioperative complications, including atelectasis. Of the 11, all but 1 had reported a respiratory infection in the month preceding surgery.\nIn 1987, Tait and Knight (4,8) reported on 2 series of children requiring elective surgical procedures. In the first, 3585 cases were reviewed retrospectively from the medical records (8). Results showed no increased risk of complications in children with URIs but showed a 3.5-fold increase in the prevalence of respiratory complications in children with a recent URI (<2 wk) compared with control children. Because of the potential for selection bias in this study, a subsequent prospective study was performed (4). This study included 489 children who received halothane anesthesia by face mask for myringotomy and tube placement. These children were divided into three groups (control, recent URI, and active URI) based on the presence or absence of a priori–defined symptom criteria. Results showed no differences among these groups with respect to the risk of perioperative laryngospasm, bronchospasm, or apnea. The authors concluded that blanket surgery cancellation for children undergoing short procedures with halothane anesthesia in which the trachea is not instrumented might be unnecessary.\nIn apparent contrast to these two studies, De Soto et al. (9) found that children with symptoms of a URI had a significant increase in the risk of postoperative arterial oxygen desaturation. Other investigators subsequently confirmed this observation, although it should be noted that all children in these studies responded rapidly after oxygen administration (10,11). In a related study, Kinouchi et al. (12) determined that children with URIs desaturated more rapidly than uninfected children after an apneic episode. Other specific complications have been associated with the presence of a URI, including bronchospasm (11,13) and laryngospasm (1,14,15). In a longitudinal study by Cohen and Cameron (1) involving more than 20,000 children, those with symptoms of a URI were 2–7 times more likely to experience respiratory-related complications and 11 times more likely if their tracheas were intubated. Although important, this study was limited by incomplete documentation of the timing and nature of the URI symptoms.\nDespite the importance of all these studies in determining outcome in children with URIs, none could identify risk factors that predicted these outcomes. However, Parnis et al. (2), in a study of 2051 pediatric surgical patients, identified 8 clinical predictors of anesthetic complications. These predictors included airway management (endotracheal tube [ETT] > laryngeal mask airway [LMA] > face mask), the parents’ statement that the child had a “cold,” a history of snoring, passive smoking, induction anesthetic (thiopental > halothane > sevoflurane > propofol), presence of sputum, presence of nasal congestion, and use of an anticholinesterase (muscle relaxant not reversed > reversed). The presence of a respiratory infection was also implicated as a risk factor for airway complications in a study by Bordet et al. (16).\nSimilar to Parnis et al.’s (2) study, Tait et al. (3) examined the incidence of and risk factors for adverse respiratory events in 1078 children undergoing a variety of surgical procedures. Results showed that children with active and recent URIs (in the last 4 wk) had significantly more episodes of overall respiratory events, breath-holding, major arterial oxygen desaturation (Spo2 <90%), and severe coughing compared with children with no URIs. Independent risk factors for adverse respiratory events in children with active URIs included use of an ETT in a child <5 yr old, prematurity (<37 wk), history of reactive airway disease, paternal smoking, surgery involving the airway, presence of copious secretions, and presence of nasal congestion.\nAll the studies outlined previously describe children who, despite the presence of a URI, had been otherwise healthy. For these children, postponing surgery has little effect on their surgical condition or outcome. However, there are many children in whom the benefits of expedient surgery may outweigh the potential risks associated with a URI. Children who require urgent corrective or palliative surgery for congenital cardiac disease, for example, may have compromised cardiopulmonary systems that may be further exacerbated by a URI. Yet there are very few data regarding outcome in children who present for cardiac surgery while harboring a URI. In a recent study by Malviya et al. (17), the presence of a URI was found to be predictive of postoperative bacterial infections and multiple complications in children undergoing corrective cardiac surgery. However, the presence of a URI did not appear to affect the patients’ overall length of hospital stay or the development of any long-term sequelae.\nDespite the increased risk of respiratory events in children with URIs, there appears to be very little residual morbidity. Indeed, there are no cases in the pediatric and adult anesthesia closed claims literature implicating URIs with serious adverse events (18,19). Although there are a few reports of atelectasis in children with URIs (7,20), two large-scale studies involving children with URIs revealed minimal morbidity (2,3). In one of these, 3 children out of 1078 developed adverse sequelae requiring rehospitalization (3). Two children with active URIs were admitted for pneumonia after surgery, and one child with a history of a recent URI was admitted for stridor. All children had uneventful recoveries.\nDespite the apparently infrequent morbidity, there are reports of deaths in children with URIs after surgery (21,22). In one report (22), a 15-mo-old girl with a history of URI in the 2 wk before surgery developed laryngospasm after tracheal extubation and had a subsequent cardiac arrest. Although the URI was implicated in her death, several other factors, including premature tracheal extubation and inadequate monitoring, were likely contributory (23). In another case report, a 3-yr-old child died after anesthesia for cautery of the nose (21). The child had a history of URI within 2 wk before surgery. Postmortem examination elicited evidence of viral myocarditis. Among high-risk children with URIs undergoing cardiac procedures, Malviya et al. (17,24) found no increase in mortality.\nTypically, children experience six to eight URIs per year, and this may be even more frequent among young children attending nursery school or day care (25). Of these infections, approximately 95% are of viral etiology and represent a spectrum of viral species. Approximately 30%–40% of URIs are caused by rhinoviruses; however, other viruses—including coronavirus, respiratory syncytial virus, and parainfluenza virus—contribute significantly to the etiology of the disease. The differential diagnosis of a URI is further confounded because many illnesses are characterized by URI-like symptoms. In addition to the common cold (nasopharyngitis), patients may present with undiagnosed infections including croup (laryngotracheobronchitis), influenza, bronchiolitis, herpes simplex, pneumonia, epiglottitis, and strep throat. Furthermore, patients may present with URI-like symptoms of noninfectious etiology, such as allergic or vasomotor rhinitis.\nAlthough most viral URIs are self-limiting, they may produce airway hyperreactivity that persists for several weeks after infection. Several studies have demonstrated significant decreases in airway conductance in volunteers with URIs when challenged by cold air, histamine, or citric acid aerosols (26,27). These effects were shown to persist for up to 6 wk after the URI and thus may have important implications for children requiring anesthesia in the acute and convalescent periods, particularly if the trachea requires intubation.\nViral invasion of the respiratory mucosa may render the airway sensitive to secretions or potentially irritant anesthetic gases. There is also increasing evidence that chemical mediators and neurologic reflexes play an important role in the etiology of bronchoconstriction. For example, release of inflammatory mediators, such as bradykinin, prostaglandin, histamine, and interleukin, at the sites of viral damage, has been associated with bronchoconstriction (25,28,29). Studies also show that bronchial hyperreactivity resulting from viral infections may be neurally mediated. Atropine, for example, has been shown to block airway hyperreactivity, and this suggests a vagal component to the response (26,27). Normally, stimulation of muscarinic receptors (M2) on the vagal nerve endings inhibits the release of acetylcholine; however, in the infected individual, it is thought that these receptors may be inhibited by viral neuraminidases, thus resulting in an increase in acetylcholine release and bronchoconstriction (30). Other mechanisms of viral-induced airway hyperresponsiveness have been postulated. For example, studies suggest that viral infections increase the response of airway smooth muscle to tachykinins (31,32). Tachykinins are a group of neuropeptides that reside in the vagal afferent C-fibers of the airways and are important in smooth muscle contraction. Under normal circumstances, tachykinins are inactivated by neutral endopeptidase; however, it is thought that during viral infections, the activity of this enzyme is inhibited such that the constrictor response of smooth muscle to tachykinins is enhanced (31,32).\nAlthough the designation of a URI implies restriction of the disease to the upper airways, several studies have shown that URIs may also produce pulmonary function abnormalities (33–35). In a study by Collier et al. (35), children with URIs were shown to exhibit spirometric changes including decreased forced vital capacity, forced expired volume in 1 s, and peak expiratory flow. Cate et al. (34) showed that volunteers infected with rhinovirus had significant decreases in diffusion capacity. Furthermore, Dueck et al. (36) showed that in sheep, the pulmonary changes associated with anesthesia (e.g., decreased functional residual capacity and increased intrapulmonary shunting) were enhanced during parainfluenza infection.\nA suggested algorithm for the assessment and management of the child with a URI is presented in Figure 1. If the child is presenting for an emergent procedure, the presence of a URI should be elicited if possible, because this knowledge will alert the anesthesiologist to the potential for complications and may permit modification of the anesthetic management to reduce any risk. Children presenting for elective procedures with symptoms of a URI require careful preoperative assessment, including a detailed history and physical. The lungs should be auscultated to exclude any lower respiratory tract involvement, and a chest radiograph should be considered if the examination is questionable. The patient should be evaluated for fever, dyspnea, productive cough, sputum production, nasal congestion, lethargy, and wheezing. In two large-scale prospective studies, nasal congestion, sputum production, and a history of reactive airway disease were identified as predictors of adverse respiratory events (2,3). Valuable information regarding the nature of presenting symptoms can also be gleaned from the parents, because they are usually acutely attuned to their child’s condition and may be able to help distinguish between an infectious and noninfectious condition. In a study by Schreiner et al. (14), confirmation of a URI by a parent was found to be a better predictor of laryngospasm than reliance on symptom criteria alone. In children with congenital heart disease, diagnosis of a URI may be further complicated because URI symptoms can be confused with those of congestive heart failure.\nIn general, children presenting with symptoms of an uncomplicated URI and who are afebrile with clear secretions and appear otherwise healthy, or those with noninfectious conditions, should be able to undergo surgery. Rolf and Coté (11) suggest that “children with a mild URI may be safely anesthetized, since the problems encountered are generally easily treated and without long-term sequelae.” Children with more severe symptoms—including mucopurulent secretions, productive cough, fever >38°C, lethargy, or signs of pulmonary involvement—should have their elective surgery postponed for a minimum of 4 wk. Similarly, if a bacterial infection is suspected, patients should be placed on antibiotic therapy, and their surgery should be postponed for ≥4 wk. Although it is relatively easy to make the decision to cancel or proceed in children who are healthy with minimal symptoms or who are overtly sick, the decision becomes harder for children who, for example, present with a few symptoms such as nasal congestion and a slight nonproductive cough for a procedure requiring use of an ETT.\nAlthough laboratory tests are available to confirm the diagnosis of a URI, none are cost-effective or practical in a busy surgical setting. The analysis of nasopharyngeal swabs or aspirates for viral isolation is not practical and, depending on the manner in which the sample is collected and on the phase of the infection, may offer limited sensitivity (2,4). Measurement of white blood cells counts as an indicator of infection is also of limited use, because patients with URIs do not necessarily present with increased white blood cell counts. The chest radiograph is also of little utility for children with URIs except in certain circumstances (e.g., cardiac surgery). Furthermore, chest radiograph findings typically lag behind the presentation of clinical symptoms in children with lower respiratory infections.\nIn assessing the suitability of any child with a URI for surgery, it is important to assess the risk/benefit ratio. This should involve consideration of the child’s presenting symptoms and age, the urgency of the surgery, comorbid conditions (e.g., asthma or cardiac disease), and the type of surgery. Another consideration is the frequency of URIs experienced by the child. In the case of the child who experiences six to eight URIs per year, it may be difficult to precisely target a period when the child is symptom free for elective surgery. Decisions regarding canceling or proceeding with surgery for children with URIs should be made on a case-by-case basis by considering the presence of identified risk factors and bearing in mind the anesthesiologist’s own comfort and experience with anesthetizing children with URIs. Awareness of the risk factors and the potential for complications in these children is imperative for optimizing management strategies and responding appropriately to events should they occur.\nCancellation of Surgery for the Child with a URI\nAs mentioned previously, postponement of surgery because of a URI was once commonplace. Although blanket cancellation of surgery because of a URI avoids the potential for complications, it may also impose emotional and economic burdens on the parents (37,38). Furthermore, blanket cancellation may not always be practical in today’s health care environment of increasing caseloads and pressures to expedite surgery. Indeed, a national survey suggests that anesthesiologists today appear less likely to cancel surgery because of a URI (39). In this survey, 40.4% of anesthesiologists with <10 yr in practice reported “seldom” (1%–25% of the time) canceling because of a URI, compared with 27.2% of those with more than 10 yr of experience.\nThe decision of how long to postpone surgery requires a balance between the need to proceed with the procedure and the time required for resolution of symptoms and diminished risk. Unfortunately, there is no consensus on the optimal time to wait before surgery is rescheduled. In a survey of anesthesiologists, most reported waiting 3–4 wk before proceeding with surgery (39). The rationale for this time period is founded on the observation that airway hyperreactivity persists for several weeks after a URI (26,27). Indeed, some studies suggest that patients recovering from a URI have a similar or increased risk of complications compared with those who have acute symptoms1 (3). Skolnick et al.1 demonstrated that the risk of respiratory complications was greatest in the 3 days after a URI but remained increased for up to 6 wk after the URI. Tait et al. (3) found that the risk remained increased for 4 wk after a URI. Although these data suggest that postponement of anesthesia and surgery for 4 wk is prudent, Berry (40) suggests that a 1- to 2-wk delay may be all that is required for children with uncomplicated nasopharyngitis.\nManagement of the child with a URI is directed at minimizing secretions and avoiding stimulation of a potentially sensitive airway. Because sputum and copious secretions have been identified as risk factors, it is important that the airway be suctioned (under deep anesthesia) to remove excess secretions. This not only reduces airway irritation from secretions, but also may be important in preventing mucus from plugging a bronchus or ETT (41).\nBecause viral infections affect the nature and quality of secretions, it is important to ensure that the patient is adequately hydrated. IV hydration should be instituted in all patients unless the procedure is very short. Humidification may also be important in children with URIs, particularly for long cases. Although there are no data from controlled trials to support the efficacy of this practice in children with URIs, humidification may help to minimize drying and inspissation of secretions by anesthetic and carrier gases and may maintain adequate ciliary clearance mechanisms. In one report, 35.2% of anesthesiologists reported using humidification often for children with URIs (39). The use of anticholinergics such as glycopyrrolate or atropine may be useful in reducing secretions and attenuating vagally-mediated hyperreactivity. One-third of anesthesiologists reported using anticholinergics frequently (39). The benefits of anticholinergics for perioperative outcomes in children with URIs, however, remains open to further investigation. Bronchodilator premedication has also been suggested as a means to reduce autonomically mediated airway complications. However, in one study, Elwood et al. (5) showed that premedication with either albuterol or ipratropium had no effect on URI-related respiratory complications. Recently, however, Silvanus et al. (42) showed that in adult patients with bronchial hyperreactivity, preoperative treatment with combined corticosteroids and salbutamol minimized intubation-evoked bronchoconstriction more effectively than inhaled salbutamol alone.\nUse of an ETT should be avoided if possible, because its use, particularly in young children, significantly increases the risk of airway complications (1,3). Although a face mask is associated with the least incidence of complications, it may not be appropriate for certain cases. For example, an ETT is likely the airway of choice for surgery of the oropharynx and neck, major thoracic and abdominal surgery, and operations lasting more than a couple of hours. The LMA, however, has been shown to provide a safe alternative for some procedures in which an ETT might otherwise be used. One study showed that the LMA is associated with fewer episodes of respiratory complications, including bronchospasm and arterial oxygen desaturation (43). In another, Tartari et al. (44) showed that use of a LMA was associated with a significantly reduced incidence of postoperative adverse events. In any case, all patients should be monitored continuously by pulse oximetry, particularly during the placement and removal of an ETT and in the immediate postoperative period (3).\nThe choice of anesthetic for induction and maintenance has been shown to be important in children with URIs. In the past, halothane was considered the volatile anesthetic of choice in these children; however, in many hospitals today, halothane has largely been replaced by sevoflurane, particularly for induction. Rieger et al. (45) showed that the incidence of complications in children with mild URIs was similar between sevoflurane and halothane but that sevoflurane provided a more rapid recovery profile. Other studies, however, suggest that sevoflurane results in fewer complications than halothane (2,3), particularly when sevoflurane is used for both induction and maintenance (3).\nRegardless of the induction drug used, it is imperative that the depth of anesthesia be sufficient to obtund the airway reflexes, particularly when an ETT is placed. The optimal depth of anesthesia at which tracheal extubation should occur is less clear. Although some clinicians prefer to extubate under deep anesthesia to avoid reflex constriction of the airways, others prefer to extubate when the patient is awake, believing that a patient with intact reflexes is in a better position to clear secretions and respond to the tactile stimulation of ETT removal. In children without URIs, the data on awake versus deep extubation are equivocal. In one study, Patel et al. (46) found no difference in emergence complications after awake versus deep extubation, whereas Pounder et al. (47) showed that awake extubation was associated with an increased risk of arterial oxygen desaturation. Kitching et al. (48) showed that awake removal of an LMA was associated with a more frequent incidence of coughing. Pappas et al. (49) showed that airway complications were unaffected by awake LMA removal during sevoflurane anesthesia but were increased when isoflurane was used. Although there are no randomized studies addressing this issue in children with URIs, one observational study showed no difference in the incidence of complications between children with URIs who were extubated under deep anesthesia versus awake (3).\nTraditionally, the response to URI-related complications has been reactive; i.e., a problem is identified, and corrective action is taken. Yet as we gain greater understanding of the risks associated with anesthetizing the child with a URI and the mechanisms of viral-induced airway hyperreactivity, it may be possible to be more proactive in minimizing the risks. Although the currently available anticholinergics may have some benefit for children with URIs, they are nonselective in terms of their effect on the muscarinic receptors (M2 and M3) responsible for airway reactivity. Jacoby and Hirshman (28) make a good case for the development of anticholinergic drugs that would selectively block the M3 receptors on airway smooth muscle that cause bronchoconstriction without blocking the vagal M2 receptors responsible for the inhibition of acetylcholine. Other promising developments include the use of recombinant human neutral endopeptidases to replace the natural forms lost during viral infections (24).\nAlthough past practices championed blanket cancellation of surgery for the child with a URI, there is a growing body of literature that now supports selective cancellation of surgery for these children (37). Whereas most studies agree that children with active and recent URIs are at increased risk for perioperative complications, these events, for the most part, are manageable and have no long-term adverse sequelae. Furthermore, these studies have identified several independent factors that place the child with a URI at risk such that anesthesiologists are now in a better position to make informed decisions regarding the suitability of proceeding with surgery for these children.\nMost practitioners would agree that children with mild uncomplicated URIs undergoing procedures that do not involve instrumentation of the airway can be safely anesthetized without any increase in risk (3,4,11,37,50,51). Furthermore, most would agree that any child with severe symptoms should have surgery postponed for at least 4 wk. The dilemma therefore arises with an otherwise healthy child whose symptoms lie between these extremes, who has associated risk factors, or who is asymptomatic but has a recent history of URI. Decisions regarding the suitability of proceeding with anesthesia for these children must be considered on a case-by-case basis, bearing in mind the presence of identified risk factors (e.g., reactive airway disease, ETT use, type of surgery, and presence of nasal congestion and sputum), the need for expedient surgery, and the anesthesiologists’ experience and comfort with anesthetizing the child with a URI. Consideration of these elements, together with a tincture of common sense and good judgment, is critical as a means to assess the individual risk/benefit profiles, identify and prepare for potential complications, and optimize the anesthetic management accordingly.\n1. Cohen MM, Cameron CB. Should you cancel the operation when a child has an upper respiratory tract infection? Anesth Analg 1991;72:282–8.\n2. Parnis SJ, Barker DS, Van Der Walt JH. Clinical predictors of anaesthetic complications in children with respiratory tract infections. Paediatr Anaesth 2001;11:29–40.\n3. Tait AR, Malviya S, Voepel-Lewis T, et al. Risk factors for perioperative adverse respiratory events in children with upper respiratory tract infections. Anesthesiology 2001;95:299–306.\n4. Tait AR, Knight PR. The effects of general anesthesia on upper respiratory tract infections in children. Anesthesiology 1987;67:930–5.\n5. Elwood T, Morris W, Martin L, et al. Bronchodilator premedication does not decrease respiratory adverse events in pediatric general anesthesia. Can J Anaesth 2003;50:277–84.\n6. Ellis G. Anaesthesia and the common cold. Anaesthesia 1955;10:78–9.\n7. McGill WA, Coveler LA, Epstein BS. Subacute upper respiratory infection in small children. Anesth Analg 1979;58:331–3.