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Having unnecessary fat in different locations of your body can have a considerable effect on your health and self-confidence. While standard weight-loss through exercise and diet plan is an excellent way to drop weight in general, even the very best exercises cannot target issue areas like the stomach, inner thighs, arms, and butts. Liposuction is a time checked treatment that is used to remove excess fat from specific areas of the body, permitting a specific to shape and contour their body to their preference. Is liposuction right for you? Learn now.\nPros of Liposuction\nThere are numerous benefits to this cosmetic procedure, including:\n• Immediately noticeable changes. Unlike standard weight loss, liposuction develops modifications that are immediately noticeable in the body. Some distinction is obvious right away, and the desired results are typically accomplished in simply a couple of days.\n• Proven and safe. This cosmetic procedure has actually been performed by knowledgeable surgeons all over the world for many years and the strategy has been fine-tuned over and once again to be safe and reliable.\n• Recovery time is generally fast. The downtime needed after having this kind of treatment is usually much less than what is needed for other kinds of cosmetic procedures, consisting of abdominoplasty, breast reduction, and more. Individuals who have had the treatment can often return to work much more quickly than they anticipated and can get back to living a healthy, active lifestyle.\n• Weight loss can be irreversible. With the ideal maintenance techniques, the fat that was gotten rid of throughout the liposuction procedure will not return.\n• Complete control over your body. With liposuction, a person can have complete control over how they wish to look, beyond what standard diet and exercise can offer. Giving people this power over their bodies enhances self-confidence and help individuals feel their best.\nWhile there many advantages to liposuction, there are naturally a couple of cautions that should be thought about prior to making the final decision to progress with the treatment.\nCons of Liposuction\nPrior to having actually liposuction done, it is necessary to analyze the prospective disadvantages of the procedure and determine if the benefits outweigh the dangers in your certain case. Your cosmetic surgeon can help you find out more about the threats related to the treatment and can help you decide if moving on is the right thing for you.\n• Complications with basic anesthesia. Due to the fact that liposuction is carried out under basic anesthesia, the procedure brings the same risks as any other type of surgical treatment where basic anesthesia is utilized. Underlying medical conditions might increase these risks.\n• Unfavorable responses. Bruising, bleeding, and pain are all to be expected, nevertheless, in uncommon cases can trigger more significant issues.\n• The possible to gain the weight back. After having actually liposuction done, it is important to maintain a healthy diet plan and exercise appropriately as advised by your doctor. Failure to do so might cause gaining back the weight that was lost or potentially much more.\nAlthough there are dangers related to liposuction, for many people, the benefits far outweigh them. Educate yourself about the treatment by having thorough conversations with your specialist and think about how liposuction has the prospective to impact you as a special person. Just you and your specialist can determine if liposuction will provide 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 North Benton OH\nLaser liposuction is a newer, minimally invasive procedure that involves heating the fat cells to melting point and removing the melted fat through a little cannula. The procedure is generally done right in your physician's workplace and is an excellent option for individuals who have less than 500 ml of fat to get rid of from any one area. Laser liposuction can be a safe, complementary treatment to weight loss in order to shape the body you have actually constantly desired.\nContact a Surgeon in your North Benton OH today.\nIf you're thinking about liposuction as a weight loss option, it is necessary that you discuss your desires with a certified plastic surgeon in your location. Your specialist will carry out a complete test and health history survey to determine if liposuction can benefit you and help you reach your physical and psychological goals. Call today for an assessment and learn more about how liposuction can assist you achieve the body of your dreams. |
CRNA Jobs in Erin, Tennessee\nLooking for travel placement jobs as a professional CRNA in Erin, Tennessee? If so, trustaff can connect you with jobs that are a great fit. We are looking for experienced, caring CRNA to fill jobs throughout the country. Whatever your location need, you can keep working as a health professional in the city and state of your choice.\n**We are having difficulty finding exact matches for your search right now. Click here for a more advanced search or fill out the form on the right to trigger a deeper search of available positions.\nTravel Nurse and Allied Health Jobs in Erin, TennesseeFind a travel CRNA job in beautiful Tennessee. Nicknamed The Volunteer State, Tennessee is known for country music, Elvis Presley, sports teams, and Vanderbilt University. Home to world-class hospitals such as Vanderbilt University Medical Center in Nashville, University of Tennessee Medical Center in Knoxville and Methodist Hospitals of Memphis in Memphis, Tennessee ensures you'll be working among some of the best healthcare professionals in the country. And beautiful forests, Lookout Mountain, Gatlinburg, Tennessee river gorge and so much more provide natural beauty to make your work feel like a vacation in itself.\nAs a Certified Registered Nurse Anesthetist (CRNA), you will be responsible for administering anesthesia to patients under the direction of a surgeon. The Nurse Anesthetist will review patient medical history and condition in order to determine proper methods of anesthesia and how the patient should respond to anesthetics. The CRNA will attend to patient needs before, during, and after surgery.\nFind my CRNA Travel Assignment Today!\nThe Best Benefits, Incredible Pay for CRNA Jobs - the 'trustaff' wayFor over fifteen years, trustaff has helped talented professionals like you take their careers to the next level. Nicknamed The Volunteer State, Tennessee is known for country music, Elvis Presley, sports teams, and Vanderbilt University. When you travel with trustaff, you'll enjoy the best of both worlds: not only are our travel nurses some of the highest-paid in the industry, trustaff travelers enjoy great employee benefits, access to hundreds of jobs, and unmatched personal service. From handling your paperwork to delivering your paycheck, our promise is people who care.\nWhat People are Saying\nView Related Pages |
Anesthesiologists – the doctors who keep patients alive during surgery, who essentially take over our breathing – make up just three per cent of all doctors, but account for 20 to 30 per cent of drug-addicted MDs. Experts say anesthesiologists are overrepresented in addiction treatment programs by a ratio of three to one, compared with any other physician group, an occupational hazard that could pose catastrophic risks to their patients.\nTheir drugs of choice are most frequently fentanyl and sufentanil, opioids that are 100 and 1,000 times more potent than morphine. They “divert” a portion of the doses meant for their patients to themselves, slipping syringes into their pockets.\nAnd later, alone in the bathroom or the call room, when the drug hits their own bloodstream, the relief, the sense that all is well in the world, the mild euphoria, is immediate.\nSee full story via Drug-addicted anesthesiologists pose danger.\nCanadian Plan to Reduce Costs of Alcohol Abuse\nCanada’s Center for Addiction and Mental Health has released a six-point plan to reduce the fiscal impact of alcohol abuse, which the report says costs every Canadian $463 annually, the CBC News reported June 11.\nThe Avoidable Cost of Alcohol Abuse in Canada 2002 report said that six public policy steps could save 800 lives and $1 billion annually.\n- increasing taxes on alcohol (the study proposed a 25-percent increase);\n- lowering the blood-alcohol concentration standard from .08 percent to .05 percent;\n- implementing a zero-tolerance policy on BAC levels for drivers under the age of 21;\n- increasing the minimum legal drinking age from 19 to 21;\n- increasing enforcement aimed at public intoxication and underage drinking; and\n- boosting counseling with at-risk drinkers in doctors’ offices.\nProjected cost savings include $561 million in lower productivity losses, $230 million in reduced healthcare costs, and $187 million in crime-related costs.\n“It’s clear that the largest impact would come from interventions affecting the level of drinking in general such as brief interventions and increasing alcohol taxation,” said CAMH senior scientist Dr. Jürgen Rehm. “However, the greatest overall cost avoidance would be achieved when multiple rather than single … alcohol interventions are implemented as part of a comprehensive alcohol policy.”\nTax hike on booze is the right way forward, say doctors from the British Medical Association\nThe BMA is pleased that one of the recommendations in its recent report on alcohol misuse, to increase taxation on alcohol, has been adopted by the Chancellor of Exchequer, Alistair Darling, in today’s (Wednesday 12 March 2008) budget.\nDr Vivienne Nathanson, the BMA’s Head of Science and Ethics, said: “It is very important that tax increases on alcohol are part of a larger plan to reduce problem drinking.” She added:\n“The evidence tells us that the cheaper and more accessible alcohol is the more people will drink. The government needs to tackle this issue so it’s good news that ministers have made a start today. These tax increases may be unpopular with some members of the public but we hope that they will look at the wider issue and recognise that the UK has a real problem on its hands regarding alcohol misuse. Tough action is needed. The UK is one of the heaviest alcohol consuming countries in Europe.\n“Drinking in moderation is enjoyable and may be good for you. Drinking way over the recommended guidelines costs many people their health and ultimately their lives. The UK spends millions of pounds every year on treating people with alcohol problems and dealing with the crime and violence often associated with alcohol misuse.”\nBritish Medical Association |
Blocking the transmission of painful signals via nerve fibers is one of the most effective ways of managing pain. Local anesthetics are inexpensive to use and quite effective in blocking the transmission of nociceptive signals (nerve impulses) at the source. Disrupting neural transmission of pain information results in diminished signaling to the spinal cord with a likely reduction in further neuropathic pain. Local anesthetics inhibit generation and transmission of nerve impulses by blocking sodium channels in the neuron's cell membrane. This slows the rate of depolarization of the neuron cell membrane and prevents the threshold potential from being reached.\nUse of local anesthetics offers a number of benefits. First, local anesthetics produce true analgesia resulting in the complete absence of pain for the duration of the block. Second, these drugs are non-scheduled agents, so there's no cumbersome paperwork or special license required. Thirdly, long-term pain states may be diminished or eliminated. Finally, the techniques used to administer these drugs are relatively easy to perform.\nWhen administered at an appropriate dose, local anesthetics have relatively few, if any, adverse side effects. The potential systemic side effects of local anesthetics involve the central nervous system and cardiovascular system. Other potential side effects include development of methemoglobinemia, nerve and skeletal muscle toxicities, and allergic reactions, including hypersensitivity or anaphylactic responses.\nUse of local anesthetics has become more common in small animal practice in recent years. Local anesthetics can be used very effectively in a number of procedures, including thoracotomy, elbow surgery, maxillomandibular procedures, local incisions, feline declawing, regional blockades, rear limb procedures, and stifle surgery. In addition to direct regional blockades, using lidocaine as a systemic blocking agent by constant-rate infusion is becoming increasingly popular.\nThere are several blocking agents available. Choice of blocking agent is typically made based on onset of action, duration of action, and route of administration:\nLidocaine, the most widely used local anesthetic, takes effect in 3 to 5 minutes and is effective for 60–90 minutes. Lidocaine can be used topically, regionally or as an IV infusion in dogs.\nMepivacaine (Carbocaine) has a medium duration of action of 2–3 hours and fairly rapid onset of about 10 minutes.\nBupivacaine (Marcaine) takes longer to take effect (15 to 20 minutes), but its anesthetic and analgesic effects last 6 or more hours. Bupivacaine is not effective as a topical analgesic, but it is an excellent choice for local infiltration.\nAll local anesthetics cause vasodilation that decreases their duration of action. The duration of blocking agents can be extended by combination with a 1:200,000 dilution of epinephrine. Epi "washing" the syringe prior to drawing up local anesthesia provides sufficient vasoconstriction to extend the block and reduce bleeding in the area. Epinephrine should never be used in circumferential limb block such as feline declaw. Local anesthetics are safe if correctly administered. Most cases of toxicity in small animals occur as a result of accidental overdose or inadvertent intravenous administration. Signs of toxicity include seizures, coma, neurotoxicity, and cardiovascular collapse.\nApplication of topical analgesia to the surface skin or mucosa can reduce pain associated with minor procedures such as wound suturing, venipuncture, arterial puncture, nasal cannulization and urinary catheterization. Solutions of lidocaine or tetracaine with or without epinephrine can be used alone or in various combinations to provide desensitization at the application site. Gauze pads soaked with solutions can be applied directly to the site. Alternately, there are several commercially prepared topical anesthetic creams and jellies that can be applied as a thick paste; however, 20 to 30 minutes of direct contact time is required to insure effective analgesia.\nInjection of lidocaine or bupivacaine into local tissue can reduce pain associated with various painful procedures. This technique is useful for small mass removal, digit amputation, arterial catheter placement, thoracocentesis, abdominocentesis, bone marrow sampling, etc. The entry area is infiltrated with small amounts of anesthetic prior to tissue penetration. An appropriate waiting time must be observed to ensure adequate desensitization of the area as described above.\nDental (Oral) Nerve Block\nThe entire muzzle can be anesthetized by blocking the infraorbital and mandibular foramen. Mandibular and maxillary nerve blocks provide excellent analgesia for pain anywhere in the muzzle. Tooth extraction is the obvious indication for these blocks, but they are also quite effective for gingival surgery, mandibulectomy, maxillectomy, jaw fracture repairs, nasal surgery or biopsy. Small amounts of bupivacaine (not to exceed 1 cc of 0.5% bupivacaine per 10 lbs of body weight) are injected near or into the infraorbital and mandibular foramina, anesthetizing the main nerve branches. This technique is relatively easy to perform by a skilled veterinary nurse and has minimal associated risks.\nThe addition of epinephrine to dental blocks causes local vasoconstriction. The benefits are twofold. First, the anesthetic is held in place longer, increasing its duration of action; second, local bleeding is controlled. Epinephrine can be added to the syringe by simply "washing" with epi prior to drawing up local anesthetic.\nIntraarticular (Joint Space)\nEffective analgesia in pre- and postoperative orthopedic cases has been achieved by injection of local anesthetics directly into the joint space, such as in cruciate ligament repair. Intraarticular morphine has also been shown to effectively reduce joint pain. The effectiveness of this technique when used preoperatively is evident in the smooth plane of anesthesia maintained when the joint capsule is incised. This is in sharp contrast to the spike in heart rate and "lightness" that is observed when the capsule is entered without anesthetic. No doubt these responses are due to pain.\nInterpleural bupivacaine infusion following thoracotomy surgery may have some analgesic benefit. Bupivacaine (1.5–2 mg/kg) is injected via an indwelling chest tube into the pleural space. Analgesia is thought to occur by direct blocking of the intercostal nerves. For maximum coverage, patients are held in sternal recumbency for 5–10 minutes postinjection and gently rolled from side to side. Drug absorption through the pleural tissue should be considered. The addition of 0.1 cc/10 cc of Na bicarbonate may reduce the stinging sensation in awake patients.\nEpidural Nerve Blocks\nInjection of local anesthetics and/or opioids directly into the epidural space is a fairly simple and safe technique to provide long-duration analgesia to the caudal half of the body while minimizing systemic side effects. Epidural analgesia can be very effective for managing pain associated with procedures such as cesarean sections, thoracotomies, pelvic or pelvic limb fractures, amputations, orthopedic procedures, and surgery of the tail or perineum. Successful epidurals may reduce gas inhalant as well as post-op pain medication requirements. Local anesthetic epidurals provide excellent muscle relaxation and short-term analgesia. They are inexpensive and do not require the use of scheduled drugs. The disadvantages include the potential for overdose, hypotension, excessive muscle relaxation, temporary loss of motor function, and injection site discomfort. Injection is generally made at the lumbosacral junction just caudal to the termination of the spinal cord. Epidural catheters can be inserted to allow long-term analgesic administration.\nMost recently, the lidocaine transdermal patch (Lidoderm®) has gained widespread acceptance in human medicine for management of neuropathic pain associated with back injury or surgery. Work is underway to investigate the use of transdermal lidocaine patches in veterinary medicine for specific conditions and procedures.\nIV administration of lidocaine by constant-rate infusion (CRI) is an effective technique for managing a variety of pain states. At the cardiac dose of 30–80 micrograms per kg per minute, lidocaine provides excellent analgesia for visceral pain (e.g., pancreatitis, parvovirus) as well as in procedures with extensive nerve involvement, such as limb amputation. Because it is safe for use in patients with GI disturbances, lidocaine is a good choice for analgesia in patients with gastric dilatation volvulus (GDV) or other similar disorders. Lidocaine seems to have benefit in patients undergoing procedures with excessive nerve trauma such as complicated back surgeries or limb amputations. IV lidocaine is extremely short acting and can be discontinued without residual effect almost immediately. Lidocaine CRI should be discontinued if the patient shows signs of toxicity including muscle tremors, seizures, nausea or vomiting.\nThe CRI dose for lidocaine is: Dog: 1–2 mg/kg IV followed by 30–50 µg/kg/min.\nNote: There are reported lidocaine CRI dosages for cats, but typically lidocaine is not recommended for use in cats due to potential for severe cardiotoxic effects.\nReferences are available upon request. |
Canine, Feline, Porcine, Poultry, Exotic/Avian, Other\nDVM or equivalent\nAll Pets Veterinary Center is located in Louisville, KY. We are a 2-doctor full service veterinary hospital providing care for dogs (50%), cats (18%) and exotic companion animals (32%) as well as occasional wildlife. The facility was custom designed and newly built in 2010. The clinic space occupies 5,000 square feet. Our services include routine preventive care with annual wellness profiles and extended vaccination schedules, routine spay and neuter, advanced soft tissue surgery, limited orthopedic surgery, digital radiography, routine and advanced dental care and surgery, digital dental radiography, in-house lab and pharmaceutical compounding, CO2 laser, isoflurane and sevoflurane gas anesthesia, full anesthetic monitoring equipment, and IV pumps. We stock prescription diets and specialty items for our exotic patients. Our techs are highly trained with an emphasis on client communication, education and reduced stress handling techniques. The majority of our clients are from the middle to upper economic classes, and their pets are treated like members of the family. We share building space with a separate business that provides boarding, day care, grooming and training.\nWe are looking for a third doctor to join our team in a full-time capacity. A strong interest and willingness to learn exotic companion animal medicine is essential. One to two years of experience working with exotics is ideal. We are one of only a very few clinics in the area that treat exotics, and the local emergency centers do not see exotics, so we must provide after hours emergency care for our own exotic patients. We refer our cat and dog clients to the local ER for after hours needs or intensive hospitalization. A candidate with skill in ultrasound diagnostic ability will have significant appeal. Interested candidates should reply to this ad by email.\nAll aspects of veterinary medicine related to small animal and exotic companion animal care including internal medicine and surgery.\nAdditional Salary Information: commensurate with experience. All licensing and professional fees included. CE allowance.\nAll Pets Vet Center is a progressive, two-doctor full-service veterinary hospital in Louisville, KY providing veterinary care for cats, dogs and exotics pets, and some wildlife. Our facility is a 15,000 sf free standing building, newly constructed in 2010, which we share with a boarding, training, grooming and day care center. We are open 6 days a week: week days 9am- 7pm and Sat 9am-1pm. We pro...vide after hours care for our exotic patients only, dogs and cats are referred to local ER centers. Currently there are 4 technicians and 2 receptionists to support 2 doctors, but the support staff will be increased to accommodate a third clinician. We provide routine preventive care with extended vaccine protocols, routine and advanced dental care and surgery, elective and advanced soft tissue surgery and limited orthopedic surgery. We employ digital radiography, digital dental radiography, ultrasound, isoflurane and sevoflurane anesthesia, full monitoring equipment, iv fluid pumps, Bair hugger heating systems, in-house blood analyzers and pharmacy compounding. |
Whenever skin sags at the inner thigh or inner arm, the problem can be corrected by restoring skin tautness.\nThis can be achieve with thigh and arm lift. The procedure is designed to remove excess skin and underlying fat.\nWe encourage you to make an appointment. Dr Chagnon will explain the procedure in detail and answer all your questions.\nThe problems of fatty infiltration and sagging skin are corrected, thereby clearly enhancing the shape of the thighs and arms.\nHowever, please note that this figure-altering procedure leaves scars that you must learn to accept.\nThis type of operation must be performed using general anesthesia. The procedure lasts from one to two hours.\nFor thigh lift, an incision is made in the creases of the groin or buttocks, depending on the targeted areas. In certain cases, scars can run down as far as the knee. In some cases, liposuction may also be needed to achieve a slimmer figure.\nFor arm lift, an incision is made at the inner arm, from the elbow to the underarm, thereby allowing the removal of excess skin and fat.\nDuring the healing period, you must avoid all sudden movement or stretching. Office work can be resumed after two weeks. More physical work can be resumed only after four weeks of convalescence. |
Intraoperative Esmolol Administration in Managing Postoperative Pain\nAuthorReina, Alysia Deborah\nMetadataShow full item record\nPublisherThe University of Arizona.\nRightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.\nAbstractBackground: Managing perioperative pain is an essential goal for all anesthesia providers. The utilization of multimodal methods for analgesia is common. Administration of opioids has traditionally been the primary method to control pain. However, opioids have additional side effects such as nausea, vomiting, respiratory depression and potential for long term misuse, all of which can lead to adverse patient outcomes. Research studies suggest perioperative administration of esmolol, a beta-blocker normally used to control heart rate and blood pressure, can decrease opioid requirements. The purpose of this quality improvement study was to assess anesthesia provider’s knowledge of using esmolol for the purpose as an alternative or adjunct to perioperative opioid administration. Methods: A non-experimental descriptive quantitative methodology was employed to evaluate knowledge of esmolol as a perioperative pain management method. A convenience sample of four anesthesia providers working in the main operating suite at a 530-bed acute care facility in a southern Texas town participated in this DNP project. Collection and analysis of data was accomplished through use of a pre and post educational intervention survey. A pre and post survey was used to identify provider knowledge and influence on practice after an education intervention. The pre and post surveys contained the same nine questions, two of which were open ended, to assess achieved learning and/or changes in practice. Results: A total of four anesthesia providers completed the pre survey, educational PowerPoint and post survey. Upon completion of both surveys, the data gathered was entered into SPSS for analysis using a Wilcoxan Signed Rank Test for comparison. No significant changes indicating enhanced knowledge of esmolol use for perioperative pain management was noted post educational PowerPoint. Commonalities regarding patient characteristics and barriers to esmolol use, such as cost and access were reported in the open-ended question. Conclusion: Results suggest anesthesia providers are knowledgeable about use of esmolol as a perioperative pain management method. Barriers surrounding the use of esmolol, such as cost, ease of access and assessment of pain, exist, limiting its use in pain management. Future educational opportunities to increase provider participation and response may provide additional insight to selection and incorporation of different pain management modalities.\nDegree ProgramGraduate College |
Who’s the Best Back Specialist Clifton NJ? | A Harvard Doctor Answers\nWhere Can I Find The Best Back Specialist Clifton? | The Pain Treatment Specialists\nBack pain is a common issue affecting up to one half of all working Americans. Booking an appointment with a back specialist Clifton will enable you to get to the root cause of your back pain symptoms. It could be that you struggle with back pain as a result of an injury, or due to sitting for long periods of time. Underlying health conditions like osteoarthritis can also cause back issues.\nNowadays, orthopedic and spine surgeons can be too quick to suggest back surgery and narcotics to diagnose and treat back issues. However, relying on opinions from back surgeons is not always the best treatment route. This is because back surgery can be incredibly risky. The number one disadvantage of back surgery is the potential of permanent or semi-permanent nerve damage. On top of this risk, there can be issues with anesthesia, blood clots, wound infections and long recovery periods.\nThis top-rated Harvard spine center is passionate about creating custom care plans using minimally invasive spine treatment options. These top-rated treatments combine the latest advancements in pain management with a holistic approach to healthcare. This state of the art spine clinic New Jersey houses a team of world-renowned spine doctors who have achieved board certification and are leaders in pain medicine. Best of all, you won’t have to worry about risky surgeries or the use of narcotics. The healthiest and most successful spine care involves a recommendation for a minimally invasive procedure in conjunction with physical therapy\nIf you’re experiencing back problems and want to explore the latest conservative treatments in Clifton NJ, consider booking an appointment with a Harvard doctor on (973) 965-8727.\nWhat Are The Best Back Treatments?\nNow that we’ve looked at why it’s important to visit this top-rated spine center in Clifton New Jersey, let’s explore the best conservative back treatments available. It doesn’t matter what previous back treatments you’ve had or why you may have back pain. This state of the art Harvard clinic will help you get back to full health in the safest and healthiest way possible.\nLumbar Epidural Steroid Injection (ESI)\nAn epidural steroid injection is a popular and highly effective treatment option. It is a fast, safe and simple procedure that provides instant pain relief.\nDuring this procedure, a pain doctor injects a local anesthetic and corticosteroid medicine directly into the lumbar region. The corticosteroid medicine will reduce inflammation and pain. The local anesthetic is highly effective in numbing the irritated nerves. Your nerves may be aggravated due to conditions like spinal stenosis or a herniated disc.\nESI is a popular and safe treatment option enjoyed by many individuals struggling with back pain. Some individuals receive 2-3 steroid injections for full effect.\nLumbar Facet Injection\nLumbar facet joint injections are a great way to receive both a diagnosis and back pain treatment. They are particularly recommended for those who are suffering from osteoarthritis or mechanical low back pain.\nA top back specialist clifton nj will use facet joint injections to diagnose potential back issues. They can also use this as a way to treat back pain without surgery. During this procedure, a pain doctor injects local anesthetic near the nerves in one of more of the facet joints located in the back. Facet joints are small joints which are located on either side of the vertebra of the spine.\nFacet joints are an excellent method of spine care because they numb aggravated nerves and help individuals to avoid risky back surgeries.\nLumbar Radiofrequency Ablation\nLumbar rfa is one of the most popular ways to treat long-term back pain without surgery or steroid medicine. It is an exciting area of pain technology that relies on thermal energy to deactivate nerves.\nDuring lumbar rfa, a back specialist clifton will place an electrode near your area of pain. They will then send radiofrequency energy from a small generator to the electrode on your skin. The radiofrequency energy will heat-up the nerves that are causing you pain. This means the nerves are deactivated and are unable to send pain signals from the lumbar to the brain.\nLumbar rfa is a safe and highly effective means to treat low back pain. It is an excellent treatment option provided by the top back specialist in Clifton New Jersey.\nPhysical therapy is highly recommended when used in conjunction with your treatment plan. A top-rated Harvard back specialist Clifton New Jersey advocates receiving physical therapy to increase the mobility, flexibility and strength of the back muscles. A physical therapist will provide you with gentle exercises for you to complete at home. They can also provide advice regarding the best way forward with your recovery.\nWhy Is My Back Sore?\nThere are many reasons you might have a sore back. That’s why it’s highly recommended to book an appointment with a top-rated Harvard back doctor at The Pain Treatment Specialists Clifton New Jersey.\nIt’s vital you understand what is causing your back pain so that you know the best way to treat it. Visiting a board certified Harvard doctor will enable you to receive a diagnosis and subsequent treatment plan that is unique to your needs.\nLet’s look at some of the most common causes of back pain:\n- Herniated disc – disc herniation describes when the soft tissue that is between each bone in your spine is pushed out. This aggravates surrounding nerves and tissues. It can be an incredibly painful condition but is easily treatable without risky surgeries or narcotics.\n- Spinal stenosis – this is a condition that describes when the spaces in the spine begin to narrow. The narrowing of the spaces in the spine can cause excessive pressure to be put onto spinal nerves. This creates pain, weakness and tingling in the arms and/ or legs.\n- Strain – strains are common and can be caused by twisting or repeatedly lifting heavy objects. It can lead to strained muscles as well as spasms.\n- Osteoarthritis – this is a mechanical form of arthritis, meaning that it is caused by wear and tear over time. The more a joint is moved and used across a lifetime, the more the moist and lubricated cartilage breaks down This means the joints are no longer covered in a soft and slippery surface. As a result, the joints can develop friction due to a lack of lubrication on the cartilage surface. This can also contribute to the formation of bony spurs on the joint. Swelling, inflammation and joint pain are common symptoms of osteoarthritis.\nThese are just a few of the many different causes of back pain. That’s why it’s vital you receive medical attention from a board certified Harvard pain doctor in Clifton NJ. At this state of the art spine clinic, you’ll receive world-class patient care provided by Harvard back specialists clifton. Best of all, you won’t have to worry about risky surgeries or narcotics!\nIf you want to explore safe, healthy and highly effective back treatments, consider booking an appointment at The Pain Treatment Specialists Clifton. This state of the art pain clinic Clifton NJ is located on Route 46 E. It has plenty of parking and is just past the Ford dealership.\nHarvard Medical School\nDirector of Pain Management\nDr. George Hanna is a nationally recognized pain management specialist and Double Board Certified in anesthesiology and pain management medicine. Dr. Hanna is currently available at Pain Treatment Specialists in Manhattan and Clifton, NJ. He is now accepting most major medical insurances, including Medicare.\nHarvard Medical School\nNY & NJ PAIN SPECIALIST\nDr. Volney is double board certified in Anesthesiology and Pain Medicine by the American Board of Anesthesiology. He is currently seeing patients at our Pain Treatment Center in Manhattan and Clifton, New Jersey. Most pain treatments are covered by all major medical insurances and Medicare.\nHarvard Medical School\nNY & NJ Pain Specialist\nDr. Michael Nguyen is world renowned in Pain Medicine. Dr. Nguyen completed his residency and advanced Pain fellowship training at Harvard Medical School. During his tenure at Harvard, Dr. Nguyen was awarded the “Mentor of the Year” and also “Teacher of the Year” award.\nHarvard Medical School\nNJ PAIN SPECIALIST\nDr. Lombardi specializes in the treatment of back, neck, and joint pain. By using a range of minimally invasive modalities as well as advanced procedures, she helps patients achieve a pain free life without the need for surgery. Dr. Lombardi will be offering her pain treatment services in Clifton, New Jersey. |
Search the Health Library\nGet the facts on diseases, conditions, tests and procedures.\nI Want To...\nFind a Doctor\nFind a doctor at The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center or Johns Hopkins Community Physicians.\nI Want To...\nFind Research Faculty\nEnter the last name, specialty or keyword for your search below.\nThomas J K Tung, M.D.\nProfessor of Anesthesiology and Critical Care Medicine\nLanguages: English, Chinese, Japanese\nResearch Interests: Regulation of intracranial pressure by intrathoracic pressure; Global brain ischemia; Spinal cord ischemia; Focal cerebral ischemic injury; Effects on edema in the brain; Osmotic therapy for stroke ...read more\nRequest an Appointment\nThe Johns Hopkins Hospital\nAppointment Phone: 410-955-2611\n600 N. Wolfe Street\nSheikh Zayed Tower\nBaltimore, MD 21287 map\nDr. Thomas Toung is a professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine.\nDr. Toung has several research interests involving experimental animal models, including osmotic therapy for stroke and effects on edema in brain, lung and peripheral organs.\nHe received his undergraduate degree from The College of Science at National Taiwan University and earned his M.D. from National Taiwan University. He completed his residency at St. Francis Hospital in Wichita, Kansas, and performed a fellowship in general surgery at Massachusetts General Hospital. Dr. Toung joined the Johns Hopkins faculty in 1971.\n- Professor of Anesthesiology and Critical Care Medicine\n- Joint Appointment in Neurosurgery\n- National Taiwan University Medical School (1960)\n- American Board of Anesthesiology / Anesthesiology (1970)\nResearch & Publications\nDr. Toung has several research interests involving experimental animal models, including osmotic therapy for stroke and effects on edema in brain, lung and peripheral organs. He has found that hypertonic saline can be administered to reduce severe brain swelling after experimental stroke and that water content is influenced in other organs.\nHe has also been studying the role of sex hormones on focal cerebral ischemic injury and whether injection of a clot to occlude the middle cerebral artery produces varying degrees of injury in male and female animals. Other research has focused on spinal cord ischemia, global brain ischemia and regulation of intracranial pressure by intrathoracic pressure.\n- Toung TJ, Nyquist P, Mirski MA. "Effect of hypertonic saline concentration on cerebral and visceral organ water in an uninjured rodent model." Crit Care Med. 36(1):256–61, 2008.\n- Ziai WC, Toung TJ, Bhardwaj A. "Hypertonic saline: first-line therapy for cerebral edema?" J Neurol Sci. 261(1-2):157–66, 2008.\n- Mirski MA, Lele AV, Fitzsimmons L, Toung TJ. "Diagnosis and treatment of vascular air embolism." Anesthesiology 106(1):164–77, 2007.\n- Toung TJ, Chen CH, Lin C, Bhardwaj A. "Osmotherapy with hypertonic saline attenuates water content in brain and extracerebral organs." Crit Care Med. 35(2):526–31, 2007.\n- Lee EJ, Lee MY, Shyr MH, Cheng JT, Toung TJ, Mirski MA, Chen TY. "Adjuvant bupivacaine scalp block facilitates stabilization of hemodynamics in patients undergoing craniotomy with general anesthesia: a preliminary report." J Clin Anesth. 18(7):490–4, 2006. |
Profile Views: 519\nPhone: +995 32 262 00 00\nEmail: Click here to send a message\nContact Alexander Kutubidze\nStr. 67, Kostava, Tbilisi 0171 - Georgia\nPlease enter your contact information in the boxes provided.\nTo prevent fraud, these will be used by CosMedicList to verify your identity.\nIf you are claiming a profile on behalf of a surgeon, CosMedicList will contact them to confirm your association.\nDr. Alexander Kutubidze is a Board Certified Plastic Surgeon graduated from the Tbilisi Medical Academy in 1996. He is a qualified plastic surgeon skilled in the latest aesthetic and plastic surgery techniques and has extensive experience from the last 15 years having number of meticulously performed plastic surgical procedures. Dr. Kutubidze has been selected to complete advanced training in US by American Society of Plastic Surgeons in 2006 as an international scholar and trained at some of the most prestigious institutions in the United States. Dr. Alexander Kutubidze has been privileged to spend time with Drs Anthony Wolfe and Foad Nahai.\nDr. Kutubidze operates in an accredited surgical suite providing state-of-the-art medical equipment and technologies. It is staffed with board-certified anesthesiologists, registered nurses and other medical professionals. The suite features the latest surgical equipment and adheres to strict patient care guidelines. |
At Westlake Hills Dentistry we know how painful wisdom teeth can be. Wisdom teeth (also known as third molars) usually start to come in during the late teens and early twenties. Some people don’t experience any pain or complications when their wisdom teeth come in, but the majority of people will experience pain and may need to have their wisdom teeth extracted. This could be because the wisdom teeth don’t have enough room to come in properly or they may become impacted and cause a great deal of pain.\nSometimes when the wisdom teeth start to come in they push your other teeth out of place. This can undo many dollars’ worth of orthodontic treatments you may have received as a teenager or young adult. Pericoronitis also may develop. This is an infection caused by a wisdom tooth that has not completely broken through the gum, and a flap of the gum material may partially cover the tooth. Food debris can get trapped under the gum flap and cause infection. If the wisdom teeth are unable to break through the gum they may become infected and impacted. Cysts may also develop which are very painful and need to be treated.\nIf you are experiencing pain or your wisdom teeth are impacted Dr. Sakos and/or Dr. Burden, may recommend the extraction of your wisdom teeth. This procedure may be done as a simple extraction, or you may need a surgical extraction depending on the condition and location of your wisdom teeth.\nDr. Burden manages all our complicated surgical cases from extractions to IV Sedation, Dr. Burden works out of our office to take care of your surgical needs. Dr. Burden graduated from the University of Texas Health Science Center in San Antonio. He completed his under-graduate studies at Texas A&M University in 2001, where he received a B.S. in Genetics.\nAdditionally, Dr. Burden also completed a one-year advanced education in general dentistry residency at UTHSCSA, where he received training in Intravenous Conscious Sedation, complicated oral surgery procedures, and implant dentistry procedures.\nPreparing for Wisdom Tooth Extraction\nIf you are having your wisdom tooth or teeth extracted Dr. Sakos will take x-rays of your wisdom teeth, and he may have a panoramic x-ray of all of your teeth taken. A panoramic x-ray shows the doctor many things to help guide him during extraction which include the following:\n- The relationship of your teeth to your wisdom teeth\n- Your upper teeth’s relationship to your sinuses\n- The lower teeth’s relationship to the inferior alveolar nerve. This nerve gives feeling to your lower jaw, lower lip, lower teeth, and chin.\n- If infection, cysts, bone disease, or tumors are present\nBased on the x-rays and examination Dr. Sakos and Dr. Burden will recommend the type of extraction they feel would be best for you.\nFirst you will be made comfortable and the doctor will answer any questions about the extraction procedure. Your wisdom teeth may be able to be extracted using only local anesthesia. If this is the case a local anesthesia will be administered and the tooth extracted.\nIf you need a more involved procedure the doctor may recommend conscious sedation or general anesthesia. If your wisdom tooth is impacted you may need oral surgery to remove it. How your wisdom teeth are positioned and the relationship to your other teeth and sinuses will determine how extensive the extraction process will be. Under conscious sedation you will be aware of your surroundings, but very relaxed. Under general anesthesia you will be completely asleep. The doctor may have to make a small incision in your gum to remove the teeth, and you may need stitches which will dissolve in a few weeks.\nAfter Wisdom Teeth Extraction\nAfter surgery the doctor may ask you to bite down on a piece of gauze for about 30 to 45 minutes when you leave the office. This helps control bleeding and keeps the area clean and protected. You should rinse your mouth with a solution of warm salt water (one teaspoon of salt to a cup of warm water) to keep the area clean. This will also help prevent infection and speed healing. Over-the-counter NSAID pain relievers such as Advil or Alleve may be used to help control pain and inflammation. You can also apply ice packs to your cheeks to help reduce pain and swelling.\nEat soft foods, do not drink through a straw, and do not smoke while your socket heals. If you had stitches they should dissolve on their own within a few weeks. You may brush your teeth as normal, but avoid the area of extraction. Most people heal and have no complications within a few weeks after extractions. If you experience fever, chills, trouble swallowing, numbness which lasts more than a few hours after extraction seek medical attention or return to the office.\nJust about everyone gets their wisdom teeth in their late teens or early twenties. But you can experience pain from wisdom teeth at any age after puberty. At Westlake Hills Dentistry we want you to have good oral health and be pain free. For more information about wisdom teeth and wisdom teeth extractions contact Westlake Hills Cosmetic Dentistry today. Our offices are equipped to provide an array of restorative procedures such as porcelain veneers, dental implants, composite bonding, and tooth-colored fillings. |
Newton / O'Brien / Shufflebarger / Betz / Dickson / Harms\nPublication Date: October 2010\n448 pp, 646 illustrations\nISBN (Americas): 9781604060249Presents evidence-based information on idiopathic scoliosis treatment and outcomes\nBased on over a decade of research and observation conducted by the members of the Harms\nStudy Group and other spinal deformity experts from around the world, this must-have clinical reference provides focused coverage of the most current evaluation and treatment guidelines for idiopathic scoliosis. It draws on case studies to guide readers through specific surgical and nonoperative approaches to the multiple types of adolescent idiopathic spinal deformity, including practical information on the rationale for each approach, techniques, and results. Features: In-depth information culled from vast clinical data of world-renowned experts in the Harms Study Group Curve assessment and treatment recommendations listed by curve type and pattern - Comprehensive discussion of pathogenesis and epidemiology, osteobiologics for spinal fusion, anesthesia for scoliosis surgery, surgical complications, and more Chapters on key treatment decisions, such as the selection of fusion levels, that teach readers how to critically address clinical questions More than 600 high-quality illustrations, including numerous full-color clinical photographs, detailed line drawings, and complementary high-resolution radiographs This state-of-the-art text is ideal for orthopaedic surgeons, neurosurgeons, and spine fellows, and is an invaluable companion for any practitioner involved in the surgical and nonsurgical care of patients with spinal deformity. |
Transmuscular Quadratus Lumborum Block Reduces Postoperative Pain in Total Hip Arthroplasty\nHow to Cite\nOrthoEvidence. Transmuscular Quadratus Lumborum Block Reduces Postoperative Pain in Total Hip Arthroplasty. ACE Report. 2021;69(1):1. Available from: https://myorthoevidence.com/AceReport/Report/13807\nThe impact of ultrasound-guided transmuscular quadratus lumborum block combined with local infiltration analgesia for arthroplasty on postoperative pain reliefJ Clin Anesth. 2021 Oct;73: 110372.\nDid you know you're eligible to earn 0.5 CME credits for reading this report? Click Here\nEighty patients undergoing total hip arthroplasty (THA) were randomized to receive an ultrasound-guided transmuscular quadratus lumborum block (QLB) combined with local infiltrative analgesia (LIA) (n=40) or LIA alone (n=40). The primary outcome of interest was postoperative pain during the first active motion measured at 6 hours postoperatively. Other outcomes of interest included active and rest...\nContinuing Medical Education Credits\nYou could be earning 0.5 CME credits for each report you read.LEARN MORE |
Anesthesia & Analgesia:\nPediatric Anesthesiology: Research Report\nExtra-1 Acupressure for Children Undergoing Anesthesia\nWang, Shu-Ming MD*; Escalera, Sandra MD†; Lin, Eric C. BS*; Maranets, Inna MD*; Kain, Zeev N. MD*†‡§¶\nFrom the Departments of *Anesthesiology, †Pediatrics, and ‡Child and Adolescent Psychiatry, Yale University School of Medicine, New Haven, Connecticut; and §Departments of Anesthesiology, Pediatrics, and Psychiatry and Human Behavior, University of California, Irvine, Irvine, California, and ¶Children’s Hospital of Orange County, Orange, California.\nAccepted for publication May 1, 2008.\nSupported by National Institutes of Health NCCAM, grant R21AT001613-02) to S.M.W., Bethesda, MD and NICHD, grant R01HD37007-02 to Z.N.K., Bethesda, MD.\nAddress correspondence and reprint requests to Shu-Ming Wang, MD, Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510. Address e-mail to [email protected].\nBACKGROUND: Acupuncture and related techniques have been used as adjuncts for perioperative anesthesia management. We examined whether acupressure in the Extra-1 (Yin-Tang) point would result in decreased preprocedural anxiety and reduced intraprocedural propofol requirements in a group of children undergoing endoscopic procedures.\nMETHODS: Fifty-two children were randomized to receive acupressure bead intervention either at the Extra-1 acupuncture point or at a sham point. A Bispectral Index (BIS) monitor was applied to all children before the onset of the intervention. Anxiety was assessed at baseline and before entrance to the operating room. Anesthetic techniques were standardized and maintained with IV propofol infusion titrated to keep BIS values of 40–60.\nRESULTS: We found that after the intervention, children in the Extra-1 group experienced reduced anxiety whereas children in the sham group experienced increased anxiety (−9% [−3 to −15] vs 2% [−6 to 7.4], P = 0.012). In contrast, no significant changes in BIS values were observed in the preprocedural waiting period between groups (P = ns). We also found that total intraprocedural propofol requirements did not differ between the two study groups (214 ± 76 μg · kg−1 · min−1 vs 229 ± 95 μg · kg−1 · min−1, P = 0.52).\nCONCLUSIONS: We conclude that acupressure bead intervention at Extra-1 acupoint reduces preprocedural anxiety in children undergoing endoscopic procedures. This intervention, however, has no impact on BIS values or intraprocedural propofol requirements.\nAt present, both preoperative psychological preparation programs1–4 and pharmacological interventions, such as midazolam, are reported to be effective for the management of preoperative anxiety in children.5–8 However, both these modalities have several limitations. For example, preoperative preparation programs are expensive and require time and trained individuals.9 Similarly, administration of oral midazolam may delay postanesthesia care unit (PACU) discharge after short procedures such as gastrointestinal endoscopy.10,11 Thus, nonpharmacological interventions, such as acupuncture and related interventions, are evaluated as alternative modalities for the management of preoperative anxiety in children.\nPreviously, our group has reported that acupuncture and related techniques are effective for the treatment of anxiety in adult volunteers, adult surgical outpatients and parents of children undergoing surgery.12–15 Furthermore, several recent investigations involving adult volunteers and patients report that acupressure administrated at Extra-1* point applying direct circular motion with thumb pressure (about 3 × 105 PA) reduced verbal stress scores and induced hypnotic effects as measured by a Bispectral Index (BIS) monitor.16–18 Since acupressure is a noninvasive stimulation technique applied to an acupuncture point, we submit that it is likely to be more appealing to children than a technique involving needles. It is important to note, however, that there are several acupressure techniques that can be used in clinical settings. Acupressure can be applied by direct finger pressure with or without circular motion16–18 or with constant pressure resulting from the application of a bead/pellet over a targeted acupuncture point.15,19 The latter described technique is obviously less labor-intensive and may thus have obvious advantages in the clinical perioperative settings.\nIn view of the findings of previous adult studies involving acupressure and anxiety coupled with the advantages of acupressure over acupuncture in children undergoing surgery, we designed a study to examine if acupressure at the Extra-1 acupoint is effective in reducing preprocedural anxiety and producing hypnotic effects.\nChildren between the ages of 8 and 17, classified as ASA Physical Status (I-II), who were scheduled to receive general anesthesia for gastrointestinal endoscopic procedures, were enrolled to this randomized, controlled trial. All children and parents spoke fluent English and none of the children had any reported developmental delays. The Yale University IRB has approved the study protocol; an informed consent was obtained from all parents and an assent was obtained from all children who participated in this study (please refer to study protocol for consent procedures).\nAcupressure interventions in this study were delivered using an acupressure-bead (Acu-pellet; Helio, San Jose, CA) attached to a self-adhesive tape that secured the bead in place and created continuous standardized pressure of 1.3 psi as measured by a tonometer (Fig. 1). The use of a self-adhesive pressure bead is a widely used technique to create continuous acupressure and avoid the need for additional manipulation once the beads are placed.15,19 The acupuncturist (SMW) applied acupressure beads to the two intervention groups based on a random computer-generated assignment. In order to prevent any possible bias, all participants were informed that the aim of this study was to determine “which acupoint on the forehead is more effective in reducing preoperative anxiety” The groups included:\n1. Ex-1 Group. Intervention applied at the Extra-1 acupoint, which is located in the midpoint between the eyebrows.15\n2. Sham Group. Intervention applied above the lateral boarder of the left eyebrow. This widely used sham point was selected as it has the same dermatomal distribution as Extra-1 and does not result in any reported clinical effects.15\nAfter institutional Human Investigation Committee approval, all children who fulfilled the above criteria were invited to participate in the study by a gastroenterologist (SE) during an office visit. On the day of the procedure, and after completion of all the routine admitting processes, the child and his/her parents were asked again by a research assistant, if they would like to participate in the study. The consent and assent stated that the researchers intend to test acupressure to two acupoints on the forehead that may reduce preprocedural anxiety. After enrollment, demographic data were obtained and a baseline self-reported anxiety questionnaire was completed. This anxiety questionnaire, the State Trait Anxiety Inventory for Children (STAIC), is considered the “gold standard” for the assessment of anxiety in children older than 6 yr.20 This scale, consisting of two parts, is designed to measure both state anxiety (i.e., anxiety changes in response to an acute condition-STAIC state anxiety scale) and trait anxiety (i.e., chronic, pervasive anxiety-STAIC trait anxiety scale).20 This questionnaire is well validated and has been used in more than 1000 studies.21\nOnce baseline anxiety assessment was completed, a disposable pediatric BIS sensor was placed on each child’s forehead. This sensor was attached to a BIS 2000 Monitor (Aspect Medical Systems Inc, Newton, MA). After a 5-min period to allow the stabilization of the BIS 2000 monitor, the acupuncturist (SMW) applied the intervention based on group assignment without the presence of a research assistant or member of the nursing staff. Thirty minutes after the placement of the acupressure bead, the research assistant returned to administer a second state anxiety scale to the child (STAIC-state anxiety) in the holding area. In order to eliminate any confounding variables the study protocol did not allow the administration of preprocedural sedative medication or the presence of parents during the induction of anesthesia.\nChildren were then brought into the operating rooms. A standardized single breath vital capacity inhaled technique (with mixture of 70% N2O/O2 and 7% Sevoflurane) was commenced through a scented mask.22,23\nAfter the establishment of an IV catheter, an anesthesiologist intubated the tracheas of all children, sevoflurane was discontinued and general anesthesia was maintained using a 70% nitrous/oxygen mixture and a propofol infusion. No narcotic drugs were administered during the procedure. The propofol infusion rate was titrated to maintain the BIS number in the range of 40 to 60. Propofol consumption was expressed as the total propofol amount used during the procedure divided by body weight and duration of the procedure. No other anesthetic or sedative drugs were administered to any of the participants in this study. The propofol infusion was terminated at the completion of the procedure and the acupuncturist was then called to remove the acupressure bead. We also documented the time interval from discontinuation of the propofol infusion until the time for tracheal extubation (time to awake).\nPatients were then transported to the PACU, and the nursing staff provided routine recovery care. IV fentanyl (0.5 μg/kg) was administrated for a visual analog scale score of 4 and above. Ondansetron 0.1 mg/kg (maximum dose 4 mg) was administered for vomiting or nausea that lasted more than 10 min. The incidence of pain, nausea, and vomiting was documented.\nOnly the acupuncturist knew the group assignment. All other personnel, including research assistants, pediatric gastroenterologists, anesthesiologists, and nursing staff, were blinded to the study group. These individuals were told that the purpose of this study was to test which acupoint is more effective for the management of preoperative anxiety and intraoperative propofol requirements. Further, the acupuncturist was not involved in the anesthetic management of patients or in any other aspect of the study.\nThe primary outcome of this study was the change in the child’s anxiety levels in the preprocedural area from baseline to 30 min after the acupressure intervention. Secondary outcomes included changes in BIS during the preprocedural period and changes in propofol requirements during the gastrointestinal procedure. Sample size for the primary outcome was calculated before based on findings from a previous study.15 Considering a repeated measures design, a medium effect size, an alfa of 0.05 and power of 85%, 26 patients were needed in each study group. Randomization was done with a computer-based random number generator and was stratified based on age, gender, and procedure. All data were imported into a SPSS version 11.0 (SPSS Inc, Chicago, IL). Baseline characteristics, and PACU recovery profile were analyzed using Student’s t-test. Two-way repeated measure analysis of variance was used to analyze changes in state anxiety and average BIS values over time. Average BIS values were calculated for each five minute segments of continuous BIS data, as directly downloaded from the BIS monitor. The Mann-Whitney test was performed for nonparametric data such as propofol consumption. P < 0.05 is considered significant.\nFifty-two children were enrolled in this randomized, controlled trial. No differences between study groups were found in any of the demographic or other baseline variables (Table 1).\nState anxiety levels of the two study groups differed over time, as evidenced by a significant group X time interaction (F = 6.1, P = 0.017). That is, although at baseline, the state anxiety of children did not differ between the two groups (P = 0.58). Thirty minutes after the application of acupressure, children in the Ex-1 group experienced a reduction of anxiety whereas children in the sham group experienced an increase in anxiety expressed as mean (range) (−9% [−3 to −15] vs 2% [−6 to 7.4], P = 0.012) (Fig. 2). Throughout the preprocedural waiting period, the average BIS was not significantly different between study groups (95 ± 3 vs 96 ± 3, P = 0.49).\nThe amount of propofol needed to maintain a BIS value of 40–60 during the endoscopic procedure was not different between the Ex-1 and sham groups (214 ± 76 μg · kg−1 · min−1 vs 229 ± 95 μg · kg−1 · min−1, P = 0.52). Also, the intraprocedural average BIS value was similar between groups (45 ± 8 vs 45 ± 8, P = 0.81).\n“Time to awake” and incidence of nausea and vomiting in the PACU were not different between Ex-1 and sham groups. The results are summarized in Table 2.\nIn children undergoing endoscopies, we found that acupressure with a self-adhesive pressure bead at Extra-1 acupoint decreases preprocedural anxiety but does not affect the preprocedural BIS value. In addition, we noted that the continued application of this acupressure intervention throughout the entire endoscopic procedure, whereas controlling for BIS levels, did not affect the patient’s total propofol requirements for the procedure.\nAdult studies by Fassoulaki et al. and Agarwal et al. have indicated that acupressure at Extra-1 acupoint decreases both verbal stress scores and BIS values.16–18 Indeed, this was one of the impetuses for this study. In contrast to these previous adult studies, we found no effects of acupressure delivered via the self-adhesive bead/pellet at the Extra-1 acupoint on BIS of children prior to surgery. This finding is consistent with our previous findings.15 The differences between Fassoulaki et al. and Agarwal et al. with our study is that Fassoulaki et al. and Agarwal et al. used direct finger pressure with circular motion whereas we used a self-adhesive acupressure bead with constant pressure. Differences in the results may be related to the differences in the acupressure stimulation techniques used.\nLack of group differences with regard to intraprocedural propofol consumption should be viewed in light of three previous studies. In a study of adult patients, Maranets and Kain noted that only higher trait anxiety (but not state anxiety) resulted in higher propofol requirements for maintenance of anesthesia.24 Thus it is not surprising that in this study reduction of preprocedural state anxiety did not result in reduced intraprocedural propofol requirements. Further, it is possible that intraprocedural effects of acupressure were suppressed by propofol general anesthesia. Indeed, a previous functional magnetic resonance imaging study by our laboratory indicated that acupuncture-induced blood oxygen level-dependent signals were suppressed by propofol general anesthesia.25 A similar observation was seen using an auditory evoked index monitor. Lu et al. noted that electroacupuncture enhances the sedative effect of propofol in a target plasma concentration of 1.5 μg/mL but not at 2.0 μg/mL.26\nThis study has a few limitations. We recognize that age, gender, and procedures may affect how a child responds to an acupressure intervention and therefore patients were randomized and stratified based on these variables. We did not, however, stratify patients based on their disease process. Consequently, we cannot exclude the fact that certain patients may have been more or less susceptible to acupressure, i.e., patients with chronic abdominal pain with no etiology compared to patients with inflammatory bowel disease. We have used a sham-control study design in order determine the specific effect of the particular acupuncture point studied. The use of an inert placebo in the settings of randomized, controlled trials is essential for both pharmacological and nonpharmacological clinical studies27 and a no-treatment control group in the setting of acupuncture or any clinical trial is highly problematic.27 In our study, we made the choice not to use a no-treatment control group for two reasons: (a) A no-treatment control group prevents blinding of the treatment, and (b) when nontreatment controls are used, the sham group controls for the possibility of a placebo effect. A review of the literature reveals that contemporary, carefully designed acupuncture studies typically use sham-control rather than no-treatment control. We believe that only points or techniques that have been shown to be ineffective or less effective should be used as sham control. Therefore, we have chosen the same sham point with the same acupressure stimulation that was found to be less effective than acupressure on Extra-1 acupoint in a previous study.15 Finally, a question can be raised as to whether the 11% difference in state anxiety between the two groups of children after the assigned intervention(s) is considered clinically significant. We submit that the answer depends on variables such as the instrument used for assessment of anxiety and the level of child expectation. Although there are no data regarding this issue of clinical significance in the pediatric anxiety literature, we did identify two adult publications that indicate that a minimum of 10% difference in the state anxiety level as assessed by the State Trait anxiety scale for adults is considered clinically significant.28,29 The state anxiety assessment tool used in this present study is the pediatric version of the instrument used in the above publications (STAIC). Therefore, we believe that the difference of 11% should be considered clinically significant.\nWe conclude that although bead-generated acupressure applied preprocedurally at Extra-1 acupoint decreases preprocedural anxiety in children undergoing general anesthesia for gastrointestinal endoscopies, it did not affect the consumption of propofol during the intraprocedural period. More research is needed to determine whether the hypnotic effects of Extra-1 acupoint are related to the specific acupressure technique used.\n1. Saile H, Burgmeier R, Schmidt LR. A meta-analysis of studies on psychological preparation of children facing medical procedures. Psychol Health 1988;2:107–32\n2. O’Byrne K, Peterson L, Saldana L. Survey of pediatric hospitals’ preparation programs: evidence of the impact of health psychology research. Health Psychol 1997;16:147–54\n3. Cassady JF, Wysocki TT, Miller KM, Cancel, Dawn D, Izenberg N. Use of a preanesthetic video for facilitation of parental education and anxiolysis before pediatric ambulatory surgery. Anesth Analg 1999;88:246–50\n4. Kain Z, Caramico L, Mayes L, Genevro, Janice L, Bornstein MH, Hofstadter MB. Preoperative preparation programs in children: a comparative study. Anesth Analg 1998;87:1249–55\n5. Kain Z, Mayes L, Wang S, Caramico LA, Hofstadter MB. Parental presence during induction of anesthesia vs sedative premedication: which intervention is more effective? Anesthesiology 1998;89:1147–56\n6. Kain Z, Mayes L, Wang S, Caramico LA, Krivutza DM, Hofstadter MB. Parental presence and a sedative premedicant for children undergoing surgery: a hierarchical study. Anesthesiology 2000;92:939–46\n7. Davis PJ, Tome JA, McGowan FX, Cohen IT, Latta K, Felder H. Preanesthetic medication with intranasal midazolam for brief pediatric surgical procedures: effect on recovery and hospital discharge times. Anesthesiology 1995;82:2–5\n8. Griffith N, Howell S, Mason DG. Intranasal midazolam for premedication of children undergoing day-case anaesthesia: comparison of two delivery systems with assessment of intra-observer variability. Br J Anaesth 1998;81:865–9\n9. McCann ME, Kain ZN. The management of preoperative anxiety in children: an update. Anesth Analg 2001;93:98–105\n10. Viitanen H, Annila P, Viitanen M, Tarkkila P. Premedication with midazolam delays recovery after ambulatory sevoflurane anesthesia in children. Anesth Analg 1999;89:75–9\n11. Viitanen H, Annila P, Viitanen M, Yli-Hankala A. Midazolam premedication delays recovery from propofol-induced sevoflurane anesthesia in children 1–3 yr. Can J Anaesth 1999;46:766–71\n12. Wang SM, Kain ZN. Acupuncture as a new modality for the treatment of anxiety. Anesth Analg 2001;92:548–553\n13. Wang SM, Peloquin C, Kain ZN. The use of auricular acupuncture to reduce preoperative anxiety. Anesth Analg 2001;93:1178–80\n14. Wang SM, Maranets I, Weinberg ME, Caldwell-Andrew AA, Kain ZN. Parental auricular acupuncture as an adjunct for parental presence during induction of anesthesia. Anesthesiology 2004;100:1399–404\n15. Wang SM, Dorothy Gaal, Inna Maranets, Caldwell-Andrews AA, Kain ZN. Acupressure and preoperative parental anxiety: a pilot study. Anesth Analg 2005;101:669–9\n16. Fassoulaki A, Paraskeva A, Patris K, Pourgiezi T, Kostopanagiotou G. Pressure applied on the extra 1 acupuncture point reduces bispectral index values and stress in volunteers. Anesth Analg 2003;96:885–90\n17. Fassoulaki A, Paraskeva A, Kostopanagiotou G, Tsakalozou E, Markantonis S. Acupressure on the extra 1 acupoint: the effect on bispectral index, serum melatonin, plasma β-endorphin, and stress. Anesth Analg 2007;104:312–17\n18. Agarwal A, Ranjan R, Dhiraaj, Lakra A, Kumar M, Singh U. Acupressure for prevention of preoperative anxiety: prospective, radomised, placebo controlled study. Anaesthesia 2005;60:978–81\n19. Schlager A, Boehler M, Puhringer F. Korean hand acupressure reduces postoperative vomiting in children after strabismus surgery Br J Anaesthesia 2000;85:267–70\n20. Spielberger CD. Manual for the State-Trait Anxiety Inventory for Children. Palo Alto, CA: Consulting Psychologists Press, 1973\n21. Finch AJ, Montgomery LE, Deardorff PE. Reliability of state-trait anxiety with emotional disturbed children. J Abnorm Child Psychol 1974;2:67–9\n22. Bourne J. General Anesthesia for out patients with special reference to dental extraction. Pro R Soc Med 1954:47:416–22\n23. Fernandez M, Lejus C, Rivault O, Bazin V, Le Roux C, Bizouarn P, Pinaud M. Single breath vital capacity rapid induction with sevoflurane: feasibility in children. Pediatr Anesth 2005;15:307–13\n24. Maranets I, Kain ZN. Preoperative anxiety and intraoperative anesthetic requirements. Anesth Analg 1999;89:1346–51\n25. Wang SM, Constable RT, Tokoglu FS, Weiss D, Freyle D, Kain ZN. Acupuncture–induced bold oxygenation level dependent signal is awake and anesthetized volunteers: a pilot study. Anesth Analg 2007;105:499–506\n26. Lu L, Ge S-J, Xue Z-G. Influence of electroacupuncture on auditory evoked potential index during propofol sedation. J Acupun Tuina Sci 2006;4:236–38\n27. Dincer F, Linde K. Sham interventions in randomized clinical trials of acupuncture–a review. Complement Ther Med 2003;11: 235–42\n28. Jacobson N, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 1991;59:12–19\n29. Fisher P, Durham R. Recovery rates in generalized anxiety disorder following psychological therapy: an analysis of clinically significant change in the STAI-T across outcome studies since 1990. Psychol Med 1999;29:1425–34\n*Extra-1 acupoint: This acupuncture point is also known as “Yin-Tang” acupoint in Traditional Chinese Acupuncture textbooks. The location of Yin-Tang is in the vicinity of three major meridians (Du, UB and SI) and one extra-meridian Yang Qiao and all these meridians are believed to be connected to one another. As a result, Yin-Tang serves as the “window” of heart yang (Essentials of Chinese Acupuncture. Foreign Languages Press, Beijing, China, 1993). Stimulation on Yin-Tang acupoint is also used to treat insomnia. Cited Here...\n© 2008 International Anesthesia Research Society\nWhat does "Remember me" mean?\nBy checking this box, you'll stay logged in until you logout. 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Pet Dental Services Wisconsin Relies On\nOur Dental Suite is Equipped Similarly to a Human Dental Office Using Advanced Techniques, Materials and Digital Dental Radiography\nLike a human dentist, our board-certified veterinary dentist, Gwenn Schamberger, DVM, DAVDC, treats conditions in your pet such as malocclusions, jaw fractures, and oral cancer. Root canals, crowns, and vital pulp therapy are also common procedures in veterinary dentistry.\nSince most animal dental patients are treated under general anesthesia, we pay special attention to our anesthetic protocols, utilizing our veterinary anesthesiologist to customize anesthesia to the needs of your pet. We work closely with you, your pet, and your primary care veterinarian for the best outcome.\nInfection of the soft tissues and bone supporting the teeth.\nSurgery to save teeth rather than extraction.\nTreatment of the inside of the tooth to prevent/treat infection.\nClosing open communication between the mouth and nose to prevent/treat infection.\nMaxillectomies and Mandibulectomies are types of surgery to remove a portion of the upper or lower jaw.\nCommon oral tumors include:\n- Fibromatons/ossifying epulus\n- Malignant melanoma\n- Acanthomatons ameloblastoma\n- Squamous cell carcinoma\nOral Disease Management\nMore common in cats, stomatitis is severe inflammation of the entire mouth with unknown cause.\nCommon condition in cats - the body "eats" away at the teeth. It can be painful and the cause is unknown.\nWhere the upper and lower teeth don't align properly - resulting in teeth hitting other teeth or into the gums/palate. |
This article needs additional citations for verification. (January 2016) (Learn how and when to remove this template message)\n|CompTox Dashboard (EPA)|\n|Chemical and physical data|\n|Molar mass||200.279 g/mol g·mol−1|\n|3D model (JSmol)|\n|(what is this?)|\nMedetomidine is a synthetic drug used as both a surgical anesthetic and analgesic. It is often used as the hydrochloride salt, medetomidine hydrochloride, a crystalline white solid. It is an α2 adrenergic agonist that can be administered as an intravenous drug solution with sterile water.\nIt was developed by Orion Pharma. It is approved for dogs in the United States, and distributed in the United States by Pfizer Animal Health and by Novartis Animal Health in Canada under the product name Domitor. Other alpha-two agonists used in veterinary medicine include xylazine and detomidine, but their use is less common in small animal surgery. The marketed product is a racemic mixture of two stereoisomers; dexmedetomidine is the isomer with more useful effects, and is now marketed as Dexdomitor. The free base form of medetomidine is sold as Selektope for use as an antifouling substance in marine paints.\nIn veterinary anesthesia, medetomidine is often used in combinations with opioids (butorphanol, buprenorphine etc.) as premedication (before a general anesthetic) in healthy cats and dogs. It can be given by intramuscular injection (IM), subcutaneous injection (SC) or intravenous injection (IV). When delivered intravenously, a significantly decreased dose is used. Some authors suggest a sublingual route is also effective. It is not recommended for diabetics, it is contraindicated in patients with cardiac disease. Due to its potent sedative effects it is commonly used in more aggressive animals, where a drug combination with a lesser effect (such as acepromazine plus an opioid, or an opioid plus a benzodiazepine) would not allow the administration of the inductive agent without risk to the veterinarian. As such the use of alpha-two agonists is only recommended in healthy animals.\nFollowing administration, marked peripheral vasoconstriction and bradycardia are noted. Often the dosage of induction agents (e.g. propofol) may be drastically reduced, as may the volumes of anasthetic gases (i.e. halothane, isoflurane, sevoflurane) used to maintain general anesthesia.\nIt is sometimes used in combination with butorphanol and ketamine (given IM) to produce general anasthesia for short periods in healthy but fractious felines that will not allow an intravenous induction agent to be given. It provides a good degree of muscle relaxation, an important factor in ketamine based anethesia protocols.\nMedetomidine has also been used in combination with morphine (or methadone), lidocaine and ketamine in constant rate infusion analgesia in canines. It is often used in so called microdoses for this analgesic effect.\nIt is thought that this family of drugs has a degree of analgesic action, though this is, in comparison to the sedative effect, minor.\nIts effects can be reversed using atipamezole (distributed as Antisedan by Pfizer). IV use of atipamezole is not licensed, IM is the preferred route. Yohimbine may also be used in an emergency situation, but is not licensed.\nUse in marine paint\nMedetomidine can be used as an antifouling substance in marine paint. It is mainly effective against barnacles, but has also shown effect on other hard fouling like tube worms. When the barnacle cyprid larva encounters a surface containing medetomidine the molecule interacts with the octopamine receptor in the larva. This causes the settling larva to increase its kicking to more than 100 kicks per minute, which makes becoming sessile nearly impossible. When the larva swims away from the surface, the effect disappears (reversible effect). The larva regains its pre-exposure function and can settle somewhere else.\nThis article includes a list of references, but its sources remain unclear because it has insufficient inline citations. (January 2016) (Learn how and when to remove this template message)\n- Sinclair MD (November 2003). "A review of the physiological effects of alpha2-agonists related to the clinical use of medetomidine in small animal practice". Can. Vet. J. 44 (11): 885–97. PMC 385445. PMID 14664351.\n- http://orion.fi/en/Research-and-developement/Achievements/ Archived March 15, 2013, at the Wayback Machine\n- Chaabane, Philip. "The Selektope ® Story" (PDF). PCI Magazine. Retrieved 12 December 2018.\n- Lind, Ulrika; et al. (August 2010). "Octopamine Receptors from the Barnacle Balanus improvisus Are Activated by the α2-Adrenoceptor Agonist Medetomidine". Molecular Pharmacology. 78 (2): 237–248. doi:10.1124/mol.110.063594. PMID 20488921. Retrieved 12 December 2018.\n- Novartis Animal Health Canada . 2003.\n- Harari, Joseph (1996). Small Animal Surgery. Williams and Wilkins. ISBN 978-0-683-03910-8.\n- Lind, U.; Alm Rosenblad, M.; Hasselberg Frank, L.; Falkbring, S.; Brive, L.; Laurila, J. M.; Pohjanoksa, K.; Vuorenpää, A.; Kukkonen, J. P.; Gunnarsson, L.; Scheinin, M.; Mårtensson Lindblad, L. G. E.; Blomberg, A. (2010). "Octopamine receptors from the barnacle Balanus improvisus are activated by the 2-adrenoceptor agonist medetomidine". Molecular Pharmacology. 78 (2): 237–248. doi:10.1124/mol.110.063594. PMID 20488921. |
+44 20 3868 9735\nPerioperative immediate hypersensitivity reactions represent rare but not negligible complications during surgery, even in a pediatric environment. Latex is the first cause of hypersensitivity reactions during anesthesia in children. We present the case of a 10 years old asthmatic boy who was labeled as allergic to latex, after an anaphylactic shock occurring right after a general anesthesia. A proper allergy work-up allowed us to rule out such a diagnosis and to precisely advise the anesthesiologist and the surgical team on how to perform a safe intervention on this patient. |
An evaluation of the analgesic effect of AnestaGel™ on mechanical allodynia in a rat model of postoperative incisional pain\nAuthors Hutchins J, Taylor W\nReceived 19 July 2017\nAccepted for publication 15 November 2017\nPublished 13 December 2017 Volume 2017:10 Pages 2807—2813\nChecked for plagiarism Yes\nReview by Single-blind\nPeer reviewers approved by Dr Amy Norman\nPeer reviewer comments 5\nEditor who approved publication: Dr Katherine Hanlon\nJacob Hutchins,1 William Taylor2\n1Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA; 2InSitu Biologics, LLC, St Paul, MN, USA\nPurpose: Sustained release hydrogel with bupivacaine (AnestaGel™) is a novel formulation of extended release bupivacaine in a biohydrogel Matrix™. We sought to compare the analgesic effects via mechanical allodynia, the pharmacokinetic characteristics via serum blood levels, and the local tissue effects via pathology, following injection of either sustained release hydrogel with bupivacaine, liposome bupivacaine, or hydrogel only (negative control group).\nMaterials and methods: Ninety rats (30 in each group) were randomized to receive a sciatic nerve block injection of either sustained release hydrogel with bupivacaine, liposome bupivacaine (Exparel®), or a biohydrogel matrix. The total force generated was obtained at varying time points. Pathologic analysis was undertaken on days 5 and 42 of the study. Six additional rats (two in each group) were randomized to receive a sciatic nerve block injection of either sustained release hydrogel with bupivacaine, liposome bupivacaine, or bupivacaine and pharmacokinetic data were obtained for up to 120 hours.\nResults: The sustained release hydrogel with bupivacaine group had significantly better response to mechanical allodynia compared to the other two groups. The pathology showed no significant adverse events at 42 days in any group. Finally, bupivacaine was present longer in the serum of sustained release hydrogel with bupivacaine group than the other two groups.\nConclusion: The sustained release hydrogel with bupivacaine achieved longer lasting analgesia with no significant findings on pathology at 42 days when compared to both positive and negative controls.\nKeywords: mechanical allodynia, local anesthetics, extended release, nerve block\nThis work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable] |
Preventive Dentistry Tulsa, OK\nIn many instances, oral implantology stands as the most effective approach for restoring missing teeth. Nevertheless, when dealing with maxillary atrophy resulting from the permanent loss of teeth, the challenges associated with implant placement and subsequent prosthodontic restoration become significantly more complex. As a result, advanced surgical methods are essential to circumvent potential complications involving the lower dental nerve and the maxillary sinus. These specialized procedures, which enable us at Smiles of Tulsa, to enhance and rebuild the alveolar ridge, involve the use of bone grafts or bone substitutes. These interventions are aimed at assisting you in the recovery of your smile.\nWhy Are Bone Grafts Needed?\nThe gradual degeneration of the maxilla is linked to various factors such as systemic, mechanical, metabolic, or inflammatory issues. Tooth loss resulting from trauma or extractions initiates a process of alveolar remodeling, which becomes more pronounced when removable prostheses are used. Additionally, the presence of air spaces within the bones, a phenomenon called pneumatization, significantly diminishes the available bone volume. When combined with suboptimal bone quality, it presents challenges for the successful insertion of dental implants. Hence, it becomes imperative to enhance the atrophic areas in the jaw to attain the ideal bone volume and promote bone regeneration. This step is crucial to ensure that implant placement yields favorable outcomes, both functionally and aesthetically.\nOver time, various surgical methods have been devised to reestablish the necessary bone volume. Among these approaches are techniques aimed at three-dimensionally reconstructing the alveolar ridge using grafts securely attached to the maxillary bone, such as onlay and inlay grafts. In the posterior segments, where aesthetic concerns are less critical, it is possible to implant thick and elongated implants. These implants enhance the contact area between the bone and implant surface, providing robust support for the forces involved in chewing.\nTypes Of Dental Bone Grafts\nThere are a number of different types of grafting materials we can use. One is known as an autologous graft, or "autografts," which are removed from your own body. They allow live-cell transplants and prevent the transmission of infectious diseases. Furthermore, there is no immunological rejection, since the grafted material comes from your own body.\nSecondly, there are homologous grafts or allografts. We get those from another person, and they are withdrawn from donors in tissue banks. Bone banks allow you to have an unlimited amount of bone without the morbidity of its extraction. There is a very nominal risk of disease transmission for the recipients of the allografts.\nLastly, heterologous grafts (or xenografts) are the third option. These are grafts between individuals of different species. Their materials may come from algae, animals, and coral. They are risk-free and easy to obtain.\nWhen Is A Dental Bone Graft Performed?\nTypically, bone grafting is employed when a fixed dental implant restoration is required. This dental bone graft serves the crucial purpose of ensuring proper bone support for the implants and their successful integration into your oral structure. Bone grafting becomes essential to either establish or preserve bone height and bone growth following tooth extraction, facilitating the placement of implants. It is also utilized to rehabilitate bone defects, whether in terms of height or width, and in procedures like maxillary sinus lifts, which are performed to enable implant placement in posterior regions, such as molars.\nHow long does a bone graft procedure take?\nThe duration of a bone graft procedure can vary depending on several factors, including the complexity of the graft, the site of the graft, and the patient's individual circumstances. On average, a bone graft procedure typically takes about one to two hours. However, it's important to note that this is a general estimate, and the actual time may be shorter or longer depending on the individual.\nFactors that can influence the duration of a bone graft procedure can include:\n|Size and Location: The size and location of the area where the bone graft is needed play a significant role. A small graft in a single tooth socket may take less time than a larger graft to reconstruct a portion of the jawbone.\n|Type of Graft: The type of graft used can impact the procedure's complexity and duration.\n|Surgical Technique: The surgical technique employed by the dentist can also affect the duration of the procedure.\n|Patient's Health: The patient's overall health and medical history can influence the procedure's duration. Patients with certain medical conditions may require additional precautions or have longer surgical times.\n|Anesthesia: The type of anesthesia used can impact how long the procedure takes. Local anesthesia is often used, but in some cases, sedation or general anesthesia may be required, which can extend the time spent in the operating room.\nRecovery After a Bone Graft Procedure\nRecovery after a bone graft procedure can vary depending on the type of graft, the location of the graft, and individual patient factors. However, here is a general overview of what you can expect during your recovery.\nIn the hours immediately following the bone graft surgery, you may still be under the effects of anesthesia or sedation. You will need someone to drive you home. It's common to experience some initial discomfort, swelling, and possibly bleeding at the graft site. We will provide specific post-operative instructions.\nSwelling and bruising around the surgical area are common side effects of a bone graft. This can peak within the first 48 hours after the procedure and gradually subside over the next few days to a week. Applying ice packs to the outside of your face for short periods during the first 24 hours can help reduce swelling.\nYou may need to modify your diet for a period after the procedure. Soft and cold foods are often recommended during the initial recovery phase. Avoid hot, spicy, crunchy, or hard foods that may irritate the graft site.\nMaintaining good oral hygiene is crucial during the recovery period. You may be instructed to avoid brushing or flossing directly over the surgical site for a specified time. Instead, you might use a prescribed mouth rinse or saltwater rinse to keep the area clean.\nRest and limited physical activity are usually advised during the initial days of recovery. Avoid strenuous exercise and heavy lifting to prevent any complications.\nWe will schedule follow-up appointments to monitor your healing progress. We will check the graft site, remove any sutures if necessary, and adjust your treatment plan as needed.\nThe complete healing process can take several months, during which the grafted bone integrates with your existing bone.\nWhile complications are relatively rare, it's essential to be aware of signs of infection, excessive bleeding, or graft failure. If you experience severe pain, persistent bleeding, or any unusual symptoms, contact us immediately.\nBone Grafting at Smiles of Tulsa\nPatients with bone loss initially present a complex circumstance, but as specialists in dental implants,Smiles of Tulsacan help ensure the best possible outcome for you and your smile. To learn more, or to set up an appointment with us, please call us at (918) 891-3059 today. |