\n8. Tait AR, Knight PR. Intraoperative respiratory complications in patients with upper respiratory tract infections. Can J Anaesth 1987;34:300–3.\n9. De Soto H, Patel RI, Soliman IE, Hannallah RS. Changes in oxygen saturation following general anesthesia in children with upper respiratory infection signs and symptoms undergoing otolaryngological procedures. Anesthesiology 1988;68:276–9.\n10. Levy L, Pandit UA, Randel GI, et al. Upper respiratory tract infections and general anaesthesia in children: peri-operative complications and oxygen saturation. Anaesthesia 1992;47:678–82.\n11. Rolf N, Coté CJ. Frequency and severity of desaturation events during general anesthesia in children with and without upper respiratory infections. J Clin Anesth 1992;4:200–3.\n12. Kinouchi K, Tanigami H, Tashiro C, et al. Duration of apnea in anesthetized infants and children required for desaturation of hemoglobin to 95%: the influence of upper respiratory infection. Anesthesiology 1992;77:1105–7.\n13. Olsson G. Bronchospasm during anesthesia: a computer-aided incidence study of 136,929 patients. Acta Anaesthesiol Scand 1987;31:244–52.\n14. Schreiner MS, O’Hara I, Markakis DA, Politis GD. Do children who experience laryngospasm have an increased risk of upper respiratory tract infection? Anesthesiology 1996;85:475–80.\n15. Olsson GL, Hallen B. Laryngospasm during anaesthesia: a computer-aided incidence study in 136,929 patients. Acta Anaesthesiol Scand 1984;28:567–75.\n16. Bordet F, Allaouchiche B, Lansiaux S, et al. Risk factors for airway complications during anaesthesia in paediatric patients. Paediatr Anaesth 2002;12:762–9.\n17. Malviya S, Voepel-Lewis T, Siewert M, et al. Risk factors for adverse postoperative outcomes in children presenting for cardiac surgery with upper respiratory tract infections. Anesthesiology 2003;98:628–32.\n18. Morray J, Geiduschek J, Caplan R, et al. A comparison of pediatric and adult anesthesia closed malpractice claims. Anesthesiology 1993;78:461–7.\n19. Morray J, Geiduschek J, Ramamoorthy C, et al. Anesthesia-related cardiac arrest in children: initial findings of the Pediatric Perioperative Cardiac Arrest (POCA) Registry. Anesthesiology 2000;93:6–14.\n20. Valdivia S, Alavedra P. Pulmonary atelectasis during anesthesia in a boy with upper respiratory tract infection. Rev Esp Anestesiol Reanim 2001;48:188–91.\n21. Jones A. Anaesthetic death of a child with a cold. Anaesthesia 1993;48:642.\n22. Konarzewski WH, Ravindran N, Findlow D, Timmis PK. Anaesthetic death of a child with a cold. Anaesthesia 1992;47:624.\n23. Bloch EC. Anaesthetic death of a child with a cold. Anaesthesia 1993;48:171.\n24. Malviya S, Voepel-Lewis T, Siewert M, et al. Postoperative outcomes in children who present for cardiac surgery with symptoms of an upper respiratory tract infection. Am J Anesthesiol 2000;27:93–7.\n25. Gwaltney J Jr. The common cold. In: Mandell G, Bennett J, Dolin R, eds. Principles and practice of infectious diseases. New York: Churchill Livingstone, 1995:561–6.\n26. Empey DW, Laitinen LA, Jacobs L, et al. Mechanisms of bronchial hyperreactivity in normal subjects after upper respiratory tract infection. Am Rev Respir Dis 1976;113:131–9.\n27. Aquilina AT, Hall WJ, Douglas RG Jr, Utell MJ. Airway reactivity in subjects with viral upper respiratory tract infections: the effects of exercise and cold air. Am Rev Respir Dis 1980;122:3–10.\n28. Jacoby DB, Hirshman CA. General anesthesia in patients with viral respiratory infections: an unsound sleep? Anesthesiology 1991;74:969–72.\n29. Martin LD. Anesthetic implications of an upper respiratory infection in children. Pediatr Clin North Am 1994;41:121–30.\n30. Fryer A, El-Fakahany E, Jacoby D. Parainfluenza virus type 1 reduces the affinity of agonists for muscarinic receptors in guinea-pig lung and heart. Eur J Pharmacol 1990;181:51–8.\n31. Dusser D, Jacoby D, Djokic T, et al. Virus induces airway hyperresponsiveness to tachykinins: role of neutral endopeptidase. J Appl Physiol 1989;67:1504–11.\n32. Jacoby D, Tamaoki J, Borson D, Nadel J. Influenza infection causes airway hyperresponsiveness by decreasing enkephalinase. J Appl Physiol 1988;64:2653–8.\n33. Picken JJ, Niewoehner DE, Chester EH. Prolonged effects of viral infections of the upper respiratory tract upon small airways. Am J Med 1972;52:738–46.\n34. Cate TR, Roberts JS, Russ MA, Pierce JA. Effects of common colds on pulmonary function. Am Rev Respir Dis 1973;108:858–65.\n35. Collier AM, Pimmel RL, Hasselblad V, et al. Spirometric changes in normal children with upper respiratory infections. Am Rev Respir Dis 1978;117:47–53.\n36. Dueck R, Prutow R, Richman D. Effect of parainfluenza infection on gas exchange and FRC response to anesthesia in sheep. Anesthesiology 1991;74:1044–51.\n37. Coté CJ. The upper respiratory tract infection (URI) dilemma: fear of complication or litigation? Anesthesiology 2001;95:283–5.\n38. Tait AR, Voepel-Lewis T, Munro HM, et al. Cancellation of pediatric outpatient surgery: economic and emotional implications for patients and their families. J Clin Anesth 1997;9:213–9.\n39. Tait AR, Reynolds PI, Gutstein HB. Factors that influence an anesthesiologist’s decision to cancel elective surgery for the child with an upper respiratory tract infection. J Clin Anesth 1995;7:491–9.\n40. Berry FA. Preexisting medical conditions of pediatric patients. Semin Anesth 1984;3:24–31.\n41. Cohen SP, Anderson PL. Mucoid impaction following nasal intubation in a child with an upper respiratory infection. J Clin Anesth 1998;10:327–30.\n42. Silvanus M-T, Groeben H, Peters J. Corticosteroids and inhaled salbutamol in patients with reversible airway obstruction markedly decrease the incidence of bronchospasm after tracheal intubation. Anesthesiology 2004;100:1052–7.\n43. Tait AR, Pandit UA, Voepel-Lewis T, et al. Use of the laryngeal mask airway in children with upper respiratory tract infections: a comparison with endotracheal intubation. Anesth Analg 1998;86:706–11.\n44. Tartari S, Fratantonio R, Bomben R, et al. Laryngeal mask vs tracheal tube in pediatric anesthesia in the presence of upper respiratory tract infection. Minerva Anestesiol 2000;66:439–43.\n45. Rieger A, Schroter G, Philippi W, et al. A comparison of sevoflurane with halothane in outpatient adenotomy in children with mild upper respiratory tract infections. J Clin Anesth 1996;8:188–97.\n46. Patel R, Hannallah R, Norden J, et al. Emergence airway complications in children: a comparison of tracheal extubation in awake and deeply anesthetized patients. Anesth Analg 1991;73:266–70.\n47. Pounder D, Blackstock D, Steward M. Tracheal extubation in children: halothane versus isoflurane, anesthetized versus awake. Anesthesiology 1991;74:653–5.\n48. Kitching A, Walpole A, Blogg C. Removal of the laryngeal mask airway in children: anesthetized compared with awake. Br J Anaesth 1996;76:874–6.\n49. Pappas A, Sukhani R, Lurie J, et al. Severity of airway hyperreactivity associated with laryngeal mask airway removal: correlation with volatile anesthetic choice and depth of anesthesia. J Clin Anesth 2001;13:498–503.\n50. Fennelly ME, Hall GM. Anaesthesia and upper respiratory tract infections: a non-existent hazard? Br J Anaesth 1990;64:535–6.\n51. Koka BV, Jeon IS, Andre JM, et al. Postintubation croup in children. Anesth Analg 1977;56:501–5.\n1 Skolnick ET, Vomvolakis M, Buck KA. A prospective evaluation of children with upper respiratory infections undergoing a standardized anesthetic and the incidence of adverse respiratory events [abstract]. Anesthesiology 1998;89:A1309. Cited Here...
by Robert Adelson, MD, FACS\nNosebleeds, or epistaxis, is a remarkably common and particularly vexing condition for the Otolaryngologist. There is a 60% lifetime incidence of epistaxis and, amongst this group of patients, about 6% will seek medical attention for bleeding. Almost 1% of all visits made to an Emergency Department are for the treatment of epistaxis, making bleeding from the nose the most common condition for which an Ear Nose and Throat doctor will be urgently consulted. Epistaxis occurs most commonly when patient risk factors such as high blood pressure, prominent blood vessels, and the use of aspirin and other blood thinning medications are combined with environmental features that challenge the normally moist lining of the nose. Periods of low humidity, cold weather, and the use of forced air heating can dry the lining of the nose in much the same way that lips become during the winter. Dry nasal mucosa is more susceptible to small insults from blowing of the nose, forceful sneezing and digital manipulation of the nostrils with resultant minor trauma to the nasal mucosa and bleeding from the well-vascularized nasal lining. While nosebleeds are unfortunately common and highly concerning to both the patient and physician, they are also treatable and preventable.\nWhat Can You Do?\nThe most important method of treatment for epistaxis is prevention. Humidification and moisturization of the nasal passages is the best defense against episodes of nasal bleeding. When nasal mucosa is moist it is less likely to develop small cracks and ulcerations in response to minor insults, and therefore less likely to bleed as a result of sneezing and forceful blowing of the nose. The generous use of nasal saline sprays should be considered during the cold and dry months of the year, and particularly when indoor heating further decreases humidity. Patients can consider using a humidifier in the room of their home during which they spend the most time and typically this involves running the humidifier in the bedroom while sleeping. Most directly, the use of intranasal moisturizers can help speed the process at the very front of the nose, which is the most common site of bleeding and an area of the nose that receives air at its coldest and driest moment during inhalation. I typically recommend lanolin nipple care cream (used by breast feeding mothers) as this widely available, safe to use in the nose, and not prone to dripping. Ponaris Oil and other over-the-counter nasal moisturizers are available and patient preference largely dictates the choice of emollient. Applying a marble-sized amount to the front of the septum every night is helpful in lubricating the area.\nDespite careful prophylactic treatment and good blood pressure control, some patients will continue to experience nosebleeds. Should you develop a nosebleed, the initial step in management is to spray the nose with Afrin (oxymetazoline ) or to apply a generous amount of the same over-the-counter medication to a cotton ball, place the cotton ball inside the bleeding nostril, and then apply very firm pressure to the flexible portion of the nose for at least 5 minutes. Bleeding that persists after this treatment should be investigated by a physician, and on an emergency basis if the bleeding does not stop with this intervention.\nHow an Otolaryngologist Can Help\nThere is a step-wise approach to treating cases of epistaxis that persist despite good preventive measures, and this typically involves examination of the nose with a small fiberoptic scope in the office setting. At the same office appointment, prominent blood vessels within the nose can be treated with cautery techniques under local anesthesia. While this is usually successful, more than one cauterization procedure may be required to achieve a complete cessation of bleeding. Further episodes of bleeding that cannot be diagnosed or treated in the office may be addressed under anesthesia, using a more compete examination with endoscopic equipment and potentially the use of lasers or other energies to treat malformed or enlarged nasal blood vessels. Finally, there are instances of severe bleeding from the nose that require more aggressive measures, such as the placement of nasal packs to apply pressure and tamponade the flow of blood. While the use of such nasal packs for 3-5 days was quite common in the past, more modern approaches to the management of nosebleeds use these uncomfortable packs only as an emergency temporizing measure. After a patient’s bleeding has been stopped with a pack, the patient is offered endoscopic surgery using specialized sinus equipment placed through the nostrils and without any skin incisions that allows the identification and ligation of the large blood vessels deep within the nose that are responsible for about 90% of the blood supply to the nasal mucosa. Clipping these blood vessels is akin to “clamping off” 90% of the flow to the nose, and has a reported success rate between 85-100,% with less than 1% requiring revision surgery for epistaxis.\nThis graduated and conservative approach to the prevention and treatment of nosebleeds provides more effective and less invasive treatment with higher success rates and a reduced need for procedures under general anesthesia. When severe or recurrent bleeding occurs, the ability to avoid packing of the nose by instead using endoscopic equipment to selectively ligate blood vessels deep within the nose offers patients highly targeted surgical options with greater success rates and less pain, inconvenience, and cost when compared to the traditional techniques.
Northwell Health Anesthesiology, PC, a subsidiary of Northwell Health, is a new and growing anesthesia group that serves our eight-county region. The PC is expanding both its ambulatory surgery centers, as well as our inpatient services. Northwell Health Anesthesiology, PC is seeking BC/BE anesthesiologists for full-time and per diem opportunities to join selected ambulatory surgery centers, as well as inpatient settings, on Long Island.\nWe are looking for general anesthesiologists, as well as anesthesiologists with experience in the areas of cardiothoracic services, and pediatrics. The team of skilled anesthesia professionals consists of physicians, nurses, and technicians who provide services in both the inpatient and ambulatory surgery.\nOne of the nation’s largest health care systems, Northwell Health delivers world-class clinical care throughout the New York metropolitan area, pioneering research at The Feinstein Institute for Medical Research and a visionary approach to medical education highlighted by the Hofstra Northwell School of Medicine.\nWe offer a competitive salary and benefits package. In addition, an academic appointment with the Hofstra Northwell School of Medicine is commensurate with credentials and experience. Physicians will be employed as members of Northwell Physician Partners, the seventh largest medical group in the country.\nYou will have immediate access to a team of highly experienced real estate professionals in every community surrounding the Health System. To help orient candidates we provide neighborhood tours and community profiles, including school, transportation, and housing information.\nFor additional information and to apply, please contact the Office of Physician Recruitment: [email protected]
Mixed emotions. While I understand the desire to obtain a cosmetic procedure at an affordable cost, I am troubled by the high pressure sales approach and commoditization of the procedure. A facelift is not a car where the product is the same at different dealerships and problems are referred back to the original manufacturer. This is a highly individualized procedure.\nThey've closed down: the operation is a franchised, 1size- fits-all shortcut procedure developed by a non-MD that relied on blindly-placed sutures instead of proven but more labor-intensive and skilled techniques. The 30% who were satisfied initially were, predictably, back @ baseline appearance by 1 year. Unusual complications unkown in regular facelift. See ASPS/ASAPS.\nLifeStyle Lift Worry. Lifestyle lift a trademarked brand name and also is a chain of facial cosmetic clinics with headquarters in troy, michigan. As advertised, the lifestyle lift is a minimally invasive, short scar lower face lift performed under local anesthesia by facial plastic surgeons, head and neck surgeons, and plastic surgeons. It is not a specific technique. Success is dependent on the surgeon's ability.
Dental Expert Oral implants are man-made titanium blog posts or vertebral origins operatively grown right into the jawbone to change missing teeth or bridge structures. The principle of oral implants dates back to the 1950’s and also was initially utilized to replace teeth lost in a tooth replacement surgical procedure. Ever since, the concept of oral implants has actually progressed to serve a variety of purposes. They can be used to repair abnormality, correct used teeth, correct rugged teeth as well as fill up voids in between teeth. An oral implant is a steel replica of the root of an all-natural tooth utilized as a supporting framework for a dental prosthetic. They give a classy and durable service for missing out on teeth and bridges. The majority of people go through oral implants without any kind ofesthetic or regional anesthesia because it is not made use of for pain relief throughout the procedure. Due to this, lots of dentists do not provide this treatment as a component of their routine treatment. In order to promote this procedure, some dental practitioners have begun using sedation dental care to people can stay clear of the discomfort and discomfort during the procedure.\nThis form of sedation makes use of an anti-anxiety medicine or anti-depressant so individuals can relax throughout the procedure without the worry of needles or surgical treatment. Sedation dental care is carried out by an oral surgeon under neighborhood anesthesia in a workplace setup. After the treatment, oral implants call for little upkeep since they are made from titanium. Nevertheless, as a result of the nature of titanium, which is an inert material, they are susceptible to wear and tear. These implants need little or no maintenance apart from cleaning them after every couple of months. The titanium that is used in the procedure comes from all-natural resources, such as the earth, which means it will certainly not trigger any type of ecological contamination. Due to the fact that titanium is non-toxic, it is used as an active ingredient in a selection of other products also including: dental implants, dental bridges, crowns as well as veneers. Dental implants will certainly not stop an individual from missing teeth. If a patient has shed one or more teeth as a result of disease, mishap, injury or a defective bite, oral implants can be an effective alternative for replacing those teeth. With oral implants, the person can have healthy and balanced teeth that look typical. This assists enhance self-confidence as well as self self-confidence, something all individuals ought to think about. It is likewise vital to note that while dentistry is taken into consideration a clinical specialty, not everyone that looks for treatment will certainly need this sort of therapy. As an individual, you should comprehend that there are some dangers connected with dental implants. When a tooth is missing, the natural connective tissue of the gum and also bone around it can separate and also enable germs to go into the mouth.\nThis can bring about an infection, dental caries as well as various other dental troubles. If a tooth is removed, there is not constantly a great prospect for having a substitute. Elements such as periodontal size, form and function can determine if an individual makes a great prospect or otherwise. While oral implants are a preferred surgical procedure, they are not for every person. There are several factors that a client ought to take into consideration before having the procedure executed. You ought to be knowledgeable on the expected advantages as well as threats of the procedure as well as ask for references from individuals who have actually had effective experiences with their specific dental practitioner. With the ideal dentist and also the appropriate prep work, you also can appreciate a recovered smile.
GFC MSU Surgical Technology Program Mission, Philosophy & Outcomes\nThe Surgical Technology Program provided by Great Falls College Montana State University is a student-centered program responsive to the needs of the community, state and nation. The program strives to provide a quality education through lecture, laboratory and preceptor-model clinical experience to produce competent entry-level graduates that will be competent in the cognitive (knowledge), psychomotor (skills) and affective (behavior) learning domains who will perform their duties ethically and professionally within the guidelines of the profession.\nThe program is an outcomes based program intended to prepare the student to function in the field of the operating room and successfully complete the certification test resulting in a Certified Surgical Technologist, CST. The graduates of this program will be prepared to:\n- Work with surgeons, anesthesiologists, nurses and other health professionals in providing direct or indirect patient care while demonstrating positive work ethic, professionalism and appropriate interpersonal skills in the surgical setting.\n- Practice professional, value directed actions based on didactic and clinical knowledge, ethical principles and legal standards as member of the surgical team.\n- Organize surgical instrumentation, supplies and equipment in an efficient manner while utilizing principles of aseptic technique for physical preparation and maintenance of the surgical environment.\n- Promote lifelong learning fostering the development of professional and personal growth, critical thinking and leadership.\n- Demonstrate understanding of biomedical sciences and technology as it applies to the patient focused events that occur in the operating room.\n- Meet the Accreditation Review Council on Surgical Technology and Surgical Assisting (ARCSTSA) benchmark pass rate for the national Certified Surgical Technologist exam
Letter to the Editor\nIvan Hronek, MD\nThe term “monitored anesthesia care” (MAC) was introduced in 19861 to improve on the term “anesthesia standby” used up until then, with the term “standby” being hard to defend when payment was requested. However, the words monitored anesthesia care do not discriminate by themselves from other types of anesthesia as any anesthesia care has to be monitored. The name of a procedure should describe its contents, but the term MAC informs that there will be monitoring and an anesthesia provider will be present but it does not say sedation may be given, and so it is impossible to be understood without further explanation.\nMore importantly, the term MAC is supposed to be distinct from general anesthesia (GA). However, depth of sedation and transition to GA has been described as a continuum by the American Society of Anesthesiologists (ASA),2and it is well accepted that, after an equivalent weight-based dose of an anesthetic, some patients are sedated whereas others, due to interindividual sensitivity differences, are under GA. The ASA Position Statement on MAC3states that when the patient loses the ability to respond purposefully, then the anesthesia is GA. Going by that definition, practitioners correctly point out that during MAC, there routinely are periods of GA. Using the term GA for cases that are MAC is not accurate either, as during many MACs, we do not guarantee loss of purposeful response or awareness at all times during the procedure.\nIn light of this criticism, there are two ways to redefine the term MAC:\n- Widen the MAC definition to include short periods of GA. The current definition of MAC already includes an anesthesiologist’s choice of monitoring only light, moderate and deep sedation. If it is considered acceptable that a term may include approaches that are not included in its name, short periods of GA could be added to its definition. We would continue to live with the fact that, for everyone’s understanding, we must add regular-language terms, such as general anesthesia, sedation, nerve block and their combinations. Stretching the MAC definition would not require changes in the existing billing or surgical and nursing software, which contain MAC as an option and do not contain sedation or the possibility of combining them.\n- Narrow the definition of MAC to describe situations in which there actually is monitoringonlyand no medication is given. The advantage here is that the term MAC would actually mean what it says—monitored anesthesia care only.\nThere would be the following anesthesia options and their combinations:\n- General anesthesia\n- Sedation or anesthesia sedation—defined as use of medication\n- MAC—defined as monitoring only (but still including preoperative evaluation, psychological support and option for immediate conversion to other types of anesthesia)\n- Regional anesthesia\nCombinations would clearly describe what actually occurred with both planned or converted MAC/sedation, MAC/sedation/GA, MAC/GA, regional/sedation, regional/MAC and regional/GA. This would also more succinctly describe regional anesthesia cases in which the question of the type of anesthesia used often comes up. As an example, the new description of the current term MAC in which periods of sedation as well as GA occur would be a combination: Sedation/GA Mix.\nLet’s ask the ASA to consider one of such redefinitions. Until any change is made, though, I believe we need to describe what actually happens, so if there is a level of nonresponsiveness to pain during a procedure that started as MAC, we need to record that as both MAC and GA, for reasons of clarity and legality.\nDr. Hronek is an anesthesiologist with Tarzana Anesthesia Medical Group in Los Angeles and moderates the LinkedIn group Anesthideas.\nLeave a Reply\nYou must be logged in to post a comment.