Terms and Conditions for Shiloh Youth Ranch\nShiloh Youth Ranch (SYR) Conditions of Enrollment: Please read carefully!\n- The Management at SYR reserves the right to dismiss a Camper who, in their opinion, is a hazard to the safety of others, or who appears to have rejected the guidelines of SYR. During the Camper's stay, the legal guardian must be within 1 hour of SYR in case of emergency or dismissal.\n- The parents/guardians submitting this application must have legal custody over the Camper. Conditions of custody, if applicable, must be fully communicated in writing to SYR, including a photocopy of the section of any court order referring to visitation rights.\n- While every precaution shall be taken to ensure the good welfare and protection of the Camper, SYR, its staff members, employees, as well as facilities outside the SYR grounds, are hereby released from any and all liability in the event of any illness, accident or misfortune that may occur to the applicant Camper. Each Camper must be covered by Provincial Health or equivalent medical insurance.\n- In the event that a Camper requires special medication, x-ray, or treatment that is beyond the basic medical treatment given at SYR, the parents/guardians will be notified immediately and will be responsible for any additional expense for additional care or transportation.\n- In case of surgical emergency, I hereby give my permission to the physician selected by the Executive Director to hospitalize, secure proper treatment for, and order injection, anesthesia, or surgery for my Camper named on this application.\n- SYR has a zero lice policy. Campers found with lice will be sent home for treatment.\n- I give permission for Shiloh Youth Ranch to use any photograph or video of my Camper for promotional materials.\n- As the parent/guardian, I may be asked to reimburse SYR for any damage caused by my Camper.\n- I have read the above terms and conditions, and I hereby accept the conditions of enrollment. |
Here are 5 curious anesthesia awareness stories, you have never heard about!\nHad an out-of-body experience in a nose job\nThis patient awoke during her nose operation. She saw her body the way it lay upon the operating table, as though she was standing outside her body with the foot from the operating table, around the right-hand side. She realized it absolutely was she who lay upon the operating table, but felt no alarm or consternation upon realizing that she was apparently standing outside her body. She saw the surgeon operating to be with her nose, but felt neither the operation, nor any pain through the operation. She saw the surgeon’s assistant. She saw the anesthetic assistant sitting next to the anesthetic machine located for the left-hand side of her body. And she pointed out that she could hardly see the faces from a of these people.\nHer blood pressure levels, blood oxygen concentration, and blood co2 concentration remained normal during the entire operation. No-one inside operating theatre observed anything unusual through the operation. Nobody saw her soul standing next to the operating table. Her body remained about the operating table over the operation. She couldn’t move, breathe, or speak in the operation, because she had received a drug that almost totally paralyzed every one of the muscles of her body, and was being mechanically ventilated by using a tube placed between her vocal cords. But shortly prior to end from the operation, once the effects of every one of the drugs she received were partly worn off, she made slight movements of her legs and arms. So, in the event she was awake, the anesthetic assistant promptly administered an additional dose of any powerful sleep-inducing drug. Otherwise, there was clearly no reason to consider she was conscious at any time in the operation. She only agreed to be capable of speaking after she awoke on the general anesthetic.\nExperienced anesthesia awareness during leg surgery\nOne patient inside the UK required a procedure that involved cutting open his leg and drilling in the bone. He was anesthetized but conscious from the operating room having a tube down his throat, aware, but struggling to move. He aimed to alert the doctors by wiggling his toes; a nurse noticed this but was told it turned out “just reflexes” and he or she should neglected. Someone then grabbed the patient’s leg and began applying a tourniquet to his groin, after which he pointed out that (1) the operation only agreed to be beginning, (2) he was acutely understanding of pain, and (3) he could do nothing at all about it. The patient were required to lie there in helpless agony while his leg was sliced open and four holes were drilled to the bone. He felt sick and stopped sucking in another try to alert the OR staff, though the ventilator began “breathing for him.” Afterward he sued and was awarded 15,000 pounds, pretty modest compensation taking into consideration the circumstances.\nExperienced anesthesia awareness during gallbladder surgery\nThis woman’s nightmare experience happened in 2008 during gallbladder surgery. She went into surgery and visited sleep for any short time. Then, sShe reached and could tell she had a breathing tube in her own throat, and heard the anesthesia Dr. conversing with someone else above her head concerning the dosages on the different drugs.\nThen, the surgeon began his incisions for that laparoscopic procedure. She felt the 1st incision near her navel.\n“At the period, I was aware, I cannot scream because in the breathing tube, all I could consider is I have had reached move one method or another; I was fighting for everyone I had i believe to move while they proceeded with all the second incision up through the rib cage, there isn’t a words to go into detail the pain.”\nThen, they placed a tube in each incision, and this time, she was fighting for just a move. The anesthesiologist asserted her high blood pressure went another option of control.\n“The surgeon then did start to do the third incision, by himself still fighting to relocate. I remember the sticking in with the scalpel for your incision but, at the period they realized something was wrong and provided the max volume of drugs without killing me that will put me under.”\nAt the end on the surgery, the doctors were can not move her to recovery for 4 hours due to her high heartbeat.\nWhen she was transferred to second recovery, the nurse’s first question was what her pain level was, and he or she answered: “it could well be much lower if I has not been awake during that surgery.”\nExperienced Anesthesia Awareness twice\nThis unlucky patient experienced Anesthesia Awareness twice. Once at three years old, but she did not remember feeling anything throughout the operation, she just heard the doctors talking. Her heartrate sky rocketed knowning that was when doctors realized the fact that was happening and gave her a bigger dose of anesthesia.\nAnd additional time, was at 16 years of age. She was having surgery to fix some breathing problems. She could hear and feel everything. The doctors had no idea of the items she was experiencing.\n“I felt the surgeon cut through me and work to repair. The pain am excruciating that I was falling in and out of consciousness. It was terrifying.”\nAfter it had been all over, she did not remember a thing until a period of time later. “When I asked over it, they thought we would test me by showing me “partial-words” and asking me to convey whatever sounded familiar (any terms I may have often heard the doctors discuss.) They asked me to go into detail any pain I had felt, and also the only thing I could remember was whenever I felt a knife/blade cut me in any respect. ”\nduring a close watch removal surgery\nThe surgical tools didn’t cause Weiher pain — only pressure — nevertheless the injections of your paralytic drug through the operation “felt like ignited fuel,” she said. “I thought, well, maybe I’ve been wrong about playing, and I’m in hell,” she said. The entire surgery lasted five-and-a-half hours. Sometime during it she either passed out or fell unconscious underneath the anesthetic. When she awoke, she started to scream.\n“All I could say to anyone was, ‘I was awake! I was awake!’” she said.\nWeiher is truly one of few people with experienced anesthesia awareness. Although usually a patient won’t remember anything about surgery that requires general anesthesia, about a couple people in most 1,000 may wake during general anesthesia, in line with the Mayo Clinic. |
[Oral history interview of Michael DeBakey talking about China by Donald A. Schanche]\nDuring 1972-1973, journalist Donald A. Schanche (1926-1994) conducted a series of interviews with DeBakey as part of his research\nfor a planned biography. Schanche worked on the project for several years, but the book was never completed. Several letters\nin the NLM DeBakey Papers indicate that Schanche, though a talented, experienced writer and editor, had difficulty drafting\nDeBakey's life story because of the sheer number and variety of DeBakey's interests and achievements. In 1976, Schanche\njoined the Foreign Division of the Los Angeles Times, and moved to Cairo. It appears that neither he nor DeBakey were able\nto follow up with the biography.\nThis interview focused on DeBakey's first trip to the Peoples Republic of China in February and March of 1973. Topics\ncovered in this interview include: DeBakey's observations on everyday life in Maoist China; briefings from the Ministry\nof Health; China's "barefoot doctors"; giving a lecture; observing surgery at a hospital; traveling by train;\nChina's health care system; members of the China-America Relations Society; earlier invitations to visit China; acupuncture\nanesthesia; visit to pharmaceutical factory; herbal pharmacies; compassionate treatment of hospital patients.\nNumber of Image Pages:\n80 (2,595,299 Bytes)\nDeBakey, Michael E.\nInterviewer: Schanche, Donald A.\nReproduced with permission of Anne Schanche Ferro. |
Ear Surgery in Lafayette, LA\nAt Plastic Surgery Associates of Lafayette, the surgeons understand the stigma that often accompanies protruding ears and work very carefully to reconstruct their ears to look normal and increase self-esteem.\nWhat is Ear Surgery?\nEar surgery, also known as otoplasty, is recommended to correct ears that protrude or are disfigured. Ear surgery corrects the shape, position, and the proportion of the ear and is appropriate for adults and children at least four years of age. Known to some as ear pinning, the procedure is purely cosmetic and cannot treat any degree of hearing loss.\nBenefits of Ear Surgery\n- Bring better proportion to your ears and facial features\nCorrect ear deformities present from birth\nRestore the ears after an accident or sports injury\n- Improves confidence\n- Makes patients feel normal\nEar Surgery Procedure\nOtoplasty surgery takes around one to three hours, depending on the complexity. Although general anesthesia is usually recommended for children, adults can either choose between general or local anesthesia.\nA small incision is then made in the fold along the back of the ear. The skin and cartilage are manipulated and reshaped to achieve the desired appearance. Even when only one ear needs to be reshaped, your doctor may work on both ears to ensure symmetry. Your ears are wrapped with a thick bandage to protect them and help your ears heal properly. The bandages also reduce swelling.\nPreparing for Ear Surgery\nIf your ear surgery is performed on an outpatient basis, be sure to arrange for someone to drive you home after surgery and to stay with you for at least the first night following surgery.\nIt is best to maintain a positive attitude before your ear plastic surgery. If combined with a thorough understanding of the expected recovery, your otoplasty procedure will be a good overall experience.\nEar Surgery Recovery\nRecovery from ear surgery is an individualized process that depends on many factors, such as physiology, extent of correction, and patient self-care.\n- You may have some swelling, tenderness, and bruising.\n- Sleep with your head elevated for at least three days.\n- You then return to our office to be evaluated by your plastic surgeon and to have your bandage replaced.\n- Your stitches are removed after seven days.\nThe next step of your recovery is giving yourself time to heal. Typically, adults require at least three days, while children are asked to limit their activities for up to seven days. Even after the initial healing, you will need to protect your ears from injury for up to three weeks. You should not bend or manipulate your ears for at least one month.*\n*Take note individual results may vary\nWhat Does Ear Surgery Cost?\nWe accept most insurance plans and we offer financing options through CareCredit®. The total cost depends on the procedure. After your consultation appointment, we give you a total cost that includes anesthesia, pre- and post-operative care, and other associated costs. To learn more, call our office today.\nWhat to Expect During your Consultation\nWe believe exceptional patient care is a right, not a privilege. Several areas will be covered during your consultation, including:\n- Your medical history\n- Discussion of your concerns and goals\n- Explanation of procedure and expected results\n- Customized treatment plan(s)\n- Applicable fees and financing information\nPlastic Surgery Associates of Lafayette offers cosmetic treatments using the latest medical advances to patients in entire Acadiana region, including New Iberia, Abbeville, Lake Charles, Alexandria, Baton Rouge, New Orleans, Shreveport, and Monroe. For your private consultation, contact our office today. |
The perioperative surgical home requires successful integration of the four phases of care—preoperative, intraoperative, postoperative and post-discharge. A preoperative evaluation clinic can play a key role in enhancing the latter, achieving added and billable value for anesthesiologists in the process.\n“Many of us in this room are capable of delivering preoperative care just like hospitalists can, and we are therefore eligible to receive payment for it,” said Thomas R. Vetter, MD, MPH, professor of anesthesiology and perioperative medicine at the University of Alabama at Birmingham (UAB). “It’s important that anesthesiologists demonstrate continued high value to our institutions, or our importance will become smaller and smaller.”\nPreoperative Consultation And Treatment\nAs Dr. Vetter explained at the 2016 American Society of Anesthesiologists (ASA) Practice Management annual meeting, the typical preoperative process involves a surgeon making the decision of when to operate and then posting the case—often as soon as the day before the surgery.\n“That’s not realistic or pragmatic,” said Dr. Vetter. “What we’re trying to do is switch the order of this so that we get an opportunity to evaluate and manage these patients earlier in the game.”\nWith their Preoperative Assessment, Consultation and Treatment Clinic (PACT Clinic), Dr. Vetter and his colleagues at UAB have undergone an evolution in their approach to preoperative clinical care. The first step, said Dr. Vetter, was to develop a preoperative patient risk screening tool.\n“You have to figure out locally what’s important to your stakeholders,” he explained. “We undertook a survey of all our anesthesiologists, our nurse anesthetists and surgeons.”\nThe result was a preoperative consult and clearance questionnaire that contains simple red flags that indicate a need for a PACT Clinic consult and clearance before a definitive surgery date. The questionnaire is completed on a tablet by patients as they are waiting in the surgery clinic and uploaded into the electronic medical record (EMR).\n“If a patient has one of the listed conditions,” said Dr. Vetter, “it’s a red flag. The patient is given a tentative surgery date of 21 days later and a priority appointment in PACT Clinic within one day.”\nAfterward, the PACT Clinic provides the surgical clinic with the estimated time needed for adequate assessment and treatment, which could be 21 days or only two days. The PACT Clinic appointment itself may be a formal evaluation and management (E&M) code–based preoperative consultation. The figure outlines some of the key elements that support the PACT Clinic concept.\nFor Dr. Vetter and his team, therapeutic intervention is a big part of the value stream, and preoperative anemia management has become one high-value target.\n“Not only does a unit of blood cost somewhere between $750 to $1,000 to acquire,” said Dr. Vetter, “but when you look at downstream morbidity and mortality, it’s $2,000 to $2,500. Allogeneic blood is lifesaving in some occasions, but overall it’s a very expensive proposition.”\nHe added, “If you can tackle perioperative blood management and reduce transfusion, that will win a lot of favor with your hospital leadership.”\nDr. Vetter and his colleagues have a pilot study underway with the Division of Orthopaedic Surgery at University of Alabama Hospital, in Birmingham.\nCoding and Documentation Requirements\nBesides downstream benefits for patients and hospitals, preoperative consultation can be an additional revenue source for anesthesiologists—if billing requirements are met.\nAccording to an ASA report entitled “What Anesthesiologists Need to Know About Reporting E&M or TCM,” “management services [that] are beyond the scope of routine preoperative evaluation are separately billable with appropriate documentation.”\nIn most cases, said Dr. Vetter, these preoperative E&M services will be provided on an outpatient basis and will be reported by Current Procedural Terminology (CPT) codes 99201 through 99205 for a new patient or 99211 through 99215 for an established patient, as defined in the CPT Manual.\nAlthough anesthesiologists also have the opportunity to bill for post-discharge care in the form of Transitional Care Management (TCM) services, Dr. Vetter advised not to start with this additional service.\n“Post-discharge care planning is really, really challenging. Anesthesiologists are better off trying to figure out how to tackle preoperative E&M and generate some additional revenue in the process.”\nFor those wishing to start their own preoperative clinic, a core group of invested physicians is essential, Dr. Vetter pointed out.\n“You’re not just going to take someone out of the operating room and successfully put them in a PACT clinic,” he explained. “You need to figure out who wants to be a part of this team.”\nAn experienced clinic/nurse manager and a core group of autonomous advanced practice nurses are equally central assets. “In order to generate this product,” said Dr. Vetter, “advanced practice nurses have to be able to practice at the top of their license.”\nDr. Vetter also stressed the importance of acquiring outside assistance before starting a clinic. “Do not attempt this on your own,” he cautioned. “A little knowledge is a dangerous thing …. I encourage you to find someone who’s got real expertise in compliance—not just in the perioperative setting.”\nCommenting on Dr. Vetter’s presentation, Joseph William Szokol, MD, chairman of the Department of Anesthesiology at NorthShore University Health System, in Chicago, underscored the need for improved financial compensation in this area.\n“Right now, most people that have a preoperative anesthesia clinic don’t get paid for it because they don’t know how to bill for it,” said Dr. Szokol. “I think that by using E&M codes, you could actually make some money and make it valuable to your practice.”\nHe added, “You may also reduce testing and case cancellation, so there are downstream benefits for the hospital. But there should be benefits for the anesthesia group, as well.”\nLeave a Reply\nYou must be logged in to post a comment. |
Salivary gland stones, also called sialolithiasis, is a condition in which mineral deposits harden and form in the salivary glands. The majority of salivary gland stones form in the submandibular salivary glands, but may also form in the parotid glands (located on the side of the face, near the ears), sublingual glands (located under the tongue) and the minor salivary glands (located inside of the cheek or lips, under the tongue and beneath the palate).\nSalivary gland stones may be formed with calcium phosphate and calcium carbonate and range in size from a few millimeters to more than two centimeters. One in four individuals with salivary gland stones develops more than one stone.\nSymptoms of salivary gland stones include:\n- Swelling, pain or both in the salivary gland\n- Worsening pain or swelling when eating or anticipating eating\n- Tenderness and swelling in the face, mouth or neck\n- Dry mouth\n- Difficulty swallowing or opening the mouth\nSalivary gland stones may lead to infection in or around the affected gland. Symptoms of a salivary gland infection include fever and pus around the stone.\nThe exact cause of salivary gland stones is unknown, but the following factors are associated with the condition:\n- Gum disease\n- Trauma to the inside of the mouth\n- Dehydration caused by illness, inadequate fluid intake or medications such as diuretics and anticholinergic drugs\nThe condition is more common among individuals ages 30 to 60 and men. Other risk factors include:\n- Having radiation therapy on the head or neck\n- Sjögren’s syndrome\n- Kidney problems\nDiagnosing Salivary Gland Tumors\nDuring an initial visit, the physician will perform a physical examination of the head and neck to check for swollen salivary glands and salivary gland stones. The condition may be diagnosed with an x-ray, ultrasound or a computed tomography (CT) scan of the face.\nImaging may be necessary to rule out other conditions:\n- Salivary gland tumor\n- Salivary gland infection\n- Radiation exposure\n- Reaction to iodine given as part of an imaging exam\n- Sjögren’s syndrome\nPatients may treat the stone by sucking on sugar-free lemon drops or ice cubes and drinking water. This will help increase saliva production and may force the stone out of the salivary glands. Patients may be able to move the stone by applying heat and gently massaging the affected area.\nThe physician may prescribe an antibiotic to treat the infection or ibuprofen to alleviate pain and swelling.\nIf the stone is not very big, the dentist or physician may press on both sides of the gland to try and push it out. Large stones may need to be surgically removed.\nSialoendoscopy is a minimally invasive procedure performed to remove a salivary gland tumor. During the procedure, the physician makes a small incision inside the mouth near the affected gland and inserts a slender tube called a sialoendoscope. Various instruments are inserted through this tube to capture and remove the stone. The patient will be under local or general anesthesia during a sialoendoscopy.\nSome patients may need extracorporeal shock wave lithotripsy (ESWL). This treatment uses shock waves to break the stone into smaller pieces and allow them to pass through the gland. Patients will typically be sedated or under general anesthesia during the procedure.\nMost salivary gland stones are removed without complications. However, if patients continue to develop salivary gland stones, the physician may recommend surgically removing the affected gland. |
Gently get out of bed as soon as possible after your surgery. When you get up, sit with your legs hanging over the edge of the bed or chair for a few minutes before standing. This will help avoid problems with dizziness, light-headedness and fainting. Do not use your arms or upper body to push yourself out of a bed or chair. You may roll to your side and then sit up or stand up. Have an adult assist you the bathroom the first few times. Always get out of bed to go to the bathroom. Begin to walk as much as possible as soon as you can after surgery. Do take it easy the first few days. Do not exert yourself in any strenuous activity. Avoid strenuous activities that involve arm movement such as raising your arms over your head and lifting with your arms. A balance of rest and reduced activity will speed up your recovery.\nWhile more experienced surgeons may charge more for their expertise, that’s not always the case. “You should not choose a qualified surgeon based on high fees any more than you should choose one based on low fees,” says Boca Raton, Florida plastic surgeon Dr. Hilton Becker in a RealSelf Q&A. “The most important factors should be education, experience, certification, and your ability to feel comfortable with your surgeon.”\nThe use of birth control will not affect the anesthesia. There is however, some evidence and literature that states birth control pills may cause some blood clots or blood clotting issues. If this has been your experience in the past with any other types of surgery, then there are certainly precautions that we can take. We will always use a compression stockings to prevent any blood clots in your calves, and we encourage you get up and slowly start walking once you are able.\nThere’s saline, silicone, “gummy bear” (aka cohesive gel), and autologous fat, explains Dr. Rowe. For the latter, you’ll need around two to three pounds of fat to inject into the chest, and patients often need touch-ups to achieve symmetry. With saline, the implant ripples more, and some patients think that it feels heavier. If a saline implant ruptures, it’s absorbed into your body safely; however, the difference is very noticeable, so you’d likely want to see a doctor ASAP anyway, explains Dr. Doft. Silicone tends to feel more natural, hold its shape, and ripple less. Dr. Doft says the majority of her patients choose silicone.\nFrom your description, you seem to be a very good candidate for this new technique and should really get the look that you are desiring without implants or any unnecessary visible scars. I would recommend that you search for an ABPS board certified plastic surgeon who is also a member of the American Society of Plastic Surgeons and the American Society of Aesthetic Plastic Surgeons in your area or an area that you would like to travel to on holiday who offers the Bellesoma technique to discuss your breast reduction and possible results. You've provided great information - the only thing that would be more helpful in order to give you the best advice about your options would be an in-person exam.\nThe first step toward finding out if you are a candidate is a thorough consultation with a board-certified plastic surgeon who has extensive experience performing breast augmentation. He or she will examine your breasts, your skin tone and the rest of your anatomy to help determine if you are an appropriate candidate. You also may have the option of viewing plastic surgery photos from past patients to better gauge expectations. Other factors, including breast augmentation cost and whether your lifestyle and commitments will allow you to take enough time off to recuperate properly, also play a role in determining your candidacy.\nBreast reduction involves reducing the size of the breast. A breast lift involves lifting the nipple-areolar complex and reducing the excess skin of the breast. Breast reductions can involve just liposuction in patients who have more fatty tissue than glandular breast tissue. Liposuction alone indeed does reduce the volume of the breasts. However, sagging of the breast can result and liposuction alone is therefore performed usually in highly selected patients.\nBoth anesthesiologists and registered nurse anesthetists can administer anesthesia. An anesthesiologist is a specially trained physician who will administer anesthesia and monitor your vital signs during surgery. A registered nurse anesthetist has specialized training to do the same. However, while a registered nurse's services can cost about $300 per hour, an anesthesiologist's services can cost closer to $500 per hour.\nFor me, the main area of concern is my forehead, which I’m told by all the greatest in injectables, to be the most common for those under thirty. After too many holiday sunburns, and recognising that I speak with very expressive eyebrows, the fine faint lines horizontally across my forehead have become much more prominent. So, in the name of beauty journalism I decided to give botox a try, here's what I learnt...\nTwenty-five percent of women will need another surgery after 10 years because implants don’t last forever. The implant could begin to leak over time or a “scar shell” could develop around it, warping the shape and causing a need for new implants. Weight loss, pregnancy, and change in preference are other factors that could lead the patient to having another surgery after a few years.\nIn the mid-twentieth century, Morton I. Berson, in 1945, and Jacques Maliniac, in 1950, each performed flap-based breast augmentations by rotating the patient's chest wall tissue into the breast to increase its volume. Furthermore, throughout the 1950s and the 1960s, plastic surgeons used synthetic fillers—including silicone injections received by some 50,000 women, from which developed silicone granulomas and breast hardening that required treatment by mastectomy. In 1961, the American plastic surgeons Thomas Cronin and Frank Gerow, and the Dow Corning Corporation, developed the first silicone breast prosthesis, filled with silicone gel; in due course, the first augmentation mammoplasty was performed in 1962 using the Cronin–Gerow Implant, prosthesis model 1963. In 1964, the French company Laboratoires Arion developed and manufactured the saline breast implant, filled with saline solution, and then introduced for use as a medical device in 1964.\nIn the 1980s, the models of the Third and of the Fourth generations of breast implant devices were sequential advances in manufacturing technology, such as elastomer-coated shells that decreased gel-bleed (filler leakage), and a thicker (increased-cohesion) filler gel. Sociologically, the manufacturers of prosthetic breasts then designed and made anatomic models (natural breast) and shaped models (round, tapered) that realistically corresponded with the breast- and body- types of women. The tapered models of breast implant have a uniformly textured surface, which reduces the rotation of the prosthesis within the implant pocket; the round models of breast implant are available in smooth-surface- and textured-surface- types.\nPost-operative patient surveys about mental health and quality-of-life, reported improved physical health, physical appearance, social life, self-confidence, self-esteem, and satisfactory sexual functioning. Furthermore, the women reported long-term satisfaction with their breast implant outcomes; some despite having suffered medical complications that required surgical revision, either corrective or aesthetic. Likewise, in Denmark, 8 per cent of breast augmentation patients had a pre-operative history of psychiatric hospitalization.\nAlthough botox is now more widely available than ever before, it’s so important you see a qualified, experienced expert, even if they are more expensive. Yes, there are some clinics that will charge you super-low prices, but remember, if it seems too good to be true, it probably is. Before booking into the Cadogen Clinic I read countless positive reviews on Facebook and Google, yes at around £300 it might not have been the cheapest, but I knew I was in safe hands. Be smart and do your research people, after all, this is your face, you don't want f*ck it up.\nSince the late nineteenth century, breast implants have been used to surgically augment the size (volume), modify the shape (contour), and enhance the feel (tact) of a woman's breasts. In 1895, surgeon Vincenz Czerny effected the earliest breast implant emplacement when he used the patient's autologous adipose tissue, harvested from a benign lumbar lipoma, to repair the asymmetry of the breast from which he had removed a tumor. In 1889, surgeon Robert Gersuny experimented with paraffin injections, with disastrous results.[further explanation needed]\nPrivate surgical suites: these surgical suites tend to be located at the surgeon’s office. They also tend to be the least expensive of the three since the surgeon can control overhead and costs associated with their operating room. One significant benefit to the private surgical suite is the doctor will be very familiar with the layout of the facility and usually uses the same surgical staff.\nDr. Sajan believes in complete transparency when it comes to his plastic surgery pricing. As such, your investment covers all costs that are associated with your procedure – including Dr. Sajan's services, as well as facility, computer imaging, operating room, anesthesia and materials fees, breast implant costs, and pre- and post-operative visits. During your initial consultation, Dr. Sajan will review all of these associated costs with you, to make sure you have a clear understanding of what is included in your investment.\nNow, there is also the of a capsular contracture. A capsular contracture simply means that when you put an implant in a human body, your immune system or your body will recognize the implant as foreign. This is one of the main reasons the implant envelope is made from silicone and no other materials like rubber, plastic, etc. because silicone is the most medically inert substance known to man. Silicone is the least offensive material to your immune system, so your immune system is likely to detect it and say OK yes this is something foreign, but it’s not aggressive so it’s not any threat to us. Therefore, what your body will do is form a capsule around the implant, and that’s the end of the immune response.\nFor women who experience breast sagging, I would recommend a breast lift; not breast reduction surgery. Breast reduction can provide a more modest breast size by removing tissue and skin from the breasts; however, a breast lift is needed to achieve a perkier, higher-positioned breast contour. It’s very common for patients to combine their breast reduction surgery with a breast lift to achieve more comprehensive breast enhancement results.\nIf you have considerable sagging, pendulous breasts, an anchor lift, which allows a cosmetic surgeon to remove a significant amount of excess skin and sagging tissues, may yield the best results. This technique involves 3 incisions: one around the edge of the areola, one vertically from the bottom of the areola to the breast crease, and one along the inframammary fold, hidden in the breast crease. Your cosmetic surgeon may also use this technique if you are having a breast reduction with lift. While the anchor lift comes with some visible scarring, these typically will fade significantly with proper care, and are easily hidden by a bikini top.\nWhen trying to determine the best implant size for your surgery, this is where you need to be very honest and exact about what you want. There is no need to feel embarrassed or shy about what you are wanting, but if you don’t accurately communicate your expectations to your Surgeon they will not be able to give you what you want. If you want an exaggerated fake look than say so, if you want an enhanced natural look that that is what you tell the Surgeon. Based on the look you are wanting the Doctor will be able make recommendations for you to achieve your desired result. There are so many varieties of implants that it is important that both you and your doctor are on the same page about expectations.\nAfter breast implants surgery, a patient has to apply bandages to protect the chest area. A tube that is inserted in order to facilitate the draining of any expected, temporary fluid discharge. A follow-up appointment is scheduled for approximately 48 hours after breast augmentation surgery. This appointment is in order to complete the routine removal of bandages, dressings, and draining tubes.\nThe weight difference between equal volumes of saline, silicone, and breast tissue is slim to none, so a natural C cup and an augmented C cup are very similar in weight, says Dr. Kolker. If you choose an implant size proportional to your frame, you will see little effect on your posture. However, if you choose large implants, you will feel the effects.\nThere’s definitely no denying, the B word has definitely been a talking point of late, not just in the media, but within my close circle of friends too. Would you? Wouldn’t you? Have you? Has she? I promise it’s not as ‘Real Housewives of Cheshire’ as it sounds... But whilst I'm only 28, the reality is that the constant stream of late nights, binge drinking (sorry Mum) and falling asleep with a full face of makeup on, are all starting to show their effects.\nSince experienced surgeons are aware of these issues with saline breast implants and their need for eventual replacement, they opt to place them under the chest muscle. The chest muscle works as an extra layer of tissue over the implant, which makes for a smoother transition from the chest wall to the implant. The finished product is a more seamless transition versus a more visible and abrupt change when the implant is not placed below the pectoral muscle. As for gel breast implants, they can also be safely placed below the pretorial muscle if that is a viable option for the patient since replacement and wrinkling is less common with this type of implant. |
At CuraWest we have extensive experience treating men and women of all ages and walks of life who have been suffering at the hands of a morphine addiction for any length of time. Our private, homestyle detox facility offers a level of comfort and clinical care that can not be found in any state-run facility or traditional hospital setting. We believe that no two addictive disorders are the same, therefore no two programs of detoxification should be identical. Our detox program is integrated and highly individualized. We understand that what works for one client might not work as well for another. One of our core objectives is to consistently put the safety and well-being of each individual client first.\nThe US National Library of Medicine suggests that morphine is an opioid analgesic that will only be prescribed to treat moderate to severe pain – it is extremely uncommon that a medical professional would prescribe this medication to treat mild pain, seeing as it is so habit-forming and potentially dangerous to use. Morphine comes in two forms – in an extended-release pill or capsule, or as a liquid. The oral solution is generally taken every four, eight or twelve hours (or as needed) for pain, and will only be used in the treatment of severe, chronic pain-related disorders that cannot be successfully treated with any other opioid pain medication.\nIn short, morphine is typically considered a “last resort,” and is only utilized when all other treatment methods have failed. In its liquid form, this medication is even more potent. In the vast majority of instances, liquid morphine will only be administered in a hospital setting in cases of acute and severe pain, such as pain related to cancer treatment, surgical procedures or severe accidents. |
This month’s edition of Current Opinion in Anaesthesiology is replete with neuro-topics, ranging from awake craniotomy to complex spinal surgery and anaesthesia for stroke thrombectomy. Well worth a read, this collection of articles provides (often excellent) summaries of evidence and current practice in numerous fields relevant to the neuroanaesthetist.\nFrom our quality-focused colleagues at the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) comes this set of guidelines for management of the most common emergencies encountered in neuroanaesthetic practice. Conceived with the purpose of addressing complex emergent issues in a concise, goal-directed and simplified manner, these cognitive aids are clear-cut and based on… Continue reading SNACC – How to Handle Neuroanaesthetic Emergencies\n“The author recommends a controlled anesthesia induction by trained pediatric anesthesiologist with suitable equipment for the children considered at risk of pulmonary aspiration.” Rapid sequence induction has no use in pediatric anesthesia. Engelhard, UK. Paediatric Anaesthesia, 2015 Jan. Read the abstract from the review article here. |
Wisdom Teeth Removal\nIf healthy and functional, your wisdom teeth can be useful. However, there are some reasons why you may need to consider removing your wisdom teeth.\nAt Dental Depot, we know that wisdom teeth removal is important. Your third molars, commonly known as your wisdom teeth, are typically the last teeth to erupt in your mouth.\nIn some cases, your wisdom teeth are in fact healthy, but because of orthodontic treatment, they need to be removed. In other cases, your wisdom teeth can become impacted or only partially erupt through the gum in a misalignment. When impacted or partially impacted, your wisdom teeth can cause swelling, pain and even infection of the surrounding gum. They can also put pressure on the adjacent teeth, which can result in permanent damage to these otherwise healthy teeth and their surrounding bone.\nSometimes, impacted or partially impacted wisdom teeth can also lead to the formation of cysts, and in worse case scenarios even tumors, which could potentially destroy an entire section of your jaw.\nLastly, a fully erupted wisdom tooth needs to be removed because they are very hard to clean and can become severely decayed. So for these reasons sometimes the smart move is to have your wisdom teeth removed.\nWhether your dentist or a specialist is removing your wisdom tooth the procedure is the same:\nFirst, a local anesthetic is given to make the procedure more comfortable. In some cases, your doctor may elect to administer nitrous oxide gas in addition to the anesthetic or use a general anesthetic to put you under entirely.\nOnce the area is numb, the extraction begins. A dental instrument called an elevator is used to wiggle the tooth in its socket.\nAfter the tooth is loosened it is removed using forceps or in some more complicated cases, a surgical handpiece is also used to assist with the removal of the tooth.\nPossible Complications With Extractions\nLike most other procedures, tooth extraction is not free of possible complications. You should be aware that there is a slight chance of infection, tenderness, prolonged bleeding, dry socket and loosening of neighboring teeth or their fillings or crowns. Another rare possibility is an upper tooth getting displaced into the sinus. Lastly, jaw fracture and temporary or permanent numbness are also very rare possibilities.\nWhen Should I Remove My Wisdom Teeth?\nThere is no single right answer for everyone; however, if your dentist has advised you that your wisdom teeth look potentially problematic it’s generally best to remove them sooner rather than later. This advice is based on the fact that the younger you are, the faster you heal. The likeliness of lingering numbness, jaw fracture or other complications also increases with age. Lastly, the longer you leave a troublesome wisdom tooth in your mouth, the longer it has to cause further problems in the future.\nRequest an appointment to get advice on wisdom teeth removal!\nCavities form when bacteria feed on the residual sugars and starches left in your mouth from eating and drinking. Eating and drinking high-sugar food and beverages transfers more sugar to your mouth, sugar that you may not be able to completely remove, even with brushing and flossing. When a bacterial cell absorbs that sugar, it\nYour baby’s first teeth are the first of many exciting development milestones. Caring for them early and knowing what lies ahead in your child’s oral development can help ensure she or he has a healthy, beautiful smile for life. What teeth are baby teeth? Baby teeth can also sometimes be referred to as primary teeth,\nThe New Year is always a wonderful opportunity to start fresh and think about your goals. Maybe you want to volunteer more or live healthier or maybe you’re ready to get started on achieving your healthiest, most beautiful smile. After all, a new year brings new dental insurance benefits for you to take advantage of. |
Marijuana + Breast Augmentation Q&A\nI smoke weed daily and hear that it can affect anesthesia, does it affect recovery also? How long will I have to wait post op before smoking again? READ MORE\nI have quit smoking for two weeks now and just had my surgery today. I was wondering when its safe to start smoking again without risking C.C.?... READ MORE\nOr eat it? I am a regular consumer of marijuana and don't want to take a break, but can if I have to for safety with general anesthesia. How much... READ MORE\nI did mdma sunday may 12 i dont do it i a regular basic , im healthy , 5'4 118 pounds , ive been drinking plenty of water but i also smoke weed ,... READ MORE\nDoes Using Medical Marijuana (Edibles: Chocolate, Brownie) Help or Hinder Breast Augmentation Recovery?\nI live in California, have legal license for Medicinal Marijuana (i have sleeping problem). I don't ever smoke, only use edibles (indica type... READ MORE\nI am really nervous about my Breast Augmentation surgery. It is scheduled for December 19, 2012. I've been smoking marijuana everyday now for about... READ MORE\nI'm having my breast augmentation tomorrow and I was wondering if I smoke pot can complicate anything on my surgery I had anxiety and I know I can't... READ MORE\nI had an operation on my lip two weeks ago to improve the appearance of my cleft lip and have been told by my surgeon that any form of smoking can... READ MORE\nI underwent a bilateral breast augmentation about three days ago and am finally starting to feel better. I know that smoking tobacco and nicotine... READ MORE\nHi got my breath done three days ago and I am healing great and have had hardly any pain at all . I had 360 (r) and 390 (l) under the muscle. I... READ MORE\nI have a breast augmentation this Friday Nov. 7th and have been smoking Marijuana to help me sleep. Is this bad for my surgery?\nMy weed is not laced with tobacco or anything else my friend with a license grows so I know this for sure. I know smoking tobacco is a big "no no"... READ MORE\nCan smoking weed, without mixing it with nicotine, be harmful to my healing 13 days post Breast Augmentation?\nI am 13 days post breast augmentation and was wondering if smoking weed could harm the healing process in any way since I could NOT sleep well at... READ MORE\nI don't smoke cigarettes anyway, just marijuana. I'm currently not smoking due to my peri Aureole mastopexy. I'm 3 1/2 weeks post op and am wondering... READ MORE\nMy surgery is on July 21st. I have my medical card and smoke marijuana because of chronic back pain. I was told by my surgeon I would need to quit... READ MORE\nI quit smoking cigarettes 3+ weeks ago for my Breast augmentation but I've still smoked Marijuana daily. I feel like I should have quit sooner now but... READ MORE\n5 days before breast aug and I took a hit of marijuana and drag of tobacco. Will this harm my recovery?\nWill this ruin me? i have a serious addiction to tobacco and obviously have no self control, will i be okay? READ MORE\nWill I be okay to walk around for 3 days at a music festival 5 weeks post op? Can I wear shirts with no bra? My breasts are now a large c/small d. Can... READ MORE\nI live in MI and have a medical marijuana card. I suffer from chronic pain (broken leg never healed properly) and anxiety. I'm a daily marijuana... READ MORE |
NetWellness is a global, community service providing quality, unbiased health information from our partner university faculty. NetWellness is commercial-free and does not accept advertising.\nSaturday, October 25, 2014\nPossible Cancer in Kidney\nMy uncle just had open-heart surgery and through general checkups, the doctors found a growth on his kidney. Some spots also showed up on his lungs on an x-ray. The doctor seemed to think it was from being under anesthesia and he had developed pneumonia. He was never examined again (for the spots and growths) and is now in the process of getting a spend-down medical card. He has workers compensation but has no medical insurance. I`m afraid he`s not being examined very well and this could be cancer. Any thoughts on his prognosis.\nThis is a hard question to answer. This is a national problem now. There is no good answer other than he needs a chest CT. A large hospital such as the Cleveland Clinic, University Hospitals in Cleveland or Ohio State University Medical Center all have programs for individuals in his situation.\nThomas Olencki, DO\nClinical Professor of Medical Oncology\nCollege of Medicine\nThe Ohio State University |
MyMediTravel currently has no pricing information available for Knee Ligament Surgery (PCL) procedures in South Korea. However, by submitting your enquiry, you'll hear back from the facility with more details of the pricing.\nSarang Plus Hospital, located in Dogok dong, Seoul, South Korea offers patients Knee Ligament Surgery (PCL) procedures among its total of 124 available procedures, across 1 different specialties. Currently, there's no pricing information for Knee Ligament Surgery (PCL) procedures at Sarang Plus Hospital, as all prices are available on request only. All procedures and treatments are undertaken by just a small team of specialists, with 2 in total at the Hospital, and they are not accredited by any recognized accreditations institutes\nGangnam Severance Hospital, located in Dogok dong, Seoul, South Korea offers patients Knee Ligament Surgery (PCL) procedures among its total of 502 available procedures, across 14 different specialties. Currently, there's no pricing information for Knee Ligament Surgery (PCL) procedures at Gangnam Severance Hospital, as all prices are available on request only. There are many specialists available at the Hospital, with 8 in total, and they are accredited by JCI Accredited\nI am an American living in Seoul. I had shoulder surgery and follow up physical therapy at Nanoori from Feb - Jun 2015. The medical care is fast and efficient. At first visit I had evaluation, x-ray, MRI, care plan and scheduled future surgery within 3 hours of arriving. Surgery was successful. Hospital stay was enjoyable. Follow up visits always had very little waiting. Staff and physicians are always friendly and helpful. I will use this hospital again if the need arises.\nAsan Medical Center, located in Dogok dong, Seoul, South Korea offers patients Knee Ligament Surgery (PCL) procedures among its total of 586 available procedures, across 16 different specialties. Currently, there's no pricing information for Knee Ligament Surgery (PCL) procedures at Asan Medical Center, as all prices are available on request only. There is currently a lack of information available on the specialists practicing at the Clinic, and they are not accredited by any recognized accreditations institutes\nAt MyMediTravel, we're making medical easy. You can search, compare, discuss, and book your medical all in one place. We open the door to the best medical providers worldwide, saving you time and energy along the way, and it's all for FREE, no hidden fees, and no price markups guaranteed. So what are you waiting for?\nKnee ligament surgery (PCL), or posterior cruciate ligament surgery (PCL Surgery), is a surgical procedure to repair or reconstruct a ligament in the knee. It may involve reattaching the ligament fibers that are torn. In some cases, additional tendon or other tissue is required in order to reconstruct ligaments that are severely damaged.\nThe PCL is one of the ligaments connecting your thigh bone to the lower leg bone. This ligament helps to stabilize your knee during movement. The PCL can be injured due to an accident. When the injury is severe and the PCL is torn, surgery is needed to reconstruct or repair it. PCL surgery is also recommended if the PCL is disconnected from the bone, more than one ligament in the knee is affected, how well your knee moves and your ability to move around or perform activities are affected, or if other types of treatment fail.\nA posterior cruciate ligament can be performed as a minimally invasive procedure. Your surgeon will start by making small incisions around your knee. Then paths will be created in the incisions to insert surgical tools. The surgery can be done to:\nRepair the PCL – if there is enough ligament that is still intact, your surgeon will secure the damaged ligament back onto the bone. Sutures will be used to repair any tears in the ligament. Sutures will also be used to secure the ligament to the bone/.\nReconstruction – during reconstruction, tendon tissue from a donor cadaver or another part of your body is used. Any damaged ligaments that remain in the knee are removed from the knee joint. Your surgeon will create small incisions on the surface of the shinbone inside the knee and the thighbone. Then, your surgeon will thread the additional tendon through the incisions and uses staples or screws to secure it. Your surgeon will test your knee’s range of motion once the graft is securely in place.\nWhen either the repair or the reconstruction is completed, your surgeon will close the skin with stitches and place bandages on the knee.\nThere are two types of anesthesia that may be used during PCL: spinal anesthesia and general anesthesia. With spinal anesthesia, you will be awake throughout the procedure but won’t feel anything in your legs. You may also be given a sedative to help you relax. With general anesthesia, you will be asleep and unaware of anything throughout the procedure.\nPCL surgery usually takes around 2 hours to complete. You need to stay in the hospital for at least one night, plan to stay in South Korea for at least 1 or 2 weeks after surgery to allow time for your body to heal and to attend follow-up checkups.\nYou can gradually return to your normal activity as recommended by your surgeon. For office work, you may be able to return to work in 2 to 3 weeks. However, you need to wait at least 3 months if you do physical work. You can generally start taking part in sports within 6 months. Complete recovery can take around six to nine months.\nThe aftercare for PCL will focus on rehabilitation and pain relief. You will need to take part in formal physiotherapy after surgery. The first few physiotherapy appointments are designed to help you control the swelling and pain. Within three weeks, your physiotherapist may begin to focus on a range of motion exercises. It is important that you visit your doctor and physiotherapist on a regular basis until you recover completely. You can always choose to do the physiotherapy at home instead of in South Korea. Physiotherapy is important to get movement, reflexes, and strength back into your knee.\nBesides physiotherapy, the following are the aftercare instructions of PCL surgery:\nImmediately after surgery, your surgeon may also prescribe pain medication. Make sure to take your medications as and when prescribed by your surgeon.\nYou may need to use a knee immobilizer and crutches during early recovery to decrease stress on the knee but keep you mobile.\nWhile resting, put pillows below your knee to keep it elevated above your feet.\nAvoid climbing up the stairs.\nEat healthy nutritious food to speed up your recovery.\nUse ice packs to reduce swelling.\nAsk family members/friends to help you and look after you during the early stages of recovery.\nFollow all post-operative instructions from your surgeon.\nBased on patient function, symptoms, and overall satisfaction, PCL surgery has a high success rate of about 90%. However, the success rate of this procedure depends on several factors, such as other potential damage that may be present in the joint.\nWhile potential risks are rare, PCL surgery does carry some risk such as infection, excess bleeding, blood clots, persistent pain, knee instability, continued stiffness and/or numbness in the knee, and a possibility of additional surgery in the future if the treatment fails.\nIf your recovery is not progressing as expected or if you experience fever and chills, increasing pain, that cannot be controlled with medications your surgeon prescribed, and persistent nausea or vomiting, it is important that you call your doctor right away.\nIf the injury is severe or if you have persistent knee instability despite other treatments, you would not be suitable to have other alternatives than surgery. However, in most cases, surgery is not required if the injury is not severe. In this case, you have the option to undergo physical therapy. During physical therapy, a therapist will teach you exercises that will help improve your knees function and stability, as well as to make it stronger. You can also take over-the-counter (OTC) pain relievers to help relieve pain and reduce swelling.\nInjury in the posterior cruciate ligament can cause disability and knee instability. You may also experience pain and swelling due to the injury. If left untreated, you might also be at a high risk of eventually developing arthritis. Before PCL surgery, you cannot walk normally or enjoy sports due to the symptoms that your PCL injury brings. After surgery, any pain and swelling should be gone. You can also enjoy activities again and the risk of developing arthritis is significantly reduced.\nWhilst the information presented here has been accurately sourced and verified by a medical professional for its accuracy, it is still advised to consult with your doctor before pursuing a medical treatment at one of the listed medical providers. This content was last updated on 11/09/2020. |
My background is that of a Board Certified Anesthesiologist with twelve years experience in academic medicine and ten years experience in private practice. My undergraduate education includes a BA in Biology from Clark University and I went on to obtain a Doctorate in Medicine from the University of Massachusetts. My training and experience afforded me a well developed understanding of human physiology, anatomy, and pharmacology from a clinical background were I functioned in the role of a cardiac anesthesiologist and then later in the field of anesthesiology for obstetrics and gynecology. I taught at the medical school and post graduate levels in anesthesiology theory and practice. I am a physician approaching my fifth year of recovery from an addiction under the guidance and monitoring with the Massachusetts Medical Society division of Physician Health Services. I seek employment in teaching and or research in my quest to regain my life and forgiveness for my mistakes. I would be happy to discuss this openly with you and the Physician Health Service would provide you with documentation of my recovery.\nAt Florida Atlantic I would gain the physician recognition of the year award and I would switch my practice interests to Anesthesia for the gravid female in the labor division of Obstetrics at Holy Cross Hospital in Fort Lauderdale. I would provide epidural analgesia for labor and delivery and manage complex fetal and maternal issues for safe and effective anesthesia in cases presenting with maternal and fetal compromise, eclampsia, uterine rupture and cord prolapse cases. I developed a keen appreciation for the physical and metabolic maternal fetal changes at late stages of labor and applied that to issues related to maternal and fetal hypoxia, hypertension, and fetal asphyxia and acidosis in the delivery period. My skills and understanding of physiology were often called on by other professionals in situations that were complex and dire and my decisions were often critical in the survival of the mother and fetus. This was a point in my career that the years of experience that I had come with brought me to a new level of confidence among my superiors and subordinates that only time and experience could muster.\nMy experience and knowledge from the University of Massachusetts and the University of Miami was invaluable however exhausting both physically and emotionally. At this time in my career I chose to move to private practice where the demands were less taxing and the compensation would allow me to earn enough money to pay off my student debt which accumulated to over one hundred and twenty five thousand dollars. Over the following 4-5 years I was able to pay my debt off and when I finished employment at Sheridan I was virtually debt free. My duties at this job were providing routine anesthesia services in hospital based and office based practices.\nI joined the faculty of the University of Miami at Jackson Memorial Hospital as a cardiac anesthesiologist in September 2000. My responsibilities were similar to my position at UMass however I expanded my experience and practice to managing cardiac and lung transplant patients. My expertise developed in managing the pharmacology and physiology of donor hearts and lungs being transplanted to recipients with life threatening cardiac and pulmonary anomalies. I became proficient in predicting and averting organ failure intra operatively and post operatively stabilizing circulation through pharmacological and ventricular assist devices, transfusion, and artificial respiratory maneuvers and devices. I worked closely with all levels of professional providers and delivered with them a standard of medical care rarely thought possible in the past.\nI joined the faculty of UMass shortly after my graduation from residency in 1991. My duties included the coordination of medical students and teaching anesthesia theory and practice. Clinically I joined the cardiac anesthesia team and began developing skills in the intra and post operative management of cardiac patients undergoing open heart surgery for valvular and vascular replacements from various pathologic conditions. My expertise developed from experience managing complex and dangerously fatal cardiovascular and metabolic compromise inherent in the disease process as well as the complications related to the use of artificial cardiopulmonary bypass circulation devices and the practice of stopping a beating heart. I became proficient in diagnosing and treating cardiovascular instability and techniques in anesthesia that averted complications related to cardiac issues when managing unstable patients, and safe and effective practices of securing airways in patients during unstable cardiac situations. I gained experience learning pharmacological and physiological techniques to maintain adequate tissue perfusion for patients undergoing vascular replacement without stopping the heart to do so. At UMass I began to use echocardiography intra operatively to evaluate left ventricular function and aortic and mitral valve viability after replacements with artificial and porcine valve implants. I also worked in areas of cardiovascular trauma with aortic arch tears and dissections requiring complete circulatory arrest and then resuscitation to patients with anoxia and without blood pressure via techniques of hypothermia and pharmacological and metabolic support with successful survivals and recoveries. I participated in peer review, residency training and lectures, and scientific paper reviews and critiques.\nI was accepted into the University of Massachusetts Residency Program in July 1988 and completed this program in June 1991. My training included intensive knowledge and understanding of anesthesia theory, pharmacology, anatomy, physiology, surgery and medicine. It would be the foundation I would draw upon in subsequent years as I developed within my field and expertise. Clinically and academically I participated in teaching and lecturing on various anesthesiology related issues and trends. I was mentored by Dr. Stephen Heard and inspired by his intelligence and dedication to clinical research an publication.\nAfter graduation from medical school I completed my internship year in Surgery at Berkshire Medical Center Residency Program in Pittsfield, Massachusetts. My first year of training consisted of managing surgical patients intra and post operatively, physical examinations, diagnosing and treatment. Rotations included trauma surgery, general surgery, plastic surgery, OB/GYN surgery, Neurosurgery, and Emergency Medicine.I completed my internship and passed the last part of the USMLE exam in this time period. I went on to continue my training in July 1988 at the University of Massachusetts Residency Program in Anesthesiology.\nThe following year after graduating from Clark University I was admitted to the University of Massachusetts Medical School. The first two years of didactics included graduate level courses in Anatomy, Physiology, Biochemistry, Genetics, Biostatistics, Neurology and Neuroanatomy, Pathology, Microbiology, Pharmacology and Cell Biology. My clinical years and sub internship were divided between rotations at UMass and affiliated hospitals in areas of medicine, surgery, psychiatry, obstetrics and gynecology, radiology and pediatric medicine. I graduated with a doctorate in medicine from UMass in June 1987. I would pass part 1 of the USMLE in my second year, part 2 in my 4th year, and part 3 the following year after completion of my internship.\nI received my undergraduate degree in Biology in 1982. My premedical courses included physics, chemistry, calculus with a major in biology.\nCompanies Worked For:\nJob Titles Held:\n© 2019, Bold Limited. All rights reserved. |
Do you accept dental insurance?\nWe offer a unique service of claims processing that enables us to submit claims electronically for you. What does this mean to you? This process enables a rapid refund process to allow you to receive reimbursement in most cases as quickly as three business days. We will help you maximize your dental benefits and minimize your out of pocket expenses.\nWhat if I have a dental emergency while the office is closed?\nYou may call our regular office phone number at anytime. If the office is closed and Dr. Yolanda Cruz is not available, call the Toronto Dental Emergency Service phone number at 416-485-7121. Otherwise, go to your nearest hospital and call us first thing in the morning.\nDo I need x-rays?\nOur office uses low radiation digital x-ray technology ( up to 90% less radiation compared to traditional x-rays). X-rays are critical in diagnosing and creating a safe treatment plan for your long-term dental health. We will take the fewest necessary to diagnose the current health of your teeth and smile.\nHow much is a cleaning?\nThis depends on the health of your teeth and gums, and how long it has been since you last had them cleaned. One of our team members will be glad to discuss this with you.\nDo you accept New Patients?\nYes. Our practice is constantly growing and we love seeing new patients such as yourself. We look forward to providing an exceptional dental experience for all of our clients. We take pride in offering the latest in dental technology in a warm and friendly atmosphere.\nWhat different payment options are available?\nFor your convenience we offer a wide range of financial options to suit your individual needs. We accept Debit, Visa and MasterCard at each appointment or for more comprehensive treatment we offer a 5% bookkeeping reduction of fees for pre-payment or alternately we offer Low-Interest financing with low payments that can make any dentistry very affordable.\nI am really nervous, is there anything available to help me with that?\nYou will notice that we make every effort to make your visit as comfortable as possible. We go to great lengths to ensure your dental experience is a positive one. We also offer many variations of sedation or “sleep” dentistry. We offer simple pill sedation to IV sedation or General Anesthesia for very anxious patients. We ensure you are at ease at each and every visit. If you have been avoiding dentistry due to fear, let us review the various comfort options we have available to make your dental treatment a reality.\nCosmetic Dentistry FAQ's\nFortunately we have advanced digital software available to our patients that would enable them to try on their smile before making a commitment. Patients love this service because they are able to have a tangible idea what the end result may look like.\nWhat are porcelain veneers ?\nPorcelain veneers are a thin layer of porcelain which covers the front surface of the tooth. They can be used on any teeth that show when you smile. Veneers have been used to “instantly” close gaps between teeth, straighten crooked teeth, permanently whiten stained teeth or create better shaped teeth. The main advantage of using veneers instead of full crowns is the minimal natural tooth removal in the preparation process. Porcelain Veneers rarely stain, chip or break. In fact, they are extremely strong and can last many years. They feel like your natural teeth and in most cases only a few visits are needed to create a spectacular new smile with porcelain veneers.\nWill this process ruin my natural teeth?\nYour teeth will be shaped as conservatively as possible. This is accomplished by proper planning before treatment and by using high powered magnification. In fact, teeth that have been filled or are particularly worn over time will actually be strengthened and protected by this process.\nHow can I avoid the “Chicklet look”?\nA high level of design and artistry is the key to successful esthetic work. We are committed to ensure that each tooth looks complimentary to your appearance and naturally blends into your smile.\nHow long do they last?\nOur goal is that with good oral health, the simple care, and regular checkups, they should last over 15 years. Grinding, clenching, finger nail biting or biting on hard brittle foods, may damage the veneers and subsequently affect their longevity. In these cases, a simple bite guard makes all the difference.\nWhat is involved in getting porcelain veneers?\nThis procedure is generally performed to correct chipped, stained, or crooked teeth. A thin layer of your natural tooth structure is reshaped and is replaced by a porcelain facing. This porcelain piece will have the ideal anatomy and color that will match perfectly to your facial structure and skin tone. A treatment plan will be designed to meet each unique smile. Veneers will consist of three (3) dental visits:\nVisit 1 – Very short visit. Impression of your present teeth is taken and sent to the laboratory where a wax up or blueprint is fabricated. The wax up will allow you and Dr. Yolanda Cruz a preview of your ideal smile.\nVisit 2 – Your teeth are prepared and a final impression is taken and sent to our porcelain ceramic specialist. Custom-made temporary veneers are fabricated and placed at this appointment. They will look like the final veneers and will allow you to test-drive your new smile.\nVisit 3 – Within 7 to 14 days your customized porcelain veneers are ready for cementation. You will have a dramatically improved smile with beautiful and natural looking porcelain veneers.\nHow much do porcelain veneers cost ?\nA complete smile makeover with porcelain veneers can often require an investment of $8,000 to more than $16,000, again depending on how many teeth need to be treated and how difficult the procedures will be. With our low interest financing, it’s possible to have the smile of your dreams for as little as $167 per month. The major thing that you have to look out for is how low porcelain veneers cost. There are some places that will quote you for $500 apiece. Although this may seem like a good deal, it may not be the best thing in the world to get a bargain on. This is something that you are going to want to make sure is done right, and done right the first time. If the porcelain veneers are not put on the right way the first time, then you have to keep going back for them to move them until they get it right. Not many people have time to keep going back to get them adjusted. If they are not adjusted just right, then you can tell that you have on porcelain veneers. Anything that has to do with your teeth is not something that you are going to want to take lightly, thus, this is not the kind of thing that you are going to want to look for a bargain on.\nNow is the best time for you to have the smile of your dreams. Look for the best “cosmetic dentist” you can find. You will not be sorry. Remember this – there is no such thing as a bargain in brain surgery, parachutes, fire extinguishers and cosmetic dentistry!\nI keep hearing about Lumineers..Are they right for me ?\nLumineers are a cosmetic solution for permanently stained, chipped, discolored, misaligned teeth, or even to revitalize old crown and bridge-work. Lumineers by Cerinate is a porcelain veneer that can be made as thin as a contact lens and is placed over existing teeth without requiring painful removal of sensitive tooth structure. LUMINEERS can only be made from patented Cerinate porcelain unavailable anywhere other than the Cerinate Smile Design Studio! In just two or three visits to the dentist, Lumineers provides a custom-made smile clinically proven to last over 20 years. Please book your Free consultation to see if Lumineers are the right choice for you.\nCan I straighten my teeth without wearing braces?\nAbsolutely. There are many ways to improve the appearance of your teeth without braces. Dr. Yolanda Cruz is an Invisalign provider and treats many patients with invisible braces. However, if you would like another method of straightening your teeth, Dr. Yolanda Cruz may recommend one of our cosmetic services, such as porcelain veneers to straighten your smile. Call us today to schedule a consultation with Dr. Yolanda Cruz. After listening to your goals and concerns, he can help you choose the best way to help you straighten your smile.\nWhat is Invisalign?\nInvisalign is the invisible way to straighten your teeth without the use of braces. Dr. Yolanda Cruz is an Invisalign provider.\nHow does Invisalign work?\nInvisalign works by using a series of custom clear removable aligners to straighten your teeth without metal, wires, or brackets. They are virtually invisible.\nIs Invisalign effective?\nYes! It has been proven effective in clinical research and in orthodontic practices nationwide, with millions of aligners placed so far !\nHow does Invisalign straighten my teeth?\nYou wear each set of aligners for approximately 2 weeks, removing them only to brush, floss, eat and drink. As you replace each invisible aligner with the next one in the series, your teeth will move little by little, week by week. This will happen until they have straightened to the final position Dr. Yolanda Cruz has prescribed.\nHow often do I need to visit my dentist during the Invisalign treatment?\nYou’ll visit Dr. Yolanda Cruz about once every 6 weeks to ensure that your treatment is progressing as planned.\nHow long with the total Invisalign treatment take?\nTotal treatment time averages 9-15 months and the average number of aligners worn during treatment is between 18 and 30, but both will vary from case to case.\nSedation Dentistry FAQ’s\nWe have 4 types of sedation dentistry options ranging from simple nitrous oxide to general anesthesia. Please visit the sedation dentistry area of our website for more info or schedule a free consultation.\nWill I remember anything after sedation dentistry?\nAt the end of the treatment, you’ll have little or no memory of what was accomplished.\nIs sedation dentistry safe for me?\nSedation dentistry protocols have been used safely for many years. Our dentists will review your medical history and monitor you closely while under sedation.\nWill I feel any pain during the procedure?\nMost patients report no discomfort or memory of the experience at all and feel surprisingly good afterwards!\nWhat dental treatments can I have while under sedation?\nAll types of dental treatment can be performed, ranging from simple cleanings to implants, dentures, cosmetic treatments, crowns, even gum surgery.\nCan I wake up in the middle of a procedure?\nThis idea makes for a Hollywood movie script, but patients can not just wake up without it being intended.\nWill I be monitored?\nDefinitely ! One of our team members is always with you and your vital signs are monitored during the entire visit. You are never alone.\nHow long can I be asleep?\nOn average, our treatments last two to six hours. This varies on the type of treatment that you require.\nWill someone need to accompany me?\nYes, due to the sedative effects of the medications we use, you will need someone to drive you to and from our office.\nDental Implant FAQ's\n“Dental Implants from Start to Finish…..right here in our office!”.\nImplants are a team effort between Dr. Yolanda Cruz and our implant surgeon, who is a certified specialist. While our surgeon performs the actual implant surgery, and initial tooth extractions and bone grafting if necessary, Dr. Yolanda Cruz fits and makes the permanent prosthesis. We will also make any temporary prosthesis needed during the implant process.\nWhat this means is that there will be no need to go to another office, fill out new forms and deal with new administrative issues. We will easily arrange it so that you can have your implant surgery and crown placement done right here in our office! Implants from A to Z; all under the same roof, just for you!\nWe perform in-office implant surgery in a dental operatory, thus optimizing the level of sterility throughout the procedure.\nWhat are dental implants and what can they do for me?\nImplants are simple titanium replacements for missing teeth. They can replace a single or multiple teeth. They are placed surgically under the gums. After a few months, they form a very tight bond with the bone, and then a simple dental crown or a denture can be secured over the implants. For patients who have trouble chewing because of missing teeth, or who are frustrated because of their dentures slipping in the mouth, dental implants offer a convenient andsecure solution for replacing teeth.\nWhat are the benefits? They feel great and they support teeth that look very natural, greatly enhancing your smile, confidence and your life. Functionally, they allow you to eat and speak without pain or discomfort, and increases your ability to chew comfortably..\nBiologically, implants can help prevent shrinkage or atrophy of your bone and this in\nturn supports your facial tissues and keeps you looking young and healthy.\nWhat is the success rate?\nImplants as a solution to missing teeth has been practiced for many decades. Generally, because of wonderful advances in implant dentistry over the years, dental implants have success rates well above 90%. Success rates depend on many factors, for example, the patient’s own health status or whether they are a smoker. Even though we cannot put a figure down as to the longevity of implants, it is known that the first implant patient who had them placed in 1965 still has them in working today. Of course, regular checkups and maintaining one’s oral hygiene is also of high importance in preventing failure.\nWhat is the procedure like?\nThere are generally two stages:\nStage 1: An opening is made in the gums and the implants are placed. We then wait for the implant to bond to your jawbone. It usually takes just about 3 months for the implant to integrate with the bone or longer if bone grafting is involved.\nStage 2: The second and final stage is to secure the new tooth or teeth to the implant structure. Implants can support a single tooth, multiple teeth or dentures.\nHow much do they cost?\nEvery patient’s need is unique. Your investment can range from $ 2000-4000 per implant. When multiple implants are placed, we can make a reduction in our fees. Your treatment cost depends on your individual needs. After a consultation, your dental needs will be more specifically determined and the best treatment option proposed to you. At this point, treatment investment can then be more accurately determined.\nDoes it hurt?\nDental implants are placed in the jaw under local anaesthesia and so the patient feels minimal discomfort at all during the procedure. After the anaesthetic wears off, there may be slight discomfort, usually managed easily with mild pain medication. In fact, many patients have reported that they didn’t even need to take any painkillers.\nAm I too old to have dental implants?\nAge does not matter here! As long as you are generally healthy and have adequate bone, you can have dental implants. We have placed implants in patients ranging in age from 19-91 years old!\nHow do I take care of my implants?\nPretty simple. It is very important that patients who have dental implants maintain their own oral hygiene at home. This includes brushing, flossing and sometimes using other cleaning aids like an interproximal brush which goes in between the teeth. Regular dental checkups and maintenance are important to ensure longevity of the implants.\nAm I a candidate for implants?\nPlease call our office today at 416-595-5490 (Downtown Toronto Location) or 647-951-8888 (Etobicoke Location) for a FREE consultation, and see why so many of our patients are living happier than ever with dental implants. If you are considering implants, your mouth must be examined and your medical and dental history reviewed. If your mouth is not suitable for implants, new simple ways of improving the site where the implant will be placed, such as bone grafting, may be make the area better suitable for implants.\nHow do I get started?\nDuring initial consultation, x-rays are needed to evaluate the quality of bone. Impressions or molds of the upper and lower jaws are then taken to be made into models so that the thickness of the bone can be assessed and a diagnostic blueprint of the teeth is made to plan the position of the implant/s . Intra oral photos are also taken as part of the diagnostic process. Once the important information is obtained and treatment planning confirmed, we can get started….It’s easier than ever to have dental implants.\nWhy should I consider dental implants?\nIf you have had the experience of having lost one or many teeth, you may know what it’s like to live with an unattractive smile, reduced chewing efficiency, embarrassment from falling dentures, and pain or difficulty while eating. Making a bridge to replace the missing teeth usually requires trimming down adjacent, sometimes perfectly healthy natural teeth. Dentures sometimes can be uncomfortable, unstable or painful during eating or speech.\nOver time, the bone at the toothless area can undergo “bone atrophy”, or loss of bone height and width. This can lead to many problems. By placing an implant in the bone, it can prevent atrophy. |
FRAXEL. REVEAL YOUNGER LOOKING SKIN!\nFraxel restore is a skin resurfacing laser that can be used on all skin types. This is important since most laser resurfacing procedures are not safe to use on darker skin types.\nFraxel Restore can be used to fix texture, fine lines and wrinkles, and most importantly, pigment, sun damage, and melasma.\nA Fraxel laser treatment is a procedure which resurfaces the skin and promotes the skin’s own natural healing abilities. This results in natural rejuvenation that removes years from your appearance.\nEach treatment is precisely customized to target either a specific problem, such as brown spots, acne scars, fine lines and wrinkles; or to achieve an overall rejuvenation with improved tone, texture, and fresher looking skin with a healthy glow.\nThis procedure is healthy for your skin. By stimulating new collagen growth, the effects are on going over several months and can last 1 to 2 years.\nKey advantages of Fraxel Laser Treatment compared to surgical procedures are:\n- No scalpel, no stitches, no needles\n- No general anesthesia – well tolerated with a topical anesthetic\n- Convenience – the procedure takes about 30 minutes in an office setting\n- High safety and proven effectiveness on multiple body areas\n- Virtually no risk of complications or adverse events\n- Natural, youthful-looking results\nCall or text us at 360-335-4951 to make your appointment. Consultations are complimentary.\nLindsey Silberman, Lifestyle Blogger, talks about her Fraxel treatment process. Lindsey is not a Camas Medspa patient, however her experience and results are typical of Fraxel Treatment patients.\nWHAT IS A FRAXEL TREATMENT LIKE?\nFraxel re:store uses a different technique known as fractional resurfacing. Instead of removing all the outer layers of skin, Fraxel® re:store Laser Skin Resurfacing involves the application of controlled amounts of focused heat into the skin.\nThere is discomfort with this procedure and therefore you a numbing cream will be applied an hour prior to your procedure.\nDowntime varies with each patient, however plan on a minimum of 5 days where your face will show the effects of the Fraxel treatment.\nWhile 3 Fraxel treatments spaced 3 months apart is optimal, you will see a noticeable and progressive skin improvement after just one treatment. The treated skin appears more youthful and smooth.\nThose of you who know me are probably very aware of my love for microneedling. Not the $40 microneedling treatments I have seen advertised around town lately (I honestly can’t imagine what that even is), but the really good medical grade treatment that puts millions... |