NSAID's use after surgeryRegister Today!\nThis is a discussion on NSAID's use after surgery in Gastroenterology Nursing, part of Nursing Specialties ... Any information, evidence based practice, about taking NSAID's after (let's assume) a normal...by brownbook Sep 16, '12Any information, evidence based practice, about taking NSAID's after (let's assume) a normal healthy adult s/p EGD or colonoscopy with a few random biopsies taken?\nOur pre-printed routing discharge form has a fill in the blank check list for the doctor to complete. Of course we're lucky if they maybe check one or two lines. We check the obvious ones.....resume normal diet and activities tomorrow.......call (fill in the phone number) for your follow up appointment etc.\nThey never fill in the blank about "you have had biopsies taken don't take NSAID's, (we actually list the main ones) for ______ weeks." We always just write "until you see your doctor at the follow up appointment."\nWhat do other GI clinics do? For a few random biopsies do NSAID's need to be avoided?\nPrint and share with friends and family.\nCompliments of allnurses.com.\nhttp://allnurses.com/showthread.php?t=785849©2013 allnurses.com INC. All Rights Reserved.\n- 1,698 Views\n- Sep 24, '12 by RNsRWeNo, never routinely.\nWe've got a line with a box in front to check if the doc specifically wants a person off of NSAIDS for 30 days, for specific GI symptoms/ulcerations/etc. Otherwise, no.\n- Oct 6, '12 by brownbookThanks for your reply. Makes sense\n- Jan 24 by Lilme04At our facility, the sedation nurse lets the recovery nurse know if cautery was used. Then the discharge form has a spot where you can check off that the pt has to avoid NSAID's for 2 weeks (in the case of cautery), or indefinitely, as the doc sees fit. Of course, if the pt has a cardiologist, we inform them, and then they dictate whether it's safe for the pt to be off their med for 2 weeks or not.
Certified Registered Nurse Anesthetist +28 years experience Female\nMrs./Ms. Lisa A Schewe has a medical practice at 1001 6Th Avenue, Leavenworth, KS. Mrs./Ms. Lisa A Schewe specializes in certified registered nurse anesthetist and has over 28 years of experience in the field of medicine. She is affiliated with numerous hospitals, including Saint Luke's South Hospital (KS) and more. New patients are welcome to contact Lisa's office in Leavenworth, Kansas. Please call or go to the doctor's office to know doctor's practice, includes clinics, staff, opening hours and medical advice or to make an appointment online.\nLisa practice address, contact phone number and fax are as below. Check locations where Lisa practices near Leavenworth, KS for appointment.\nSpecialty: Certified Registered Nurse Anesthetist\nMrs./Ms. Lisa A Schewe has been identified as specializing in certified registered nurse anesthetist and has been in practice for more than 28 years.\nDoctors can have one or more medical licenses for different specialities in Missouri or different states. Related medical licenses for Mrs./Ms. Lisa A Schewe are as mentioned below:\nWhat is Nurse Anesthetist, Certified Registered?\n(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resus... [View more]\nMrs./Ms. Lisa A Schewe is professionally affiliated with the following hospitals in Leavenworth area and more:\nAn affiliated hospital is a hospital where a doctor can practice and admit patients. Affiliation usually means doctors can admit patients to a hospital.\nThis doctor has multiple office locations in Kansas and more. See office information for details.\nAppointments may be made for routine visits or new problems that you may be experiencing. Knowing what questions to ask before, during and after appointments is vital to better understand, and therefore manage, an illness.\nIf your insurance plan is accepted and have any questions regarding your insurance, please visit the office location or contact to get information about insurances provided by this doctor.\nTell us about your experience by posting a comment or review about Lisa in Leavenworth KS to help others decide which doctor is right for them.
Development of a Real-Time, Bedside, Brain Functional Connectivity Monitor\nAssociate Professor, Anesthesiology\nUniversity of Colorado Anschutz Medical Center\nAs an instructor and cardiothoracic anesthesiology fellow at Washington University and Barnes Jewish Hospital in 2018, Broc Burke, MD, PhD, had developed a long-term goal to become an independent investigator in perioperative and critical care bedside neurological monitoring. He was able to apply practical experience as a Senior Staff Engineer/Scientist in real-time controls and signal processing, and with the backing of a mentoring committee, he succeeded to obtain a 2018 IARS Mentored Research Award for his investigation focused on “Development of a Real-Time, Bedside, Brain Functional Connectivity Monitor.” With this study, Dr. Burke set out to develop a non-invasive, quantitative measurement that correlates with the NIH stroke scale, a goal he reached successfully. The outcomes from this study propelled Dr. Burke forward in his career and helped him to obtain a competitive position at an academic anesthesia department at the University of Colorado Anschutz Medical Center, where today he serves as an Associate Professor in Anesthesiology. At this new institution and in his new position, his research has shifted focus. While he is still using some of the computational techniques and optical techniques that he developed during his IMRA-funded study, his research questions have changed. However, his former lab continues to advance the development and application of the optical technology for patients with Parkinson’s Disease as well as autism, the research that he initially pursued back in 2018. The IMRA support opened opportunities for Dr. Burke to develop relationships with the research community in anesthesia, which has and will continue to be a critical resource during his career as an independent researcher. Below, he describes his research journey, how the IMRA impacted his research and career trajectory and his vision for the future of anesthesia research.\n1. What is your current position? How long have you been in this position?\nAssistant Professor, 2 years.\n2. What was your role when you were first funded by IARS?\nInstructor at Washington University/Barnes Jewish Hospital\n3. What was the goal of your initial research project? Was it met?\nThe initial goal was to develop a non-invasive quantitative measurement that correlates with the NIH stroke scale. Yes, the goal was met.\n4. How did your findings impact patient care?\nMy findings made it possible for me to obtain a competitive position at an academic anesthesia department.\n5. How did your research impact the field of anesthesiology?\nThe results have the potential to improve the diagnosis and care of critically ill patients with, or at risk for, ischemic stroke.\n6. Has your research subject area evolved since the award?\nWith my new position and institution, my research area has pivoted. While I am still using some of the computational techniques and am still using optical techniques, my research questions have changed. The lab that I worked in during my IARS grant has continued the development and application of the optical technology for patients with Parkinson’s Disease as well as autism.\n7. How did the award affect your research/professional trajectory?\nThe award allowed me to develop relationships with the research community in anesthesia, which has and will continue to be a critical resource during my career.\n8. How do you feel about having received the IARS Mentored Research Award?\nThe time and resources that the IARS Mentored Research Award provided were critical as I transitioned from my time as a trainee to an early-career clinical investigator.\n9. What would you like to convey to our donors, the people who made this award possible?\nThe transition from trainee to attending is one of the greatest periods of attrition for clinical researchers. The support provided by IARS is critical to identifying and supporting this key group of researchers.\n10. What drew you to academic anesthesiology and to your particular area of research?\nAcademic anesthesiology is arguably the most data rich specialty in medicine. Despite the amount of data available to anesthesiologists, the number of researchers using this data to improve the care of our patients is exceptionally low when compared to other specialties.\n11. What do you hope for the future of anesthesia research?\nWith the surplus of clinical data and the diversity of patients that anesthesiologists care for, I am excited to see the increasing breadth of research topics and number of colleagues embracing research in our field.
Patient Controlled Analgesia Pumps Market Research, 2031\nThe global patient controlled analgesia pumps market size was valued at $277.7 million in 2021, and is projected to reach $407.9 million by 2031, growing at a CAGR of 3.9% from 2022 to 2031. Patient controlled analgesia pumps are medical devices, which are used to deliver medications, such as pain relievers into a patient’s body at intervals in accurate dosages. The pump is attached to an intravenous (IV) line, which is a small, flexible tube inserted into a vein. Normally, this medication is administered when the button is pressed. These pumps are medical devices that delivers the medications into a patient’s body in controlled amounts. The infused medications play vital role in therapeutics or medical treatments, and are widely used in healthcare settings such as patient, outpatient, private clinics, and at-home settings.\nThe patient controlled analgesia pumps market is segmented into Type, Application and End user. These analgesic pumps help to manage the patient pain during and after surgery, for treatment of burns, treatment of chronic pain, and also used in pediatric patients. The applications of these analgesic pumps for delivery of medications such as morphine, fentanyl and hydromorphone. Patient controlled analgesia infusion pumps are available in electronic and mechanical pumps. Furthermore, patient-controlled analgesic pumps promote better patient management and care, thus offering several advantages in comparison to conventional modules. Key advantages of PCA include greater patient satisfaction, fewer post-operative complications, less sedation, improved quality of recovery, and less use of medication (as doses are set).\nRise in technological advancements for patient controlled analgesia pumps owing to massive pool of chronic diseases creates an opportunity for the patient controlled analgesia pumps market. The growth of the patient controlled analgesia pumps market is expected to be driven by high potential in untapped, emerging markets, due to availability of improved healthcare infrastructure, increase in unmet healthcare needs, rise in prevalence of chronic diseases, and surge in demand for advanced analgesic pumps. Furthermore, the healthcare industry in emerging economies is developing at a significant rate, owing to rise in demand for enhanced healthcare services, significant investments by government to improve healthcare infrastructure, and development of the medical tourism industry in emerging countries.\nIn addition, upsurge in incidence of pain cases due to rise in surgical procedure that requires pain management, in turn increases the requirement of affordable patient-controlled analgesic (PCA) pumps. Furthermore, rapid rise in aging population is one of the major drivers for the patient controlled analgesia pumps market. Aging is accompanied by a high susceptibility of diseases due to decreased immunity and degeneration. Globally, the geriatric population has increased significantly and is vulnerable to various disorders such as cardiovascular, stroke, diabetes, gastric diseases, and intestinal illnesses.\nMoreover, factors such as high demand of home-based healthcare, numerous applications of patient controlled analgesia pumps, rise in geriatric population, and surge in affordability in the developing economies are projected to supplement the market growth. Early diagnosis of chronic diseases at or near bedside or at home increases the chances of successful treatment and further minimizes the hospital expenditure. The home healthcare is gaining popularity as it is a cost-effective alternative to hospital-based treatments of chronic diseases. Home-based patient controlled analgesia pumps provide better and immediate results. Portability, compact and ergonomic design, and user-friendly features of analgesic pumps are key contributors to their widespread adoption in home care settings.\nThe demand for patient controlled analgesia pumps is not only limited to developed countries but is also being witnessed in the developing countries, such as China, Brazil, and India, which fuel the growth of the market. Furthermore, rise in health awareness related to several diseases and ease of accessibility boost the adoption of patient controlled analgesia pumps. Moreover, increase in promotional activities by manufacturers and growth in awareness for chronic diseases and early diagnosis among the general population are expected to fuel their adoption in the near future. Moreover, technological advancements in analgesic pumps such as wireless connectivity and high demand of infusion pumps for pain management drive the patient controlled analgesia pumps market opportunity.\nHowever, stringent government regulations for the approval of medical devices and recall of several products due to errors while transporting the medications during infusion therapies are expected to hinders the market growth. For instance, according to the Food and Drug Administration (FDA) norms, the patient controlled analgesia pumps should be efficacious, accurate, and consistent. The procedure for obtaining a regulatory approval for infusion pumps (Class II) is stringent and time-consuming. The other disadvantage of the regulatory procedure includes high cost of these trials, which further limits the innovation in the products, and therefore small companies find it difficult to survive in the market without the support from large enterprises. This in turn decreases market competition, which leads to the high cost of the pumps. In addition, lack of awareness about using advanced infusion systems and stringent regulations imposed on product approval are likely to restrain the patient controlled analgesia pumps market forecast.\nThe outbreak of COVID-19 has disrupted workflows in the health care sector around the world. The disease has forced a number of industries to shut their doors temporarily, including several sub-domains of health care. The global patient controlled analgesia pumps market experienced a decline in 2021 due to global economic recession led by COVID-19. In addition, the COVID-19 outbreak disrupted the supply chain across various end-user industries such as healthcare, and industrial. However, the market is anticipated to witness recovery in 2021, and show stable growth for patient controlled analgesia pumps market in the coming future. This is attributed to the increase in adoption patient controlled analgesia pumps. In addition, increase in the COVID-19 cases led to decline in the number of surgical procedures this had led to decrease in demand for patient controlled analgesia pumps Many key market players registered the decrease in their revenues from the analgesic pump segments, which was mainly due to the decline in the patient visit to the hospitals, reallocation of the healthcare resources and effect on the supply chain around the globe.\nThe patient controlled analgesia pumps market is segmented into type, application, end user, and region. By type, the market is categorized into electronic & wireless and mechanical. On the basis of application, the market is segregated into oncology & hematology, gastroenterology, and others. By end user, the market is classified into hospitals, ambulatory surgical centers, and others. Region wise, the market is analyzed across North America, Europe, Asia-Pacific, and LAMEA.\nThe market is segmented into electronic & wireless and mechanical. The electronic & wireless segment dominated the patient controlled analgesia pumps industry in 2021, owing to rise in advanced features in electronic patient controlled analgesia pumps.\nThe market is segregated into oncology & hematology, gastroenterology, and others. The oncology & hematology segment dominated the patient controlled analgesia pumps market size in 2021, and is anticipated to continue this trend during the forecast period. This is attributed to rise in R&D activities in oncology and hematology field for analgesic pumps.\nBy End User\nThe market is classified into hospitals, ambulatory surgical centers, and others. The others segment held the largest patient controlled analgesia pumps market share in 2021, owing to rise in number of home care setting and cancer treatment centers for several diseases this has led to increases the demand for analgesic pumps. In addition, rise in number of cancer treatment centers due to surge in prevalence of cancer disease and availability of a wide range of choice of treatment in some developing nations propels the segment growth. For instance, according to National Cancer Institute (NCI), data published in U.S. 2019, there are 71 INC-Designated Cancer Centers, located in 36 states and the District of Columbia.\nThe patient controlled analgesia pumps market is analyzed across North America, Europe, Asia-Pacific, and LAMEA. North America accounted for a major share of the patient controlled analgesia pumps market in 2021, and is expected to maintain its dominance during the forecast period.\nPresence of several major players, such as Becton, Dickinson and Company, ICU Medical, Inc., and advancement in manufacturing technology of patient controlled analgesia pumps in the region drive the growth of the market. Furthermore, presence of well-established healthcare infrastructure, high purchasing power, and rise in adoption of patient controlled analgesia pumps are expected to drive the market growth.\nAsia-Pacific is expected to grow at the highest rate during the forecast period. The market growth in this region is attributable to presence of medical devices manufacturer companies in the region as well as growth in the purchasing power of populated countries, such as China and India. Moreover, rise in personalized healthcare expenditure and adoption of high-tech based analgesic pumps drive the growth of the market. Asia-Pacific offers profitable opportunities for key players operating in the patient controlled analgesia pumps market, thereby registering the fastest growth rate during the forecast period, owing to the growing infrastructure of industries, rise in disposable incomes, as well as well-established presence of domestic companies in the region.\nIn addition, rise in contract manufacturing organizations within the region provides great opportunity for new entrants in this region. Moreover, favorable reimbursements, rise in prevalence of chronic pain, and fibromyalgia also supports the market growth. Increase in number of initiatives and enhanced investments from the government for the overall development of healthcare system support the growth of infusion pumps in these developing regions. In addition, the increase in healthcare awareness about the infusion therapies and growth in per capita healthcare expenditure in the developing countries further provide opportunities for the patient controlled analgesia pumps market growth.\nCompetitive analysis and profiles of the major players in the patient controlled analgesia pumps, such as Ace-medical, Arcomed AG, B. Braun SE, Becton, Dickinson and Company, Changzhou Medical Bioengineering Co., Ltd., Fresenius SE and Co. KGaA, Henan Tuoren Medical Device Co., Ltd., ICU Medical, Inc., Micrel Medical Devices SA, and SCW Medicath Ltd. are provided in this report.\nSome Example Of Acquisition In The Market\nIn September 2021, ICU Medical announced the acquisition of Smiths Medical to expand its product portfolio. The Smiths Medical business includes syringe and ambulatory infusion devices, vascular access, and vital care products.\nKey Benefits For Stakeholders\n- This report provides a quantitative analysis of the market segments, current trends, estimations, and dynamics of the patient controlled analgesia pumps market analysis from 2021 to 2031 to identify the prevailing patient controlled analgesia pumps market opportunities.\n- The market research is offered along with information related to key drivers, restraints, and opportunities.\n- Porter's five forces analysis highlights the potency of buyers and suppliers to enable stakeholders make profit-oriented business decisions and strengthen their supplier-buyer network.\n- In-depth analysis of the patient controlled analgesia pumps market segmentation assists to determine the prevailing market opportunities.\n- Major countries in each region are mapped according to their revenue contribution to the global market.\n- Market player positioning facilitates benchmarking and provides a clear understanding of the present position of the market players.\n- The report includes the analysis of the regional as well as global patient controlled analgesia pumps market trends, key players, market segments, application areas, and market growth strategies.\nPatient Controlled Analgesia Pumps Market Report Highlights\nMarket Size By 2031\nUSD 407.9 million\nCAGR of 3.9%\n2021 - 2031\nBy End user\nKey Market Players\nArcomed AG, Micrel Medical Devices SA, Changzhou Medical Bioengineering Co., Ltd., SCW Medicath Ltd, Henan Tuoren Medical Device Co., Ltd., Fresenius SE and Co. KGaA, Becton, Dickinson and Company, ICU Medical, Inc., B. Braun SE, Ace-medical\nThis section provides various opinions of top-level CXOs in the global patient controlled analgesia pumps market. According to the insights of CXOs, the global patient controlled analgesia pumps market is expected to exhibit high growth potential attributable to factors such as increase in demand for patient controlled analgesic pumps and rise in investments for analgesic pumps. Moreover, rise in number of surgeries requires analgesic pumps to manage the pain thereby, contribute towards the market growth.?\nCXOs further added that patient controlled analgesic pumps includes the advanced features such as efficient pain management, bar-code readers, computer-based pump programming systems, and dose error reduction devices. Thus, such advanced features in analgesic pumps lead to increase in demand for patient controlled analgesic pumps and drive the market growth.?\nFurthermore, North America is expected to witness largest growth, in terms of revenue, owing to increase in adoption of patient controlled analgesic pumps and rise in healthcare infrastructure. Upsurge in healthcare expenditure in the emerging economies is anticipated to offer lucrative opportunities for the market expansion. However, Asia-Pacific is anticipated to witness notable growth, owing to rise in distribution network of patient controlled analgesic pumps and increase in investments for manufacturing patient controlled analgesic pumps during the forecast period.
Knee Treatment & Replacement\nOur Services Offered At Lee Health\nUsing innovative joint replacement methods, Lee Health-affiliated orthopedic surgeons provide innovative solutions for your knee pain. Our surgeons reconstruct hundreds of knee joints each year.\nTreatments include routine and complex total knee replacement, revision of previously replaced joints that have worn out or failed, partial knee replacement, and arthroscopic knee surgery.\nWe also provide more conservative treatments such as cortisone injections and viscosupplementation.\nSchedule an Appointment Today\nLPG Orthopedics - Coconut Point\n23450 Via Coconut Pt Estero, FL 33928Fax: (239) 343-4198\nLPG Orthopedics - The Sanctuary\n8960 Colonial Center Dr, Suite 206 Fort Myers, FL 33905Fax: (239) 343-4198\nOur orthopedic program includes the following:\n- Pre-operative total joint education class\n- Navigators, nurses, therapists, care managers and patient care technicians who specialize in the case of joint patients\n- Emphasis on group activities and individual care\n- A patient support person is educated to act as “coach” in the recovery process\n- A comprehensive patient guide for you to follow before your surgery and beyond\n- Reunion luncheons for former patients and coaches\n- Newsletters to update you with new information about arthritis and joint care\n- Public education seminars about hip and knee pain\nAn orthopedic nurse navigator:\n- Guides patients through the entire surgical process from preadmission to discharge\n- Facilitates preoperative education about the procedure, recovery, and rehabilitation\n- Maintains communication with the patient and family before, during and after the hospital stay\n- Answers any questions a patient might have about the procedure, recovery and rehabilitation\nCall 239-343-3341 to contact the Lee Memorial Hospital orthopedic nurse navigator or 239-343-0297 for the navigator at Cape Coral Hospital or Gulf Coast Medical Center.\nRobotic Knee Treatment & Replacement\nRobotic Knee Replacement Surgery\nDo you have trouble standing up, difficulty walking or climbing stairs, or experience stiff knees? Your physician may recommend you to a Lee Health knee surgeon to see if robotic surgery is a treatment option for you. Learn more here!\nFrequently Asked Questions\nThe leading cause of joint pain, osteoarthritis, is also known as degenerative joint disease. The cartilage that serves as a cushion and allows for smooth motion of the knee breaks down and wears away. Eventually it wears down to bone. Rubbing of bone against bone causes discomfort, swelling and stiffness.\nA knee replacement is a surgical procedure in which the surgeon removes the damaged bone and cartilage at the ends of the bones in your joint and replaces it with artificial parts. The goal of knee replacement is to allow you to move easily with less discomfort.\nA partial or uni-compartmental knee replacement is a procedure in which only one of the three compartments in the knee is repaired. Candidates for this procedure have arthritis primarily in the medial compartment of the knee. Your surgeon will determine if this is the right procedure for you.\nYou may have a general anesthetic, which most people call "being put to sleep." Some patients prefer to have spinal or epidural anesthetic that numbs your leg only and light sedation. The choice is between you and the anesthesiologist.\nWe recommend that most people take at least one month off from work, unless their jobs are quite sedentary.\nYou will be seen for your first post-operative office visit two weeks after surgery. The frequency of follow-up visits will depend on your progress.\nYes. High-impact activities, such as running, downhill skiing, singles tennis and basketball are not recommended.\nYes. You may have a small area of numbness to the outside of the scar that may last a year or more and is not serious. Kneeling may be uncomfortable for a year or more, but you can kneel if you want to. Some patients notice some clicking when they move their knee. This is the result of the artificial surfaces coming together and is not serious. You may notice that your knee is warm for up to one year, again, this is not unusual. It is your knee healing from the surgery.\nAre you planning to have Knee Replacement at Lee Health?\nLearn more below!\nJoint Center Pre-Op Education Classes\nThis Joint Center Pre-Op Education class is designed to prepare you for the different stages of your journey and will include what to expect before surgery, during your hospital stay, and continued recovery after discharge. You may attend a LIVE version of the class or review the same content in this ONLINE program.