The Anesthesiologists Physician List compiles thousands of specialized Physicians into one easy to use database. The CSV file format makes it easy to export the data into Excel, Microsoft Access, SQL, and CRM's. Kickstart your campaign with a targeted Anesthesiologists directory to find doctors most interested in your service or product.\nAnesthesiologists practice anesthesia. They not only administer anesthesia prior to an operation, but are responsible for developing customized plans of the amount, duration, and timing of the drug administration. In addition to "putting the patient to sleep" other practices such as numbing the patient or calming with sedation are also the responsibility of these specialized doctors. Minimizing post-operation pain is the goal of Anesthesiologists, and their training allows them the opportunity to work with patients with a variety of medical needs.\nYou shouldn't have to break the bank in order to put more grow your sales. If you are looking for an affordable way to market your product or service to a specialized group of physicians, then the Anesthesiologists list is definitely the marketing tool you need to produce the results you want. |
Cetacaine Topical Anesthetic Spray\nGeneric Name: benzocaine, butamben, and tetracaine hydrochloride\nDosage Form: aerosol, spray\nDisclaimer: This drug has not been found by FDA to be safe and effective, and this labeling has not been approved by FDA. For further information about unapproved drugs, click here.\nThe onset of Cetacaine-produced anesthesia is rapid (approximately\n30 seconds) and the duration of anesthesia is typically 30-60 minutes,\nwhen used as directed. This effect is due to the rapid onset, but short\nduration of action of Benzocaine coupled with the slow onset, but extended\nduration of Tetracaine HCI and bridged by the intermediate action\nIt is believed that all of these agents act by reversibly blocking nerve\nconduction. Speed and duration of action is determined by the ability\nof the agent to be absorbed by the mucous membrane and nerve\nsheath and then to diffuse out, and ultimately be metabolized (primarily\nby plasma cholinesterases) to inert metabolites which are excreted in\nCetacaine is a topical anesthetic indicated for the production of anesthesia\nof all accessible mucous membrane except the eyes. Cetacaine\nSpray is indicated for use to control pain or gagging.\nCetacaine in all forms is indicated to control pain and for use for surgical\nor endoscopic or other procedures in the ear, nose, mouth, pharynx,\nlarynx, trachea, bronchi, and esophagus. It may also be used for\nvaginal or rectal procedures when feasible.\nDosage and Administration\nCetacaine Spray should be applied for approximately one second or\nless for normal anesthesia. Only a limited quantity of Cetacaine is\nrequired for anesthesia. Spray in excess of two seconds is\ncontraindicated. Average expulsion rate of residue from spray, at normal\ntemperatures, is 200 mg per second.\nTo apply, insert the Jetco cannula (J-4) firmly onto the protruding plastic\nstem on the bottle and press the cannula forward to actuate the spray\nvalve. The cannula may be removed and reinserted as many times as\nrequired for cleaning, or sterilization, and is autoclavable.\nCetacaine Liquid Apply 200 mg (approximately 6 – 7 drops or 0.2 cc)\nwith a cotton applicator or directly to tissue. Do not hold the cotton\napplicator in position for extended periods of time, since local reactions\nto benzoate topical anesthetics are related to the length of time\nof application. Liquid in excess of 400 mg (approx. 12 – 14 drops or\n0.4 cc) is contraindicated.\n*See Cetacaine Liquid Kit instructions for additional directions for application\nby Luer-lock syringe and applicator tip.\nCetacaine Gel Apply 200 mg of gel (a bead approximately 0.5 inch\n(13 mm) in length and 3/16 inch (5 mm) in diameter) and spread thinly\nand evenly over the application area. Gel in excess of 400 mg (a bead\napproximately 1 inch (26 mm) in length and 3/16 inch (5 mm) in diameter)\nAn appropriate pediatric dosage has not been established for Cetacaine\nSpray, Liquid or Gel.\nDosages should be reduced in the debilitated elderly, acutely ill, and\nvery young patients.\nTissue need not be dried prior to application of Cetacaine. Cetacaine\nshould be applied directly to the site where pain control is required.\nAnesthesia is produced within 30 seconds with an approximate\nduration of 30 – 60 minutes. Each 200 mg dose of Cetacaine (Spray\nresidue, Liquid or Gel) contains 28 mg of benzocaine, 4 mg of butamben\nand 4 mg of tetracaine HCl.\nHypersensitivity Reactions: Unpredictable adverse reactions (i.e. hypersensitivity,\nincluding anaphylaxis) are extremely rare.\nLocalized allergic reactions may occur after prolonged or repeated use\nof any aminobenzoate anesthetic. The most common adverse reaction\ncaused by local anesthetics is contact dermatitis characterized by erythema\nand pruritus that may progress to vesiculation and oozing. This\noccurs most commonly in patients following prolonged self-medication,\nwhich is contraindicated. If rash, urticaria, edema, or other manifestations\nof allergy develop during use, the drug should be discontinued. To minimize\nthe possibility of a serious allergic reaction, Cetacaine preparations should not\nbe applied for prolonged periods except under continual supervision. Dehydration\nof the epithelium or an escharotic effect may also result from prolonged contact.\nPrecaution: On rare occasions, methemoglobinemia has been reported\nin connection with the use of benzocaine-containing products.\nCare should be used not to exceed the maximum recommended\ndosage (see Dosage and Administration). If a patient becomes cyanotic, treat appropriately\nto counteract (such as with methylene blue, if medically indicated).\nUse in Pregnancy\nSafe use of Cetacaine has not been established\nwith respect to possible adverse effects upon fetal development.\nTherefore, Cetacaine should not be used during early pregnancy, unless\nin the judgment of a physician, the potential benefits outweigh\nthe unknown hazards. Routine precaution for the use of any topical\nanesthetic should be observed when Cetacaine is used.\nCetacaine is not suitable and should never be used for injection. Do\nnot use on the eyes. To avoid excessive systemic absorption, Cetacaine\nshould not be applied to large areas of denuded or inflamed tissue.\nCetacaine should not be administered to patients who are\nhypersensitive to any of its ingredients or to patients known to have\ncholinesterase deficiencies. Tolerance may vary with the status of the\nCetacaine should not be used under dentures or cotton rolls, as retention\nof the active ingredients under a denture or cotton roll could possibly\ncause an escharotic effect. Routine precaution for the use of any\ntopical anesthetic should be observed when using Cetacaine.\nJetco® Cannula for Cetacaine Spray\n- The supplied 4" stainless steel Jetco® cannula (J-4) for Cetacaine Spray is specially designed for accessibility and application of Cetacaine, at the required site of pain control. Replacement J-4 cannulas are available as a 10-pack (Item # 0205).\nCetacaine Spray contains CFC-114 and CFC-11, substances which\n- Cetacaine Spray, 20 g bottle, including propellant* (Item #0220, NDC 10223-0201-3) which includes one J-4 cannula.\n- Cetacaine Gel, 32 g pump jar, (Item # 0217, NDC 10223-0217-3)\n- Cetacaine Liquid Chairside Kit (Item # 0218 NDC 10223-0202-6) which includes one 14 g bottle of Cetacaine Liquid with Luer-lock dispenser cap, 20 syringes and 20 delivery tips.\n- Cetacaine Liquid Clinical Kit (Item # 0212, NDC 10223-0202-5) which includes one 30 g bottle of Cetacaine Liquid with Luer-lock dispenser cap, 100 syringes and 100 delivery tips.\n- Cetacaine Liquid, 14 g bottle (Item # 0203, NDC 10223-0202-2)\n- Cetacaine Liquid, 30 g bottle (Item # 0211, NDC 10223-0202-4)\nharm public health and environment by destroying ozone in the\nPRINCIPAL DISPLAY PANEL - 20 g Bottle Box\nItem No. 0220\nEffective Only on\n(One Cannula Included)\nButamben 2.0%, Tetracaine\nCetylite Industries, Inc.\nPennsauken, NJ 08110-3293\nbenzocaine, butamben, and tetracaine hydrochloride aerosol, spray\n|Labeler - Cetylite Industries, Inc. (001283704)|\n|Cetylite Industries, Inc.||001283704||MANUFACTURE(10223-0201), ANALYSIS(10223-0201), LABEL(10223-0201), PACK(10223-0201)|\nMore about Cetacaine (benzocaine / butamben / tetracaine topical)\n- Side Effects\n- Dosage Information\n- Drug Interactions\n- Support Group\n- 0 Reviews – Add your own review/rating\n- Drug class: mouth and throat products |
Author(s): Baratta JL, Schwenk ES, Viscusi ER\nAbstract Share this page\nAbstract SUMMARY: Uncontrolled postoperative pain may result in significant clinical, psychological, and socioeconomic consequences. Not only does inadequate pain management following surgery result in increased morbidity and mortality but it also may delay recovery, result in unanticipated readmissions, decrease patient satisfaction, and lead to chronic persistent postsurgical pain. Pain is multifactorial in nature, and understanding both the complexity of pain and its side effects is imperative to achieving a successful surgical outcome. In this section, we review the consequences of pain as they pertain to plastic surgery with a focus on the impact of pain on the surgical stress response and risk of wound infections and the effect of improved pain control on flap surgery. Uncontrolled acute postoperative pain may lead to chronic persistent postsurgical pain, which has a high incidence in patients undergoing breast cancer surgery. To achieve optimal postoperative analgesia, one must recognize the barriers to effective pain management, including both physician/nursing-related barriers and patient-related barriers, as well as the increasingly common appearance of opioid-tolerant patients.\nThis article was published in Plast Reconstr Surg\nand referenced in Journal of Anesthesia & Clinical Research |
The University of Utah School of Medicine Anesthesiology Residency Program\nThe Department of Anesthesiology of the University of Utah School of Medicine has maintained national prominence both clinically and academically for over twenty years. Excellent training is available for candidate interested in an academic career or in private practice.\nAdvantages: The Anesthesiology Residency\n- Uniform resident success in passing Boards, obtaining fellowship positions and employment.\n- Excellent case load mix and numbers (approximately 500 cases/resident per year)\n- All clinical rotations occur at University or affiliated hospitals within 2 miles with the exception of clinical rotations of IMC month. The close proximity of affiliated hospitals minimizes commuting times and facilities lecture attendance.\n- All required training occurs in Salt Lake City; there is no need to send residents to other programs.\n- Training in subspecialties of pediatric anesthesia, neurosurgical anesthesia, cardiac anesthesia, perioperative echocardiography, and obstetrical anesthesia, as well as pain management are particularly strong.\n- Residents typically find affordable housing within ten minutes or less drive from the hospitals.\nThe University of Utah and its affiliated hospitals offer a total of thirty-nine residency positions in anesthesiology. The Department of anesthesiology is approved by the American Board of Anesthesiology (ABA), and accredited by the ACGME for three years (CA1-CA3) of residency training. Residents are accepted into the program every July. The positions (CA1) are awarded to applicant students through the NRMP (National Residents Matching Program). Internships (PGY1) are available through the University of Utah and at affiliated hospital. Residency training is approved by the ABA and all affiliated hospitals are approved by the Joint Commission on Accreditation of Hospitals. Administration of all types of general and regional anesthesia is supervised by faculty anesthesiologists. This includes anesthesia for a wide variety of routine and unusual surgeries, anesthesia for cardiovascular and pulmonary procedures, neuroanesthesia, pediatric anesthesia, obstetrical anesthesia, handling of the emergency airway, dental anesthesia, the management of pain and intensive care.\nThe CA3 year of training consists of advanced anesthesia training, research, or special training in clinical areas such as pain management, cardiac, obstetrical and pediatric anesthesia, and intensive care. |
Preoperative Testing Could Be a Waste of Time and Money\nJan. 19, 2000 (Washington) -- Whether prompted by fear or good clinical judgment, physicians routinely order billions of dollars' worth of preoperative tests for patients, particularly for older individuals undergoing common procedures such as cataract surgery. But those tests don't seem to matter a bit when it comes to patient outcomes, and, according to the co-author of a study published in the Jan. 20 issue of The New England Journal of Medicine, they should no longer be performed.\n"The statement [we] want to make is that people need preoperative histories and physicals, but that routine testing does not produce better outcomes," co-author James M. Tielsch, PhD, tells WebMD. He adds that the research study was purposely designed to "provide more convincing evidence to change practice."\nThe research, conducted by Oliver D. Schein, MD, MPH, Tielsch, and colleagues from the Dana Center for Preventive Ophthalmology at the Wilmer Eye Institute at Johns Hopkins University in Baltimore, is the first large study to assess the clinical value of tests that are customarily ordered prior to surgery. And although the surgery specifically examined was cataract removal, a co-author and another prominent researcher in the field say the research is applicable to preoperative tests for a host of other surgeries, as long as an adequate history and physical exam are performed prior to the procedures.\n"I think there is little doubt on our team that [the findings] certainly apply to a large amount of ophthalmic surgeries," such as glaucoma surgery, some types of retinal surgery, and most corneal surgeries, Tielsch says. Similarly, no routine preoperative testing is necessary for surgeries in which there is little blood loss, and when local anesthesia is used, with or without IV sedation, says Tielsch, a professor of international health who holds joint appointments at the Johns Hopkins schools of medicine and public health.\nThe investigators hope to convene meetings this spring with internists, anesthesiologists, and surgeons to develop guidelines based on the findings. Initially, they will concentrate on eye surgeries, he says, and likely will address what effect different modes of anesthesiology management may have on adverse events. |
Darin J. Correll, MD\nAttending Anesthesiologist, Department of Anesthesiology, Perioperative and Pain Medicine | Brigham and Women’s Hospital\nChair of the Acute Pain Committee and Chair of the Task Force for Opioid-related Education | Brigham and Women’s Hospital\nAssistant Professor of Anesthesia | Harvard Medical School\nDr. Correll received his Bachelor of Arts degree from Brandeis University in Waltham, MA and his Medical Doctorate degree from Jefferson Medical College of Thomas Jefferson University in Philadelphia, PA. He completed a residency in anesthesiology, then a two-year clinical and research fellowship in Regional Anesthesia and Acute Pain Management, at Thomas Jefferson University Hospital. Dr. Correll’s research addresses all aspects of perioperative pain assessment, education and management.\nPostoperative pain continues to be poorly controlled despite the numerous management techniques that are available. Some of the most difficult patients to effectively manage are those with chronic pain and/or opioid tolerance before their surgery. Another inadequately addressed problem resulting from insufficient postoperative pain management is the development of persistent postsurgical pain. To examine these issues, Dr. Correll utilizes various research techniques including scientometric analysis, retrospective analyses, survey-based studies and placebo-controlled trials. Specific areas of interest include trying to better understand the measurement tools that are used to assess pain, analyses of adjunctive analgesics to improve pain control (including in the opioid tolerant/chronic pain patient), trials of investigational new analgesics, and getting a better understanding of patients’ expectations of pain, knowledge of pain “risks” (including for persistent postoperative pain) as well as the drivers of patient satisfaction with pain control.\n- Barreveld AM, Correll DJ, Liu X, Max B, McGowan J, Shovel L, Wasan AD, Nedeljkovic SS. Ketamine decreases postoperative pain scores in patients on chronic opioids: results of a prospective, randomized, double-blind study. Pain Medicine. 2013; 14(6): 925-34.\n- Correll DJ, Vlassakov KV, Kissin I. No evidence of real progress in treatment of acute pain 1993-2012: a scientometric analysis. Journal of Pain Research. 2014; 7: 199-210.\n- Oliver JB, Kashef K; Bader AM, Correll DJ. A survey of patients’ understanding and expectations of persistent postsurgical pain in a preoperative testing center. Journal of Clinical Anesthesia. 2016; 34: 494–501.\n- Kator S, Correll DJ, Ou JY, Levinson R, Noronha GN, Adams CD. Assessment of low-dose intravenous ketamine infusions for adjunctive analgesia. American Journal of Health-System Pharmacy. 2016; 73(5 Suppl 1): S22-29.\nOngoing Research in this Area\nI. “A Randomized, Double-Blind, Parallel Group, Placebo-Controlled Study to Evaluate the Analgesic Efficacy and Safety of VVZ-149 Injections for Post-Operative Pain Following Laparoscopic Colorectal Surgery”\nSponsor: Vivozon, Inc.\nRole: Site-responsible Investigator\nCollaborators: Srdjan Nedeljkovic, MD (Department of Anesthesiology); Jose Zeballos, MD (Department of Anesthesiology)\nThe objective, of this phase 2 clinical trial, is to make a preliminary assessment of the efficacy and pharmacokinetics of VVZ-149, a novel analgesic drug candidate with dual antagonist activity of GlyT2 (glycine transporter type 2) and 5HT2A (subtype of serotonin receptor).\nII. “Correlating the Multidimensional Affect and Pain Survey to a Unidimensional Pain Scale”\nRole: Principal Investigator\nCollaborator: Pritesh Topiwala, MD (Department of Anesthesiology)\nThe objective, of this study, is to examine how patients’ rating of their postoperative pain, using a verbal numeric scale, correlates with the Multidimensional Affect and Pain Survey (MAPS). This is to determine if, and at what value, there is a change in the correlation from somatosensory qualities to emotional qualities.\nIII. “Evaluation of Satisfaction with Postoperative Pain Control following Elective Thoracoscopic Surgery”\nRole: Principal Investigator\nCollaborator: Emily Siu, MD (Department of Anesthesiology)\nThe objective, of this study, is to examine the level of satisfaction with analgesia after elective thoracic surgery using a validated patient outcome questionnaire. The aim is to determine what items and variables are correlated with the degree of satisfaction.\nThe major pharmaceutical agents commonly used for postoperative pain management remain the opioid analgesics. To ensure the benefits of their use outweigh the risks, an understanding of the appropriate usage of these agents is needed both by the providers as well as the patients, to ensure the patients’ wellbeing. There are several possible side effects/downsides to the use of opioids with two being the most potentially devastating – respiratory depression and the development of addiction/misuse. To examine these issues, Dr. Correll utilizes various research techniques including database analyses, survey-based studies and placebo-controlled trials. Specific areas of interest include the utilization of techniques to enhance patients’ understanding of opioid analgesic modalities to improve pain control and safety with their use, determining proper monitoring for patients on opioids, utilization of adjunctive analgesics to reduce opioid requirements and determining the “correct” method to control postoperative pain in opioid-replacement therapy patients.\n- Shovel L, Max B, Correll DJ. Increasing knowledge on the proper usage of a PCA machine with the use of a post-operative instructional card. Hospital Practice. 2016; 44(2): 71-5.\n- Jungquist CR, Correll DJ, Fleisher LA, Gross J, Gupta R, Pasero C, Stoelting R, Polomano R. Avoiding adverse events secondary to opioid-induced respiratory depression: Implications for nurse executives and patient safety. The Journal of Nursing Administration. 2016; 46(2): 87-94.\nOngoing Research in this Area\nI. “Impact of preemptive acetaminophen on postoperative opioid use and complications in Laparoscopic Sleeve Gastrectomy surgery”\nCollaborators: Emad Alsarraf, PharmD (Pharmacy Department); Marjan Sadegh, PharmD (Pharmacy Department); Sarah Culbreth, PharmD (Pharmacy Department); Scott Shikora, MD (Department of Surgery)\nThe objective, of this study, is to evaluate the effect of preemptive oral acetaminophen on postoperative opioid consumption and adverse events following LSG.\nII. “Acute pain management while on buprenorphine: A survey of opioid use disorder patients in office-based opioid treatment”\nCollaborators: Marjan Sadegh (Pharmacy Department); Joji Suzuki, MD (Addiction Psychiatry); Claudia Rodriguez, MD (Addiction Psychiatry)\nThe objective, of this study, is to identify the reasons buprenorphine patients experience acute pain, and whether buprenorphine was discontinued or not prior to the procedure; to determine the adequacy of acute pain treatment when buprenorphine was and was not discontinued; and to determine the frequency at which relapses occurred in the context of acute pain issues.\n- Pritesh Topiwala, MD – Chronic Pain fellow\n- Anant Shukla, MD – as an undergraduate from Boston University and then as a Research Assistant\n- Louisa Shovel, MBBS – as a visiting Anesthesia Resident/Research Fellow from the United Kingdom\n- Antje Barreveld, MD – as a 3rd year Anesthesiology Resident for a Clinical Research Tract Elective\n- Kiana Kashef, MD – as a 3rd year Anesthesiology Resident for a Senior Research Project\n- John Quick, MD – as a 3rd year Anesthesiology Resident for a Clinical Research Elective/Senior Research Project\n- Johanna Peralta, CRNA – as an SRNA student from Northeastern University for a Clinical Research Block\n- Jennifer Oliver, DO – as a 3rd year Anesthesiology Resident for a Senior Research Project\n- Emily Siu, MD – a 3rd year Anesthesiology Resident for a Clinical Research Elective/Senior Research Project |
Full-time associate veterinarian wanted for a multi-doctor practice in Eastern North Carolina, just 45 minutes from the beach! We are a walk-in based practice, allowing for a high medical and surgical caseload. Our staff offers cutting-edge veterinary medical care to companion animals in our facility just built in 2013. We have 5 examination rooms, 3 wet-dry tables, 2 surgery tables, 3 anesthesia machines, digital radiology, Toshiba ultra-sound, in-house IDEXX diagnostics, companion laser and paperless medical records using Cornerstone software. Our hospital also offers full-service boarding. After hour emergencies are handled by a local veterinary emergency hospital.\nWe are looking for a motivated veterinarian who enjoys a busy caseload, has excellent communication skills, and enjoys working as part of a team.\nWe are offering a generous benefit package with a salary commensurate with experience, CE allowance, and vacation/sick time. New graduates welcome to apply; mentorship is available. |
The medical journal\nAnesthesia Anesthesiology has a report about people who don’t go under all the way during surgery and end up with some awareness when they should be asleep.\nThis article has been reproduced in a new format and may be missing content or contain faulty links. Contact [email protected] to report an issue.\nThe study wasn’t designed to look at awareness during surgery but instead to gauge whether patients who experienced awareness went on to develop post-traumatic stress disorder.\nStill, the numbers in the study are pretty shocking: of 2,681 patients surveyed, 98 reported being awake during previous surgery when they should have been unaware and asleep.\nResearchers think 46 had actually been aware. Many suffered pain or were, to put it technically, pretty freaked out.\nI’m going to write a story for Wired News about anesthesia failure among surgery patients. Please let me know in the comments if you’ve ever had such an experience or know of good resources about this topic.Go Back to Top. Skip To: Start of Article. |
A patient who required surgery for a serious injury woke up from anesthesia to discover his doctor did surgery to the wrong area of his body.\nA superintendent at a commercial building in D.C., he could not work for an extended period of time because of the rehab, additional treatment and harm caused by the negligent surgery. He had extra medical bills, lost income, and the lingering affects of a surgery he never needed.\nThere are several protocols to prevent surgery to the wrong body part - identifying and initialing the surgical site, taking a "time out" where everyone in the operating room stops what they are doing before the surgery and identifies the patient, the surgery being performed and other important factors.\nUnfortunately, either these patient safety rules weren't followed or the doctors and nurses just ran through a checklist quickly, without really checking.\nSo you'd think that would be an easy case and that the physician practice group that employed the doctor would admit legal responsibility and settle the case fairly and quickly. But they still required the patient to file a medical malpractice lawsuit before making any offer to settle the case.\nThe medical malpractice case against the doctor and doctor's practice settled shortly after the lawsuit was filed.\nAnd the superintendent is doing better - he switched doctors, of course. |
Leon D. James DDS, MBA received an undergraduate degree from Prairie View A&M University in Biology. In 2006, he received his Doctoral of Dental Surgery from the Prestigious Howard University College of Dentistry in Washington, DC. In 2007, Leon completed an intensive general residency program at Bronx Lebanon Hospital, focusing on Total Mouth Rehabilitation, Implants, Cosmetics, and Sedation Dentistry. Earlier in Dr. James’ career, he dedicated himself to serve the underserved communities. In 2004, Dr. James became a member of the National Health Service Corp and served as a dental director at Charter Oak Community Center in Hartford, Connecticut.\nDr. James also completed specialty training for IV sedation at Montefiore Hospital, and Implantology at the Medical College of Georgia. He also completed advanced training in orthodontics, in which he has received Diplomate degrees in Implantology, Cosmetic Dentistry, and Orthodontics. Dr. James has built his life on the philosophy of being “A Student for Life”; therefore in 2014, Dr. James received his MBA degree from Texas Tech University.\nIn 2010 and 2015, Dr. Leon D. James was selected as one of Leading Physicians of the World for Implant and Cosmetic Dentistry.\nReserve your first visit with our team today! |
Effective, safe & cost effective procedure without any of the risks associated with medications, surgery, injections, or anesthesia.\nHealing hands are the best medicine! DeMaine Chiropractic believes everyone should benefit from a therapeutic and healing massage.\nDeMaine Chiropractic provides complete care following a workplace accident to help patients recover and return to work with as few complications as possible\nSport activities is an important step in maintaining your health. Exercise strengthens your heart, bones, and joints and reduces stress, but also injuries are very common. |
Cardiac complications occurring in the postanesthetic care unit (PACU) are typically due to hypotension, hypertension, and dysrhythmias. Patients with known coronary artery disease or congestive heart failure are more prone to these complications after surgical procedure.\nDecreased intravascular volume, or hypovolemia is due to inadequate intravenous fluid administration or blood loss. Patients can be resuscitated with crystalloids, colloids, and various blood products. If fluid resuscitation is inadequate to perfuse end organs, then vasopressors and inotropes should be added.\nMyocardial ischemia with acute heart failure and ventricular or valvular dysfunction can also lead to hypotension. This may be associated with tachycardia and ST segment changes on electrocardiogram. A history of coronary artery disease predisposes patients to these complications and should be noted on preoperative evaluation. Drug-eluting stents typically require antiplatelet therapy for surgical procedures; if antiplatelet therapy is halted, patients may be at increased risk for acute coronary events. Suspected coronary thrombosis requires immediate evaluation for cardiac catheterization.\nDecreased systemic vascular resistance in the PACU setting is usually iatrogenic and leads to hypotension. Disease states that cause decreased SVR include sepsis, spinal shock from spinal cord injury, and histamine release during anaphylactic reactions. While supportive measures are instituted, the underlying cause should be identified and treated. Residual effects of anesthetics, including inhalational, intravenous, and neuraxial agents, also produce hypotension. Treatment is indicated if mean arterial pressure is 20% less than baseline.\nPain is a common cause of hypertension in the PACU. Surgical trauma and pain cause increased sympathetic tone leading to hypertension and tachycardia. Multimodal pain management strategies are preferable.\nHypercarbia from respiratory failure also leads to hypertension. Treatment includes promoting effective gas exchange via invasive or noninvasive, positive pressure ventilation.\nUrinary retention and bladder distention are a common cause of hypertension in the PACU. It is more common after inguinal hernia repair, neuraxial anesthesia, and in elderly men with prostatic obstruction. Patients may require bladder catheterization.\nPatients who remain intubated in the PACU, if not adequately sedated, may become hypertensive from irritation of the endotracheal tube.\nArrhythmias occur often in the PACU and some can be life-threatening. If cardiac arrest should occur, PACU treatment may have to be tailored to accommodate surgical incisions. Thorough review of current Advanced Cardiac Life Support (ACLS) algorithms should be undertaken.\nBradycardia in the PACU can be due to vasovagal reflexes, residual effects of anticholinesterases, β-blockers, or opioids. Bradycardia may also result from severe myocardial infarction with complete heart block. The ACLS algorithm should be consulted for unstable bradycardia. Anticholinergic medications and pacing options must be readily available.\nSinus tachycardia can result from pain, hypovolemia, fever, sepsis, or certain drugs such as albuterol or anticholinergics. |
Best RIRS Surgery Hospitals and Cost in Germany\nChoose from 1 best RIRS Surgery hospitals in\nTop Hospitals For RIRS Surgery\nAbout RIRS Surgery\nThe Surgery does not involve any inscisions or cuts and usually a painless procedure. In this procedure a fibreoptic endoscope is inserted through urethra and it then travels from urinary bladder and ureters to kidney. The endodscope has required equipments for removing stones from kidney. The stoned can be removed either by crushing or by breaking them through laser. The procedure is performed under local or spinal anesthesia.\nAverage RIRS Surgery Cost\n|India||Starting from $3000|\n- Retrograde Intra-renal surgery\nThe Park-Klinik Weißensee is modern tertiary care hospital that was rebuilt on the site of the former municipal hospital in Berlin Weißensee / Pankow in 1997. The hospital is a 350 bedded building with light-flooded ambience to benefit the patients and employees. It offers a wide range of medical services, including inpatient, outpatient and emergency care. With over 700 employees committed to the healthcare services, the hospital ensures impeccable medical care to all the patients. The clinic is situated in the middle of a historically grown park and offers excellent clinical care, modern facilities and above-average patient satisfaction. |
Dr. Paradis Esfandiari\nDr. Paradis Esfandiari is the President of Blue Lecture Series.\nDr. Esfandiari strongly values Continuing Education and has a unique vision for all professionals worldwide. He believes CE is integral in maintaining knowledge, ethics and efficiency as a practitioner in whichever realm of study one participates.\nDr. Esfandiari works closely with instructors to design course curricula and ensure they meet the standards necessary for licensure accreditation. He also manages and oversees each specific course in terms of logistics.\nHe works hard to produce the most rewarding Continuing Education experiences possible. Dr. Esfandiari aims to consistently recruit the world's best instructors, effective and valuable accredited course curricula, and the most luxurious venues & catering all at a shockingly affordable price.\nDr. Esfandiari also practices in Downtown Tampa Bay, FL. His particular interests include oral medicine, endodontics and cosmetic dentistry.\nDr. Esfandiari was voted into Tampa's Best Dentists of 2019 with the prestigious Tampa Style Magazine, and he has been a featured guest on America's Leading Healthcare Talk Radio Show, The Weekly CheckUp on 102.5 FM the Bone.\nDr. Anish N. Shah\nDr Shah is the Keynote Instructor for Top Tips in Oral Surgery, Oral Pathology & the Anxious Patient from London, UK.\nTraining in a variety of Oral & Maxillofacial Surgery units, Dr Shah fast became a member and subsequently a fellow of the Royal College of Surgeons by examination. Dr Shah was also one of a handful of Oral Surgeons in the UK who trained to the level of instructor in Advanced Life Support including advanced airway management skills and continues to teach healthcare professionals in Emergency Medicine in relation to Dentistry. He has run numerous courses throughout UK and Europe and has a distinctive style of teaching.\nIn addition, he continues to examine for the Royal College of Surgeons as clinical faculty in relation to education and holds both a diploma in Clinical Education and a Fellowship of the higher education academy which champions and recognises teaching excellence working with institutes and academics around the globe.\nDr Shah is an exclusively private Oral Surgeon and is clinical Lead for Surgery at 75 Harley Street, Waterside Dental in Canary Wharf and Boston House Dental Clinic, London. He carries out all aspects of dent alveolar surgery and teaches both undergraduates and postgraduates. In addition he has a special interest and passion for Oral Medicine and lectures widely on the subject.\nDr Shah also spent several years as the Clinical Lead for Oral Surgery services dedicated to Adults and Children with Special Needs and has been strategic in developing referral protocols and guidelines.\nDr. Laleh Sharifian\nDr. Sharifian is an Adjunct Instructor for Top Tips in Oral Surgery, Oral Pathology & the Anxious Patient from London, UK.\nDr. Sharifian developed an early interest in sedation and dental anxiety in her career since she qualified from Guys Hospital London in 1999. Dr. Sharifian was awarded the Malleson Prize in the UK for her early research in the field of dental anxiety and went on to obtain her post-graduate diploma from Guys in Conscious Sedation.\nDr. Sharifian owns and operates Ivy Sedation in London, UK, a private dental sedation specialist organization which provides all the equipment and consumables to offer sedation services to general dentists. She works clinically as a dental seditionist as well as a private-practice family and cosmetic dentist in the Canary Wharf region of downtown London.\nDr. Sharifian currently lectures on conscious and intravascular sedation at Europe's prestigious Society for the Advancement of Anesthesia in Dentistry. She brings an acclaimed and proven style of lecturing through both clinical and academic experience in dental sedation training.\nDr. Narcisse Alavi\nDr. Alavi is a lecturer of psychology also based in London, United Kingdom. Dr. Alavi specializes in organizational and behavioral psychology particularly with healthcare patients and providers alike.\nDr. Alavi earned her Bachelors of Science in Psychology at the University of Hertfordshire in the United Kingdom. She then went on to complete a Masters of Science in Organizational and Occupational Psychology before obtaining a Doctorate (PhD) in Psychology.\nDr. Alavi's lecturing interests primarily include identification factors of stress and anxiety from an occupational standpoint. She enjoys shedding light on dental anxiety factors and management in patients, and she also observes stress and mental abuse in healthcare providers.\nDentistry is consistently among the top careers in terms of suicide in the United States. Dr. Alavi's perspective serves to prevent, identify and manage symptoms of anxiety and stress in both patients and dentists.\nDr. Alavi has served as a lecturer on occupational psychology in multiple private organizations and London-based Universities, and she is an adjunct instructor with Blue Lecture Series.\nMs. Farnoush Olamaei\nMs. Farnoush Olamaei is the Program Coordinator for Blue Lecture Series.\nMs. Olamaei is the primary point of contact for all delegates associated with Blue Lecture Series courses. She manages and oversees logistics for all BLS events and works with students and instructors directly to ensure a rewarding and unique CE experience.\nMs. Olamaei works with the nation's most prestigious venues to ensure that the Blue Lecture Series experience is as luxurious, memorable yet affordable as possible. She oversees all logistics associated with Blue Lecture Series and is integral to a memorable Continuing Education weekend.\nOlamaei is a Florida native and prides herself in being personable, approachable and effective in management. She is integral to the Blue Lecture Series vision of luxury, quality and creating a unique and memorable experience for our delegates. |
Publication Year: 2012\nAuthors/Editor: Valchanov, Kamen; Webb, Stephen T.; Sturgess, Jane\nPublisher: Cambridge University Press\nDoody's Star Rating®:Score: 98\nDissects the nature of complications and helps anesthetists and anesthetic practitioners understand, avoid and manage them efficiently\nLeading experts combine the detailed clinical management of common and important anesthetic and perioperative complications with discussion of the key philosophical, ethical and medico-legal issues that arise with assessing a medical complication. Initial chapters discuss how and why complications occur, the prevention of complications and risk management. The main body of the text reviews the clinical management of airway, respiratory, cardiovascular, neurological, psychological, endocrine, hepatic, renal and transfusion-related complications, as well as injury during anesthesia, complications related to regional and obstetric anesthesia, drug reactions, equipment malfunction and post-operative management of complications. Each chapter contains sample cases of complications and medical errors, giving clinical scenario, outcomes and recommendations for improved management. This is an important practical and clinical text for all anesthetists and anesthetic practitioners, both trained and trainees. |
What Dr. Pimple Popper calls an episode we at Wolpoe Facial Plastic Surgery call Tuesday. We have extensive experience removing all manner of cysts, lumps and bumps with the best functional and aesthetic outcomes. Most procedures can be done in the office under local anesthesia. Call to schedule your appointment today!\nGet to know Dr. Wolpoe and his team.\nHelp us learn about you and your goals.\nFind a treatment plan that's right for you. |
Anesthesia: We utilize the safest available anesthetics to provide an extra margin of safety, especially for our older or high-risk patients. Using the most modern equipment, the patient’s vital signs are monitored during all anesthetic procedures.\nBoarding: Let us be your pet’s “home away from home.” Our hospital employs a team that is specifically dedicated to the pets in our boarding facility. The care, feeding and TLC of your beloved pet are their primary concern.\nDentistry: The statistics are staggering, 85% of pets over the age of 3 have some form of dental disease. Unfortunately, much of this disease can occur under the gum line of the teeth. To help identify these often hidden dental issues, our hospital utilizes digital dental radiographs with all dental cleanings. Our pet dental cleaning includes: patient assessment, anesthesia, full mouth radiographs, teeth cleaning/polishing and fluoride treatment.\nDigital Radiology: We provide on-site, digital radiography to aid in the quick diagnosis of many disorders and ailments. As an added benefit to our clients and patients, we utilize the expertise of our staff veterinarians as well as Board Certified Veterinary Radiologists for radiograph interpretations.\nElectrocardiography Services: We provide ECG services on-site as well as consultations with veterinary cardiology specialists.\nExaminations: An examination by a veterinarian is an extremely important part of providing optimal health care for your beloved pet. Regular (at a minimum, once per year) wellness exams allow the veterinarian to evaluate your pet’s general health. It is always better to identify potential health issues early. Since your pet cannot verbally communicate with you, an examination by a veterinarian and your at-home observations are vital to your pet’s health. Every year for a dog or cat is equivalent to five to seven human years, so it is very important that your pet receives a wellness exam at least once a year.\nGrooming: Our professional staff possesses over 20 years of experience in pet grooming. We offer breed specific haircuts or your own personalized styles. Our groomers will work with you to get the perfect groom for your dog or cat. All grooms include: bath, dry, haircut, outer ear cleaning, anal gland expression and nail trim.\nHospitalization: Should your pet require supportive care for their illness, we are available. We will provide your pet with a clean, quiet environment (including isolation ward if necessary) where we can attentively monitor your pet’s recovery, administer mediations (orally or by injection), monitor their treatment (i.e. fluid therapy through I.V. catheter) and adjust treatment as needed.\nIn-house (and referral) Diagnostic Laboratory: Our facility is equipped to provide serum chemistry, hematology, serology, urinalysis and parasite testing. Common in-house laboratory tests that we perform: urinalysis, fecal exam, complete blood count (CBC), blood clotting times, blood chemistries, in-house cytology and heartworm testing). To enable an even broader spectrum of diagnostic capabilities, we also utilize the services of a referral diagnostic lab.\nMicrochipping (permanent identification): According to Home Again, 1 in 3 pets will go missing during their lifetime. Without ID, 90% of pets never return home. These statistics are why we feel it is extremely important for pets to be permanently identified with a microchip. Identification collars can slip off; a microchip provides a greater chance of a pet being reunited with its family.\nNutritional Counseling: We can provide guidance regarding your pet’s nutritional needs for each of their life stages. Our hospital can also provide information on diets that assist in the therapeutic maintenance of many different health concerns (heart, kidney, skin, urinary, etc). On premises, we carry a full line of high quality prescription and non-prescription diets.\nOrthopedics: The ability to actively move about without pain is necessary for a dog or cat’s quality of life. If a pet is experiencing problems with their joints or ligaments, there are options that our veterinarians can recommend.\nPain Management: Even though your pet cannot verbally communicate when they are uncomfortable, we know that he or she can still feel pain and discomfort. Quite often there are subtle signs of the pain a pet is experiencing (panting, difficulty getting up, laying in different positions, etc). We give the highest priority to your pet’s comfort and well-being.\nPediatric Care: One of the best things a pet parent can do is provide exceptional care during the early stages of a puppy or kitten’s life. Examinations, immunizations, deworming, proper nutrition, training…. it can all seem overwhelming. Let us be a valued resource in starting off right with your new addition. To aid in providing the best level of care during this important developmental time, we offer discounted puppy and kitten wellness packages.\nPharmacy: We maintain a complete inventory of pharmaceuticals, vitamins, shampoos, flea/tick control products, dental health products and heartworm preventatives to meet the needs of your pet. In addition, for the convenience of our clients, we also offer home delivery through our online pharmacy.\nSenior Pet Care: As pets age their needs change. We offer specific full-service diagnostic packages to enable early detection of disease and intervention for senior pets.\nSurgery: Our dedicated surgical team and surgical suite provides for the performance of a wide variety of procedures. We utilize the safest anesthetic agents and use the most modern equipment to enable us to monitor and assess the patient’s vital signs during all anesthetic procedures. The safety, comfort and well-being of our patients is our priority. Some of the surgical procedures that we perform: ovariohysterectomy (spay), castration (neuter), laceration repair, tumor removal, foreign body removal, abscesses, exploratory and cat declaw.\nUltrasound: A diagnostic tool used to examine a pet’s internal organs without having to resort to exploratory surgery. Ultrasound is a safe and painless procedure. With ultrasound, the veterinarian can observe and study how an organ or process is functioning versus relying completely on a single point in time picture (x-ray). As an added benefit to our clients and patients, we utilize the expertise of our staff veterinarians as well as Board Certified Veterinary Radiologists for ultrasound interpretation.\nVaccinations: Immunizations that have been handled properly and that are administered at the appropriate times help protect pets from disease. We will consider your pet’s lifestyle and exposure to other animals before we tailor a vaccination program for your dog or cat. Up-to-date vaccination records are important, especially if you board your pet. Through a Pet Portal (available on our site) you have the ability to access your pet’s medical records and print a copy of their vaccination history if needed. |
Description of the procedure\nA pacemaker is a small battery-powered electronic device that is surgically implanted, usually in your chest, to monitor and regulate abnormal heart rate and rhythm (arrhythmia).\nA pacemaker consists of a pulse generator and leads. The generator produces electrical signals and the leads (insulated wires) transmit the signals to the heart.\nWhen should this procedure be performed?\nYour doctor will recommend this procedure when required.\nWhy is this procedure performed?\nWhen the heart no longer beats with a normal rhythm, a doctor may suggest a pacemaker. An abnormal heart rhythm may happen for a number of reasons:\n- damage to the heart muscle from a heart attack\n- problems with the heart's electrical system\n- use of certain medications (e.g., beta-blockers)\n- imbalance of minerals called electrolytes in your body (e.g., sodium, potassium, calcium)\n- certain medical conditions (e.g., diabetes, hyperthyroidism)\nAn abnormal heart rhythm can have a major impact on a person's daily activities. Household chores, exercise, and other normal activities can lead to dizziness, fainting, and fatigue because of the poor blood and oxygen supply to the body. Palpitations can also occur.\nAre there any risks and precautions?\nCertain risks are common to all surgery and every time a local or regional anesthetic is used. These risks depend on many factors including the type of surgery and your own medical condition. The possible, but very rare, side effects include: side effects of the anesthetic, breathing problems, infection, and bleeding.\nAlthough pacemaker surgery is generally considered safe, it does have some risk of side effects or complications. These include:\n- blood clots\n- damage to the blood vessel and heart muscle\n- heart attack\n- puncture of the lung and collapsed lung\n- swelling or bruising at the site where the generator was implanted\n- allergic reaction to the sedative or anesthetic\nIf you experience these side effects or complications, contact your doctor immediately.\nIf you are concerned about any symptoms following this procedure, speak to your doctor. Take the time to be sure you understand all the risks of complications and side effects as well as any precautions you or your doctor can take to avoid them. Be sure your doctor understands all your concerns.\nWhat happens during the procedure?\nThe procedure is usually performed under local anesthesia by a surgeon or cardiologist. You will also be given a sedative to help you relax. This procedure is done with the help of an X-ray machine.\n- Through an opening made below the collarbone, insulated wires (also known as leads) are inserted into a large vein and attached to the chambers on the right side of the heart. For some heart conditions, the wires are attached to the right and left sides of the heart.\n- With one end of the wires attached to the heart, the other ends are connected to the pacemaker. A pocket is made under the skin or under the muscle in the upper chest, and the pacemaker is placed in this pocket.\n- The opening is then stitched closed.\nThe procedure typically takes 1 to 2 hours.\nHow should I prepare for this procedure?\nDo not eat for 8 hours before the procedure. You may be able to drink clear liquids until 2 hours before the procedure. If your doctor has recommended different times, follow the timing recommended by your doctor.\nTell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any medication allergies and medical conditions that you may have. Arrange for someone to drive you home from the hospital.\nAsk your doctor or pharmacist whether you need to stop taking any of your medications before the procedure.\nFollow any additional instructions from your doctor.\nWhat can I expect after the procedure?\nSome people are sent home the same day, but most remain in the hospital for 1 to 2 days. While there, the doctors will check the pacemaker using a heart monitor and adjust the settings if necessary.\nThere are certain precautions you must take to keep your pacemaker working properly. For the first few days, do not raise your arms above your head. If you do, the wire leads that attach to the heart may move and the pacemaker will not work. Your doctor may also advise you to avoid heavy lifting and strenuous exercise for a few weeks.\nOnce you leave the hospital, it is important to:\n- Avoid standing too close to certain mechanical equipment as they may interfere with the electrical signals from the pacemaker (e.g., welding equipment, high-power generators). Discuss what is considered a safe distance with your doctor.\n- Make sure security personnel at airports or other areas know about the pacemaker, since it may set off these security systems.\n- Tell your doctors or other health care professionals that you have a pacemaker in order to avoid problems with certain diagnostic equipment (e.g., magnetic resonance imaging [MRI] machines) and other procedures\nAlthough cell phones are not likely to pose a significant health risk if you have a pacemaker, experts recommend the following precautions while using a cell phone:\n- hold your cell phone at least 6 inches away from your pacemaker unit\n- if your cell phone is turned on, do not put your cell phone in a shirt pocket over your pacemaker\n- hold your cell phone to the ear on the opposite side of your pacemaker\nYou should follow-up with your doctor from time to time to check that your pacemaker is working properly. Pacemaker batteries generally last on average 5 to 10 years. Your doctor will change the batteries when it is needed. The leads may be replaced at the same time, if it is needed. Your doctor may be able to check your pacemaker over the telephone if your pacemaker has this feature.\nWhen properly implanted and functioning normally, the pacemaker will prevent your heart from beating irregularly.\nAll material copyright MediResource Inc. 1996 – 2017. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/procedure/getprocedure/Pacemaker-Surgery |
What is a fair cost for nipple reduction all by itself? One surgeon I spoke to told me it would cost almost 2000 dollars.\nHow Much Does Nipple Reduction Surgery Cost?\nDoctor Answers 15\nHow Much Does Nipple Reduction Cost?\nClick on the link below to view a short, informative video about nipple reduction, including before-and-after views.\nAll the best.\nHave a question? Ask a doctor\nNipple reduction cost\nNipple reduction cost\nYou might also like...\nNipple Reduction Cost determinants\nNipple reduction prices vary greatly because the s a wide range of due to a number of variables including differing techniques that can be performed. My recommendation is to first find a few qualified surgeon board certified by the American Board of Plastic Surgery, that you trust, then compare prices between them. In our office it is approximately $1,500. Factors that influence the price include:\n1. Location - Will it be performed in a hospital with an overnight stay, an independent out- patient facility or a doctors office? (doctor's office is least expensive)\n2. Type of Anesthesia - local, IV sedation or General Anesthesia? Will a board certified anesthesiologist or a nurse anesthetist be used, or an RN? (local anesthesia will save you money)\n3. Experience and training of your surgeon. The best trained (and longest) would be a surgeon board certified by the American Board of Plastic Surgery\n4. Length and Complexity of Surgery - how much will be removed, one or both sides, etc.\nNipple Reduction Surgery Fees\nSurgical Fees vary considerably from office to office. In our office, it would be about $1500 - $2000 + MD Anesthesia fees (if necessary).\nNipple reduction surgery\nIn our office nipple reduction surgery costs, done alone and under local anesthesia, ranges between $800 to $1200.\nNipple reduction is an excellent procedure for the patient suffering from prominent nipples. This procedure can reduce the height and width of the nipple, usually preserving sensation. It can be done under local anesthesia or in combination with other procedures (under general anesthesia).\nI like to use the “sleeve” technique to reduce the height of the nipple. This procedure leaves the core of the nipple intact preserving nerves and lactiferous ducts. The suture line generally heals very nicely in this area. The width of the nipple can be reduced by removing a triangular segment from the tip area.\nI hope this helps.\nAtlanta - Nipple reduction pricing\nThe range for the nipple reduction at our licensed facility is $1,500.00 to $2,000.00. We would need to see you for a consultation to give an exact price. The consultations are free.\nThe cost of nipple reduction surgery can vary.\nThere are a number of factors involved in determining the cost for nipple reduction surgery. There are multiple techniques used depending on the size of the nipple both in projection and in width. Some techniques require additional time and effort and expertise. Most procedures can be performed with local anesthesia thus lowering the cost.\nPrice of nipple reduction surgery\nThe price of nipple reduction surgery may vary between surgeons and surgery centers. The biggest interments of the price will be the amount of work that is required and how much time the surgery will take. If you only require a small amount of skin excision with minimal work into the breast tissue itself, this may readily be done as an outpatient or an office procedure under local anesthesia. This may help meet your aesthetic goals and also limit costs.\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. |
Certified nurse anesthesis\nLearn how to become a certified registered nurse anesthetist including the clinical requirements, education path, and salary of this lucrative career. Medical staff application - crna page 1 certified registered nurse anesthesis (crna) welcome thank you for applying to nash health care, inc attached please find a. A nurse anesthetist is an advanced practice nurse who specializes in the administration of anesthesia a certified registered nurse anesthetist (crna. Nurse anesthetists, nurse midwives, and nurse practitioners, also referred to as advanced practice registered nurses (aprns), coordinate patient care and may provide. Crnas, certified registered nurse anesthetists, are some of the most advanced, and highest paid of all nurses learn more about how to become a crna.\nMayo clinic school of health sciences offers nurse anesthesia doctoral programs and a clinical rotation. Congratulations to the llusn crna class of 2017 100% graduates passed the national certification exam on their first attempt 100% found employment within six months. There are several paths to becoming a certified registered nurse anesthetist (crna) learn more about the prerequisites, education and certification requirements. Learn how to become a nurse anesthetist and see if a then you will have to pass a certification exam to call yourself a certified registered nurse anesthetist.\nLearn the requirements to enter the medical field as a certified registered nurse anesthetist (cnra), and the projected job growth. Certified nurse anesthetist salaries, benefits packages, yearly bonuses, job descriptions, statistics and available positions. As of jan 2018, the average pay for a nurse anesthetist (crna) is $139,471 annually or $7502 /hr.\nCertified registered nurse anesthetist what is a nurse anesthetist a certified nurse anesthetist (crna) is one of the roles of a broader group of nurses called. View salary range, bonus & benefits information for certified nurse anesthetist jobs in the united states or search by specific us and canadian cities and towns view.\nThe aana is the professional association representing more than 50,000 certified registered nurse anesthetists and student registered nurse anesthetists nationwide. What type of education do nurse anesthetists need to become a certified registered nurse anesthetist, professionals must have a bachelor's degree and their.\nWhat is a nurse anesthetist nurse anesthetists provide anesthesia and related care before and after surgical the certified registered nurse anesthetist. Certified registered nurse anesthetist (crna) careers learn why crnas are some of the best paid nurses. Certified registered nurse anesthetists are advanced practice nurses who safely provide more than 40 million anesthetics for surgical, obstetrical and trauma care. |
Upper Arm Lift in Oklahoma City\nPatients who deal with the dreaded "bat wing" effect of loose skin on their upper arms often choose to turn to plastic surgeon Dr. Anureet Bajaj for an arm lift in Oklahoma City. Dr. Bajaj can help you achieve arms that are slimmer and more toned. Following an arm lift, you will be able to show off your upper arms more proudly in public.\nArm Lift is Best For:\n- removing loose skin on the upper arms\n- eradicating small pockets of fat\n- improving self-image\n- patients with good skin elasticity\nArm Lift in Oklahoma City\nWhat to Expect:\nWhen you undergo your arm lift with Dr. Bajaj, a local anesthetic with sedation may be used, which will help you sleep through the procedure. In some cases, however, a general anesthetic may be the best option.\nDr. Bajaj will begin your arm lift by making incisions that travel from arm pit toward your elbow, located on the insides of your arms. These incisions should be minimally visible. At this point, she may choose to employ liposuction techniques to eradicate any small pockets of fat that prevent your arms from looking slimmer. At the incision sites, Dr. Bajaj will then remove the loose skin and tissues that contribute to the sagging look of your upper arms. She will then close the incisions with sutures, creating a more toned and taut appearance.\nAn incision on the inner part of the arm allows for removal of loose skin and tissue.\nSurgical dressings will then be applied, as well as compression garments which will maintain the new sleeker shape of your arms. These compression garments must be worn for several weeks after surgery, as you heal.\nYou should expect two to four weeks for recovery after your arm lift with Dr. Bajaj. As you leave the office, you should have transportation home as well as assistance for a few days, as your activity will be limited. You may need to keep your arms elevated for a few days.\nIt is not uncommon to experience some swelling and discomfort. To help manage this discomfort, Dr. Bajaj may prescribe medication. With limited movement and keeping your arms elevated as much as possible, the swelling should dissipate within two weeks.\nLearn More About Arm Lift\nWe encourage you to look into your options for an arm lift in Oklahoma City. Please contact Oklahoma City plastic surgeon Dr. Bajaj or call 405‐810‐8448 to set up a consultation. |
With less-invasive facial plastic surgery procedures like a mini-facelift in NYC, Dr. White can enhance specific areas of aging in the lower portion of the face with subtle, natural-looking results.\nJowls, excess skin, and creases around the mouth often develop as the skin, tissues and musculature of the face advance in age. Gravity, loss of skin elasticity, genetics, sun damage, and loss of facial volume can all contribute to these changes in your facial appearance. If you are noticing the effects of aging concentrated along the lower portion of your face, but are not yet ready for a full facelift, a mini facelift may provide the more specific degree of cosmetic enhancement you need.\nDr. Matthew White is highly skilled and experienced in all aspects of facial and reconstructive surgery and can determine the ideal approach for restoring a more youthful appearance with natural-looking results. For this reason, Dr. White is considered to be one of the top providers of the mini facelift New York has to offer.\nBenefits of a Mini Facelift\nThis procedure offers mini facelift New York patients the option of addressing excess skin and muscular laxity affecting only the lower third of the face. For many patients, targeting this area can provide significant improvement to the overall appearance of the face and keep them looking younger for longer periods of time.\nBenefits of a mini facelift include:\n- Removal of excess skin\n- Lifts and smooths sagging skin and tissue along the jawline and lower face (jowls)\n- Tightens underlying facial musculature\n- Reduces the appearance of folds and wrinkles framing the mouth and chin (nasolabial folds and marionette lines)\n- Provide lift to the lower cheek\nEvery patient is different and Dr. White customizes each procedure to effectively improve areas of concern and provide maximum enhancement. This is why Dr. White is one of the best providers of the mini-facelift New York has to offer and why he is such a sought after surgeon.\nMini Facelift NYC Candidates\nIdeal candidates for the mini facelift procedure are typically men and women in their 40s or early 50s showing key signs of facial aging in the lower third of the face. Jowls along the jawline, loose skin, wrinkles, and creasing below the cheek line and around the mouth can all potentially be addressed with a mini facelift.\nDuring a consultation, Dr. White thoroughly examines all aspects of the face to determine if mini facelift is indeed the appropriate procedure for meeting your aesthetic needs.\nTraditional VS Mini Facelift\nWhether you undergo a traditional or a mini facelift will mainly depend on how extensive your signs of aging are. For example, if you want to remove a large amount of lax tissue around the neck and cheeks, and tighten skin throughout your entire face, a traditional facelift will likely be ideal, because it’s a more intensive procedure. However, if you want to address minor sagging skin around your cheeks, jawline and neck, but you don’t need to address the forehead or eye area, you may be able to achieve the results you desire with a mini-facelift.\nWhen compared to the traditional approach, a mini facelift comes with a number of benefits that are appealing to many patients. The scars tend to be extremely minimal, and are easily concealed within your hairline and facial contours. There are also very few side effects associated with the mini facelift, and patients report considerably less swelling, bruising and post-operative pain when compared to the traditional approach. Also, because it’s a less intensive procedure, it can be performed relatively quickly and with local anesthesia, rather than the general anesthesia that is required with a traditional lift.\nMini Facelift Procedure\nThe mini facelift procedure can be performed under mild sedation and local anesthesia. Surgery may take about two hours to complete, depending on the degree of enhancement Dr. White is trying to achieve. After the anesthetic has taken effect, Dr. White makes a small incision along the front of the ear. Through this incision, he accesses, lifts, and secures lax tissue and musculature to a more elevated position. The skin is then smoothed upward and any excess is removed before carefully closing the incision.\nThis process is then repeated to create symmetrical results on the other side of the face. Every mini facelift procedure is custom-tailored to the unique needs and cosmetic goals of each patient and may be performed in combination with other procedures such as eyelid lift, BOTOXⓇ Cosmetic, or lip augmentation to provide more extensive rejuvenation.\nThe Importance of SMAS Lifting\nWhen seeking your facelift surgeon, it’s important to select a surgeon with extensive experience performing SMAS (superficial muscular aponeurotic system) lifting, like Dr. White. With this approach, the surgeon tightens your skin and addresses the lax underlying muscles and tissues.\nBy correcting the aging structure beneath the surface of the skin, SMAS lifting enhances your facial contours in a long-lasting and natural way. Conversely, when a surgeon only lifts the skin during a mini facelift, and ignores the underlying tissues, the results tend to appear artificial.\nThe Recovery Process\nRecovery after the mini facelift procedure is generally less intensive than a traditional facelift. After mini facelift surgery, most patients do not typically experience significant discomfort and pain is often easily managed with medication.\nSwelling and bruising is common and generally resolves within seven to ten days after surgery. Dr. White recommends elevating the head during the first few days of recovery to aid in healing. Sutures are typically removed about one week after surgery.\nIt is very common for Dr. White to perform complementary procedures in conjunction with the mini facelift, because blending surgeries allows him to achieve the comprehensive transformation many of his patients are looking for. Although every treatment plan is unique, Dr. White tends to combine the following surgeries with the mini facelift:\nNeck lift. If sagging skin and excess fatty deposits underneath the chin are contributing to an older appearance, you may need a neck lift to restore youthful definition to the area. In many cases, Dr. White can rejuvenate the neck through the same incisions used during the mini facelift.\nBrow lift. When forehead creases, furrows between the eyebrows and a perpetually sad, tired or angry expression have developed, Dr. White may perform a brow lift along with the mini facelift to achieve a more refreshed and pleasant overall look.\nEyelid lift. If your eyes are displaying telltale signs of aging with wrinkles, heavy bags and crow’s feet, eyelid surgery may be recommended. When performed with a mini facelift, this procedure can restore a well-rested look that has the potential to take years off your appearance.\nContact Dr. W. Matthew White\nIf you are looking for one of the most experienced providers of the mini facelift NYC has to offer, look no further than Dr. Matthew White. For more information, please contact our office. Our friendly staff can answer any questions you may have and schedule your consultation with Dr. White. |
Olutoyin A. Olutoye, MD\nDr. Olutoye's interests include the effect of drugs on the fetus and the fetal brain during Maternal-Fetal surgery as well as the effect of pediatric obesity on the efficacy of anesthesia drugs.\nOlutoye OA, Glover CD, Diefenderfer JW, McGilberry M, Wyatt MM, Larrier DR, Friedman EM, Watcha MF: The effect of intraoperative dexmedetomidine on postoperative analgesia and sedation in pediatric patients undergoing Tonsillectomy and adenoidectomy. Anesthesia &Analgesia 2010 Aug;111(2):490-5.\n* Texas Children's Hospital physicians' licenses and credentials are reviewed prior to practicing at any of our facilities. Sections titled From the Doctor, Professional Organizations and Publications were provided by the physician's office and were not verified by Texas Children's Hospital. |
Wound infiltration with bupivacaine provided complete postoperative pain relief in 14 of 19 women undergoing biopsy of a benign breast lump under general anaesthesia. Fifteen patients formed a control group in whom the wound was infiltrated with saline. They had inadequate relief of pain despite receiving significantly more opioid analgesia than the bupivacaine group in the postoperative period. The analgesia from bupivacaine usually outlasted the postoperative pain. No adverse reactions were apparent.\n|Number of pages||2|\n|Journal||Annals of the Royal College of Surgeons of England|\n|Publication status||Published - Mar 1985| |
It is impossible to give you a single monetary number for you to aim for when considering a breast augmentation. There are multiple variables that can affect the cost of your breast augmentation.\nFirst, there is the cost for the surgeon himself. It goes without saying that you should only use a board certified plastic surgeon. Usually, a more experienced surgeon will charge more for his/her services. Although some patients will fly to destination medical centers, such as India or Thailand, I personally think you are taking a huge risk. It is especially problematic if you have problems following surgery and then expect a surgeon here in the US to be able to address complications you acquired by your surgery in another country. The price for the surgeon will vary by geographic region. You can expect to pay more in a place like New York City compared to a smaller town in the South. It should also hopefully go without saying that rarely will a decent plastic surgeon put his services on a discount website like Groupon. This is not an oil change for your car. Although it is reasonable to be aware of costs, not all surgeons are equal, and you should never select a surgeon on price alone.\nBreast augmentation is done under a general anesthesia, so you will also need to consider the cost of the anesthesiologist or nurse anesthesiologist. There is also the cost of the operating room. Even if the surgery is done in the surgeon’s office, there is still an overhead cost associated with this which will be passed on to the patient.\nAnother factor is the type of implant used. Silicone implants cost more for the surgeon to buy, and again, this cost will be passed on to the patient, either directly or indirectly. Additionally, certain types of silicone implants can cost more than others. However, contrary to what many patients think, the size of the implant does not affect cost – only the type of implant.\nSome women will also need a breast lift. If a woman’s breasts are significantly saggy (the medical term is “ptotic”), you must have a lift to get your desired look. Also depending on how much ptosis there is, different types of lifts will add to the time and cost of the surgery. If the surgery requires more time, then so will the surgeon, the operating room and the anesthesiologist.\nAll of these factors contribute to why it is very hard to give you an accurate estimate of how much your breast augmentation should cost. When you see a plastic surgeon for a consultation, they should give you the total cost of your surgery and include these in the estimate.\nMost surgeons, if not all, will include follow-up for a year or more at no additional expense. |
Background XaraColl, a collagen-based implant that delivers bupivacaine to sites of surgical injury, provides been proven to lessen postoperative make use of and discomfort of opioid analgesia in sufferers undergoing open medical procedures. with a laparoscope. The summed discomfort strength and total usage of opioid analgesia through the initial 24 hours had been like the values seen in previously reported research for XaraColl-treated sufferers after open up surgery, but had been lower through 48 and 72 hours. Bottom line XaraColl would work for make use of in laparoscopic medical procedures and may offer postoperative analgesia in laparoscopic sufferers who often knowledge considerable postoperative discomfort in the initial 24C48 hours pursuing hospital discharge. Randomized handled trials to judge its efficacy within this application are warranted specifically. Keywords: laparoscopic, hernioplasty, hernia fix Introduction It really is broadly accepted that sufferers typically experience much less postoperative discomfort with minimally intrusive (laparoscopic) surgery, which contributes to quicker patient recovery, decreased medical center stay, and lower medical center costs set alongside the matching open up procedure.1 These advantages imply that laparoscopic methods are being used and developed for a growing variety of surgical treatments,2,3 allowing more functions to become conducted with an ambulatory basis progressively.4 However, there continues to be little question that lots of sufferers undergoing ambulatory medical procedures suffer significant postoperative discomfort still,5,6 with 30% reporting moderate to severe discomfort after a day.7 Indeed, regardless of the dependence on smaller incisions in comparison to open up procedures, the amount of visceral trauma is comparable or even more extensive with laparoscopic access even. Therefore, the administration of early postoperative discomfort (ie, for at least the first 24C48 hours) is normally arguably just like important for sufferers who are quickly discharged after ambulatory medical procedures as for those that CX-4945 remain under medical center care for much longer with potent analgesics easily accessible if required. XaraColl (Innocoll Technology, Athlone, Ireland) is normally a biodegradable and completely resorbable collagen matrix impregnated with the neighborhood anesthetic bupivacaine, which is normally under advancement for postoperative analgesia (Amount 1). The merchandise is normally implanted during CX-4945 produces and medical procedures bupivacaine for regional, sustained actions at the website(s) of operative trauma, while maintaining low systemic amounts well below the medications cardiotoxicity and neurotoxicity thresholds.8 Recently reported multicenter randomized controlled studies have recommended that XaraColl is effective and safe for reducing postoperative discomfort and/or patient want of opioid analgesics for 72 hours carrying out a laparotomy procedure such as for example open hernioplasty9 or total stomach hysterectomy.10 Rabbit Polyclonal to FGB. The principal goal of this study was to determine whether it had been possible to implant and appropriately position XaraColl laparoscopically. We know about no other research in which a purpose-designed, intraoperative anesthetic-delivery operational program continues to be evaluated for make use of in laparoscopic medical procedures. Amount 1 XaraColl (Innocoll Technology, Athlone, Ireland). Components and strategies We executed a feasibility research to investigate the usage of XaraColl in ten guys going through laparoscopic inguinal or umbilical hernia fix (“type”:”clinical-trial”,”attrs”:”text”:”NCT 01224145″,”term_id”:”NCT01224145″NCT 01224145). The analysis was performed at Kirby Operative Middle (Houston, TX, USA) relative to the Declaration of Helsinki and Great CX-4945 Clinical Practice suggestions following acceptance by an institutional review plank. Eligible sufferers included guys at least 18 years who had been generally healthful and planned for the unilateral laparoscopic inguinal hernioplasty with the transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) technique, or for the laparoscopic umbilical hernioplasty. We excluded sufferers who were planned for the bilateral inguinal hernia fix, had currently undergone the fix at the same site from the planned procedure, or who acquired any concomitant disease that would considerably increase their operative risk or make it tough to complete the mandatory assessments. Patients who had been getting treated with CX-4945 realtors that could have an effect on their analgesic response, such as for example central alpha realtors, neuroleptic realtors, and various other antipsychotic realtors, monoamine oxidase inhibitors, or systemic corticosteroids, were excluded also. Sufferers who had been regarded ideal and supplied created up to date consent underwent extra screening process techniques after that, including a. |
At Smile Solutions Dentistry, having a painful root canal experience is not common and rarely something we encounter. If the appropriate steps are followed, the risk of post-operative complications is very low. One reason patients could have discomfort during a procedure is due to difficulty receiving profound anesthesia. This is typically due to the way anesthetic agents work in our bodies. Anesthetics are basic chemicals and will neutralize in acidic environments like infections reducing their effectiveness. This can lead to sometimes uncomfortable situations. This is rarely an issue at Smile Solutions Dentistry. Typically this is solved by receiving a second or third carpule of anesthetic.\nIt is normal to be sore for 48-72 hours while your body is healing. Extreme pain is rare and if it occurs you should seek a dental expert immediately. Here are a few reasons you could be experiencing discomfort after a root canal procedure: a) improper irrigation, b) improper gutta percha placement, c) forceful irrigation beyond the apex of a root, d) fracture of a tooth’s root, e) an unforeseen extra canal that was not found during the procedure. These are a few of the reasons that root canals could be painful after a procedure. Due to all of these factors, it is important to seek a dental provider that you trust and has a reputation for performing root canal/endodontic procedures with a high success rate. |