\|1 Day After Surgery\|\nFriday, November 21, 2014\nSurgery was November 10th in Temple at the Children's Hospital. The surgeon, Dr Danny Little, was great! He went over everything with us during pre-op, was very open about what was going to happen and about how long it would take. Originally he stated that surgery would last about 30 minutes and Dylan would only be away from us about 45 minutes. We carried Dylan to the operating room doors and handed him off to the nurses...probably the single hardest thing I have ever done in my life! Surgery took a little longer than expected, it took about 1 hour 15 minutes. I was on pins and needles when the 30 minutes passed, then 45, then an hour! We heard the anesthesiologist coming down the hall and felt some relief. She was coming to tell us that the surgery went well and that they were going to be waking him up and moving him to AICU (Acute ICU) in a few minutes, but she wanted to tell us he was ok. The surgeon came in about 15 minutes later and told us that the cyst was attached differently than expected and that's why it took longer. Rather than having a single root that attached to his skull, he had a root system that spread along his skull & they have to scrap all that off, so it took longer. We went up and saw him in his little bed hooked up to everything and the AICU nurses said he had already eating 4 ounces! He was a hungry fella when he woke up. We were able to go home that day, and I stayed home with him the next day just to make sure he was back to normal. The follow up a week later went well & the biopsy came out great! He said from our initial appointment to surgery it grew from the size of a pea to a lima bean. That's kind of quick! The incision looks great, and scaring should be minimal.
- Alle tidsskrifter\n- Helse- og sosialfag\n- Humanistiske fag\n- Pedagogikk og utdanning\nThis paper focuses on women diagnosed with Ductual Carcinoma in Situ (DCIS). Aim: To emphasize the experience of women who are diagnosed with and treated for DCIS. Furthermore, to discuss the interventions which can be used to help these women. Methods: The article is a qualitative study. First, we did a systematic literature search and picked out articles that lived up to the set inclusion criteria. These articles were later analyzed, and three themes were found. To understand and to compare the experiences found with a Danish context, two qualitative semi-structured interviews were performed with two Danish women who had been diagnosed with and treated for DCIS. The findings are compared and discussed throughout the article. Results: Given the lack of information and the uncertainty about DCIS, women diagnosed with DCIS often deal with anxiety and confusion about the future. More information is needed to help women understand what DCIS is, and how this diagnosis differentiates from invasive breast cancer.\nWithin the field of implementation science there is increasing recognition of the relevance of organizational context and culture, i.e. influences beyond the individual level, for successful implementation of evidence-based nursing practices. Applying the Cultural Historical Activity Theory (CHAT), the aim of this study was to explore how the organizational culture in an emergency department in Denmark influenced nurses’ priorities with regard to the use of research. The study was designed as an ethnographic inquiry based on fieldwork and semi-structured interviews. Based on an activity system analysis, the concept of flow culture emerged. This culture is defined as a cultural–historical activity system, mediated by artefacts, in which the objective of the nursing staff is primarily to free up beds, thus ensuring a flow of patients. A flow culture leads to a strong focus on securing vacant beds which impeded the nurses’ use of research in everyday clinical practice.\nBackground: Standardized work up plans of cancer patients was implemented to ensure coherent cancer pathways; however, research indicates that patients still experience their pathways as fragmented and incoherent. Aim: To identify what patients with esophageal, cardia, or gastric cancer consider important aspects of a cohesive cancer pathway. Methods: The study consists of field research based on observations and semi-structured interviews. Result: Four themes were identified: 1: The relation is important “It feels safe when you meet the same health care professional”. 2: Responsibility “You have to know exactly what you want or they take the lead. 3: Information “How do you know what to ask for?” 4: Cooperation “It was incredibly effective”. Conclusion: The study indicates that coordination of information and a single point of access through a health care professional allows for the involvement of the individual patient’s needs and ensures the patient’s experience of a coherent cancer pathway.\nPatients at intensive care units who develop delirium experience longer stays in intensive care as well as increased morbidity and mortality. A Danish survey in 2009 showed no consensus regarding the assessment tools for sedation or delirium, the frequency of assessment, or on which patient groups such tools were used in Denmark. The aims of this study were to describe clinical practice within the assessment of the sedation and delirium of intensive care patients and to compare the results to the 2009-survey. Method: A questionnaire was issued by email to all intensive care units in Denmark caring for ventilated adult patients. An intensive care nurse with daily patient contact was asked to answer questions regarding the practice of the unit. Results: Nearly all of the intensive care units replied. RASS was the most common tool used for sedation assessment, and CAM-ICU was only used for delirium assessment. Conclusion: A common language for sedation and delirium assessment has emerged.\nThis article provides an overview of the nursing role and responsibility in regard to dying patients and how a health promotion perspective may contribute to a good and dignified death. The experience of death and dying which can have serious consequences for both the dying person and the family’s grief work and health in the period after death is also discussed. Factors that emphasize a health promotion perspective of palliative care patients and their families will be presented and discussed. All approaches to the patients and their families must be based on the individual and adjusted context and framework. The possibility of monitoring the bereaved after the death is emphasized as an important health promotion intervention.
Made miraculous by our hands and hearts\nThe surgical pioneers at St. Mary’s of Michigan continuously seek out newer, better procedures and techniques that result in faster recovery, less pain, less risk of infection, less anesthesia, less blood loss, and less trauma to our patients' bodies.\nIsn't a knife at all. Instead, it fights tumors non-invasively with precision radiation -- accounting for even the most subtle patient movements like breathing. Because it adjust its beams to protect healthy parts of the body, CyberKnife can focus more on the area needing to be removed. CyberKnife can be used anywhere in the body with no pain, no anesthesia, and no recovery time.\ndaVinci Robotic Surgical System\nTransforms major surgeries like prostate removal and hysterectomy into minimally invasive procedures. Every surgical maneuver occurs with direct input from a highly trained surgeon, who controls the robot’s micro-instruments that are inserted into a patient’s body. Tiny incisions replace large ones. As a result, patients are often back on their feet in days rather than weeks.\nTo find out if you may be a candidate for either CyberKnife or the daVinci robotic surgical system, talk to your doctor or call 1-844-907-8000.
Dr. Don Paxton is an anesthesiologist in North Hollywood, who manages patient pain levels before, during, and after surgical procedures.\nWe invite you to write a review about your experience with Dr. Paxton.\n10061 Riverside Drive, Suite 723, North Hollywood, CA 91602\n8325 Brimhall Road, Suite 100, Bakersfield, CA 93312-2245\n\|Doctor Specialty\|\|Pain Management\|\n\|Doctors\|\|2 See them all\|\n\|Doctor’s Specialty\|\|Pain Management\|\n\|Doctor’s Title\|\|Pain Management Specialist\|\nNOTE: Please contact the doctor’s office to confirm your coverage before making an appointment.
Get the facts about birth control so you can decide which type is right for you.\n- Birth Control Facts about birth control to help decide which type is right for you.\n- Type 2 Diabetes Basic facts about type 2 diabetes & risk factors to be aware of.\n- Binge Eating Disorder Facts about binge eating disorder, including symptoms and causes.\n- COPD Get the facts about chronic obstructive pulmonary disease (COPD), including symptoms and complications.\n- Chronic Idiopathic Constipation Learn about chronic idiopathic constipation, including treatment\n- Diabetic Macular Edema Facts about diabetic macular edema, including the different types.\n- Eating Disorders Facts about different types of eating disorders.\n- Flu Facts about influenza (flu), including symptoms and vaccines.\n- Food Allergy Facts about food allergy, including the symptoms and signs.\n- GERD Get the facts about gastroesophageal reflux disease (GERD).\n- View All Care Guides Prepare for your next visit with our extensive library of Care Guides\nBook Online Now\nDr. Holly Zoe has the following 2 specialties\n- Pain Medicine\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.\nDr. Holly Zoe has the following 8 expertise\n- Back Pain\n- Chronic Pain\n- Neck Pain\n- Cancer Pain\n- Complex Regional Pain Syndromes\n- Acute Pain\nDr. Holly Zoe has 1 board certified specialty\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. Holly Zoe is Board Certified in 1 specialty\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.\nShowing 5 of 82\nI have been a patient of Dr. Zoe for three years. Due to very painful injuries, I needed someone who could correctly diagnose and treat the injuries so that I could regain my mobility and life. She did just that and expertly so and not just with medications. She used her expertise as an anesthesiologist and medical instruments to pinpoint the source of the pain and treat it effectively.\nI went to Zoe for about 3 yrs. I met her mabey2 times face to face. I ended up going through withdrawal thanks to her. Also found out she had turned my pimp form on me without my knowledge. So if your doing the right thing and finding a real doctor make sure to get a copy of your records. You might be surprised\nDr.Zoe is the worst doctor I have ever been to. That's if you ever see her. I hadn't seen her for over a year now it's always a pac and it's never the same one. I knew she was in the office I seen her in the lobby, and the still sent the pac in!!! She's a chicken as a doctor. She thinks she can play GOD with your life and pain. I wouldn't send a enemy to see her. Nobody deserves that. Her nurses don't even know how to hook up a oxygen tank I had to do it and she just walked out of the room. Unbelievable but very true!!!\nI used to like this facility until I met with Dr. Zoe. I was doing well on my medications and she came in and messed up everything! She was ignorant and accused me of things that were not true. When I tried to explain to her she dismissed me. All of her staff have left and now I know why!! It seems as if this is a new way of treatment judging from the recent comments. Needless to say, I'm looking for a new pain management specialist!\n27 Years Experience\nNew York University School Of Medicine\nGraduated in 1991\nDr. Holly Zoe accepts the following insurance providers.\n- Aetna Choice POS II\n- First Health PPO\n- UHC Choice Plus POS\n- UHC Navigate HMO\n- UHC Options PPO\nLocations & DirectionsMark Alan Greenfield Md, 1352 E Center St Ste A, Pocatello, ID\nDr. Holly Zoe is similar to the following 3 Doctors near Pocatello, ID.
American Anesthesiology is seeking a full-time BE/BC anesthesiologist to join our highly skilled team of 9 anesthesiologists in Jackson, TN. This busy practice provides services at Jackson Madison County General Hospital and several surgery and endoscopy centers in the area. Proficiency in all general cases in a fast paced OR setting preferred: cases include pediatric, regional blocks, OB, craniotomies and vascular. Our practice works together in a cohesive care team model. Experienced providers or graduating residents welcome to apply.\nThe Jackson Anesthesia incentive package includes; sign-on bonus, medical loan repayment and relocation assistance.\nJackson, TN is located in the center of West Tennessee. It is just a short drive away from large metropolitan cities such Memphis and Nashville, TN and is a natural regional hub. Although it is a small and friendly community, Jackson offers a myriad of medical, legal, educational, and employment opportunities for its residents. The area offers great local attractions such as the Symphony Orchestra, country clubs, cultural arts, camping, fishing, hunting and a wide array of shopping and restaurants. In 2013, Jackson, TN was “America's Most Livable Small City” according to the U.S. Conference of Mayors. It is a town with no state income tax, low cost of living and great quality of life.\nOur clinicians enjoy a competitive compensation package with many locations offering sign on bonuses, relocation and tuition reimbursement.\nOur benefits include:\nHealth (various options), life, vision, dental and disability insurance\n401(k) with annual matching program\nAdvanced and continuing medical education\nLeadership training and advancement opportunities\nEmployee stock purchase plan at a 15% discount\nProfessional liability insurance\nSupport and payment for mandatory license/s and hospital credentialing\nThese benefits are for full time employees, employees in other types of employment classifications may be eligible for some of these benefits.\nWith a 35+ year record of success, MEDNAX has grown from a single medical practice to a trusted health solutions partner. As part of our national medical group, we give you the tools you need to build the career you want, and the flexibility to adapt as your personal needs and professional interests change.\nWe invite you to grow with us and help shape the future of health care.\nMEDNAX is a growing physician group practice of anesthesia providers. Currently with practices in Florida, Georgia, Illinois, Indiana, Michigan, Minneapolis, New Jersey, New York, South Carolina, North Carolina, Maryland, Texas, Tennessee and Virginia. MEDNAX and its affiliated professional group practices (American Anesthesiology) employ more than 1,200 physicians and 1,700 anesthetists in both hospital and office-based settings.
Anaesthesiology is used to prevent patients from feeling pain while undergoing surgery and other medical procedures. It is performed by Anaesthetists. Their major role is in providing anaesthesia during surgery. They prepare patients for surgery. They talk to patients and assess them to decide on the most appropriate form of anaesthesia. At the Bridgewater Hospital the role of the Anaesthetist during surgery procedures is to:-\n- Administer general anaesthesia, which makes patients become unconscious. They observe patients during operations, monitor their progress and respond to any changes. They then bring patients to full consciousness after the procedure, and make sure that they have appropriate pain-relief medication and fluid replacement as they recover.\n- Administer local anaesthesia, which makes specific parts of the body feel numb. An example is when relieving pain in childbirth.\n- Prescribe sedation for patients who are about to undergo certain procedures, such as radiology.\nA number of our Anaesthetists also specialise in Pain Management. They provide effective treatments for patients who have pain unrelated to surgery.
is ativan used intermuscular\n27 Aug 2012\nI worked at a couple of different outpatient eye surgery centers and we used Diprivan (propofol) or Sodium pentathol and sometimes fentanyl to put people to sleep for just a few minutes (2-3 minutes) while the anesthesiologist numbed up the eye with local injections(lidocaine and marcaine) When the person went into the OR they were awake but their eye was numb and they were unable to see out of it. Cataract surgery is a very simple procedure that should only take about 7-15 minutes for the surgery itself (what takes the longest is the prep and recovery period) There is very little pain involved. Most people, if they complain of anything, complain of a scratchy feeling like a grain of sand or an eyelash in the eye for a few hours when the numbing wears off. This is for the most part gone by the following morning. The eye heals quite quickly. I have never seen anyone need any sedation because they are asleep when the eye is anesthesized. Most places start an IV to give the medicine so anything you get is through the IV.\n- Ativan Information for Consumers\n- Ativan Information for Healthcare Professionals (includes dosage details)\n- Side Effects of Ativan (detailed)\nSearch for questions\nStill looking for answers? Try searching for what you seek or ask your own question.\nMy mother is having cataract surgery next week. She was prescribed Plavix because if a mild stroke last year. I know that you have to stop taking ...\n1 answer • 15 Aug 2013\nAfter cataract surgery I have servere light sensitivity and no post surgery treatment has done anything but a slight reduction. It has been 60 days ...\n1 answer • 7 Jan 2014\nA patient is on this med for non-hodgkins lymphoma and wants cataract surgery\n1 answer • 20 Apr 2015
Join now to get access to this content and more.\nBecome a SOAP member and have access to our benefits.\n- For Review: SOAP Consensus Statement on Neuraxial Procedures in Thrombocytopenic Parturients\n- Sample Centers of Excellence Applications\n- ASA Corner\n- SOAP Policy and Procedure Manual (P&P Manual)\n- SOAP Expert Opinions\n- SOAP's Learning Modules\n- 2019 Annual Meeting Lecture Videos\n- December 2018 - SOAP Unofficial Guide to ASA Committees Webinar\n- Submit a Position\n- View Job Postings\n- Previous Meeting Archives\n- Previous Meeting Abstract Search\n- CMS Guidelines\n- Member Benefits\n- Newsletter Clinical Articles\n- ACOG Documents\n- Search our Patient Safety Archive\n- Ask SOAP a Question\n- Global Health Opportunities\n- And more…\nFetal Surgery Meets ERAS: Implementation of a New Anesthetic Protocol for Fetoscopic Myelomeningocele Repairs\nAbstract Number: T2C-2\nAbstract Type: Case Report/Case Series\nThe majority of open fetal surgery is typically performed under general anesthetic with a high-dose inhalational agent in order to provide uterine relaxation. Concerns regarding fetal exposure to high-dose agents at critical periods in fetal neurodevelopment as well as desire for rapid maternal recovery have ignited interest in alternative anesthetic approaches to these procedures.\nOur Center has been performing laparotomy with fetoscopic myelomeningocele repair since 2016, and starting in September 2017 we begin using a protocol that is inspired by our institution’s drive towards ERAS for abdominal surgery. This protocol revolves around the use of IV anesthetics over inhalational agents, opioid-sparing techniques such as regional anesthesia and limiting the use of supplemental IV fluids while encouraging early ambulation and oral hydration. Our protocol is divided into preoperative, intraoperative and postoperative goals.\nPreoperatively, patients remain on a clear liquid diet until 2 hours prior to OR time. They are given carbohydrate-rich drinks prior to surgery, with maintenance fluids administered sparingly. An epidural catheter is placed for intraoperative and postoperative use. Indomethacin is administered for tocolysis.\nIntraoperatively, our operating room temperature is set to 80ºC and the patient is placed on a forced air warming blanket. Anesthesia is typically induced with propofol and rocuronium, and anesthesia is maintained with either inhalational agent or a propofol infusion. Magnesium infusion is begun, and if inhalational agent is used a propofol infusion is started for postoperative nausea & vomiting prophylaxis. A nitroglycerin infusion is used for uterine relaxation. Transthoracic echocardiography is performed to evaluate volume status intraoperatively, and small boluses of IV crystalloid or colloid are administered along with a phenylephrine infusion to maintain adequate uteroplacental perfusion and maternal blood pressure. The epidural catheter is connected to an infusion of 0.125% bupivacaine & 2 mcg/mL fentanyl at 12 mL/hr. Goal fluid administration is typically 1-2 liters.\nPostoperatively, neuromuscular blockade is reversed with sugammadex and the patient is extubated with the epidural catheter running and magnesium infusion continued. The epidural catheter is discontinued on postoperative day 1 or 2, and indomethacin is continued for up to 48 hours as needed. Furosemide 20mg was given immediately postoperatively at the discretion of the treatment team.\nSince this protocol was initiated, none of our three patients have required additional supplemental diuresis in the postoperative period (as compared with ⅔ of our patients prior to this initiation) and the patients have verbalized satisfaction with their analgesia.\nThis protocol illustrates that common techniques used for general abdominal surgery can safely be adopted for fetal surgery, decreasing the morbidity of these groundbreaking procedures.