Fitzsimons, Michael G. MD; Baker, Keith H. MD, PhD; Lowenstein, Edward MD; Zapol, Warren M. MD\nThe incidence of substance abuse, including alcohol, among physicians is unknown.1 The incidence of substance abuse by anesthesiologists in training or in practice is also uncertain. Although the incidence of alcohol abuse among physicians appears to be no more prevalent than among other professionals, physicians may display a higher misuse of prescription opioids. Anesthesiology residents appear to have one of the highest known incidences of addiction to pharmaceutical substances of all groups of health care providers. The incidence of substance abuse is estimated as 1.6% of anesthesiology residents in the United States.2 This high incidence of substance abuse is believed due to a combination of workplace stress inherent in commencing this demanding profession (i.e., assuming responsibility for the safe induction, maintenance, and emergence of the anesthetized, paralyzed, often critically ill surgical patient), theorized second-hand occupational exposure and sensitization to the effect of opioids,3,4 and the ready availability of potent drugs used to anesthetize patients (particularly narcotics). Collins et al.’s5 survey of 111 training programs in 2005 reported that 80% of programs had experience with trainee impairment, primarily opioid abuse. Nineteen percent of programs reported at least one death due to overdose or suicide between 1991 and 2001. The highest risk of drug-related death for anesthesiologists is within the first 5 years after completion of medical school.6 Residents in anesthesia are over-represented in the Medical Association of Georgia’s Impaired Physicians Program.7 Additionally, anesthesiology residents and attending anesthesiologists have more years of life lost due to suicide and drug-related deaths than internists.6\nFor the past decade, anesthesiology residency programs have relied on education (lectures by recovered physicians, movies depicting the impact of physician drug addiction including loss of career or life, etc.) and strict control of substances (daily accounting, establishing operating room [OR] pharmacies, etc.), to detect and discourage substance abuse by anesthesiologists. These measures have not reduced the incidence of substance abuse.1 Recent technologic advances, including surveillance of drug transactions via anesthesia drug dispensing systems (Pyxis) along with analysis of anesthesia information managements systems and pharmacy information management systems may allow earlier detection of diversion by analysis of abnormal patterns of usage. These practices are not yet widely adopted.8\nOther professions responsible for the lives of others (aviation, transportation, etc.) that have experienced problems with substance abuse are now required by the United States Congress to conduct random urine testing to attempt to reduce risk to the public. Illicit drug use decreased significantly after random testing was initiated in the US military in the early 1980s.9 Among impaired physicians, recovery is improved when random urine monitoring occurs because of the consequences of a positive substance screen.10,11 Presumably, physicians who understand the consequences of a positive urine screen would avoid use of illicit substances. Pre-employment drug testing of housestaff physicians at a teaching hospital has been reported.12 We are not aware of any civilian anesthesiology residency programs that require random drug testing. Mandatory random substance testing is common among physicians in recovery programs.\nOver the past two decades, substance abuse within the residency of the Department of Anesthesia and Critical Care (DACC) at the Massachusetts General Hospital (MGH) has reflected the national incidence, despite education and strict accounting of drugs. We therefore decided to initiate preplacement and postemployment random urine testing of all anesthesia residents to attempt to deter and detect substance abuse.\nA DACC Committee on Chemical Dependency was established in 2003 to investigate the feasibility, cost, and ramifications of random urine testing for occupationally available controlled substances. The committee was chaired by the department chairperson (W.M.Z.) and included the residency program director (K.H.B.), director of critical care, volunteer faculty members, chief residents, Office of General Counsel, and the medical director of the MGH Occupational Health Clinic (OHC). The senior hospital administration was informed and reviewed and approved our proposed program. The MGH OHC was invited to participate in the development of our program, because they had established protocols and instituted preplacement and “for-cause” urine testing for employees under the regulations of the Department of Transportation guidelines.\nAt the time our policy was approved (2003), mandatory testing had not been a requirement for becoming a resident in our program. Thus, current residents and those already committed to our program through the National Resident Matching Program were entered into the testing process on a voluntary and anonymous basis. The election of participation or nonparticipation of any resident was not known to our committee or the department leadership. However, beginning in 2004, we informed all resident applicants that random testing would be required if they matched to the MGH residency in anesthesiology. All new residents who began training from July 2005 onward have signed formal written contracts that acknowledge that they agree to our mandatory random urine testing policy.\nWe planned our urine testing frequency based on reported risk levels and our experience with substance abuse among our own residents. Residents in the first clinical anesthesia year (CA-1) are subject to at least two random tests per year with an additional 20% of the class subjected to a third test. Residents in their second and third clinical anesthesia year (CA-2, CA-3) are subject to at least one test a year with 30% of the trainees subjected to a second test. The additional testing is intended to eliminate any belief that once any individual completes a test, he/she would be exempt from screening for an entire year. We believe that more frequent testing would be disruptive to patient care.\nThe random urine testing protocol is in accordance with the previously established MGH OHC protocol for preplacement and for-cause testing. We decided not to observe collection of urine specimens to maintain privacy and dignity. Each urine sample is split to allow later confirmatory analysis if required.\nThe DACC committee determined the occupationally available substances that we would screen for. We focus on substances commonly available from the OR pharmacy. However, we omitted two substances, sufentanil and propofol, which are available. At the time we designed our panel, propofol was not considered a significant drug of abuse; however, propofol is an increasingly common substance of abuse13 and metabolites do appear in urine.14 Sufentanil was not added to our panel because it is rarely used in our department and would add substantial costs to testing. Distribution patterns for sufentanil are monitored by our pharmacy. The for-cause test includes a broader spectrum of substances of abuse. Our protocol allows screening for other substances as warranted by the circumstances (Table 1).\nUrine drug testing is performed at an outside facility. The sample is initially screened for substances by enzyme immunoassay. Confirmatory analysis of a positive immunoassay is via gas chromotograpy ± mass spectroscopy.\nAn independent certified medical review officer (MRO) receives, interprets, and reports all results of the workplace urine drug-testing program.15 When necessary, the MRO directly contacts the tested resident and determines whether the results were truly positive or due to confounding factors, such as taking a prescription medication. Results confirmed as positive by the MRO are reported directly to the Chairperson of the MGH DACC. Any positive immunoassay, which is ultimately deemed excusable by the MRO, is considered a negative result and is not reported to the department in any fashion.\nAny resident suspected of illicit drug use because of their behavior is immediately removed from clinical duty and placed on a Medical Leave of Absence. The Hospital’s Professional Staff Health Status Committee is informed as required by Joint Commission on the Accreditation of Healthcare Organizations. The resident is confronted by at least two individuals, including the department chairperson and/or a designee. A psychiatrist experienced in dealing with drug abuse is in attendance whenever possible. The individual then undergoes mandatory urine drug testing. A positive urine test results in immediate referral for clinical evaluation or inpatient treatment. Outpatient treatment may occur through the Massachusetts Medical Society’s Physician’s Health Service.\nEach state has its own requirements for reporting substance abuse among practitioners. Physicians are generally required to self-report their own dependence or abuse. Certain circumstances may dictate that a hospital directly report abuse to the state medical board. The American Board of Anesthesiology currently requires that a resident with documented abuse of alcohol or drugs receive an unsatisfactory evaluation for “Essential Character Attributes.” Other agencies such as the Department of Public Health or Federal Drug Enforcement Agency, and local police may need to be notified.\nWe have data on MGH DACC residents for the 6 yr before implementation of our policy (1998–2003) and for the 4 yr after testing began (January 2004 to December 2007) at MGH. The 6-yr period before testing was the time for which we could obtain reliable employment records. Resident drug abuse “events” were reported and analyzed for the year of occurrence and training level at the time of the event. Drug abuse events were defined as a positive urine test for illicit drugs, admitted diversion of a substance for personal use, direct observation of illicit use of a substance, or request for treatment for substance abuse or dependence. We calculated our incidence in events/resident year. The incidence before and after testing was compared using Fisher’s exact test.\nForty-three percent (43%) of residents voluntarily elected to participate in random urine testing during the initial phase-in. The CA-1 class, which knowingly would be subjected to the most frequent testing, consented at the highest rate (65% of the class) (Table 2). Approximately one-third of the CA-2 and CA-3 classes consented. We found no evidence that introduction of our policy interfered with resident recruitment. The program matched every position offered between 2003 and 2006 and did so with our usual “ranked to match” ratio.\nSince the inception of the urine testing program for residents, 236 urine tests (preplacement, random, and for-cause) have been performed (Table 3). Eighty-four preplacement, 150 random, and two for-cause tests have been performed.\nSubstance Abuse Events\nOverall, the incidence of substance abuse was 1% in the 403 resident-years during the 6 yr before testing began. During this same time, in the most highly vulnerable CA-1 residents, the incidence of drug abuse in the 138 resident-years was 2.2% (three events). During this time period, one event occurred in a resident during the second year (CA-2). In contrast, no events have occurred during 330 resident-years since testing began in 2004. The data are associated with a P value of 0.13 by Fisher’s exact test. Thus, we cannot conclude from our data whether there has been a decrease in the incidence of abuse.\nThe total costs of the testing program are composed of two elements, test collection and analysis and administrative fees. We estimate collection and analysis expenses at less than $20,000/yr. The program requires approximately 20% of a full time equivalent nurse practitioner, which amounts to $20,000 per year. We estimate that at full implementation, a total cost of $50,000 per year would be associated with testing all residents in our program at the desired rate.\nSubstance abuse appears to be more frequent in anesthesiologists than in other medical specialties. Education and substance control measures have not significantly reduced this incidence. This report describes the development and initial experience of mandatory random drug testing in a civilian academic department of anesthesiology. Only 8% of anesthesia residencies use random urine testing, and all of them are military programs.2 More than 60% of all program directors would approve of random urine screening.2 This is the first report of random urine drug testing of civilian anesthesia residents.\nOur preliminary experience does not have the statistical power to determine the effect of urine drug testing on the incidence of resident drug abuse. Assuming an incidence of 1%, an estimated decrease of 20% and a power of 80%, it would require a comparison of 800 resident-years, with and without drug testing within our own program, to establish a statistically significant effect at the P < 0.05 level. Large multicenter studies will be required to demonstrate efficacy.\nAnesthesiologists are responsible for the care of the public and this carries an ethical obligation to ensure that medical care is delivered by unimpaired individuals. Though empirical data indicate that the greatest risk of substance abuse is early in the anesthesia residency and diminishes with time, the hazard remains thereafter.16\nAny drug testing program is expensive. However, the costs must be weighed against the benefits. The United States Postal Service estimated a cost savings of more than $100 million dollars over a 10-yr period when they studied the effect of preplacement urine testing between September 1987 and May 1988. The savings were primarily due to lower rates of absenteeism, reduced involuntary turnover, fewer Employee Assistance Program referrals, fewer medical claims, and less frequent disciplinary action than would have been realized had those testing positive been employed.17 Zwerling et al.18 evaluated the cost-benefit relationship of pre-employment drug screening among United States Postal Service workers in Boston, MA. They were unable to find a definite benefit, because the costs and benefits of drug testing are based on many assumptions, such as the incidence of substance abuse within the population tested.\nWe estimate our annual cost at less than $50,000. The financial benefits of a drug testing program are more difficult to determine. Detoxification may involve 3–7 days of intensive medical and psychiatric care at a fee of up to $9000. Inpatient treatment for 30 days is approximately $25,000. Residential treatment of up to 90 days is common. Outpatient treatment for 4–8 wk approaches $8000. Our previous experience suggests that residents generally take 6 mo to return to duty after substance abuse events. We estimate the cost of diagnosis, initial management, and lost clinical revenue at more than $60,000–$70,000 for a single event. When the costs of psychiatric care, follow-up through physicians’ health services for 3–5 yr, and mandatory drug testing for a physician in recovery is considered, the total cost of returning a physician to unrestricted medical practice is likely in excess of $100,000. Thus, if we deter a single physician from illicit drug use we can save a significant amount of money.\nEstablishing a program of substance testing was not easy and we encountered several limitations and challenges. First, the OHC moved off-site shortly after our testing program was established. This required our residents to change clothes, leave the hospital, and walk two blocks. We have addressed this by configuring a newly constructed toilet adjacent to the OR suites for urine sampling. Second, most substances are only detectable in urine for about 2–4 days after use. Detection times are dependent on dose, sensitivity of the method of detection, route of administration, duration of substance use, and variability between individuals.19 Our initial protocol permitted a 36-h window to appear for testing. This time frame increases the admittedly small likelihood of a false negative result. Because anesthesiologists work in an environment where their presence is critical at nearly all times, residents cannot be called away at a moment’s notice to undergo a test. Thus, we believe that we should allow some time for residents to make appropriate arrangements for urine sampling after clinical obligations are complete. However, the establishment of our new sampling site will enable reduction of the time between notification and mandatory urine sampling. We are planning to reduce the interval.\nAdministration of a urine-testing program in a large academic anesthesia department where residents cover multiple services (intensive care unit, pain, obstetrics) in several hospitals, and spend time in distant locations (laboratories, simulator, etc.) presented additional problems. All randomization, notification, and record keeping in our program occurs through the OHC. The clinic contacts individuals directly via the hospital paging system. If a resident does not respond and notify the clinic of his/her time of availability after three pages, a member of the Committee on Chemical Dependency or the residency Program Director is notified. If the paged physician is not able to free himself from clinical responsibilities for urine sampling he/she is rerandomized to another day. This provides a potential breach in the random nature of the program.\nThe greatest problem to date is that the number of tests obtained (236) has fallen short of the number called for (Table 3). The rate of testing increased progressively each year on the CA-1 and CA-2 residents. In 2007 we achieved an average of about 1.5 tests per CA-1 resident and approximately one test per CA-2. This increase was not observed in the CA-3 residents, and only approximately 1/3 of CA-3 residents were tested in calendar year 2007. We speculate that this is due to the many rotations outside of the MGH ORs and this hospital. This unsatisfactory rate needs to be addressed. Establishment of a comparable testing program at other hospitals through which residents rotate would solve much of this problem. Better coordination of the Occupational Health Service with our scheduling system so residents on vacation are not selected for sampling and so residents at other hospitals can be paged through the paging system of the outside rotations will likely increase adherence. We expect that our proximate and new testing location and a more intensive follow-up via our paging system will increase the number of tests we successfully perform each year.\nThe risk of a false positive result is also a major concern. Indeed, false positive results have been reported with urine screening. Rifampin and fludroquinolones have been reported to cause false positive testing for opiates20,21 and oxaprozin for benzodiazepines.22 Nonsteroidal antiinflammatory drugs have been reported to cause false positive results for barbiturates and cannabinoids.23 We experienced one false positive urine screen for morphine, which was attributed by independent MRO review to the consumption of poppy seeds in a bagel, and was considered a negative result. This event prompted us, in conjunction with the Occupational Health Service to raise our confirmatory level from 300 to 2000 ng/mL, the level accepted by the federal government. Poppy seeds have traces of morphine and codeine and positive urine screens have been reported after consuming them.24\nEducation of physicians and their families, and stringent substance control have not reduced the incidence of substance abuse in anesthesiology residents. We envision substance testing as one component of a policy intended to prevent individuals from embarking on a course of behavior with potentially deadly results. In fact, nearly 20% of addicted individuals will die or nearly die (require resuscitation) before substance abuse is detected.2 A large and sufficiently powered study to determine the impact of preplacement and random urine testing on the incidence of resident substance abuse is very difficult within a single anesthesia department. We do not know if those residents who were not tested in this preliminary experience were those at highest risk and avoided testing. It is possible that our announcing a mandatory policy served to drive at-risk resident applicants to other training programs that do not test and shifted the burden to another academic department within the field of anesthesia. A multidepartment study would need to address all causes of false negative results, including delay in testing after notification, failure to appear for testing, and substances that are not included or difficult to detect by urinalysis.\nWe have demonstrated that it is feasible to establish and operate a random urine testing program for civilian residents in anesthesiology and define some of the impediments to complete adherence and suggest measures to improve (and approach complete) adherence. Although our data may suggest a decrease in the incidence of substance abuse, we cannot make this definite conclusion. Only larger, presumably multi-institutional, studies will have the power to determine whether random testing will decrease substance abuse in anesthesiology residents. If it were proven to reduce the incidence of abuse in anesthesia residents, a program could be expanded to other specialties and groups at risk for substance misuse.\nPhysicians are placed in a position of direct responsibility for their patient’s safety. A system-level effort to address the effectiveness of substance screening among all physicians has been suggested.25 Substance abuse by physicians endangers patients and jeopardizes the public’s trust in our profession. The profession of anesthesiology should be encouraged to conduct a large trial powered to determine if randomized urine testing will reduce the incidence of drug abuse in anesthesia residents.\nThe authors thank Hui Zheng, PhD, for statistical assistance, Dr. Debra Weinstein, Vice President for Education, Partner’s Healthcare, Dr. Jo Shapiro, Senior Associate Director of Partners GME, and Ann Prestipino, Senior Vice President for Surgery and Anesthesia Services and Clinical Business Development, Massachusetts General Hospital for their administrative support instituting the Random Urine Testing Program.\n1. Brewster JM. Prevalence of alcohol and other drug problems among physicians. JAMA 1986;255:1913–20\n2. Booth JV, Grossman D, Moore J, Lineberger C, Reynolds JD, Reves JG, Sheffield D. Substance abuse among physicians: a survey of academic anesthesiology programs. Anesth Analg 2002;95:1024–30\n3. Gold MS, Byasr JA, Frist-Pineda K. Occupational exposure and addictions for physicians: case studies and theoretical implications. Psychiatr Clin North Am 2004;27:745–53\n4. McAuliffe PF, Gold MS, Bajpai L, Merves ML, Frost-Pineda K, Pomm RM, Goldberger BA, Melker RJ, Cendan JC. Second-hand exposure to aerosolized intravenous anesthetics propofol and fentanyl may cause sensitization and subsequent opiate addiction among anesthesiologists and surgeons. Med Hypotheses 2006;66:874–82\n5. Collins GB, McAllister MS, Jenson M, Gooden TA. Chemical dependency treatment outcomes of residents in anesthesiology: results of a survey. Anesth Analg 2005;101:1457–62\n6. Alexander BH, Checkoway H, Nagahama SI, Domino KB. Cause-specific mortality risks of anesthesiologists. Anesthesiology 2000;93:922–30\n7. Talbott GD, Gallegos KV, Wilson PO, Porter TL. The Medical Association of Georgia’s Impaired Physician’s Program. Review of the first 1000 physicians: analysis of specialty. JAMA 1987;257: 2927–30\n8. Epstein RH, Gratch DM, Grunwald Z. Development of a scheduled drug diversion surveillance system based on an analysis of atypical drug transactions. Anesth Analg 2007;105:1053–60\n9. Bray RM, Marsden ME, Rachal JV, Peterson MR. Drugs in the military workplace: results of the 1988 worldwide survey. In: Gust SW, Walsh JM, Thomas LB, Crouch DJ, eds. Drugs in the workplace research and evaluation data. Vol. II. NIDA Monograph Series No. 100. Washington, DC: NIDA, 1990:25–44\n10. Jacobs WS, Repetto M, Vinson S, Pomm R, Gold M. Random urine testing as an intervention for drug addiction. Psychiatric Ann 2004;34:781–4\n11. Shore JH. The Oregon experience with impaired physicians on probation. An eight-year follow-up. JAMA 1987;257:2931–4\n12. Lewy RM. Pre-employment drug testing of housestaff physicians at a large urban hospital. Acad Med 1991;66:618–9\n13. Wischmeyer PE, Johnson BR, Wilson JE, Dingmann C, Bachman HM, Roller E, Tran ZV, Henthorn TK. A survey of propofol abuse in academic anesthesia programs. Anesth Analg 2007;105: 1066–71\n14. Simons PJ, Cockshott ID, Douglas EJ, Gordon EA, Hopkins K, Rowland M. Disposition in male volunteers of a subanesthetic does of an oil in emulsion of 14C-propofol. Xenobiotica 1988;18: 429–40\n15. Sgan SL, Hanzlick R. The medical review officer. A potential role for the medical examiner. Am J Forensic Med Pathol 2003;24: 346–50\n16. Gravenstein JS, Kory WP, Marks RG. Drug abuse by anesthesia personnel. Anesth Analg 1983;62:467–72\n17. Peat MA. Financial viability of screening for drugs of abuse. Clin Chem 1995;41:805–8\n18. Zwerling C, Ryan J, Orlav EJ. Costs and benefits of preemployment drug screening. JAMA 1992;267:91–3\n19. Verstraete AG. Detection times of drugs of abuse in blood, urine, and oral fluid. Ther Drug Monit 2004;26:200–5\n20. Zacher JL, Givone DM. False-positive urine opiate screening associated with fludroquinolone use. Ann Pharmacother 2004;38:1525–8\n21. Daher R, Haidar JH, Al-Amin H. Rifampin interference with opiate immunoassays. Clin Chem 2002;48:203–4\n22. Fraser AD, Howell P. Oxaprozin cross-reactivity in three commercial immunoassays for benzodiazepines in urine. J Anal Toxicol 1998;22:50–4\n23. Rollins DE, Jennison TA, Jones G. Investigation of interference by nonsteroidal anti-inflammatory drugs in urine tests for abused drugs. Clin Chem 1990;36:602–6\n24. Struempler RE. Excretion of codeine and morphine following ingestion of poppy seeds. J Anal Toxicol 1987;11:97–9\n25. Leape LL, Fromson JA. Problem doctors: is there is system-level solution. Ann Intern Med 2006;144:107–15 |
|Year : 2015 | Volume\n| Issue : 3 | Page : 223-228\nBehavioral response and pain perception to computer controlled local anesthetic delivery system and cartridge syringe\nTD Yogesh Kumar, J Baby John, Sharath Asokan, PR Geetha Priya, R Punithavathy, V Praburajan\nDepartment of Pedodontics and Preventive Dentistry, KSR Institute of Dental Science and Research, Tiruchengode, Tamil Nadu, India\n|Date of Web Publication||9-Jul-2015|\nDr. J Baby John\nDepartment of Pedodontics and Preventive Dentistry, KSR Institute of Dental Science and Research, Tiruchengode - 637 215, Tamil Nadu\nSource of Support: None, Conflict of Interest: None\n| Abstract|| |\nAim: The present study evaluated and compared the pain perception, behavioral response, physiological parameters, and the role of topical anesthetic administration during local anesthetic administration with cartridge syringe and computer controlled local anesthetic delivery system (CCLAD). Design: A randomized controlled crossover study was carried out with 120 children aged 7-11 years. They were randomly divided into Group A: Receiving injection with CCLAD during first visit; Group B: Receiving injection with cartridge syringe during first visit. They were further subdivided into three subgroups based on the topical application used: (a) 20% benzocaine; (b) pressure with cotton applicator; (c) no topical application. Pulse rate and blood pressure were recorded before and during injection procedure. Objective evaluation of disruptive behavior and subjective evaluation of pain were done using face legs activity cry consolability scale and modified facial image scale, respectively. The washout period between the two visits was 1-week. Results: Injections with CCLAD produced significantly lesser pain response, disruptive behavior (P < 0.001), and pulse rate (P < 0.05) when compared to cartridge syringe injections. Application of benzocaine produced lesser pain response and disruptive behavior when compared to the other two subgroups, although the result was not significant. Conclusion: Usage of techniques which enhance behavioral response in children like injections with CCLAD can be considered as a possible step toward achieving a pain-free pediatric dental practice.\nKeywords: Behavior, cartridge syringe, computer controlled local anesthetic delivery system, local anesthesia, pain perception\n|How to cite this article:|\nYogesh Kumar T D, John J B, Asokan S, Geetha Priya P R, Punithavathy R, Praburajan V. Behavioral response and pain perception to computer controlled local anesthetic delivery system and cartridge syringe. J Indian Soc Pedod Prev Dent 2015;33:223-8\n|How to cite this URL:|\nYogesh Kumar T D, John J B, Asokan S, Geetha Priya P R, Punithavathy R, Praburajan V. Behavioral response and pain perception to computer controlled local anesthetic delivery system and cartridge syringe. J Indian Soc Pedod Prev Dent [serial online] 2015 [cited 2023 Feb 7];33:223-8. Available from: http://www.jisppd.com/text.asp?2015/33/3/223/160394\n| Introduction|| |\nDental anxiety and fear are a matter of concern for the treating dentist. The use of local anesthetic injections is one of the most anxiety-provoking procedure in dentistry. Though it produces pain and anxiety, its proper administration provides a relatively painless treatment and also helps in gaining the child's cooperation.\nThe present study was planned to assess the pain perception, behavioral response, physiological parameters, and role of topical anesthetic administration during local anesthetic administration with cartridge syringe and computer controlled local anesthetic delivery systems (CCLAD).\n| Materials and Methods|| |\nThis randomized controlled trial with crossover design was carried out in the children who had reported as outpatients in Department of Pediatric Dentistry. The study protocol was approved by the institutional review board and ethical committee consent (ref 011/KSRIDSR/EC/2011) was obtained. Written consent was obtained from parents of participating children.\nInclusion and exclusion criteria\nOne hundred and twenty children were included in the study based on the following inclusion criteria:\n- Age 7-11 years;\n- Children with American Society of Anesthesiologists I status;\n- No previous history of dental treatment and, who needed at least two clinical sessions of operative procedures preceded by local anesthetic injection, one on either side of the maxilla or mandible, neither of which was due to emergency.\nExclusion criteria were:\n- Children allergic to local anesthetics (lignocaine);\n- Children under medications that could alter the pain perception;\n- Medically compromised and special children;\n- Uncooperative patients (Frankl behavior rating 1-definitely negative).\nThe children were randomly divided into two groups: Group A - receiving injections with CCLAD (Single Tooth Anesthesia [STA] Wand, Milestone Scientific Pvt. Ltd., Livingston, USA) during first visit and then cartridge injections; Group B - receiving injections with cartridge syringe (conventional) during first visit followed by CCLAD injections. Randomization pattern was generated using computer software (Random allocation software). Both the groups were further randomly divided into three subgroups: Subgroup one-children receiving 20% topical benzocaine (Mucopain, IPCA Laboratories, Bangalore, India) gel, subgroup two children receiving pressure using a cotton applicator; subgroup three children receiving no topical gel.\nMeasurement of baseline data\nBefore commencement of the treatment procedure, pulse oximeter probe (FTP-101, SCure Pvt. Ltd., Gujarat, India) and blood pressure (BP) cuff of digital BP monitor (Omron Healthcare Pvt. Ltd., Singapore) were fixed on the right hand index finger and on the left arm respectively. The baseline data of pulse rate and BP were obtained in the counseling room 10 min before procedure with the patient seated on a chair in an erect position. Three readings were taken and the mean score was calculated.\nInjection procedure and interpretation\nChildren were familiarized with the interpretation of modified facial image scale (FIS) after being seated on the dental chair. The injection procedure was explained to all the children using standard and similar euphemisms. The injection site was dried with cotton and topical anesthetic gel was applied and allowed to remain for 30 s. In subgroup two, the cotton applicator stick was pressed firmly to the tissue near the injection site as a counter-stimulation during the injection procedure. All injections which consisted of 2% lignocaine with 1:1,00,000 epinephrine were then administered with a one inch 30 gauge needle using the bi-rotational technique to minimize needle deflection. In Group A, injections were administered with STA mode (1 cc per 207 s) was used initially till 1/4 th of cartridge was administered followed by the normal mode (1 cc per 35 s). In Group B, injections were given slowly at approximately 1 ml/min with an aspirating cartridge syringe (Septodont, France). All the injections were given by the same operator/primary investigator, to ensure that the results were not influenced by inter-operator variability. Objective evaluation of disruptive behavior was done using face legs activity cry consolability (FLACC) scale by a calibrated dental assistant. The physiological parameters (pulse rate, BP) were recorded during the injection procedure. Subjective evaluation of pain was rated using a modified FIS after the injection procedure. The washout period between the visits was 1-week. During the next appointment, the child was administered local anesthetic injection using the alternative technique on other side of the jaw.\nThe data obtained were statistically analyzed using SPSS software (15.0, SPSS Inc., Chicago Ill, USA). t-test, Mann-Whitney test were used for comparing mean scores of FIS, FLACC of both modes of local anesthetic administration. ANOVA and Kruskal-Wallis test were used for comparing quantitative variables between the three subgroups. Tukey honestly significant difference test was used with ANOVA to compare the means of three subgroups that were found to be statistically significant. P ≤ 0.05 was considered as statistically significant.\n| Results|| |\nOne hundred and twenty children, 71 boys and 49 girls (mean age = 9.23 ± 1.52 years) were included in the study. The attrition rate was 4.5% (n = 10) as they did not report for the second appointment. 110 children were subjected to both computerized and conventional (cartridge syringe) injection technique.\nComputer controlled local anesthetic delivery system versus cartridge syringe\nChildren who received injections with CCLAD showed a significant decrease (P < 0.002) in pain perception as seen by FIS scores when compared to cartridge group. There was a significant decrease (P < 0.001) in the disruptive behavior on comparing the two groups [Table 1]. Pulse rate was significantly increased (P = 0.04) in cartridge group. There were no significant differences in systolic and diastolic BP (P > 0.05) among the groups during injection [Table 2].\n|Table 1: Comparison of mean FIS and FLACC scores in cartridge and CCLAD group|\nClick here to view\n|Table 2: Comparison of physiological parameters in cartridge and CCLAD group|\nClick here to view\nComparison between topical subgroups\nThere was a statistically significant difference between the three topical subgroups based on FIS and FLACC scores. Children who were given 20% benzocaine topical gel application showed lesser pain response and disruptive behavior when compared to applicator pressure and no topical gel subgroups, although it was not significant. This was evident while receiving injections with cartridge syringe and CCLAD [Table 3].\n|Table 3: Comparison of mean FIS and FLACC scores of benzocaine, applicator pressure, and no gel subgroups in cartridge and CCLAD group|\nClick here to view\nOn comparing the topical subgroups with each other, children who received injections with CCLAD showed no significant difference in FIS (P = 0.94) and FLACC (P = 0.99) scores between benzocaine and applicator pressure subgroups. Whereas, both benzocaine and applicator pressure subgroup was significantly better than no topical gel group [Table 4]. In children receiving injections with cartridge syringe, there was a significant difference between benzocaine and no topical gel group when FIS (P = 0.01) and FLACC (P = 0.001) scores were compared. There was a significant difference between FLACC (P = 0.04) scores of benzocaine and applicator pressure group, whereas, FIS (P = 0.407) scores showed no significant differences [Table 4]. There were no significant differences in physiological parameters irrespective of topical application method used for both modes of local anesthetic administration.\n|Table 4: Comparison of FIS and FLACC score within the topical groups in CCLAD group|\nClick here to view\nThe children receiving cartridge syringe injections showed more facial expressions, leg movements and were difficult to console when compared to CCLAD injections. On assessing the overall children's behavior, 71 children (64%) showed better behavioral response while receiving CCLAD injections. 13 children (12%) demonstrated better behavioral response with cartridge syringe injections. 26 children (26%) showed similar behavioral response during both modes of local anesthetic administration.\nThirty-eight children preferred receiving local anesthesia with CCLAD while only 6 children preferred cartridge syringe injections. 66 children found both methods to be similar.\n| Discussion|| |\nPediatric dentists prefer techniques and strategies that help to enhance the behavior of the children in the dental office. Dental anxiety and fear are strongly related to the impairment of having a quality oral health care in an individual's life. Successful dental treatment in a child depends not only on the quality of treatment, but also in instilling a positive attitude toward dental care.\nVarious methods like usage of topical anesthesia and prolonged injection time, distraction techniques, counter-stimulation, warming the anesthetic solution, varying the rates of infiltration, buffering the local anesthesia, reduced speed of injection, cooling of soft tissue injection site, and change in appearance of anesthetic delivery system have been used to eliminate/minimize pain during injections.\nStudies by Asarch et al., Gibson et al., Allen et al., Ram and Peretz, Tahmassebi et al., have compared the pain response during local anesthetic delivery with cartridge and CCLAD. ,,, Asarch et al., Ram and Peretz and Tahmassebi et al. found no significant differences in pain response and disruptive behavior between both the techniques of administration. ,, Asarch et al., Ram and Peretz concluded that CCLAD produced lesser disruptive behavior than traditional syringe. , Palm et al. stated that the measurement of associated change in physiological parameters during injection procedure would have minimized observer bias and provided validation for direct observation measures. These parameters were assessed by San Martin-Lopez et al., Langthasa et al. , However, the results were contradictory and not conclusive. There is minimal evidence which supports the role of topical anesthetic while administering injections with cartridge and CCLAD, which provided the rationale for conducting the present study.\nIn the studies by Asarch et al., Gibson et al., Allen et al. parallel study design was followed where the children were subjected to injection either by traditional syringe or CCLAD. ,, The possible demerit of this study design is that, in behavioral research the comparison of pain responses between individuals may be inappropriate as pain threshold differs in each person. Hence, in the present study crossover design was followed where the children served as his/her control. This was in accordance with the studies done by Ram et al., Palm et al., Langthasa et al. ,,\nThe children aged 7-11 years belong to concrete operational period according to Jean Piaget's cognitive theory. The children in this age group become capable of reasoning logically when the problem is displayed before them which would help them in making the decision regarding pain perception. Children who had a previous history of dental treatment were excluded as their previous experiences might influence the results of the study. In the present study, no attempt was made to sex match as the studies by Ram and Peretz, Tahmassebi et al. suggests there was no significant difference in pain reaction between girls and boys. , However, Chapman HR, Kirby Turner NC stated that girls in general report more fear than boys. \nAsarch et al., Gibson et al., Allen et al. in their studies blindfolded the patients and switched on the sound of CCLAD during both injection procedures to reduce bias. ,, However, in our study we did not practice this as we believed blindfolding a child during the first visit for treatment might increase his/her anxiety level and alter the pain perception and physiological parameters. Standard and similar euphemisms and distraction techniques were used as alternative methods to reduce anxiety in both the groups.\nFacial image scale was used to assess the subjective pain response. This scale is a valid and reliable measure of dental anxiety for employment with young children in clinical settings. Ideally a scale should be short in length to maximize response from children and minimize time for administration; easy to hold the attention of child and be simple to score and interpret. In this study, the scale was modified to three faces signifying:\n- No discomfort,\n- Mild discomfort,\n- Severe discomfort.\nThis was done to reduce the confusion among children while assessing pain.\nObjective evaluation provides better information about the discomfort experienced by the child during injection procedure. The subjective evaluation can also differ according to child's pain threshold level. In this study, FLACC scale was used to assess the behavior of the child during injection procedure. FLACC pain assessment tool incorporates five categories of pain behaviors: Facial expression; leg movement; activity; cry; and consolability. FLACC scale is a validated and a reliable scale used in assessing pain in acutely ill adults and children postgeneral anesthesia. FLACC scale can be used for quantifying pain behaviors in children who cannot verbalize the presence or severity of pain.\nThe present study suggests that children who received injections with CCLAD showed significantly less pain and disruptive behavior when compared to children who received injection by cartridge. Gibson et al. compared CCLAD and traditional syringe in children of 5-13 years and concluded that no significant difference in pain ratings between them. Palm et al. compared the pain perception while administering mandibular block with CCLAD and traditional method in children aged 7-18 years and concluded that mandibular block was less painful with the CCLAD. Langthasa et al. compared pain perception while experiencing injections with a comfort control syringe (CCS) and conventional syringe in children aged 6-14 years. Injections with CCS were less painful and produced significantly less disruptive behaviors than a conventional syringe. The age of patients and site of injection varied in all the above studies. Thus, the use of CCLAD produced less pain ratings irrespective of age and site of injection when compared to the traditional technique.\nIn the present study, children who received injections with cartridge showed more disruptive behavior as measured by FLACC scale. Gibson et al. reported that significantly fewer children cried or exhibited body movements while receiving injections with CCLAD during first 15 s. Allen et al. reported a gradual increase in disruptive behavior in CCLAD group after the initial 15 s contrary to the above results. This may be due to increased injection time with CCLAD, which might result in restless behavior particularly in preschool children. Asarch et al., Ram and Peretz reported no significant differences in disruptive behavior while receiving injections with CCLAD and a traditional method respectively. ,\nPulse rate was significantly increased in children receiving cartridge injection. This may be due to increased and uncontrolled injection pressure while using cartridge syringe. The infiltration of injection fluid leads to increased pressure built up causing pain. Kudo found a positive correlation between pressure at the start of injection and intensity of pain. San Martin-Lopez et al. showed a significant difference in heart rate on comparing computerized device and conventional syringe. Langthasa et al. found no significant differences in pulse rate, BP and body temperature while administering injections with CCLAD and traditional syringe. There were no significant differences in systolic and diastolic BP between both the techniques in the present study which were in accordance with Langthasa et al. \nIn this study, benzocaine gel application produced lesser pain response and disruptive behavior than the other 2 topical subgroups in children receiving both CCLAD and cartridge syringe injections, although it was not statistically different. Nayak and Sudha showed 18% benzocaine gel had the most rapid onset of action and was superior in pain reduction when compared to 5% lignocaine ointment and 5% eutectic mixture of local anesthetics cream due to its low dissociation constant. \nIn children who received CCLAD injections, the pain perception and behavioral response was nearly similar while using benzocaine and topical applicator pressure and was significantly better than no topical gel application. Thus, the injections with CCLAD were less painful irrespective of the topical application method (benzocaine and counter-stimulation) used. Children who received injections with cartridge showed the significantly lesser disruptive behavior when benzocaine topical application was used. The subjective pain response showed no statistically significant difference irrespective of whether benzocaine or topical pressure was used. Subjective evaluations may have differed due to variations in pain threshold among the children. However, children may show a change in their behavior in the presence of pain.\nThe children who received cartridge syringe injections showed more facial expressions, leg movements and were difficult to console when compared to CCLAD group. Ram and Peretz showed that there was no significant difference in crying, facial expression, hands, legs, and torso movements while receiving injections with CCLAD and conventional syringe. This was seen irrespective of the age group (3-5 years, 6-10 years) being compared. Body movements, crying and application of restraints occurred more frequently while using a traditional syringe. \nThere were a few limitations in this study that need to be considered. The operator and subjects were not blinded to the mode of local anesthetic delivery. An attempt was made to minimize this bias by using an independent observer for coding the behaviors. The reliability of these results could have been further improved by videotaping the injection procedure and allowing a third investigator to evaluate it.\nTechniques which enhance the behavioral response in children should be considered for a better pediatric dental practice. Use of CCLAD can be considered as a possible step toward achieving a relatively pain-free and successful pediatric dental practice.\n| References|| |\nTen Berge M, Veerkamp JS, Hoogstraten J. 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The assessment of pain sensation during local anesthesia using a computerized local anesthesia (Wand) and a conventional syringe. J Dent Child (Chic) 2003;70:130-3.\nTahmassebi JF, Nikolaou M, Duggal MS. A comparison of pain and anxiety associated with the administration of maxillary local analgesia with CCLAD and conventional technique. Eur Arch Paediatr Dent 2009;10:77-82.\nPalm AM, Kirkegaard U, Poulsen S. The wand versus traditional injection for mandibular nerve block in children and adolescents: Perceived pain and time of onset. Pediatr Dent 2004;26:481-4.\nSan Martin-Lopez AL, Garrigos-Esparza LD, Torre-Delgadillo G, Gordillo-Moscoso A, Hernandez-Sierra JF, de Pozos-Guillen AJ. Clinical comparison of pain perception rates between computerized local anesthesia and conventional syringe in pediatric patients. J Clin Pediatr Dent 2005;29:239-43.\nLangthasa M, Yeluri R, Jain AA, Munshi AK. Comparison of the pain perception in children using comfort control syringe and a conventional injection technique during pediatric dental procedures. J Indian Soc Pedod Prev Dent 2012;30:323-8.\nSivakumar N, Muthu MS. Child psychology. In: Pediatric Dentistry-principles and Practice. 2 nd\ned. New Delhi: Elsevier India Pvt. Ltd.; 2011. p. 71-89.\nChapman HR, Kirby-Turner NC. Dental fear in children - A proposed model. Br Dent J 1999;187:408-12.\nBuchanan H, Niven N. Validation of a Facial Image Scale to assess child dental anxiety. Int J Paediatr Dent 2002;12:47-52.\nBuchanan H. Development of a computerised dental anxiety scale for children: Validation and reliability. Br Dent J 2005;199:359-62.\nVoepel-Lewis T, Zanotti J, Dammeyer JA, Merkel S. Reliability and validity of the face, legs, activity, cry, consolability behavioral tool in assessing acute pain in critically ill patients. Am J Crit Care 2010;19:55-61.\nNieuwenhuizen J, Hembrecht EJ, Aartman IH, Krikken J, Veerkamp JS. Comparison of two computerised anaesthesia delivery systems: Pain and pain-related behaviour in children during a dental injection. Eur Arch Paediatr Dent 2013;14:9-13.\nKudo M. Initial injection pressure for dental local anesthesia: Effects on pain and anxiety. Anesth Prog 2005;52:95-101.\nNayak R, Sudha P. Evaluation of three topical anaesthetic agents against pain: A clinical study. Indian J Dent Res 2006;17:155-60.\nKlein U, Hunzeker C, Hutfless S, Galloway A. Quality of anesthesia for the maxillary primary anterior segment in pediatric patients: Comparison of the P-ASA nerve block using CompuMed delivery system vs traditional supraperiosteal injections. J Dent Child (Chic) 2005;72:119-25.\n[Table 1], [Table 2], [Table 3], [Table 4]\n|This article has been cited by|\n||Computer-controlled Intraligamentary local anaesthesia in extraction of mandibular primary molars: randomised controlled clinical trial\n| ||Rodaina H. Helmy, Sarah I. Zeitoun, Laila M. El-Habashy |\n| ||BMC Oral Health. 2022; 22(1) |\n|[Pubmed] | [DOI]|\n||“Comparative study of conventional anesthesia technique versus computerized system anesthesia: a randomized clinical trial”\n| ||S. Berrendero, O. Hriptulova, M. P. Salido, F. Martínez-Rus, G. Pradíes |\n| ||Clinical Oral Investigations. 2021; 25(4): 2307 |\n|[Pubmed] | [DOI]|\n||Computer-Controlled Local Anesthesia Complication: Surgical Retrieval of a Broken Dental Needle in Noncooperative Autistic Paediatric Patient\n| ||Damian Chybicki, Malgorzata Lipczynska-Lewandowska, Gaja Torbicka, Anna Janas-Naze, Michael J. Wahl |\n| ||Case Reports in Dentistry. 2020; 2020: 1 |\n|[Pubmed] | [DOI]|\n||Assessment of computer-controlled local anesthetic delivery system for pain control during restorative procedures: A randomized controlled trial\n| ||Hrishikesh Saoji, Mohan Thomas Nainan, Naveen Nanjappa, Mahesh Ravindra Khairnar, Meeta Hishikar, Vivek Jadhav |\n| ||Journal of Dental Research, Dental Clinics, Dental Prospects. 2019; 13(4): 298 |\n|[Pubmed] | [DOI]| |