Lateral Ankle Ligament Reconstruction\nWhat is lateral ankle ligament reconstruction?\nLateral ankle ligament reconstruction is a surgery to tighten and firm up one or more\nankle ligaments on the outside of your ankle. It’s also known as the Brostrom procedure.\nIt’s most often done as an outpatient surgery, so you can go home the same day.\nYour ankle is a hinge joint that allows motion up and down, and from side to side.\nYour foot and ankle have several ligaments. These are strong band-like structures\nthat keep the bones in your ankle and feet tightly connected. On the outer side of\nyour foot, you have several ligaments. These include the anterior talofibular ligament\n(ATFL) and the calcaneofibular ligament (CFL). These help keep your ankle and foot\nsteady when you walk.\nIf you have had repeated ankle sprains or if you have certain foot deformities, your\nligaments can start to get weak and loose. If this happens, your ankle may become\nDuring lateral ankle ligament reconstruction, the surgeon makes a small cut on the\noutside of your ankle. This is done while you are under general anesthesia. Then your\nsurgeon tightens one or more of the ligaments on the outside of your foot.\nWhy might I need a lateral ankle ligament reconstruction?\nYou might need this surgery if one or more of the ligaments on the outside of your\nankle has loosened or stretched. This leads to a condition called chronic ankle instability.\nIt can cause chronic pain, repeated ankle sprains, and an ankle that often gives way\nwhen you walk or perform activities.\nAt first, an ankle sprain may stretch and partially tear your ankle ligaments. This\nfirst sprain makes it more likely that you will sprain your ankle again. This is more\nlikely if you did not have the first sprain treated properly. More sprains may loosen\nyour ligaments even more.\nCertain mechanical problems with your foot can make you more likely to develop an\nunstable ankle, such as:\n- Hindfoot varus\n- Plantar flexion of the first ray\n- Midfoot cavus (high arches)\n- General looseness of your ligaments—for example, from a medical condition like Ehlers-Danlos\nYou may have already been treated with physical therapy and special foot inserts.\nA healthcare provider may advise surgery if other treatments for your ankle haven’t\nworked. It’s not common to need this surgery right after a first ankle sprain.\nWhat are the risks of a lateral ankle ligament reconstruction?\nEvery surgery has risks. Risks for this surgery include:\n- Excess bleeding\n- Nerve damage\n- Stiffness in your ankle joint\n- Blood clot\n- Complications from anesthesia\n- No improvement in your ankle stability\nYour own risk for complications depends on your age, the anatomy of your foot, and\nyour general health. Talk with your healthcare provider about any concerns you might\nhave. You can discuss the risks that most apply to you.\nHow do I get ready for a lateral ankle ligament reconstruction?\nTalk with your healthcare provider about how to prepare for your surgery. Ask if you\nshould stop taking any medicines ahead of time, like blood thinners. If you smoke,\ntry to stop smoking before your procedure. Tell your healthcare provider about all\nthe medicines you take. This included over-the-counter medicines like aspirin. Also,\ntell him or her about any changes in your overall health, like a recent fever.\nBefore your procedure, you may need imaging tests, such as X-rays or an MRI. You should\nnot eat or drink anything after midnight the night before your procedure.\nYou may need to plan some changes to your home and activities before surgery. You\nwon’t be able to walk on your foot normally for a while.\nWhat happens during a lateral ankle ligament reconstruction?\nThere are a number of methods used for lateral ankle ligament reconstruction. Ask\nyour healthcare provider about the details of your surgery. An orthopedic foot surgeon\nwill perform your surgery. The surgery may take 2 or more hours. You can expect the\n- You will probably receive general anesthesia to make you sleep through the procedure\nor regional anesthesia to numb the involved leg.\n- During the surgery, your vital signs, like your heart rate and blood pressure, will\nbe watched carefully.\n- After cleaning the affected area, your surgeon will make a cut through the skin and\nmuscle of your ankle.\n- If your surgery is minimally invasive, your surgeon will cut a small incision. He\nor she will put small instruments and a camera through the incision to perform your\n- Your surgeon may remove your ATFL and your CFL ankle ligaments from where they attach\non your fibula.\n- He or she may make these ligaments shorter.\n- Your surgeon may then reattach these ligaments to your fibula by using small new holes\ndrilled into your bone.\n- Your surgeon may make other repairs, if necessary.\n- The layers of skin and muscle around your ankle will be surgically closed.\nWhat happens after a lateral ankle ligament reconstruction?\nSomeone will watch you for a few hours after your surgery. When you wake up, you will\nlikely find your ankle in a splint. Often, lateral ankle ligament reconstruction is\nan outpatient procedure. This means you can go home the same day. You should have\nsomeone drive you home.\nYou will have some pain for a while after your surgery, especially for the first few\ndays. Pain medicines may help to relieve your pain. Carefully follow all instructions\nabout medicines and wound care. Keeping your leg elevated may help reduce swelling\nand pain, too. You’ll probably need to use crutches and keep weight off your ankle\nfor at least a few weeks. Make sure to tell your surgeon right away if you have high\nfever, chills, or increasing pain from your ankle.\nYou will need to return in about 10 days after your surgery to have your stitches\nor staples removed. Your surgeon might also replace your splint with a boot or cast\nat this time. In a few weeks, your healthcare provider will likely replace this cast\nwith a removable brace. You’ll need to use this brace for several months.\nYour healthcare provider will give you specific instructions about how to strengthen\nyour ankle and leg muscles as you recover. You may benefit from physical therapy as\nwell. This will help make sure that your surgery will be a success.\nBefore you agree to the test or the procedure make sure you know:\n- The name of the test or procedure\n- The reason you are having the test or procedure\n- What results to expect and what they mean\n- The risks and benefits of the test or procedure\n- What the possible side effects or complications are\n- When and where you are to have the test or procedure\n- Who will do the test or procedure and what that person’s qualifications are\n- What would happen if you did not have the test or procedure\n- Any alternative tests or procedures to think about\n- When and how will you get the results\n- Who to call after the test or procedure if you have questions or problems\n- How much will you have to pay for the test or procedure
Garza Galante Plastic Surgery\n322 U.S. 41 #103\nSchererville, IN 46375\nPhone: (219) 322-3131\nMo–Fr: 8 a.m.–5 p.m.\nLiposuction Before & After Case 32\nBefore & After\nView 1 of 3\nView 2 of 3\nView 3 of 3\nTo contour her midsection and thighs, this 35 year old mother of one from Northwest Indiana chose tumescent liposuction. Like many women, she wanted her clothing to fit more comfortably and yearned to feel confident in a swimsuit again. Unlike many mothers her age, she already had a very shapely physique that needed only tailored reshaping.\nThe patient had localized fat deposits on her abdomen, hips, inner and outer thighs, and knees. Fortunately, she had good skin tone, an important factor when selecting patients who will see the greatest benefits from tumescent liposuction. Indiana patients who start out with firmer skin tone generally see their skin retract and heal in a very smooth fashion over the newly contoured fat tissue.\nThis patient's procedure was performed under local anesthesia with sedation at the surgery center near my office in Indiana. Tumescent liposuction helps reduce the bruising and swelling that can occur with traditional liposuction techniques. Within a week after her procedure, she was back to her regular activities. I required her to wear a compression garment, which is easily concealed beneath clothing, for a one month after surgery to reduce swelling.\nShe is seen here 3 months following tumescent liposuction. The view from the back is especially remarkable because it shows the dramatic improvement to body contour and shape that liposuction makes possible. Learn how liposuction can help slim your profile by scheduling a consultation for yourself.\nProvider: Dr. Galante\nAbout This Patient\n*Keep in mind that each patient is unique and your results may vary.
At Treendale Pet Medical, we offer the more comfortable cupid control.\nYour pet will have some calming assistance therapy some vets may describe as sedation. Whilst our caring nurses prepare for cupid control, your fur child will be in a safe place listening to soft music. We use pheromones in the cage to assist with a fear free experience which reduces stress. DAP for doggies and Feliway for felines are used to help make your pet feel right at home. This is part of our magic carpet ride of pheromones.\nOur hospital wards have underground heating and temperature control with air conditioning so the temperature will be just right for your pet's maximum comfort!\nComfortable and clean bedding is provided for every patient. Our animal loving care nurses will make sure your pet has a blanket and is safe, warm and comfortable after cupid control. Strong analgesia is used pre and post surgery to prevent discomfort. We use K-Laser therapy post operatively to reduce discomfort and inflammation. Laser therapy speeds wound healing, reduces inflammation and helps prevent pain and discomfort.\nAnalgesia is very important. Your pet will get four kinds of pain control if you choose Treendale Pet Medical for your pet's surgery. Hear what one of our patients had to say about her surgery...
The purpose of this study was to investigate the effect of general anesthesia and surgery on melatonin production, and to assess the relationship between melatonin secretion and cortisol levels. Twenty (9 males and 11 females) consecutive otherwise healthy patients aged 27 to 52 years were included in this study. The patients underwent laparoscopic cholecystectomy or laparoscopic hernioplasty. All patients had general anesthesia with the same anesthetic drugs. Serum cortisol levels were measured at several time periods. Urine collections for melatonin were performed from 18:00 to 7:00 the day prior to surgery, on the operation day, and on the first postoperative day. Baseline melatonin metabolites were measured the night prior to surgery, and the level was found to be 1979 ± 1.76 ng. The value decreased to 1802 ± 1.82 ng (NS) on the night of surgery, and it became a significantly higher, reaching 2981 ± 1.55 ng the night after surgery (p = .003). The baseline daytime cortisol level was significantly lower than the baseline night cortisol level (6.87 ± 1.51 μg/dl, 14.89 ± 1.66 micrograms/dl, respectively, p < 0.0001). Surgery induced a significant increase in both day and night cortisol levels. Daytime cortisol levels increased from 6.89 ± 1.51 μg/dl to 16.90 ± 1.27 μg/dl (p < 0.0001), whereas right levels increased from 14.89 ± 1.66 μg/dl to 29.20 ± 1.24 μg/ dl (p < 0.0001). The morning after surgery, cortisol levels decreased to 10.16 ± 1.40 μg/dl, lower than the value obtained on the day of surgery (p < 0.0001). As was true of melatonin, cortisol levels did not reach the pre operative level (p < 0.005). The finding of the current study is that melatonin and cortisol levels show an inverse correlation after surgery.
The PSNet Collection: All Content\nSearch All Content\n- Communication Improvement(24)\n- Culture of Safety(9)\n- Education and Training(21)\n- Error Reporting and Analysis(15)\n- Human Factors Engineering(25)\n- Legal and Policy Approaches(3)\n- Logistical Approaches(6)\n- Policies and Operations(10)\n- Quality Improvement Strategies(17)\n- Research Directions(3)\n- Specialization of Care(4)\n- Technologic Approaches(14)\n- Transparency and Accountability(1)\n- Device-Related Complications(1)\n- Discontinuities, Gaps, and Hand-Off Problems(10)\n- Failure to rescue(1)\n- Fatigue and Sleep Deprivation(2)\n- Identification Errors(2)\n- Interruptions and distractions(3)\n- Medical Complications(5)\n- Medication Safety(25)\n- Nonsurgical Procedural Complications(3)\n- Psychological and Social Complications(12)\n- Second victims(2)\n- Surgical Complications(56)\n- Transitions of Care(1)\nTan JM, Cannesson MP. APSF Newsletter. 2023;38(2):1,3–4,7.\nA 62-year-old Spanish-speaking woman presented to the pre-anesthesia area for elective removal of a left thigh lipoma. Expecting a relatively simple outpatient operation, the anesthesiologist opted not to use a Spanish language translator and performed a quick pre-anesthesia evaluation, obtaining her history from the medical record. Unknown to the anesthesiologist, the patient was trying to communicate to him that she had undergone jaw replacement surgery and that her mouth opening was therefore anatomically limited.\nA 63-year-old woman was admitted to a hospital for anterior cervical discectomy (levels C4-C7) and plating for cervical spinal stenosis under general anesthesia. The operation was uneventful and intraoperative neuromonitoring was used to help prevent spinal cord and peripheral nerve injury. During extubation after surgery, the anesthesia care provider noticed a large (approximately 4-5 cm) laceration on the underside of the patient’s tongue, with an associated hematoma.\nArna D, ed. Curr Opin Anaesthesiol. 2022;35(6):710-737.\nMeyer TA. Anesthesiology News. October 31, 2022.\nA 49-year-old woman presented to an Emergency Department (ED) with abdominal pain nine hours after discharge following outpatient laparoscopic left oophorectomy. The left oophorectomy procedure involved an umbilical port placed using an Optiport visual trocar, a suprapubic port, and two additional ports laterally.\nSaver C. AORN J. 2022;116(2):111-132.\nA 65-year-old female with a documented allergy to latex underwent surgery for right-sided Zenker’s diverticulum. Near the conclusion of surgery, a latex Penrose drain was placed in the neck surgical incision. The patient developed generalized urticaria, bronchospasm requiring high airway pressures to achieve adequate ventilation, and hypotension within 5 minutes of placement of the drain. The drain was removed and replaced with a silicone drain. Epinephrine and vasopressors were administered post-operatively and the patient’s symptoms resolved.
Intoduction: The phrase "Monitored Anesthesia Care" refers to instances in which an anesthesiologist has been called upon to provide specific anesthesia services to a particular patient understanding a planned procedure, in connection with which a patient receives local anesthesia. Monitored anesthesia care is being increasingly used in the 1990s for a wide variety of diagnostic and therapeutic procedure. The primary objective in providing monitored anesthesia care is to ensure patient comfort and safety. METHOD: We classified patients in three groups by premedication and oxygen administration, no premedication and no oxygen administration (group A), premedication and oxygen administration (group B), premedication and no oxygen administration (group C), measured vital signs and SpO2 (peripheral oxygen saturation) from just before operation, and checked the satisfaction score of surgeon and patients. RESULT: SpO2 and satisfaction score of surgeon and patients are the best at premedication and oxygen administration group. CONCLUSION: Monitored anesthesia is assumed to give more comfort and safety to patients than local anesthesia alone.
\|\| Checking for direct PDF access through Ovid\nThe study aimed to assess the efficacy of erbium laser technology compared with traditional drilling for caries removal.A systematic search was conducted through Medline via PubMed, Embase, Cochrane databases, CNKI till December 2016. Randomised controlled trials, quasi-randomized controlled trials, or controlled clinical trials with data comparing the efficacy of erbium laser technology versus traditional drilling for caries removal were included.Fourteen studies were selected in our meta-analysis. Erbium laser technology showed an increased time when removing caries compared with drilling (mean difference: 3.48, 95% confidence interval: 1.90-5.06, P < .0001). However, erbium laser technology reduced the requirement for local anesthesia (risk ratio: 0.28, 95% confidence interval: 0.13-0.62, P = .002). Erbium laser technology was also not significantly different to traditional drilling with regard to restoration loss, pulpal vitality, and postoperative sensitivity.Erbium laser technology showed an increased time for cavity preparation compared with traditional drilling. However, erbium laser technology reduced the requirement for local anesthesia. There was no significant difference between erbium laser technology and traditional drilling regarding restoration loss, pulpal vitality, and postoperative sensitivity.
1: I’m too old to have a baby\nHello, I would like to tell my story. I am 41 years old and I already have two children, aged 11 and 9, whom I love very much. Unfortunately, I drifted apart with my husband. We tried a lot to revitalize our relationship. So I got pregnant unplanned. A detail story at get abortion pills in Dubai. We have long since completed family planning. An unplanned child does not fit into our current, difficult family situation. My husband accuses me of deliberately trying to get pregnant. But that’s not true. Now we are about to divorce. Pregnancy over 40, even more unplanned , is a risk for a woman. In addition, you are no longer so resilient. I am already feeling my limits and am about to be born out. I was now at the doctor at Get abortion pills in Dubai and told him that I became pregnant unplanned . After the examination, the doctor informed me that I was already eight weeks pregnant. I urgently need someone to talk to!\nTalking to the counselor at Get abortion pills in Dubai was good for me. She listened to me and I was able to express my fears and worries for once. We couldn’t save our marriage, but even if it wasn’t planned , I want to give birth to the child . I am now in the 14th week.\nThe two big children look forward to having a sibling. Thank you for the encouragement and support during the difficult time. I noticed that by expressing my fears I was relieved of a lot of pressure and burden. Even if I did not plan to become pregnant now have hope that it will go on well. It won’t be easy, a child needs a lot of care, a lot of time and a lot of love. But I know about my two children, there is also a lot of joy and the beauty outweighs the difficulties. Through the advice from Get abortion pills in Dubai I also felt that I am not alone, that gave me courage and strength. I know it won’t be easy, but I can feel my decision for the child, even if it wasn’t planned, even if I accidentally got pregnant in a difficult situation, I will make it. They make me feel like I’m not alone at my age and that you really care about me. Thank you!\n2: This is what an abortion costs in Dubai\nUnfortunately, there is no general answer to the question of how much an abortion costs. Because the individual abortion clinics charge different costs for carrying out an abortion, which sometimes differ greatly from one another. One thing can be said with certainty, however: the cost of an abortion should not be underestimated. Since the costs are not covered by the health insurance, you have to pay for the termination yourself and usually pay several hundred euros for it.\n3: Abortion pill – that’s the cost of drug abortion\nIn the case of an abortion with medication (using the so-called “abortion pill”), the costs of the abortion range between 350 and 600 euros. However, it is not possible to get the abortion pill from the pharmacy at Get abortion pills in Dubai and to carry out the abortion on your own. Because pharmacies are not allowed to sell the drug; this is only issued in outpatient departments and hospitals. Before carrying out the medical abortion, in addition to the cost burden, the possible complications must also be considered; for example, profuse bleeding, abdominal pain and infection can occur.\nSurgical abortion – these costs are to be expected\nA surgical abortion is usually a little more expensive than the drug one and costs up to 800 euros. The specific price depends on which services are included. Because before the abortion can be carried out, an ultrasound – possibly also further examinations – is necessary. The abortion itself is performed under anesthesia. General anesthesia or just local anesthesia can be considered, depending on the woman’s wishes.\n4: Abortion at a flat rate\nSome abortion clinics differentiate between the costs of an abortion after the week of pregnancy (for example up to the tenth week of pregnancy / from the tenth week of pregnancy) and quote a flat rate for this. In this case, whether the abortion is drug or surgical has no effect on the costs.\nThese services are not included in the price The costs mentioned do not include any necessary psychological follow-up care that may arise due to the risks and consequences of an abortion. Additional services, such as a rhesus injection, are also billed separately.\nThe abortion costs mentioned relate to abortions that are carried out up to three months after the start of the pregnancy (see also the legal situation in UAE ). Other regulations apply to so-called “late terminations”.\n5: Get free advice\nBefore you decide to take the big step of an abortion, you can take advantage of the free advice offered by an independent advice center Abortion tablets in Dubai in advance. It is also good to know that there are numerous financial and other support offers from both the state and private aid organizations to make life with a child possible.
No doubt you've read or heard about the patient at George Washington University Hospital who objected to having a fully supervised medical student examine her while she was under general anesthesia. Such examinations by medical students and residents have long been a mainstay of training young physicians in the fine art of the pelvic exam. There is no other way to do a pelvic exam that is unimpeded by the patient's voluntary and involuntary muscle guarding. However, some patients find the practice so objectionable that they are now adding notes to their surgical consent forms forbidding anyone but the attending physician from performing a pelvic exam while they are under anesthesia. Indeed, a New York-based group called "People Against Non-Consensual Pelvic Exams" has begun to actively lobby for federal legislation to ban such practices.1\nIt isn't just lay people who have decried the practice of using patients under anesthesia to introduce young physicians to pelvic anatomy and teach them how to do a bimanual exam. In a recent study, students at five Philadelphia-area medical schools were asked how important it would be to tell a patient that a medical student was going to perform a pelvic examination on her while she was anesthetized.2 Students who had already completed an ob/gyn clerkship thought the consent was significantly less important than did those who had not completed a clerkship. The study's authors viewed the change in attitude as inappropriate and urged clerkship directors to ensure that students only perform examinations on patients who have given explicit consent. Dr. Peter Ubel, the principal author and director of the Program for Improving Health Care Decisions at the University of Michigan, was quoted in The Washington Post as saying "There's no way a physician would ever equate a pelvic exam with rapethere is no rape content to it. But the fact that someone else perceives it that way makes it important."3 Yet, Dr. Ubel admitted that it typically takes up to 100 exams to ensure that a clinician is proficient in pelvic examination, leading me to wonder how and where he thinks the students should get their training.\nAt first glance, it seems very reasonable to contend that a patient's right to autonomy dictates informed consent before medical students or residents perform exams in the operating room, and the American College of Obstetricians and Gynecologists has endorsed the policy.4 Indeed, even if legislation is passed banning such examinations or the vast majority of patients start refusing to give consent, there are other ways to teach students how to do pelvic exams. Sophisticated models and gynecologic training associates or "professional" surrogate patients can be used. The bigger risk, however, is that legislation outlawing examination on anesthetized patients or mandating consent may trigger a series of events culminating in irreparable harm to medical students and postgraduate medical education.\nThe next blow, for example, may be organized patient objections to having students, residents, or fellows present at deliveries or in the operating room. This possibility already worries program directors troubled about the impact of the 80-hour work restriction on residents' and fellows' surgical and obstetrical experience. And what if objections are raised to having students and physicians-in-training round on patients, complete physical examinations, draw blood, or participate at codes? Perhaps some future "People Against Non-Consensual Presentation of their Cases at Rounds or M&M Conferences" will lobby successfully for legislation banning discussion of interesting cases for teaching and quality assurance purposes. Indeed, in many ways, implementation of the 80-hour workweek itself was a reaction to consumer pressure rather than a response to solid evidence that longer work hours are either dangerous to patients or harmful to training. Similarly, the potentially onerous Health Insurance Portability and Accountability Act (HIPAA) regulations are an over-reaction to perceived but completely unsubstantiated threats to patient privacy.\nWhen I was a young physician, patients received much of their care from relatively unsupervised medical students and residents. Large municipal hospitals with enormous indigent patient populations and few attending physicians often were the most sought-after training sites. Whether it was suturing lacerations in the emergency room, performing uncomplicated vaginal deliveries, or repairing episiotomies, students often acquired practical surgical skills with fairly minimal supervision. During their clerkships and externships, students mastered physical diagnosis, medical management, and triage of sick patients. In my day, by their third year in training, ob/gyn residents performed essentially unsupervised cesarean deliveries and chief residents were often the senior operators for hysterectomies. Senior residents routinely placed chest tubes, central lines, and epidural catheters without supervision after observing a couple of placements. Now all of these procedures are carefully supervised by attending physicians, who are present at every delivery and surgery. And even this new, intensely supervised training model is being challenged.\nThe fact of the matter is that the education of medical students and postgraduates has always depended on a social contract between patient and doctors-in-training. Patients gave the young apprentices access to their bodies and medical histories and permitted them to participate in their medical and surgical care in exchange for helping society gain competently trained physicians. This contract is gradually being undermined by the slow dissolution of the physician-patient relationship as a result of the professional liability crisis, antagonism from consumer groups, and the movement to a "shift" mentality among increasingly overworked and underpaid physicians. Even worse, politicians are exacerbating the potential crisis by appeasing highly vocal activists with passage of expensive, complex, and frequently unworkable regulations. In the short run, regulations designed to "protect" patients from overworked residents and to ensure their privacy may make a small portion of the public happy. In the long run, though, we may find that the newer physicians caring for us are far less well equipped than those who entered practice in years past after superb training. Many changes are needed in American medicine, including tort reform, a rational medical insurance system, more nurses, and cheaper drugs. What we need the most, though, is for the public, policy-makers, and politicians to exercise common sense.\n1. Mission statement. Non-Con: People Against Non-Consensual Pelvic Exams. Available at: http://www.shamexam.org/missionstatement.htm . Accessed July 16, 2003.\n2. Ubel PA, Jepson C, Silver-Isentadt A. Don't ask, don't tell: a change in medical student attitudes after obstetrics/gynecology clerkships toward seeking consent for pelvic examinations on an anesthetized patient. Am J Obstet Gynecol. 2003;188:575-579.\n3. Goldstein A. Practice vs. Privacy on Pelvic Exams: Med Students' Training Intrusive and Needs Patient Consent, Activists Say. The Washington Post. May 10 2003; A01.\n4. ACOG Committee on Ethics. Statement of the ACOG Committee on Ethics Regarding Ethical Implications of Pelvic Examination Training. Available at: http://www.acog.com/from_home/publications/press_releases/nr04-25-03.cfm . Accessed July 16, 2003.\nCharles J. Lockwood, MD\nCharles Lockwood. Who really loses when patient rights collide with physician training?\nOct. 1, 2003;48:8-11.
Before being used to remove unwanted tattoos, laser beams eradicated climbing ivy from the exteriors of homes and blasted clouds out of mostly blue skies. Beam away body ink with today's Groupon: for $99, you get one laser tattoo-removal treatment for up to 16 square inches at Allure Cosmetic Medical Center in Orange Park (up to a $400 value).\nThe skin-rejuvenating staff at Allure Cosmetic Medical Center removes pesky hairs, wrinkles, cellulite, tattoos, and other unwanted body blemishes with an array of cosmetic, nonsurgical services. Laser tattoo removal treats tattoos of all sizes and colors, generally removing black ink faster and more successfully than other common colors, such as green, purple, and caput mortuum. During the procedure, a beam of light passes harmlessly through the outer layer of the skin to be absorbed by the tattoo ink, which breaks up into tiny ink particles that are naturally eliminated by the body, reuniting only for money-motivated nostalgia tours.\nModerate discomfort is expected with the procedure, though physicians can numb the area with local anesthesia or readings from VCR owner’s manuals at no additional cost. While some faint tattoos will fade completely after one 5–20 minute treatment, most tattoos require 5 to 10 treatments before they are fully erased from a mother's memory banks.\n664 Kingsley Ave.\nOrange Park, Florida 32073Get Directions
View Entire Collection\nBy Clinical Topic\nDiabetes – Summer 2012\nFuture of Nursing Initiative\nHeart Failure - Fall 2011\nInfluenza - Winter 2011\nNursing Ethics - Fall 2011\nTrauma - Fall 2010\nTraumatic Brain Injury - Fall 2010\nFluids & Electrolytes\nMONDAY, Oct. 3 (HealthDay News) -- Exposure to multiple anesthesia/surgery before the age of 2 years is a significant risk factor for the development of learning disabilities (LDs) later in life, but not for the receipt of an individualized education program for an emotional/behavior disorder (IEP-EBD), according to a study published online Oct. 3 in Pediatrics.\nRandall P. Flick, M.D., M.P.H., from the Mayo Clinic in Rochester, Minn., and colleagues investigated the cognitive and behavioral outcomes in children who were exposed to anesthesia before they reached the age of 2 years. Of the 8,548 participants who were born between 1976 and 1982, 350 who were exposed to anesthesia before age 2 years were matched with 700 unexposed controls on the basis of known risk factors for LDs. Multivariable adjustments were made for the burden of illness. The outcome measures included LDs and receipt of an IEP-EBD.\nThe investigators found that the risk of developing LDs significantly increased after exposure to multiple, but not single, anesthesia/surgery, even after accounting for health status (hazard ratio, 2.12). The pattern was similar for decreases in group-administered tests of cognitive ability and achievement. The rate of children receiving IEP-EBP remained unaffected by exposure.\n"We cannot exclude the possibility that multiple exposures to anesthesia/surgery at an early age may adversely affect human neurodevelopment with lasting consequence," the authors write.\nFull Text (subscription or payment may be required)\nSign up for our free enewsletters to stay up-to-date in your area of practice - or take a look at an archive of prior issues\nJoin our CESaver program to earn up to 100 contact hours for only $34.95\nExplore a world of online resources\nBack to Top
The role of peripheral corticotropin-releasing factor (CRF) and afferent pathways in mediating abdominal surgery-induced delayed gastric emptying was investigated using an intravenous injection of the competitive CRF antagonist alpha-helical CRF9-41 and capsaicin pretreatment in adult fasted rats. Gastric emptying of a non-caloric solution was measured by the phenol red method. Intravenous CRF (0.13 nmol) inhibited by 65% gastric emptying. CRF effect was completely reversed by simultaneous intravenous injection of alpha-helical CRF9-41 (13 nmol). Abdominal surgery under enflurane anesthesia inhibited gastric emptying by 60% measured 3 h postoperatively. Enflurane anesthesia alone had no effect on gastric emptying 3 h after exposure. Abdominal surgery-induced delay of gastric emptying was reversed by 46, 60, and 100% by capsaicin pretreatment (125 mg/kg, -3 wk), intravenous injection of alpha-helical CRF9-41 (13 nmol), and combined pretreatments with capsaicin and CRF antagonist, respectively. Capsaicin and alpha-helical CRF9-41 given alone or in combination did not influence gastric emptying. These results indicate that peripheral CRF receptors along with capsaicin-sensitive afferent neurons contribute to somatovisceral stress (abdominal surgery)-induced delayed gastric emptying.
Living with pain and stiffness in your knee can be physically and emotionally overwhelming. Not only does this pain reduce your quality of life, but the stiffness can prevent you from completing simple tasks each day. Medications may mask the discomfort, but most prescription pain relievers are not recommended for long-term use. Fortunately, a knee replacement surgery can restore the knee joint back to a healthy, functional state. If you will become part of the 600,000 knee replacements performed each year in the United States, use this guide to understand what happens during and after the procedure.\nKnee Replacement 101\nMost patients who need a knee replacement have severe inflammation and damage to the cartilage of the joints. This damage may stem from arthritis or an injury that causes enormous pain and immobility.\nDuring a knee replacement, surgeons will replace damaged cartilage with artificial pieces to create a healthier and functioning joint surface. Small incisions will be made on both sides of the knee, allowing the surgeon to remove the damaged parts of your joint.\nYour surgeon will administer anesthesia before the knee replacement begins. Due to this, you will most likely be required to stay in the hospital the day of the surgery.\nMost patients will be required to say in the hospital for a few days. This gives your body time to recover from the anesthesia as well as time for your surgeon to evaluate your mobility progress.\nYour surgeon and physical therapists will work with you in the hospital, helping you move your new knee joint and walk with and without assistance. Moving your new knee joints after surgery is essential for reducing inflammation and helping you heal in a more efficient manner.\nYou will also be required to use a CPM, or continuous passive motion, on the knee in the hospital and at home. Designed to keep the knee joint in motion, the CPM machine reduces swelling, prevents the buildup of scar tissue, and decreases stiffness and pain.\nAfter a few days, your surgeon will release you from the hospital. However, working with a physical therapist is imperative to continue with your walking and stretching exercises. Physical therapy will increase your stamina while strengthening your new knee joint to ensure the most effective recovery.\nKnee replacement surgery may seem overwhelming, but it is one of the best options for relieving pain and stiffness in the joint. With this guide, you will have a better understanding of the procedure and learn what will be necessary during your recovery. To learn more, contact a company like Orthopaedic Associates Of Rochester.Share\n16 February 2017\nAre you pregnant or planning to conceive? If so, it is time to begin learning about the medical professionals that will work with you through the nine months of pregnancy and through the labor and delivery. Many women are unaware of the important role that a midwife plays throughout a pregnancy. Knowing what a midwife does and how having a midwife can help you through what can be a difficult time will help you find one that you will feel comfortable with. My site is filled with information about pregnancy, labor and delivery and working with a midwife to help other soon-to-be mothers make the decisions that are best for their situations.
Unwanted pregnancy is a serious and stressful problem for women. As stated in this paper, technologies that afford safe and effective abortion are well accepted and provide relief from a great difficulty. Many women fear surgery and will go far to avoid it. There is substantial apprehension about general anesthesia during surgery and also fear that local anesthesia may not prevent pain. This leads to a high demand for a medical abortion alternative. Some women consider that the quick and definitive surgical alternative is easier; some find that swallowing a pill is easier. Privacy is greatly valued. Medical abortion technology seems to meet this need more than surgical abortion, especially if the surgical alternative mandates hospital admission and absence from home. The high values placed on privacy, autonomy, and the wish to be able to be at home combine, in at least some settings, to create a demand for a self-administered home treatment for early abortion. Given a choice between surgery and any of several medical abortion methods, most eligible women appear to prefer the medical method.\nWinikoff, Beverly. 1994. "Acceptability of first trimester medical abortion," Robert H. Ebert Program on Critical Issues in Reproductive Health Publication Series. New York: Population Council. Version of record: https://doi.org/10.2307/2136257.\nRobert H. Ebert Program on Critical Issues in Reproductive Health
You’ve decided to prioritize your pet’s dental health and schedule a dental cleaning at Fairfax Veterinary Clinic—which is good. Or, maybe you’ve heard that your dog or cat needs a “dental” or a “dental prophylaxis,” but you’re not entirely sure what that includes, or why anesthesia is necessary. In recognition of National Pet Dental Health Month, we give you a comprehensive explanation of what your pet’s dental involves.\nWhy professional pet dental cleanings matter\nPeriodontal disease is one of the most commonly diagnosed conditions in dogs and cats, and considered the number one pet health problem. By age 3, 80% of dogs and 70% of cats have early periodontal disease signs. This destructive inflammatory disease goes mostly undetected, because the most damage takes place under the gum line and along the tooth root. Untreated periodontal disease can result in significant dental complications, and eventual organ damage caused by high bacteria counts in the bloodstream. Moderate to severe periodontal disease is easily recognizable as:\n- Bad breath\n- Red, inflamed gums (i.e., gingivitis)\n- Unusual drooling\n- Rubbing the face on carpet or furniture\n- Heavy tartar\n- Loose or broken teeth\nThe only periodontal disease treatment is a professional veterinary dental cleaning (i.e., dental prophylaxis, and a comprehensive oral health assessment and treatment [COHAT]), and the veterinarian can thoroughly assess dental problems and safely clean your pet’s teeth only when your pet is under anesthesia.\nPre-anesthetic safety measures for pet dentals\nWhile veterinary anesthesia concerns many pet owners, at Fairfax Veterinary Clinic we practice the most advanced anesthetic safety guidelines, and use customized protocols for every pet. Additionally, prior to your pet’s dental, we’ll recommend blood work to ensure they are healthy, and that their kidneys and liver are functioning well and can metabolize any medications used.\nOn an as-needed basis, we may also recommend:\n- Chest X-rays\n- ECG (i.e., electrocardiogram)\nDental anesthesia for pets\nImagine your pet’s reaction if we asked them to open up, say “Ah,” and then hold completely still while we manipulated their mouth and used sharp instruments—it wouldn’t go well! Anesthesia not only allows us to reach every nook and cranny in your pet’s mouth, but also reduces your pet’s stress, anxiety, fear, and pain. Your pet will wake up with no memory of the procedure, and will recover quietly and calmly before returning home.\nSome of the key safety features in our anesthetic protocol include:\n- Pre-medication to relax your pet\n- Intravenous (IV) catheter\n- Endotracheal tube\n- Gas anesthesia\n- Supplemental oxygen\nDental X-rays for pets\nMuch like the tip of an iceberg, more than half of each canine or feline tooth lies below the gum line, anchored by one to three roots. Dental X-rays provide our Fairfax Veterinary Clinic veterinarians with an enhanced view of each tooth, from the visible crown, to the root and surrounding bone that are not visible to the naked eye. X-rays help them to diagnose different pathologies, including infection, inflammation, bone loss, tooth erosion or resorption, and fracture, and help the veterinarian get to the root of the problem—literally—and make a treatment plan specific to your pet. Treatment may include tooth extraction (i.e., removal), biopsy, antibiotic therapy, or “salvage” procedures to save vulnerable teeth.\nOral health assessment for pets\nAs your anesthetized pet enjoys their peaceful nap, our veterinarian performs a detailed exam of their entire oral cavity that includes not only each tooth but also the surrounding structures, such as the tongue, soft palate, upper and lower jaws, and the upper airway. Any findings are recorded in your pet’s dental chart and considered when making your pet’s customized treatment plan.\nDental cleaning for pets\nDental calculus (i.e., visible tartar) is carefully removed with specialized dental instruments that are powerful enough to break apart the concrete-like bonds of plaque and tartar, while protecting the tooth’s enamel. Our state-of-the-art handpieces are designed to clean above and below the gum line, driving periodontal disease from every known hiding place, and restoring your pet’s pearly whites. Following the cleaning, each tooth is polished to smooth away microscopic grooves made during the scaling process. This essential step seals the tooth surface and discourages plaque reformation.\nDental extractions for pets\nIdeally, your pet would have a pristine exam and perfect X-rays, but thanks to the pervasive nature of periodontal disease, this is rarely the case. Fortunately, pets handle dental extraction well, especially at Fairfax Veterinary Clinic, because we use delicate techniques and comprehensive pain management.\nPrior to any painful procedure or manipulation, the area is numbed with a local nerve block. Pets go home with additional pain medication, to keep them comfortable and promote timely healing. If your pet has dental surgery, we’ll schedule a follow-up appointment. Your pet must eat only soft foods until this recheck, to prevent incision damage.\nDental home care for pets\nAt your pet’s discharge appointment, we’ll review any medications or instructions, and provide resources for maintaining your pet’s newly restored dental health at home. While toothbrushing is the gold-standard, many effective alternatives, such as dental diets, treats, chews, and water additives proven to reduce plaque and tartar, are available.\nProtecting your pet’s dental health is essential to their lifelong comfort and wellbeing. If you realize that your pet’s teeth need some professional attention, that’s OK—it’s never too late or too soon to start fresh. Contact Fairfax Veterinary Clinic to schedule a dental consultation.
\|Year : 2018 \| Volume\n\| Issue : 3 \| Page : 150-154\nA comparative study of ultrasound-guided femoral nerve block versus fascia iliaca compartment block in patients with fracture femur for reducing pain associated with positioning for subarachnoid block\nNeena Jain, Pooja Rawat Mathur, Veena Patodi, Saurav Singh\nDepartment of Anaesthesiology, Jawaharlal Nehru Medical College, Ajmer, Rajasthan, India\n\|Date of Web Publication\|\|31-Dec-2018\|\nDr. Pooja Rawat Mathur\n131/1, Jeevan-Jyoti, Shantipura, Ajmer - 305 001, Rajasthan\nSource of Support: None, Conflict of Interest: None\nContext: Lower extremity peripheral nerve blocks are increasingly being recommended for pain control in patients with fracture femur as it reduces pain and shortens the duration of hospital stay. Aims: To compare analgesic efficacy of ultrasound guided femoral nerve block (FNB) and fascia iliaca compartment block (FICB) in patients with fracture femur for reducing pain associated with positioning for subarachnoid block. Settings and Design: It was a prospective, randomized, double blind study. Methods and Material: Group A (n = 25) received ultrasound guided FNB and Group B (n = 25) received ultrasound guided FICB using 0.5% ropivacaine. Primary objective was to observe reduction in pain associated with positioning (sitting) for subarachnoid block. Statistical Analysis used: For data analysis t test, Mann Whitney test and Chi-square test were applied. Results: Visual analog scale (VAS) score for pain before giving peripheral nerve block between Group A (7.60 ± 0.57) and Group B (7.44 ± 0.50) was comparable (P = 0.302). VAS score for pain in sitting position before giving subarachnoid block was lesser in Group A (1.88 ± 0.83) than in Group B (2.40 ± 0.57) (P = 0.013). Mean reduction in VAS score for pain was more in Group A (5.72 ± 0.73) compared to Group B (5.04 ± 0.73) (P = 0.002). Conclusion: Ultrasound guided FNB is more efficacious in reducing pain associated with positioning (sitting) for subarachnoid block in patients undergoing surgery for fracture femur compared to ultrasound guided FICB.\nKeywords: Anesthesia, anesthetics, femoral fractures, local, nerve block, patient positioning, spinal, ultrasonography\n\|How to cite this article:\|\nJain N, Mathur PR, Patodi V, Singh S. A comparative study of ultrasound-guided femoral nerve block versus fascia iliaca compartment block in patients with fracture femur for reducing pain associated with positioning for subarachnoid block. Indian J Pain 2018;32:150-4\n\|How to cite this URL:\|\nJain N, Mathur PR, Patodi V, Singh S. A comparative study of ultrasound-guided femoral nerve block versus fascia iliaca compartment block in patients with fracture femur for reducing pain associated with positioning for subarachnoid block. Indian J Pain [serial online] 2018 [cited 2020 Jan 26];32:150-4. Available from: http://www.indianjpain.org/text.asp?2018/32/3/150/249098\n\| Introduction\|\| \|\nFemur fracture is a very painful condition perioperatively, which is further exaggerated by movements., Paracetamol, nonsteroidal anti-inflammatory drugs, and opioids have their limitations, ranging from mild systemic side effects such as nausea, vomiting, constipation, and urinary retention to serious complications such as respiratory depression and nephrotoxicity and are often contraindicated due to their interactions with other drugs.,\nRegional analgesia overcomes the shortcomings and offers an attractive alternative to systemic analgesics for perioperative use.,,,, Lower extremity peripheral nerve blocks are increasingly being recommended for pain control in patients with fracture femur as it reduces pain, time to first rescue analgesia, need for systemic analgesics, and incidence of delirium and shortens the duration of hospital stay.,,,\nThe femoral nerve block (FNB) and fascia iliaca compartment block (FICB) are simple methods which require minimal instruments with few absolute contraindications, being hypersensitivity to local anesthetic agents or the presence of vascular or neurological problems in the affected limb. However, these simple techniques are underused in the management of pain relief in femur fracture.\nUltrasound guidance improves visualization of anatomical structures, success rate, quality of sensory block, and onset time and decreases dose of local anesthetics and complications compared to nerve stimulator or landmark techniques.\nStudies have compared FNB with FICB, employing the use of nerve stimulator and landmark technique, but the use of ultrasound-guided (USG) technique to compare these two blocks remains unexplored.\nIn the present study, we compared the analgesic efficacy of USG FNB with USG FICB using 0.5% ropivacaine in patients with fracture femur in reducing pain associated with positioning (sitting) for subarachnoid block.\nDuration of analgesia, perioperative patient comfort, and complications were also assessed.\n\| Subjects and Methods\|\| \|\nA prospective study was initiated after clearance from the institutional ethical committee. Based on the study by Ghimire et al., the sample size was calculated to be 22 patients in each group, keeping a power of 0.8 and α error of 0.05. To allow for study error and attrition, final sample size of 25 patients were randomly allocated to each group.\nAfter valid written and informed consent, a total of 50 adult patients (18–80 years) with American Society of Anesthesiologists (ASA) Physical Status 1 and 2 posted for elective surgery for fracture femur were allocated into two groups using a computer-generated table of random numbers.\nPatients with psychiatric illness, anxious or agitated patients, presence of peripheral sensorineural deficit, allergic to local anesthetic agents, on anticoagulants, infection at the site of block performance, sepsis, vertebral column deformity, suspected compartment syndrome in the lower limbs, on analgesics within 8 h before performing nerve block were excluded from the study. The anesthetist performing the block was not blinded to the procedure, but the patient and assessor of pain visual analog scale (VAS) score were blinded to group allocation.\nPreparations for giving general anesthesia, emergency resuscitation, and ultrasound equipment for the peripheral nerve block were kept ready. On arrival of the patient in the operation theater, pain VAS score was assessed using a standard 10-cm VAS, with 0 corresponding to no pain and 10 designating the worst possible pain.\nThe site to be blocked was painted with 5% povidone–iodine followed by spirit and was draped. A linear 7–13 MHz ultrasonography probe (SonoScape A8, SonoScape Medical Corp., Shenzhen, China) was used with in-plane approach of needle (18G Tuohy needle) advancement. Probe was moved laterally or medially and rocked back and forth until a good-quality picture was obtained. Mark on the probe was always kept on the lateral side for image orientation. Optimal gain, depth, and focal point were set to obtain the best possible view of the concerned anatomical structures.\nGroup A (n = 25) received USG FNB. Landmark included the identification of femoral nerve lateral to femoral artery at the level of femoral crease followed by injection of 0.5% ropivacaine 20 ml after careful aspiration adjacent to femoral nerve.,,\nGroup B (n = 25) received USG FICB. Landmarks included identification of femoral artery, iliopsoas muscle, fascia iliaca, and sartorius muscle followed by injection of 0.5% ropivacaine 30 ml after careful aspiration between fascia iliaca and iliopsoas muscle.,,,\nTwenty minutes after the peripheral nerve block, patients were placed in sitting position for subarachnoid block and pain VAS score was assessed. Injection bupivacaine 0.5% heavy 15 mg was given intrathecally using a 25G Quincke needle.\nDuration of analgesia was defined as loss of pinprick sensation in the anterior part of thigh (after the peripheral nerve block) to either when pain VAS score was >3 (assessed every hour postoperatively) or when the patient demanded for rescue analgesia. Perioperative patient comfort was assessed postoperatively using the standard 10-cm VAS for comfort, with 0 corresponding to least comfortable and 10 designating the most comfortable state. Complications such as nausea, vomiting, hypotension, bradycardia, hematoma, and local anesthetic toxicity were carefully monitored.\nNo loss of pinprick sensation in the anterior part of thigh within 20 min of performing the peripheral nerve block was considered as block failure. Such patients were excluded from the study.\nVariables were analyzed statistically and expressed as mean ± standard deviation. Categorical data were compared using Chi-square test. Quantitative parametric data were analyzed using unpaired Student's t-test while nonparametric data were analyzed using Mann–Whitney test. P < 0.05 was considered statistically significant. GraphPad Prism software version 6.01 for Windows (GraphPad Software Inc., La Jolla, California, USA, 2012) was used for data tabulation and analysis.\n\| Results\|\| \|\nBoth groups were comparable in terms of demographic profile such as age, sex, weight, ASA physical status, distribution of fracture, and types of surgery performed as evident from [Table 1]. VAS score for pain before performing peripheral nerve block between Group A (7.60 ± 0.57) and Group B (7.44 ± 0.50) was comparable (P = 0.30) [Table 2]. VAS score for pain in the sitting position before giving subarachnoid block was significantly less in Group A (1.88 ± 0.83) when compared to Group B (2.40 ± 0.57) (P = 0.01) [Table 2].\nMean reduction in VAS score for pain was also more in Group A (5.72 ± 0.73) compared to Group B (5.04 ± 0.73) (P = 0.00) [Figure 1]. Duration of analgesia between Group A (480.3 ± 39.85 min) and Group B (458.8 ± 42.68 min) was comparable (P = 0.07) [Figure 2]. VAS score for perioperative patient comfort between Group A (7.52 ± 0.50) and Group B (7.44 ± 0.50) was comparable (P = 0.58) [Figure 3]. No complications were observed in both groups.\n\| Discussion\|\| \|\nAnesthetic technique most commonly used for patients with fracture femur includes neuraxial blocks, with subarachnoid block being routinely used.,\nPositioning of the patients with femur fracture is a painful condition as evident from pain VAS scores assessed before performing the peripheral nerve block in our study as well as previous studies.,, Moreover, patients presenting with fracture femur usually are the elderly and have multiple comorbidities, which precludes the use of systemic analgesics.\nSandby-Thomas et al. in their survey on perioperative management of patients with fracture femur reported that the most frequently used agent for analgesia and sedation during patient positioning for subarachnoid block was midazolam followed by ketamine and propofol. Other alternative agents were rarely used, and these included nitrous oxide, sevoflurane, and remifentanil. Nerve blocks were used infrequently to aid with positioning. No sedation or analgesia was given for positioning in 15.1% of patients. A 2012 survey of three Toronto, Ontario–area hospitals found that regional nerve blocks for hip fractures were performed by only 33% of attending emergency physicians and only 6% performed them often or almost always. A 2009 survey in the United Kingdom found that 55% of emergency departments regularly use regional anesthesia techniques for hip and femur fractures.\nA 2002 Cochrane systemic review of nerve blocks for hip fractures undertaken shortly after admission to hospital concluded: “Nerve blocks resulted in statistically significant reductions in reported pain levels and in the quantity of parenteral or oral analgesia administered to control pain from the fracture or during surgery.” Guidelines from the National Institute for Health and Clinical Excellence state, “Consider nerve block for additional analgesia or to limit opioid dosage.”\nThus, lower limb peripheral nerve blocks may prove to be a useful tool in an anesthetists' armamentarium for not only improving perioperative patient comfort and reducing pain exaggerated by movements but also increasing the ease, success rate, and decreasing time for performing subarachnoid block.\nThe FNB results in anesthesia of the skin and muscles of the anterior thigh and most of the femur and knee joint. The distribution of anesthesia and analgesia that is accomplished with the fascia iliaca block depends on the extent of the local anesthetic spread and the nerves blocked. The block should result in blockade of the femoral nerve in all instances (100%) and lateral cutaneous nerve of the thigh in 80%–100% instances. The psoas muscle and pectineus muscle separate the obturator nerve from the femoral nerve along its course, and therefore, this nerve is not reliably blocked by FICB. These blocks are well suited for surgery on the anterior thigh and knee, quadriceps tendon repair, and postoperative pain management after femur and knee surgery.\nFNB and FICB were earlier performed using landmark or nerve stimulator technique, but advent of ultrasound overcame their shortcomings and is now a preferred technique. Several randomized control trials have also proved the superiority of ultrasound over other techniques. Our study aims to compare FNB with FICB using USG technique as this remains unexplored.\nRopivacaine, the S-enantiomer of 1-propyl-2', 6'-pipecoloxylidide, was chosen because it has lower toxicity than the R-enantiomer. Reduced central nervous system and cardiac toxicity, along with lower lipid solubility which leads to less propensity for motor blockade than bupivacaine, has made ropivacaine one of the most commonly used long-acting local anesthetics in the peripheral nerve blockade.,, Anupreet et al. also concluded that the onset of action of sensory and motor block was early in ropivacaine group with faster recovery of motor functions as compared to bupivacaine group.\nOur finding that FNB proves to be significantly more effective than FICB in reducing pain during positioning (sitting) for subarachnoid block was consistent with the study by Newman et al., who had postblock pain VAS score of 4.4 and 5.4 for FNB and FICB, respectively, using 0.5% levobupivacaine. They had mean reduction in pain VAS score of 3.7 and 2.8 for FNB and FICB, respectively (P = 0.05). Somvanshi et al. had postblock pain VAS score of 1.84 for FNB with mean reduction in pain VAS score of 7.28 (P = 0.01) using 0.5% ropivacaine. Kumar et al. had postblock pain VAS score of 2.94 for FICB with mean reduction in pain VAS score of 4.56 for (P = 0.01) using 0.5% ropivacaine.\nDeposition of ropivacaine within the vicinity of femoral nerve using ultrasound guidance that gives articular branches to hip joint increases the chances of the nerve getting block. This may be the reason why, in our study, the FNB proved to be more efficacious analgesic than FICB, which requires deposition of large volume of local anesthetic away from the femoral nerve.\nWe observed that FNB and FICB provided longer duration of postoperative analgesia compared to intrathecal 0.5% heavy bupivacaine alone which has a duration of 60–240 min. It will not only decrease the use of systemic opiates and their adverse effects postoperatively but also delirium. This improves functional recovery and quality of life and decreases duration of hospital stay.\nAlthough our results were consistent with the previous studies, the use of ultrasonography for performing peripheral nerve blocks were the reasons for no failures and better perioperative patient comfort in our study.,, Other reasons for no failures being stringent selection of cooperative patients, same anesthesiologist performing all the procedures, same assessor assessing the VAS score.\nHence, we recommend more widespread use of these USG lower limb blocks, especially FNB for perioperative analgesia and comfort during transfers, imaging, and patient positioning for patients with femur fractures.\nIn resource-limited hospital settings, FICB which is easy to learn and perform can be used as it also provides satisfactory analgesia and patient comfort.\nMajor limitations of our study included assessment of VAS score which is subjective and varies with the level of understanding between patient and anesthesiologist and assessment of comfort level that may vary from person to person as per their experience. Thus, objective assessment of these parameters may be difficult.\n\| Conclusion\|\| \|\nUSG FNB is more efficacious in reducing pain associated with positioning (sitting) for subarachnoid block in patients with fracture femur compared to USG FICB. It can be performed safely without complications, providing good patient comfort and longer duration of postoperative analgesia in the patients undergoing surgery for fracture femur.\nFinancial support and sponsorship\nConflicts of interest\nThere are no conflicts of interest.\n\| References\|\| \|\nSomvanshi M, Tripathi A, Meena N. Femoral nerve block for acute pain relief in fracture shaft femur in an emergency ward. Saudi J Anaesth 2015;9:439-41.\n] [Full text]\nSingh AP, Kohli V, Bajwa SJ. Intravenous analgesia with opioids versus femoral nerve block with 0.2% ropivacaine as preemptive analgesic for fracture femur: A randomized comparative study. Anesth Essays Res 2016;10:338-42.\n] [Full text]\nSahota O, Rowlands M, Bradley J, Van de Walt G, Bedforth N, Armstrong S, et al\n. Femoral nerve block intervention in neck of femur fracture (FINOF): Study protocol for a randomized controlled trial. BMC 2014;15:189. Available from: https://www.trialsjournal.biomedcentral.com\nKumar D, Hooda S, Kiran S, Devi J. Analgesic efficacy of ultrasound guided FICB in patients with hip fracture. J Clin Diagn Res 2016;10:UC13-6.\nNewman B, McCarthy L, Thomas PW, May P, Layzell M, Horn K, et al.\nAcomparison of pre-operative nerve stimulator-guided femoral nerve block and fascia iliaca compartment block in patients with a femoral neck fracture. Anaesthesia 2013;68:899-903.\nYun MJ, Kim YH, Han MK, Kim JH, Hwang JW, Do SH, et al.\nAnalgesia before a spinal block for femoral neck fracture: Fascia iliaca compartment block. Acta Anaesthesiol Scand 2009;53:1282-7.\nRitcey B, Pageau P, Woo MY, Perry JJ. Regional nerve blocks for hip and femoral neck fractures in the emergency department: A Systematic review. CJEM 2016;18:37-47.\nYang L, Li M, Chen C, Shen J, Bu X. Fascia iliaca compartment block versus no block for pain control after lower limb surgery: A meta-analysis. J Pain Res 2017;10:2833-41.\nGhimire A, Bhattarai B, Koirala S, Subedi A. Analgesia before performing subarachnoid block in the sitting position in patients with proximal femoral fracture: A Comparison between fascia iliaca block and femoral nerve block. Kathmandu Univ Med J (KUMJ) 2015;13:152-5.\nMiller RD, Cohen NH, Eriksson LI, Fleisher LA, Weiner-Kronish JP, Young WL. Miller's Anaesthesia. 8th\ned. Philadelphia: Elsevier Saunders; 2015. p. 1721-66.\nMackey DC, Butterworth JF, Mikhail MS, Morgan GE, Wasnick JD. Morgan and Mikhail's Clinical Anesthesiology. 5th\ned. New York: McGraw-Hill Education; 2014. p. 975-1023.\nRange C, Egeler C. Fascia Iliaca Compartment Block: Landmark and Ultrasound Approach. Anaesthesia Tutorial of the Week 193; 2010. Available from: http://www.frca.org.uk\n. [Last accessed on 2018 Feb 23].\nChooi CS, White AM, Tan SG, Dowling K, Cyna AM. Pain vs. Comfort scores after caesarean section: A randomized trial. Br J Anaesth 2013;110:780-7.\nSandby-Thomas M, Sullivan G, Hall JE. A national survey into the peri-operative anaesthetic management of patients presenting for surgical correction of a fractured neck of femur. Anaesthesia 2008;63:250-8.\nHaslam L, Lansdown A, Lee J, van der Vyver M. Survey of current practices: Peripheral nerve block utilization by ED physicians for treatment of pain in the hip fracture patient population. Can Geriatr J 2013;16:16-21.\nMittal R, Vermani E. Femoral nerve blocks in fractures of femur: Variation in the current UK practice and a review of the literature. Emerg Med J 2014;31:143-7.\nParker MJ, Griffiths R, Appadu BN. Nerve blocks (subcostal, lateral cutaneous, femoral, triple, psoas) for hip fractures. Cochrane Database Syst Rev 2002;1:CD001159.\nMcClure JH. Ropivacaine. Br J Anaesth 1996;76:300-7.\nKuthiala G, Chaudhary G. Ropivacaine: A review of its pharmacology and clinical use. Indian J Anaesth 2011;55:104-10.\n] [Full text]\nStoelting RK, Flood P, Rathmell JP, Shafer S. Stoelting's Pharmacology and Physiology in Anesthetic Practice. 5th\ned. Philadelphia: Lippincott Williams and Wilkins; 2015. p. 282-313.\nKaur A, Singh RB, Tripathi RK, Choubey S. Comparision between bupivacaine and ropivacaine in patients undergoing forearm surgeries under axillary brachial plexus block: A prospective randomized study. J Clin Diagn Res 2015;9:UC01-6.\n[Figure 1], [Figure 2], [Figure 3]\n[Table 1], [Table 2]
Introduction Intraoperative monitoring of nociception has recently made substantial progress in adult anesthesia. In contrast, pediatric data are scarce. Newborn-Infant Parasympathetic Evaluation (NIPE index, Mdoloris Medical Systems, Loos, France) is the first nociception index specifically designed for young children. It is a dimensionless index comprised between 0 and 100. Two previous studies suggested that NIPE could indeed ‘detect’ nociception in anesthetized children. The objective of our study was to investigate if NIPE allowed to detect and to provide a quantitative assessment of nociception in children.\nMethods Children were anesthetized with sevoflurane, and received a bolus of alfentanil (10 µg/kg before intubation). Before surgical incision, each participant received three tetanic stimulations (5 s, 100 Hertz) with a 5 min interval, in a randomized order: 10, 30 and 60 milliamps. NIPE and heart rate variations were assessed after each stimulation.\nResults Thirty children (2.4±1.6 years) were included. Mean delay between alfentanil and the first stimulation was 19±4 min. Mean baseline NIPE was 75±10. NIPE variation after the stimulations was significant at 10, 30 and 60 mA (linear mixed regression model, p<0.001). The intensity of stimulation significantly influenced the amplitude of NIPE variation (linear mixed regression model p<0.001), but had no statistically significant effect on heart rate variation (p=0.52).\nDiscussion NIPE might allow a quantitative assessment of nociception in young children in these anesthetic conditions. This study provides a basis for future research investigating the potential benefits of NIPE-guided intraoperative analgesia in pediatric anesthesia.\nTrial registration number NCT04381637.\n- pain measurement\n- anesthesia, conduction\nData availability statement\nData are available on reasonable request.\nStatistics from Altmetric.com\nContributors NS had the idea of the study, was responsible for study conception and design, participated in patient recruitment, data acquisition, data analysis, data interpretation. She wrote the article and revision. She is guarantor. SL was responsible for patient recruitement, data acquisition, he participated in data analysis and interpretation, drafting of the article and revision. JB was responsible for patient recruitment, data acquisition, she participated in data interpretation, critical revision of the manuscript. EC wrote the statistical plan, performed the statistical analysis, she participated in drafting of the manuscript and revision. MH was responsible for data management, she contributed to designing the study, data analysis, critical revision of the manuscript and revision. BT contributed to study conception and design, data analysis and interpretation, he was responsible for critical revision of the manuscript and revision. IC contributed to study conception and design, data analysis and interpretation, she was responsible for critical revision of the manuscript and revision. All authors approved the final version of the manuscript and agreed to be accountable for all aspects of the work.\nFunding This work was supported by the APICIL foundation and the French Society of Anesthesiology and Intensive care (SFAR).\nCompeting interests None declared.\nProvenance and peer review Not commissioned; externally peer reviewed.\nSupplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.\nIf you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
About Plexus Technology Group LLC\nSince 2009, Plexus Technology Group (Plexus TG), a subsidiary of MiraMed Global Services, has helped individual anesthesia providers, anesthesia physician groups, ambulatory surgery centers, and hospitals improve efficiencies and streamline essential OR processes with innovative technology.\nDesigned by an anesthesiologist, Plexus TG’s flagship product, Anesthesia Touch, is a full-featured, scalable, easy to use, anesthesia information management system (AIMS) that works on both an iPad, as well as, a touchscreen Windows workstation. Anesthesia Touch is a native iPad iOS application that made its debut on the first generation iPad in 2010. In addition to providing a state-of-the-art AIMS solution, Plexus TG offers real-time integration, enhanced mobility, automatic vital sign capture and extensive quality data analytics.
Survey of Swedish anesthesia personnel reveals need to improve knowledge, particularly in elderly and fragile patients, reports Annals of Medicine and Surgery\nNew York, NY, August 19, 2014 /3BL Media/ – Postsurgical cognitive side effects can have major implications for the level of care, length of hospital stay, and the patient’s perceived quality of care, especially in elderly and fragile patients. A nationwide survey of Swedish anesthesiologists and nurse anesthetists has found there is low awareness of the risks of cognitive side effects following surgery. Furthermore, only around half of the respondents used depth-of-anesthesia monitors. Results are published in Annals of Medicine and Surgery.\nWashington, DC, June 30, 2014 /3BL Media/ – Anesthesia providers are missing opportunities to clean their hands during surgical procedures, according to a study published in the July issue of the American Journal of Infection Control, the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC).
LeAnn Rimes’ Hospital Visit Prompted by Dental ‘Nightmare’\nLeAnn Rimes is feeling "much better" after being forced to reschedule her Friday night (Oct. 5) performance in Wendover, Nev., tweeting she was, "under anesthesia" and suffering from "a massive infection." While she didn't specify what the infection was, LeAnn described it by writing, "I feel like I got hit in my right side of my face with a baseball bat."\nOn Sunday (Oct. 7), the 30-year-old posted on her website about going to the emergency room the night before, "The ER at 3am, THAT is an interesting place to be. Feeling much better now, thanks to my husband's best friend who's an ER doc. I've been living in a dental nightmare for 10 months. I'm getting back on track though, I hope."\nEarlier this year, the "Give" singer had to cancel several shows in order to undergo dental surgery, following an emergency root canal. "Needless to say, I'm resting today (Sunday)," she added. "Thank you all for your support and understanding. The last 10 months of pain are hard for me to wrap my head around. I'm sure it's difficult for you all to understand too. Let's just pray I'm on the mend. I'll see you all on the road very soon."\nLeAnn is expected to perform in New Wilmington, Pa., on Thursday (Oct. 11). See her tour schedule here.
Received date: June 22, 2015; Accepted date: July 20, 2016; Published date: July 25, 2016\nCitation: Gupta M, Shivapour J, Lawrence A, Snyder C (2016) Does Anesthesia Induction during Electrophysiologic Studies Induce Tachycardia in Pediatric Patients. J Cardiovasc Dis Diagn 4:250. doi:10.4172/2329-9517.1000250\nCopyright: © 2016 Gupta M, 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.\nVisit for more related articles at Journal of Cardiovascular Diseases & Diagnosis\nBackground: Anesthesia is essential to facilitate the majority of pediatric electrophysiology studies (EPS); however, a risk of an arrhythmia exists during its induction. The purpose of this study was to determine the incidence of arrhythmia during anesthesia induction in pediatric EPS.\nMethods: IRB approved retrospective review of pediatric EPS from 1/99 to 1/14. Inclusion criteria: Age ≤ 21 years and comprehensive EPS under general anesthesia. Data collected: demographics, EPS results, and anesthesia records. Patients were grouped based upon route of anesthesia administration: Intravenous (IV) agents (propofol, ketamine, and kentanyl) and Inhalational (IH) agents (sevoflurane, isoflurane and desflurane).\nSinus Tachycardia (STACH) was defined as variable heart rates of >140 and <180 beats per minute (bpm) originating from sino-atrial node with a duration of ≥5 minutes. Supraventricular Tachycardia (SVT) was defined as an abnormal heart rhythm arising due to abnormal electrical activity of the heart, originating proximal to the bundle of His, with sustained rates ≥ 180 bpm.\nResults: Inclusion criteria were met by 378 patients, 57% male, median age 14 ± 4 years, with IV induction utilized in 275 (72%) patients. During induction, 39 (10%) developed tachycardia: 38 STACH and 1 SVT. STACH was more common with IH anesthesia when compared to IV (p<0.0001). Patients with Wolff-Parkinson-White (WPW), irrespective of anesthesia type, had twice the risk of developing STACH, 17/114 vs. 21/264 of others (p = 0.02).\nConclusion: Sinus Tachycardia occurred in 10% of pediatric electrophysiology cases performed under\nanesthesia. It was seen more frequently when IH agents were used compared to IV. Patients with WPW have\ndouble the risk of developing sinus tachycardia during anesthesia induction when compared to patients with other forms of SVT.\nSupraventricular tachycardia; Wolff-Parkinson-White syndrome; Pediatric electrophysiology study; Route of Anesthesia induction; Atrioventricular Nodal Reentrant Tachycardia\nAn Electrophysiology study (EP study) is a specialized intra-cardiac procedure utilizing catheters to evaluate the cardiac conduction system. Due to the highly technical nature of these studies and the fact that they are often performed on children and adolescents, it is important to perform these procedures while the patient is comfortable and/or asleep. These studies can be performed under sedation only in older adolescents if the patient is cooperative. The use of general anesthesia to allow pediatric patients to undergo a comfortable electrophysiology study (EPS) is becoming the standard of care. The use of anesthetic agents during these pediatric procedures has been well documented and its use is rarely associated with rare lifethreatening cardiovascular adverse events . The cardiovascular side effects associated with the utilization of anesthetic agents include cardiac arrest, desaturation, hypotension, bradycardia/tachycardia, and changes in cardiomyocyte repolarization time (QT prolongation) resulting in arrhythmias [1-8].\nInhalational anesthetic agents such as sevoflurane, isoflurane and desflurane have been utilized by pediatric anesthesiologists during operating room cases and have reported occurrences of arrhythmias [4,8-11]. The initiating factors for these arrhythmias consist of transient electrolyte imbalances, hypotension, hypertension and fluctuation in core body temperature [3,4]. Additional cardiac effects associated with the use of these agents includes decrease in effective refractory period (ERP), changes in the heart rate and the ventricular activation time have been reported [2-4]. These agents also affect the myocardial potassium channels leading to prolongation of QTc interval and subsequent arrhythmias [1-4].\nPediatric patients undergo EPS for diagnosis and treatment of their arrhythmias. There is an assumed risk of arrhythmia occurrence during anesthesia induction, but the incidence and nature of these arrhythmias in pediatric patients undergoing these procedures is unknown. To date, no studies have investigated the risk of arrhythmias during anesthesia induction for EPS. Understanding when and if arrhythmias occur during induction may lead to identification of less arrhythmogenic agents that could be utilized in the future.\nThe primary objectives of this study were to determine the incidence and type of arrhythmias during induction of anesthesia in pediatric patients undergoing EPS and if they differ when utilizing different anesthetic agents and modes of anesthesia.\nInstitutional review board (IRB) approved retrospective chart review was performed for all the patients who had an EPS from 01/99 to 01/14. The data collected included demographics, indications for EP study, route of anesthesia administration, medications used for induction, and occurrence and type of arrhythmia during induction. Routine monitoring during anesthesia induction included continuous electrocardiography (ECG), blood pressure monitoring, peripheral pulse oximetry and respiratory rate monitoring. Intermittent positive pressure ventilation was used to maintain an end-tidal carbon dioxide (ETCO2) in the normal range of 40 - 48 mmHg when available. The endotracheal intubation was facilitated by rocuronium or vecuronium.\nAnesthesia and EP reports were recorded. The patients were then divided into 2 groups based upon mode of anesthesia induction either (1) Inhalational anesthesia (IH) or (2) intravenous anesthesia (IV). The inclusion criteria were: age<21 years, EPS performed under general anesthesia. Those patients with congenital heart disease were excluded. The frequency and type of arrhythmias that occurred during anesthesia induction were documented. All data were collected and analyzed using the SAS software (SAS software version 9.3; SAS, Campus Drive, Cary, NC). The differences between variables were assessed using Chi-Square test, and Fisher exact test and the differences were considered significant at a p valve of <0.05. Patient characteristics (including gender, age, weight and height), type of anesthesia induction and types of arrhythmia between the two groups were compared. For the purposes of this study, all WPW patients and those with ventricular pre-excitation were categorized as WPW.\nFor the purpose of this study, General anesthesia was defined as general insensibility to pain and other sensations induced by certain interventions and drugs to permit the performance of surgery or painful procedures. Inhalational induction (IH) was defined as induction of anesthesia through mask using inhaled anesthetics, and examples include isoflurane, sevoflurane, desflurane and nitrous oxide (N2O). Intravenous induction (IV) was defined as induction of anesthesia using intravenous agents, and examples include propofol, fentanyl, midazolam, lorazepam and ketamine. Supraventricular tachycardia (SVT) was defined as a tachycardia that originates proximal to the bundle of His with consistent heart rate of >180 bpm. Sinus tachycardia (STACH) was defined as persistent and variable heart rates>140 and <180 bpm originating from SA node. Sinus Bradycardia was defined as sinus rhythm originating from SA node with a persistent heart rate of less than 50 bpm. Hypotension was defined as a systolic blood pressure<70 mmHg at any time during anesthesia induction. The anesthesia induction time was defined as the time from initiation of anesthesia induction to the time of first intravenous access attempt for EPS. The maintenance phase was defined as the point when the drugs used to initiate the anesthetic are beginning to wear off and the anesthesia is then maintained with maintenance agent, typically an inhaled or intravenous anesthetic. Isoflurane was used for induction in earlier part of this study but after 2005, it was mainly used for anesthesia’s maintenance.\nThe data search revealed 408 pediatric patients that underwent EPS under general anesthesia, of which 378 (93%) met inclusion criteria. The median age at the time of the EP study was 14 years (mean 13.5 ± 4 years) with 217 (57%) being males. The most common indications for the EPS were concealed pathway (34%), WPW (30%), and AVNRT (26%) (Table 1).\n\|Characteristics and demographics\|\|Number\|\|Percent\|\n\|Age in years (±SD)\|\|13.5 (± 4)\|\n\|Route of anesthesia induction\|\n\|Indications for EP study\|\nSD: Standard deviation, WPW: Wolf Parkinson White, AVRT: Atrio-ventricular reentry tachycardia, AVNRT: Atrioventricular nodal reentrant tachycardia\nTable 1: Common indications for the EPS.\nThe patients that met inclusion criteria were then divided into 2 groups based on route of anesthesia induction: IV vs. IH. IV anesthetic agents were administered to 275 (73%) patients while 103 received IH agents.\nNo statistically significant differences existed between the groups with respect to other demographics.\nTachycardia was recorded in 39 patients (10%) during anesthesia induction, with STACH accounting for 38 and SVT in one patient. When tachycardia was analyzed based on route of anesthesia administration, a significantly higher number of patients that had IH anesthesia, 22/103 (21%) developed tachycardia compared to 16/275 (6%) that had IV [p<0.0001] (Table 2). In the IH group, 1 patient developed SVT as well. Upon further analysis of those with STACH, it was noted to occur more frequently in male patients (13%) compared to female patients (5%) [p = 0.0237].\n\|Arrhythmias during anesthesia induction\|\|Intravenous anesthesia\|\|Inhalational anesthesia\|\|p value\|\nSVT: Supraventricular tachycardia\nTable 2: Arrhythmias during anesthesia induction.\nAnother group that had relatively frequent episodes of tachycardia during anesthesia induction was those with WPW. In this cohort of patients, 17/114 (15%) had STACH and 1 had SVT (Table 3). In those with concealed pathway 18/129 (14%) developed STACH and only 2/99 (2%) AVNRT patients developed STACH during anesthesia induction [p = NS].\n\|Indications for EP study\|\|SVT during anesthesia induction\|\|Sinus tachycardia during anesthesia induction\|\n\|Concealed pathway\|\|0%\|\|18 (129)\|\nTable 3: Indications for EP study.\nDue to the complexity of a pediatric EPS and for the safety and comfort of children during these procedures, the use of pediatric anesthesia is becoming more widespread. Instead of utilizing any anesthetic agent for pediatric EPS, the optimal anesthetic agent should have minimal effect on cardiac conduction tissue specifically in both the normal atrioventricular conduction system and in the accessory pathway(s) and that anesthetic agents should adequately suppress the sympathetic responses to induction and stimulation to allow predictable progression of procedure.\nMultiple anesthetic agents have been reported that would allow rapid titrations to prevent unwanted responses and make patients comfortable. Much has been published about potential side effects of these anesthetic agents on cardiac and accessory pathway conduction during EPS [7-12], but little is published about the potential cardiovascular side effects of anesthetic agents during induction and their propensity to induce any type of tachycardia during anesthesia induction.\nThis study illustrated the incidence of tachycardia during anesthesia induction. The patients receiving IH anesthesia during induction experienced significantly more sinus tachycardia (21%) when compared to those that received IV anesthesia agents (6%) [p<0.0001]. This may be due to a higher incidence of hemodynamic disturbances like hypotension, peripheral vasodilatation, a decrease in cardiac output due to depressed myocardial contractility leading to hypotension, or secondary to cardiac conduction tissue sensitization to IH agents. In addition, isoflurane and desflurane are also known to produce a dose dependent increase in heart rate [7-12].\nInduction using an IV anesthetic agent caused significantly less tachycardia when compared to inhalational agents [p<0.0001]; suggesting potentially less arrhythmogenic effects of propofol and ketamine on the electrophysiological properties of normal and accessory pathway conducting system. A number of studies have demonstrated less cardiovascular side effects of propofol on conduction properties of normal and accessory pathways in patients with WPW syndrome during adult EP studies [7-12]. One study showed successful use of propofol for EP study for treatment of tachyarrhythmias except for atrial ectopic tachycardia [5,6]. Halogenated anesthetic agents (sevoflurane, isoflurane and desflurane) have resulted in prolongation of the repolarization time of the heart leading to QTc prolongation and induction of arrhythmias in various studies [4,8,11]. Isoflurane has also been reported to increase the antegrade accessory pathway effective refractory period in children with WPW ; however, effects on the AV nodal conduction time were not reported [8,11].\nBased on the results from this study, SVT occurrence during anesthesia induction is rare (1/376). The use of IH anesthetic agents increased the occurrence of STACH during anesthesia induction, and therefore, these agents should be used with caution in patients where tachycardia can affect the hemodynamic stability or ability to perform the EP study. The reasons may be secondary to a decrease in peripheral vascular resistance, dehydration, or direct effect of the inhalational agent on the cardiac conduction tissue. Further molecular and basic science studies are needed to better define the direct effects of inhalational agents on sino-atrial nodal tissue.\nSinus tachycardia (STACH) is seen in 10% of pediatric patients undergoing EP study during anesthesia induction. SVT occurrence during anesthesia induction is rare, occurring in less than 1% of all cases. Inhalational anesthesia use has more risk of developing sinus tachycardia during induction compared to Intravenous agents. Those patients with WPW have double the risk of developing sinus tachycardia when compared to non-WPW patients. Male patients undergoing EP studies under general anesthesia have a significantly higher risk of developing STACH.\nMake the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
The incorporation of laser into dentistry has brought many benefits to the table. It has gotten rid of several traditional practices that were time-consuming, painful, and involved a long healing period. The technology uses a strong and intense light beam to achieve the desired cosmetic and restorative results.\nYuma, AZ dentists, Drs. Thor G. Thorson, Stephen S. Garner, and Jason R. Boeskin make use of this advanced technology to make dental procedures more comfortable and less painful for their patients. A combination of state-of-the-art dental equipment and well-trained professionals makes Gild Ridge Dental one of the best dental practices in Yuma, Arizona.\nWhy should you choose laser dentistry?\n- Since the laser cuts and seals the wound almost immediately, the healing period is reduced drastically.\n- Tissue regeneration occurs much effectively as compared to traditional oral surgeries.\n- It helps to preserve the natural tissues of the mouth.\n- The need for an anesthetic would be reduced.\n- There would be no need for stitches or sutures.\n- The chances of contracting a bacterial infection are next to none.\nWhat are the applications of laser in dentistry?\nRemoval of soft tissues: When the gums need a surgery, such as during the removal of puffy gums, a laser can be used. Dental lasers can dissolve the soft tissues to give the gums a complete makeover.\nCrown lengthening: Sometimes, the excessive growth of the gums makes the teeth look much smaller than they really are. Dental lasers can reshape the gums to make the teeth look longer.\nDisinfecting a cavity: Removing the decay and disinfecting a cavity used to be a complicated process. Lasers can effectively kill the bacteria near the site of the cavity prior to carrying out a filling process.\nDrilling the tooth: With the use of lasers, the need for drills and anesthesia are completely eliminated. They are widely used for tooth preparation.\nTumor removal: Dental lasers can be used to remove benign tumors and reduce the risk of oral infections.\nTeeth Whitening: Laser teeth whitening is a process of removing the stains from the surface of the teeth using a whitening gel and a laser to activate it.\nCall us at (928) 317-1900 or schedule an online appointment to get the best dental services in the Yuma, AZ region.
Uniportal VATS for Iatrogenic Tracheal Injury\nmediaposted on 13.01.2021, 21:39 authored by Cemal Kutlu\nThe authors present a case of uniportal VATS for repair of an iatrogenic tracheal injury. The patient was a 90-year-old woman who developed progressive subcutaneous emphysema after laparoscopic cholecystectomy. A double-lumen tube was immediately inserted to control subcutaneous emphysema. Then she was transferred to the authors’ unit for further evaluation and treatment. A bronchoscopy was performed under general anesthesia and a tracheal injury was detected in the distal part of the trachea extending to the right main bronchus. A decision was made to perform a surgical repair, and she was re-intubated with a left double lumen tube and taken to the operation room. Uniportal VATS was performed through a 4 cm incision in the 5th intercostal space in the mid-axillary line. The azygos vein was divided using an endo-stapler to reveal the tracheobronchial angle. A tracheal injury 5 cm long was identified on the right side of the distal trachea extending to the right main bronchus. Stay sutures were placed on both edges to expose meticulously the proximal and distal end of the injury. The tracheal injury was repaired with 4-0 polypropylene suture using a continuous suture technique. The suture line was covered with paratracheal fatty tissue and the operation was completed after inserting a chest tube.\nOn the postoperative bronchoscopy, the trachea with visible suture lines was intact and healthy. She was extubated immediately after surgery and discharged home on the fourth postoperative day. After that, on routine follow-up, the patient was examined periodically. She did not have any complaints in this period and no evidence for stricture was observed. Three months after the surgery, the trachea was considered intact and healthy again, indicating that no complications have occurred.
One of the reasons Dr. Teitelbaum has created this separate photo gallery is that women wish to see photos of others whose condition is similar to theirs. And the photos on the internet are overwhelmingly of Caucasian patients.\nThe first step in learning more about enhancing your bust with plastic surgery is to read through the comprehensive information Dr. Teitelbaum has prepared on this website. His descriptions are very educational, insightful, and display his creative and state-of-the-art thinking about breast augmentation. It will become clear to you that he is one of the world's leaders on this procedure. The next would be to arrange to have a personal consultation with him either in person, or on the phone if you live outside of the Los Angeles area. Once you see the facilities and design of his Santa Monica office you will know that he offers something special.\nHis priority will be to listen carefully to you and come to a thorough understanding of exactly what you want. He will then take an extensive medical history, perform a comprehensive examination and take multiple critical measurements. Equally as important is that he will analyze the aesthetics of your torso with his discerning eye. The importance of the measurements cannot be overstated: there is an ideal implant size to fill up a breast and create the most beautiful shape. If the breast implant is too small, the breast will be underfilled or disproportionately filled. If it is too large, the breast will look stuffed and round. He has written and lectured on this topic all over the world, and patients who had consulted with other plastic surgeons before Dr. Teitelbaum comment about the enhanced level of thoroughness.\nHe has used virtually every type of implant available in the United States, worked on the development and testing of several, and so his knowledge of implants is on the highest and most current level. He will describe to you how the various implant types and incisions will affect your result. Whether the implant should be placed in front of the muscle or behind the muscle will also be discussed. He will give you all of your viable options and help you to understand which is best for you.\nBreast implants can be filled with either saline or silicone. Today saline implants are used less often than silicone, which are thought by most to be softer, feel more natural, look less round, weigh less, and perhaps last longer. And while in the past we spoke as if there were just two types of silicone implants - regular round silicone implants and gummy bear teardrop implants - there is now a wide array of "gumminess" in both round and teardrop implants. Round silicone breast implants vary from the very softest and squishiest to the firmest and most ripple resistant. Teardrop implants are now available in less cohesive and softer versions, in addition to the traditional teardrop implants, which though firmer, hold their shape better. Dr. Teitelbaum is an expert in implant technology and has hundreds of different implants on display in his office for you to see and feel.\nDr. Teitelbaum is adept at the armpit, areola, and under the breast incisions. But with the emergence of overwhelming data in the past ten years of the superiority of the under the breast incision, Dr. Teitelbaum will advise most every patient that it is best. You will see that every aspect of his treatment of you will be based on the most up-to-date scientific information available. What he does is always in a state of evolution, improving as new information and technology becomes available.\nThe decision whether to go in front or behind the pectoralis muscle is also important to your outcome. He has written and lectured extensively about this topic and will explain to you the very specific maneuvers he does to customize the operation for the needs of each patient.\nA library of before and after photographs of African-American patients is available in the photo gallery on this website, and more will be available to you when you visit his office.\nBeing sure that your breast augmentation surgery will make you big enough – but not too big – is probably one of your greatest concerns, and Dr. Teitelbaum will employ every available method to help you envision your outcome and make a decision about the breast implant size and shape that you want. There will be no surprises when you wake up! This is your body, and it should look as close as possible to the way you want it to be. Dr. Teitelbaum has worked in developing 3D breast augmentation simulation software with multiple companies, since long before they became widely available. He will show you a simulation of your results with the latest technology available, which is now the Vectra system. You will also be given implants to try on under an unpadded bra he provides so you can see how various sizes will look on you. He also holds a patent on an acclaimed device that can use the critical measurements he takes to select an implant that will create the shape you want. By using these various methods, you will be able to understand the various options, implant size, type, fill, and dimensions and the results they will give you.\nWhere does surgery take place?\nDr. Teitelbaum has hospital privileges at Providence St. John's Hospital in Santa Monica and UCLA Medical Center in Los Angeles. But there is no better place to do a breast augmentation than at the Aesthetic Surgical Center of Santa Monica, the private operating room Dr. Teitelbaum built to care for his exclusive clientele. Here Dr. Teitelbaum can be sure that each patient receives absolutely uncompromising quality of care. There are no nurse anesthetists, but only the best MD anesthesiologists who can do the safest and most comfortable anesthesia. There are no techs or LVN's or recent nursing graduates; only highly experienced plastic surgery operating room nurses. In fact, he has a single team of nurses he has worked with for many years, each of whom is outstanding as an individual, and as a team know exactly what to do together. The instruments are kept new and perfectly maintained. Modern special air filtering and other technologies not routinely seen in private surgical centers are seen throughout the facility. There is an unwavering commitment to simply do the best that is possible.\nWhat should I expect the day of my breast augmentation surgery?\nYou will be asked to come to the office about one hour before your surgery. You will then meet with your nurses, your anesthesiologist, and Dr. Teitelbaum. The plan will be reviewed and photos taken. You will go to the operating room and will be put painlessly to sleep. You will not feel or remember any of the surgery. Breast augmentation surgery with Dr. Teitelbaum usually takes less than thirty minutes. This is possible because of the high level of preoperative planning, experienced nursing and anesthesia staff, and Dr. Teitelbaum's outstanding surgical dexterity. After surgery you will be in the recovery room for about 45 minutes, and then you will be ready to go home.\nThe Easiest Recovery Anywhere?\nMany surgeons are now discussing "rapid recovery" breast augmentations, but how consistently can they deliver it? Dr. Teitelbaum is a disciple of Dr. John Tebbetts, the man who described in 2001 how to do a "24-hour return-to-normal-activities" breast augmentation. Since then Dr. Teitelbaum has been using these techniques and has gone on to teach them to other surgeons around the world and write about them in plastic surgery textbooks. He has performed breast augmentation at major plastic surgery meetings over closed circuit television. In front of the scrutinizing eyes of these plastic surgeons, Dr. Teitelbaum's patients returned to normal activities the next day with a minimal amount of pain. Patients generally drive in about two days, go to work in four, and go to the gym again at three weeks without restriction. You will not have any drains, tubes, pain pumps, special bras, or bandages. With a precise and gentle procedure none of these are necessary.\nYou will be given Dr. Teitelbaum's private email, cell phone, and home phone numbers. He will encourage you to call him 24/7 whenever you have a question after surgery.\nAccessibility: If you are vision-impaired or have some other impairment covered by the Americans with Disabilities Act or a similar law, and you wish to discuss potential accommodations related to using this website, please contact our Accessibility Manager at 310.315.1121.\n© Steven Teitelbaum MD, A Medical Corporation. All Rights Reserved. Designed & Developed by Studio III in collaboration with air conditioned la

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