Intensif Review: Micro Needling & Acne Treatment\n- 6.3/10 Overall\nPeer Reviewed Literature\nConsistency of Results\n- Treatment improves oily skin, pores, texture, fine lines and skin tightening.\n- Only 1-2 days redness post treatment.\n- Excellent results particularly for acne scarring, good technology for deep delivery of topicals. Can be used on all skin types.\n- This procedure achieves tightening and crepey skin reduction without downtime.\n- Another way to treat texture and acne scars.\n- Procedure requires topical anesthesia to be comfortable otherwise the procedure can be uncomfortable.\n- Multiple treatments are required to achieve maximum results. More aggressive treatments require about one week of recovery time. ?\n- Skin needs to be thin to respond, so best for thin skin on the neck; patients with small faces; superficial wrinkles and superficial to moderate acne scars.\n- Results can be subtle and it doesn't work on everyone.\nThings You should know:\n- 3-5 treatments necessary. treatments at 4-week intervals.\n- Not for deep scars or wrinkles.\n- Procedure has some downtime.\n- Results can be variable.\n- 3 months to see final results.\nMost Common Use Cases :\n- Fine wrinkles\n- Shallow acne scars\n- Texture improvement\n- Lifting and tightening\n- Good for patients who either don't want laser or have smaller areas to treat\nOften combined with some form of local RF heating\n"We use this for under eye wrinkles, acne scars, wrinkles around the mouth and for overall tightening of a thin to medium skinned patients with textural issues"- Amy Taub M.D.\n"It is not "a no downtime" procedure, multiple treatment sessions are necessary. Requires some form of anesthesia (numbing), post-operative recovery takes a few days. Results are variable." Neil Sadick M.D.\nIntensif is a fractional RF micro needling technology designed to target multiple layers of tissues to address both laxity, deep wrinkles, acne scars, stretch marks and various other textural irregularities.\nTypical Clinical Applications:\nNon-surgical skin tightening and wrinkle reduction.\nBest Patient Candidates:\nAll skin types.\nIntensif US Procedure Cost & Price Range:\n$800 to $1000 USD per treatment.\nAverage Number of Treatments Needed: |
About our Brisbane Gastroscopy (Upper GI Endoscopy) Service\nOpen access gastroscopy, otherwise known as an endoscopy or esophagogastroduodenoscopy is a flexible fibre-optic scope examination of the oesophagus, stomach and initial part of the duodenum. We carry out this procedure in our Brisbane clinic. This is a non-surgical procedure that allows visualisation of the internal aspect of these organs for the purposes of identifying certain conditions and potential pathology. It allows biopsies to be taken and where indicated procedures such as dilatation and stopping of bleeding. Endoscopy involves inserting a flexible telescope (gastroscope) through your mouth to view your oesophagus, stomach and duodenum. To book an appointment, please contact our Brisbane office.\nWhat happens during the procedure?\nAs the gastroscope is passed into your stomach, gas is blown in to help see the inner lining. Biopsies can be collected to look for inflammation, tumours or Helicobacter pylori (the bacteria associated with stomach ulcers.) Additionally, any sites of bleeding can be treated. The procedure usually takes 20-30mins and is carried out at the Brisbane Private or Northwest Private Endoscopy suites.\nWill I be awake during the procedure?\nAn anaesthetist will be present and you will have the opportunity to discuss this further with them. Although it is not normally a general anaesthetic, you will be heavily sedated and often will not recall the procedure.\nHow will I know what is identified at the Gastroscopy?\nYour Brisbane surgeon Dr Renaut will speak with you and/or your family members immediately after the procedure. Often you are still groggy when you talk to Dr Renaut, so you are more than welcome to phone his rooms the following day. Additionally, the results of any biopsies are usually available then. A formal report is sent to your general practitioner and copies can also be sent to any other doctors you nominate who are involved in your care.\nPre-operative Preparation for Gastroscopy\nPatients are required to drink water only for six hours prior to the procedure and then nothing at all for two hours prior to the procedure. No specific preparation is otherwise required. It is usually performed under conscious sedation which for all intents and purposes is a light anaesthetic sometimes referred to as a twilight sedation.\nWhat about my usual medications?\nIn general, these should all be taken as usual with a sip of water. Exceptions will include:\n- Warfarin or other blood thinning drugs\n- Insulin or other diabetic tablets.\n- Iron supplements.\n- Any herbal and naturopathic drugs\nMany of these contain unidentifiable substances in unknown quantities that make them potentially unsafe. You will need to check with the manufacturers as to what these contain. These should be ceased in accordance with specific instructions issued by Dr Renaut’s Brisbane office.\nAlternatives to Gastroscopy\nAs far as alternatives are concerned indirect visualization of the oesophagus, stomach and duodenum can be achieved with a procedure known as a barium swallow and meal. Whilst this is less of an inconvenience to the patient in that sedation is not required, it is less accurate with regard to identifying pathology and has the distinct disadvantage of not allowing biopsies to be taken. If pathology is identified with this investigation then a gastroscopy is required as a secondary procedure.\nComplications associated with a gastroscopy are rare. Occasionally bleeding can occur particularly if biopsies are taken this almost always settles without the need for further intervention. Excessive bleeding which is most unusual often presents to the patient as black tarry stools. This once again usually settles of its own accord but if it persists may require an admission to hospital for a blood transfusion and a further gastroscopy. Perforation of either the oesophagus, stomach or duodenum has been known to occur but once again this is most unusual. The risk of perforating the oesophagus rises if a dilatation is being performed but the indications for this are specific and your specialist will discuss this with you prior to your procedure. As far as the anaesthetic is concerned, in most instances this equates to conscious sedation i.e. a light anaesthetic or twilight. For this reason most complications relating to the anaesthetic are rare and are very much related to the existence of other conditions such as heart disease, chest disease, diabetes and obesity. Your anaesthetist will discuss these issues with you on the day, prior to your procedure.\nPost-operative Care following a Gastroscopy procedure\nYour Brisbane specialist will speak with you immediately after the procedure. The results of any biopsies taken will be available a few days later and this information will be passed on to you by phone or in a follow up consultation as necessary. You will be sent home with a formal report that is a copy of the report that is sent to your referring doctor and/or G.P.\nEffects of Sedation and Safety Issues\nOnce you have been given the all clear by the recovery staff to be discharged it is imperative you go home with a friend or family member and rest for the remainder of the day. Even though you may feel ok after the procedure, small amounts of sedative will remain in your bloodstream. For this reason, you must not drive a car or operate machinery for 24 hours after the procedure. Failure to follow this advice carries the same implications as drink driving and is against the law. You should also not sign any contracts or legal documents for 24 hrs. You should not consume alcohol as the sedative effects will be increased. You should be cautious with simple tasks around the house, e.g. using knives etc. You must be taken home and cared for overnight by a responsible adult. The following day you should be completely back to normal and ready to resume your day to day activities. A normal diet can be resumed almost straight away unless there are specific instructions to the contrary. If you do suffer one of the unusual complications such as excessive bleeding or pain or if you feel unwell, for more than a few hours then you should not hesitate to contact your specialist or G.P. |
Treatment Spotlight: Laser Hair Removals\nLaser hair removal is not only one of the most popular treatments in aesthetic medicine but now thanks to Aria it’s also one of the most affordable. Aria Medical Aesthetics has made it so easy for everyone to feel and look their smoothest. Our monthly memberships are determined as to what the treatment size is.\nHow It Works:\nAria laser hair clients are free to choose which area or areas they would like laser hair performed. Simply choose the area sizes you want laser hair performed and we will schedule an appointment appropriate for the treatment area.\n- B12 MIC Shots (gain energy)\n- B12 LIPO Shots (increase metabolism and mental clarity)\nBroad Spectrum SPF 30+ Sunscreen\nAn elegant, moisturizing 80-minute water-resistant sunscreen that is formulated with highly effective hydrators and enhanced with antioxidants and skin soothing phytonutrients.\n- Developed to be used daily, and immediately following skin treatments.\n- Broad Spectrum UVA/UVB sun protection\n- Moisturizing UV protection for the face\n- Ideal for use post-procedure\nOur Rewards Programs\nOur Employee of the Month: Anil Bhardwaj, MD (Owner and Director)\nDr. Bhardwaj is a Board Certified Anesthesiologist and is a practicing Anesthesiologist with Integrated Anesthesia Associates. Dr. Bhardwaj provides perioperative care of patients in addition to the specialties performed by the surgical division including; General Surgery, Neuro-surgery, Orthopedics, OB-Gyn, Vascular surgery and ENT. As a part of the anesthetic care team, Dr. Bhardwaj performs invasive hemodynamic monitoring and nerve blocks using ultra-sound guidance.\nAfter 25 years as a Practicing Anesthesiologist, Dr. Bhardwaj began to develop an interest in aesthetics and the aftercare and healing process of his patients after complicated surgeries. Dr. Bhardwaj is a founding member of Aria Medical Aesthetics since it was established in 2015. Dr. Bhardwaj and his highly credentialed staff operate on a high standard of safety combined with exceptional client service.\nDr. Bhardwaj is certified in cosmetic injectable techniques from The Esthetic Skin Institution and certified from Cynosure for performing laser and photo light therapies for skin rejuvenation. Dr. Bhardwaj is a dedicated professional in the field of aesthetic medicine. He specializes in cosmetic injectables and laser treatments for skin care. With an artistic eye and many years of skill with injections as a practicing anesthesiologist, he is able to produce natural and subtle results in non-surgical facial rejuvenation. Dr. Bhardwaj’s compassion and honesty inspires trust and confidence in his patients to achieve the optimal results they most desire to look and feel their best. |
In this column, Ray Painter, MD, and Mark Painter also answer questions about coding for bladder hydrodistention under moderate sedation and re-positioning of a ureteral stent by a radiologist.\nA patient was seen in the office with a urinary tract infection, problems with urination, and a history of gross hematuria. The patient was treated with an antibiotic, a computed tomography scan was ordered, and a cystoscopy was scheduled. On the return visit, the patient was told that the urine culture was negative and the CT scan was normal. A cystoscopy was performed and the patient was found to have BPH with significant obstruction. The problem of BPH and the potential treatment were discussed, including the urologist’s recommendation for a laser prostatectomy. A total of 25 minutes was spent in counseling the patient.\nThe doctor wants to charge a level III established patient visit. I’ve tried to tell her that the E&M is included in cysto, but she won’t believe me because she’s heard you say she could charge. Please help.\nYour doctor is correct. Since the discussion was on the “treatment” of the disease process and not merely a discussion of the findings of the cystoscopy, that service would be considered “separately identifiable.” The time spent was well documented and certainly should be considered “significant.” Therefore, the encounter meets the definition of the –25 modifier: “Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service,” and should be charged separately.\nRelated - ICD-10: Different codes but identical guidelines\nThe time spent was 25 minutes, which is closer to a level IV (30 minutes) than a level III (15 minutes), and since the times are average times and not threshold times, the appropriate charge would be:\nNEXT: Procedure code for bladder hydrodistention under moderate sedation?\nIs billing for stone prevention counseling possible?\nModifiers for multiple stones raise questions\nPapillotomy billing: Two pathways to choose\nWhat is the procedure code for bladder hydrodistention under moderate sedation?\nThere is no specific code for bladder hydrodistention under moderate (conscious) sedation. However, there are codes for the dilation of the bladder for interstitial cystitis under general or spinal anesthesia: 52260-Cystourethroscopy, with dilation of bladder for interstitial cystitis; general or conduction (spinal) anesthesia. There’s also a code for the same procedure under local anesthesia: 52265-Cystourethroscopy, with dilation of bladder for interstitial cystitis; local anesthesia.\nRead: How to code for prostate needle biopsy\nIf the hydrodilation was performed because the patient has interstitial cystitis, under moderate (conscious) sedation we would recommend reporting code 52265. If the procedure was performed in a hospital or ambulatory surgical center and the sedation was given by an anesthesiologist, the work would more closely mimic 52260. However, since it specifically states “general or conduction (spinal) anesthesia,” a –52 modifier would be required and processing of the claim would result in lower payment, thus our recommendation for 52260. (We are assuming the local anesthesia is used in addition to the sedation.) If the service was provided for another disease, we would recommend 51700-Bladder irrigation, simple, lavage and/or instillation or 53899-Unlisted Procedure. None of the codes listed include moderate (conscious) sedation according to CPT guidelines. Therefore, depending upon payer rules, you may report codes 99143-99149 depending on who provided the sedation monitoring and the amount of time spent.\nNEXT: Advice on CPT codes for re-positioning of ureteral stent by radiologist\nPlease provide advice on the CPT codes used for the re-positioning of a ureteral stent by a radiologist.\nWe would need to know the details of the procedure in order to specifically answer your question. What portal of entry did the radiologist use? Was the stent removed and reinserted? Was the catheter manipulated from the bladder or from the kidney? Providing us with the operative report would be most beneficial.\nThere is no specific CPT code for repositioning of a ureteral catheter by a radiologist. However, there are several CPT codes to be used by radiologists for inserting and/or removing ureteral catheters, depending on the specific work performed.\nYou ask specifically for CPT codes; therefore, we assume that you were not asking for billing advice. If that assumption is wrong and you are requesting recommendations for appropriate billing, we would not be able to give that advice without knowing your specific payer billing rules and the documentation developed to support the service rendered.\nSocial media: Why you need to be involved\nNephrectomy gone wrong leaves patient paraplegic\nDivorce: Understand the federal tax ramifications\nThe information in this column is designed to be authoritative, and every effort has been made to ensure its accuracy at the time it was written. However, readers are encouraged to check with their individual carrier or private payers for updates and to confirm that this information conforms to their specific rules.\nSubscribe to Urology Times to get monthly news from the leading news source for urologists. |
Dependence of perioperative glycemia on analgesia technique for hip joint arthroplasty\nAim. The hip joint arthroplasty has high risk of perioperative hyperglycemia due to stress response and insulin resistance. The analgesia technics differ in terms of provided analgesia and anti-stress protection. The aim of our study was analyzing of blood glucose, insulin and HOMA-index dynamics during perioperative period in patients who underwent total hip arthroplasty according to the anaesthesia and analgesia techniques.\nMaterial and Methods. The study included 150 patients undergoing primary total hip joint replacement. We analyzed the dynamics of blood glucose, insulin and HOMA-index in relation to four variants of intraoperative anaesthesia and three variants of postoperative analgesia techniques, pathology type and patients' gender. Tests were taken before and during surgery, as well as at the 1st postoperative day.\nResults and Discussion. The preoperative glycemia level before surgery among all groups did not differ significantly (р>0,1). In the operating room, after the general anaesthesia administration but before the start of the surgery, the patients demonstrated significant increase in glycemia up to 6,3 mmol/L, and it was significantly higher compared to groups of patients with nerve blocks, paravertebral+caudal anaesthesia and spinal anaesthesia (р<0,01). At the traumatic stage of surgery, glycemia was significantly higher in groups of general anaesthesia and nerve blocks, 6,98 аnd 6,43 mmol/L, respectively. At the 1st postoperative day, the highest level of glycemia was detected in patients receiving systemic opioid analgesia, whose level of glycemia was 0,87 mmol/L higher than the initial value before surgery; in the group of epidural analgesia, this difference was 0,1 mmol/L, and in the group of paravertebral analgesia - 0,42 mmol/L. The analysis of the insulin level , depending on the methods of intraoperative analgesia, revealed the following: the lowest level of insulin at the traumatic stage of the operation in the group of spinal anaesthesia was found to be 2,61 mIU/L higher compared to the level prior to the operation, and the values of this group significantly differed from other groups at this stage of the study (p<0,05). At all other stages of the study, the level of insulin among intraoperative anesthesia groups did not differ significantly (p>0,05). The difference in insulin levels between postoperative analgesia groups at any stage of the study was not statistically significant (p>0,1). In the intraoperative period, there was a decrease in the HOMA index in the group of spinal anesthesia, while in all other groups this rate was gradually increasing. The higher HOMA index was found in patients operated on under general anesthesia, who received systemic opioid anesthesia after surgery. The level of glycemia, insulin and HOMA did not significantly differ in any stage of the study between gender groups and groups by type of pathology: coxarthrosis or fractures (p>0,1).\nConclusion. Regional analgesia provides a positive effect on the level of glycemia, insulin secretion and insulin resistance development in patients undergoing hip joint arthroplasty.\nСeliksular MC, Saraсoglu A, Yentur E. The Influence of Oral Carbohydrate Solution Intake on Stress Response before Total Hip Replacement Surgery during Epidural and General Anaesthesia. Turk J Anaesthesiol Reanim 2016; 44: 117-23. https://doi.org/10.5152/TJAR.2016.65265\nGottschalk A, Rink B, Smektala R, Piontek A, Ellger B, Gottschalk A. Spinal anesthesia protects against perioperative hyperglycemia in patients undergoing hip arthroplasty. J Clin Anesth. 2014;26(6):455-60. https://doi.org/10.1016/j.jclinane.2014.02.001\nHermanides J, Huijgen R, Henny CP, Mohammad NH, Hoekstra JB, Levi MM, DeVries JH. Hip surgery sequentially induces stress hyperglycaemia and activates coagulation. Neth J Med. 2009;67(6):226-9.\nHwang JS, Kim SJ, Bamne AB, Na YG. Do Glycemic Markers Predict Occurrence of Complications After Total Knee Arthroplasty in Patients With Diabetes? Clin Orthop Relat Res. 2015;473:1726-1731. https://doi.org/10.1007/s11999-014-4056-1\nJamsen E, Nevalainene PI, Eskelinen A, Kalliovalkama J, Moilanen T. Risk factors for perioperative hyperglycemia in primary hip and knee replacements. A prospective observational study of 191 patients with osteoarthritis. Acta Orthopaedica. 2015; 86 (2): 175-182. https://doi.org/10.3109/17453674.2014.987064\nKim TK, Ljunggren S, Hahn RG, Nystrom T. Insulin sensitivity and beta-cell function after carbohydrate oral loading in hip replacement surgery: a double-blind, randomised controlled clinical trial. Clin Nutr. 2014;33(3):392-8. https://doi.org/10.1016/j.clnu.2013.08.003\nLjunggren S, Nystrom T, Hahn RG. Accuracy and precision of commonly used methods for quantifying surgery-induced insulin resistance: Prospective observational study. Eur J Anaesthesiol. 2014;31(2):110-6. https://doi.org/10.1097/EJA.0000000000000017\nMaradit Kremers H, Schleck CD, Lewallen EA, Larson DR, Van Wijnen AJ, Lewallen DG. Diabetes Mellitus and Hyperglycemia and the Risk of Aseptic Loosening in Total Joint Arthroplasty. J Arthroplasty. 2017;32(9S):S251-S253. https://doi.org/10.1016/j.arth.2017.02.056\nMraovic B, Suh D, Jacovides C, Parvizi J. Perioperative Hyperglycemia and Postoperative Infection after Lower Limb Arthroplasty. J Diabetes Sci Technol. 2011;5(2):412-418. https://doi.org/10.1177/193229681100500231\nPili-Floury S, Mitifiot F, Penfornis A, Boichut N, Tripart MH, Christophe JL, Garbuio P, Samain E. Glycaemic dysregulation in nondiabetic patients after major lower limb prosthetic surgery. Diabetes Metab. 2009;35(1):43-8. https://doi.org/10.1016/j.diabet.2008.06.007\nSaluk J, Banos A, Hopkinson W, Rees H, Syed D, Hoppensteadt D, Abro S, Iqbal O, Fareed J. Prevalence of metabolic syndrome in patients undergoing total joint arthroplasty and relevance of biomarkers. Int Angiol. 2017;36(2):136-144.\nWang G, Long A, Zhang L, Zhang H, Yin P, Tang P. Impact of perioperative average blood-glucose level on prognosis of patients with hip fracture and diabetes mellitus. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2014;28(7):844-7. [Article in Chinese].\nThis work is licensed under a Creative Commons Attribution 4.0 International License. |
We know the option of surgery is often a difficult choice, and that is why the team at Community Animal Hospital is determined to provide the best surgical care, from highly trained surgeons to the safest, most advanced anesthesia available. We use state-of-the-art monitoring techniques throughout all of our procedures, and a technician is assigned to your pet’s care at all times during each surgery to ensure their safety and comfort. You can rest assured that each of our patients is provided with body temperature regulation as well as comprehensive pre- and post-op pain management.\nOur own veterinarians perform soft tissue surgeries and orthopedic surgeries on our patients. We are also able to bring in a referral surgeon if more advanced procedures are needed. We will be happy to discuss your pet’s surgical options with you if you have questions or concerns.\nWhat You Need to Know Before Your Pet's Surgery\nMany people have questions about various aspects of their pet's surgery, and we hope this information will help. It also explains the decisions you will need to make before your pet's upcoming surgery. |
An eyelid procedure can also be created without an incision. This procedure is called the buried suture technique. It’s also performed under general anesthesia or with IV sedation and local anesthetic.\nEyelid Surgery (Non-incisional method)- (BPS)\nUSD1,461 starting from\nBanobagi Plastic Surgery /\nBanobagi Plastic Surgery\nTop hospitals and Clinics South Korea |
I am in a lot of pain somedays and dont like taking all of these big bad painkillers they throw at us like candies i was just wondering mail or female, if you use this Gabapentin to help your Fibromyalgia\n14 Oct 2011\nI am a male & take Gabapentin for nerve skeletal pain due to two broken vertabrae C-1 C-2 that took 2 operations to fix & I also take 8 8mg Dilaudid but I defininatly think the Gabapentin works very well,I don't know what type of pain your illness causes but I don't get any side effects except for maybe a little sedation. I can't see any harm in it. Good luck.\n14 Oct 2011\nI have tried gabepentin with not very good results. I do however take Lyrica & it is wonderful for the fibromyalgia & arthritis I have. I had to stop for three months due to an insurance do hickey, but am back on just 1 pill last night & sleep like alog & no pain in hands today!. I will increase my 75mg each week until I can reach a total of 225 mg a day. Hope this helps too. Some people complain about side effects of weight gain or ankle swelling, but I'd much rather have 5 extra pounds than all the pain. Just my thoughts...\n- Gabapentin Information for Consumers\n- Gabapentin Information for Healthcare Professionals (includes dosage details)\n- Side Effects of Gabapentin (detailed)\nSearch for questions\nStill looking for answers? Try searching for what you seek or ask your own question.\nI have been on gabapentin Nuerontin for near 5 years. My insurance got messed up and now I have to pay way more than I can afford. So I have to go ...\n2 answers • 9 Jan 2011\nPersisting Pain -- Shingles - doe's the pain med have to be oxycodone ? is hydrocodone just as good?\n... and will drinking a couple of beer's efect the gabapentin. thanks Sue\n4 answers • 28 Aug 2011\nThe rash is almost gone, but the pain is still very bad. Now I am on Percidan and Neurontin but the pain keeps coming back.\n1 answer • 28 Feb 2013 |
Pain syndromes in autosomal dominant polycystic kidney disease\n- Theodore I Steinman, MD\nTheodore I Steinman, MD\n- Professor of Medicine\n- Harvard Medical School\n- Samir M Parikh, MD\nSamir M Parikh, MD\n- Associate Professor of Medicine\n- Harvard Medical School\nOver 60 percent of patients with autosomal dominant polycystic kidney disease (ADPKD) have abdominal and flank pain . Abdominal pain is typically related to the kidney cysts but may also be related to liver cysts. Pain may be acute or chronic.\nMost patients can be effectively treated, but a minority develop chronic pain that is debilitating .\nA thorough history provides the best clues to the underlying cause of pain, and radiographic studies are an important adjunct to making the diagnosis. Pain is often not well managed, because there is the reflex response of many clinicians to give narcotics for complaints of pain without understanding the etiology.\nThis topic provides an overview of the pathophysiology and common presentations of pain in ADPKD and a stepwise approach to its initial management, focusing on pain related to the kidneys.\nThe general management and the renal and extrarenal manifestations of ADPKD are discussed separately. (See "Course and treatment of autosomal dominant polycystic kidney disease" and "Renal manifestations of autosomal dominant polycystic kidney disease" and "Extrarenal manifestations of autosomal dominant polycystic kidney disease".)\n- Gabow PA. Autosomal dominant polycystic kidney disease--more than a renal disease. Am J Kidney Dis 1990; 16:403.\n- Hogan MC, Norby SM. Evaluation and management of pain in autosomal dominant polycystic kidney disease. Adv Chronic Kidney Dis 2010; 17:e1.\n- Ansell J, Gee W, Bonica J. Diseases of the kidney and ureter. In: Management of Pain, 2nd ed., Bonica J (Ed), Lee & Febiger, Philadelphia 1990. Vol 2, p.1232.\n- Ammons WS. Renal afferent input to thoracolumbar spinal neurons of the cat. Am J Physiol 1986; 250:R435.\n- Ammons WS. Bowditch Lecture. Renal afferent inputs to ascending spinal pathways. Am J Physiol 1992; 262:R165.\n- Nam TS, Baik EJ, Shin YU, et al. Mechanism of transmission and modulation of renal pain in cats; effects of transcutaneous electrical nerve stimulation on renal pain. Yonsei Med J 1995; 36:187.\n- Gabow PA. Autosomal dominant polycystic kidney disease. N Engl J Med 1993; 329:332.\n- Gibson P, Watson ML. Cyst infection in polycystic kidney disease: a clinical challenge. Nephrol Dial Transplant 1998; 13:2455.\n- Ravich L, Lerman PH, Drabkin J. Ruptured renal cyst in polycystic disease. Urology 1976; 7:60.\n- Carels RA, van Bommel EF. Ruptured giant liver cyst: a rare cause of acute abdomen in a haemodialysis patient with autosomal dominant polycystic kidney disease. Neth J Med 2002; 60:363.\n- Bajwa ZH, Gupta S, Warfield CA, Steinman TI. Pain management in polycystic kidney disease. Kidney Int 2001; 60:1631.\n- Delaney VB, Adler S, Bruns FJ, et al. Autosomal dominant polycystic kidney disease: presentation, complications, and prognosis. Am J Kidney Dis 1985; 5:104.\n- Bennett WM, Elzinga LW, Barry JM. Polycystic kidney disease: II. Diagnosis and management. Hosp Pract (Off Ed) 1992; 27:61.\n- Ubara Y, Katori H, Tagami T, et al. Transcatheter renal arterial embolization therapy on a patient with polycystic kidney disease on hemodialysis. Am J Kidney Dis 1999; 34:926.\n- Tarrass F, Benjelloun M. Acute abdomen caused by spontaneous renal cyst rupture in an ADPKD haemodialysed patient. Nephrology (Carlton) 2008; 13:177.\n- Chauveau D, Fakhouri F, Grünfeld JP. Liver involvement in autosomal-dominant polycystic kidney disease: therapeutic dilemma. J Am Soc Nephrol 2000; 11:1767.\n- Bajwa ZH, Sial KA, Malik AB, Steinman TI. Pain patterns in patients with polycystic kidney disease. Kidney Int 2004; 66:1561.\n- Segura JW, King BF, Jowsey SG. Chronic pain and its medical and surgical management in renal cystic diseases. In: Polycystic Kidney Disease, Watson ML, Torres VE (Eds), Oxford University Press, Oxford 1996. p.462.\n- Grantham JJ, Torres VE, Chapman AB, et al. Volume progression in polycystic kidney disease. N Engl J Med 2006; 354:2122.\n- Elzinga LW, Barry JM, Torres VE, et al. Cyst decompression surgery for autosomal dominant polycystic kidney disease. J Am Soc Nephrol 1992; 2:1219.\n- Elzinga LW, Barry JM, Bennett WM. Surgical management of painful polycystic kidneys. Am J Kidney Dis 1993; 22:532.\n- Casteleijn NF, de Jager RL, Neeleman MP, et al. Chronic kidney pain in autosomal dominant polycystic kidney disease: a case report of successful treatment by catheter-based renal denervation. Am J Kidney Dis 2014; 63:1019.\n- Torres VE, Chapman AB, Devuyst O, et al. Tolvaptan in patients with autosomal dominant polycystic kidney disease. N Engl J Med 2012; 367:2407.\n- Riella C, Czarnecki PG, Steinman TI. Therapeutic advances in the treatment of polycystic kidney disease. Nephron Clin Pract 2014; 128:297.\n- Chapman, A, Rahbari-Oskoui, F. Renal cystic disorders. In: Therapy in Nephrology and Hypertension, 3rd, Wilcox, CS (Eds), Saunders, Philadelphia 2008..\n- Ernst E, Canter PH. The Alexander technique: a systematic review of controlled clinical trials. Forsch Komplementarmed Klass Naturheilkd 2003; 10:325.\n- Maher CG. Effective physical treatment for chronic low back pain. Orthop Clin North Am 2004; 35:57.\n- de Mattos AM, Olyaei AJ, Bennett WM. Pharmacology of immunosuppressive medications used in renal diseases and transplantation. Am J Kidney Dis 1996; 28:631.\n- Henrich WL, Agodoa LE, Barrett B, et al. Analgesics and the kidney: summary and recommendations to the Scientific Advisory Board of the National Kidney Foundation from an Ad Hoc Committee of the National Kidney Foundation. Am J Kidney Dis 1996; 27:162.\n- Whitcomb DC, Block GD. Association of acetaminophen hepatotoxicity with fasting and ethanol use. JAMA 1994; 272:1845.\n- Eisenach JC, De Kock M, Klimscha W. alpha(2)-adrenergic agonists for regional anesthesia. A clinical review of clonidine (1984-1995). Anesthesiology 1996; 85:655.\n- Tryba M, Gehling M. Clonidine--a potent analgesic adjuvant. Curr Opin Anaesthesiol 2002; 15:511.\n- Smith H, Elliott J. Alpha(2) receptors and agonists in pain management. Curr Opin Anaesthesiol 2001; 14:513.\n- Dimou P, Paraskeva A, Papilas K, Fassoulaki A. Transdermal clonidine: does it affect pain after abdominal hysterectomy? Acta Anaesthesiol Belg 2003; 54:227.\n- Goyagi T, Tanaka M, Nishikawa T. Oral clonidine premedication enhances postoperative analgesia by epidural morphine. Anesth Analg 1999; 89:1487.\n- Lee YH, Lee WC, Chen MT, et al. Acupuncture in the treatment of renal colic. J Urol 1992; 147:16.\n- Resim S, Gumusalan Y, Ekerbicer HC, et al. Effectiveness of electro-acupuncture compared to sedo-analgesics in relieving pain during shockwave lithotripsy. Urol Res 2005; 33:285.\n- Osenbach RK, Harvey S. Neuraxial infusion in patients with chronic intractable cancer and noncancer pain. Curr Pain Headache Rep 2001; 5:241.\n- PATHOPHYSIOLOGY OF KIDNEY-RELATED PAIN\n- PAIN SYNDROMES\n- Acute pain\n- - Infection\n- - Cyst rupture/hemorrhage\n- - Nephrolithiasis\n- Chronic pain\n- - Renal cysts\n- - Hepatic cysts\n- - Mechanical back pain\n- Abdominal and/or flank pain\n- Back pain\n- Recurrent pain\n- PAIN MANAGEMENT\n- Noninvasive approaches\n- - Physical maneuvers\n- - Non-narcotic analgesics\n- - Opioids\n- - Other interventions\n- Invasive management\n- SUMMARY AND RECOMMENDATIONS |
I feel too young to have this. Please help!\nLoose Neck Skin at 35. Options? (photo)\nDoctor Answers 14\nNeck Muscle Bands Require Neck Lift, Non Surgical Will Not Correct\nThank you for your question. The two folds that you see beneath your chin are caused by laxity of the Platysma Muscles beneath the neck skin. These can be tightened with a surgical neck lift.\nNon surgical neck lift is a marketing term-there is no non surgical method that can lift skin and tighten the loose muscles beneath the skin. Fillers can be used to add volume to the face and camouflage the problem but must be repeated at best every 9 months. At age 35 you have many years left and in time you will spend much more money on fillers than you would on a neck lift which will correct the actual problem that concerns you.\nConsult a plastic surgeon who is certified by the American Board of Plastic Surgery for a proper diagnosis and advice.\nLoose Neck Skin at 35. Options?\nDirect excision of the loose skin through an incision under the chin would be the most effective and quickest way to address the issue.\nNeck Lift Tightens Loose Skin and Muscles for Years to Come\nYou are younger than most who have such a degree of skin laxity on your neck, but that is probably due to genetics. The only real solution is to permanently tighten the plastysmal muscle on the neck and remove excess, sagging skin through a neck lift. It's a simple, outpatient procedure that takes about an hour or two. You'll recover within a week and your rejuvenated neck and jawline will last for years. I hope this helps.\nYou might also like...\nThe Nonsurgical 3D Vectoring Necklift Can Work Well For Early Onset Looseness (Laxity)\nThe neck, like the face, hands, and chest, are vulnerable to assault from long-term ultraviolet exposure, the dictates of our genetics, gravitational effects, and changes in muscle mass and elasticity with chronological aging. A variety of surgical options exist for dealing with neck problems. These include full lifts, mini-lifts, minimal incision lifts, and S-Lifts. All are predicated on cutting away excess skin, shoring up the underlying tissue, and reinforcing the long, thin, sheet-like muscle layer, known as the platysma.\nBut all these methods of repair are true surgery, which are expensive, postoperatively painful, demand protracted recuperative times away from work and social activities, and risk permanent scars. Happily, and especially in a person as young as 35, The Nonsurgical 3D Vectoring Necklift offers a viable alternative for diminishing unsightly turkey necks and cords.\nLike its facial counterpart, The Nonsurgical 3D Vectoring Facelift, which is discussed elsewhere in Realself, The Nonsurgical 3D Vectoring Necklift entails the strategic placement of "strands" or "strains" (i.e. threadlike deposits) of volumizing fillers (my favorite for this purpose being a combination of Radiesse, a calcium-based volumizer and Juvederm Ultra Plus XC, a hyaluronic based material) starting from the more "fixed' areas near the angles of the mandible down and outward across the jawline and extending inward radially toward the more mobile and lax central portion of the neck. The three dimensional result of creating these vectors (directions of force) in this fashion is to stretch the skin under the chin and smooth it.\nGratifying results are typically seen immediately, and there is continued improvement in appearance over the course of the next four to eight weeks as the presence of the volumizing fillers within the tissues stimulates new native collagen formation leading to subsequent additional skin retraction and lifting of the target areas. The procedure typically takes about fifteen minutes to perform using only local anesthesia and typically entails little in the way of discomfort, bruising or swelling, i.e. little or no downtime.\nA platysmaplasty helps loose skin and muscle problems of the neck.\nA platysmaplasty is a surgery under local anesthesia which fixes the muscle and skin under the chin in the anterior neck well for roughly $4500. A lower face/neck lift is an alternative which is a little bigger procedure but definitely gets the job done for roughly $8-10,000 and again can be done under local. Sincerely,David Hansen,MD\nLoose Neck Skin at 35. Options?\nA neck lift is a general term used for rejuvenating the neckline to create a more youthful attractive appearance. Factors which are considered during your consultation to determine if you are a #candidate for #rejuvenating the neck include:\n•Visibility and amount of excess fat below the chin and along the neckline.\n•The presence of banding down the front of the #neck.\n•The amount of #excess skin and condition of your skin.\n•Presence of Prominent Digastric Muscles (a.k.a. submandibular gland fullness).\nPatients who desire facial rejuvenation that is affordable, quick, and effective should also consider the Lite-lift™. Like the Life-Style™ facelift, this is a modified facelift, individualized for each patient, that can be performed in the office with a local anesthetic and improve signs of aging around the neck, jawbone and lower face. These procedures are not "Thread-lifts" or "String-lifts". We do not use the "barbed" sutures employed in these other lifting operations. The Lite-lift™ uses longer lasting techniques that are discussed below. Because the incisions are limited, there is less bruising, swelling and healing time for most patients. Many patients can be back to work in one to two weeks looking rested and more youthful.\nThe best candidates for #LiteLift are non-smoking patients 35-60 years old with early changes of the lower face and the neck. But whose skin has elasticity with well defined bone structure. Older patients who cannot or do not wish to have a longer operation or general anesthetic can be improved with a Lite Lift™. If you are not a candidate at the time of your #consultation, your board certified plastic surgeon can recommend non-surgical alternatives to address your concern. Consulting with a board-certified plastic surgeon who specializes in #neck lift procedures is important to ensure you are receiving the best advice, care, and surgical experience possible.\nSurgical Necklift Most Effective\nYour case is the best example, however of a young patient "hoping" for a non-surgical alternative, seeking one out and then being disappointed.\nA Neck-lift is a relatively minimally invasive procedure which dollar for dollar will give you the nicest and longest lasting result.\nLaser Assisted Weekend Necklift\nCervicofacial Liposculpture is first employed to contour the unfavorable fatty changes seen in the face and neck as time passes by, such as the ‘Turkey neck’ and ‘double chin’.\nCareful attention is then turned to tightening the neck muscles and eliminating neck bands. Finally, I employ laser technology to ‘resurface’ the underside of the neck skin, thereby ‘shrinkwrapping’ the skin of the neck restoring a youthful contour.\nA consultation with a board certified facial plastic surgeon will help determine which procedures will provide the best results for you.\nThe loose skin and bands under the neck can be fixed with a limited necklift. It can be done through a small incision under the chin that is well hidden. The two bands seen through the skin are two muscles. The edges of the muscles can be sewn together and it leads to a smooth profile. Dr. J\nDisclaimer: This answer is not intended to give a medical opinion and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.\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. |
Services & Procedures\nWelcome to Avondale Dental Centre, the family and general dental practice of Dr Sinan Najar, Dr David Crum and Dr Lana Nekrutenk. Our privately owned dental clinic prioritises helping the families of Avondale have healthy, comfortable smiles.\nWe welcome new patients of all ages and look forward to seeing your smile.\nA customised preventive dentistry treatment plan can help patients of any age avoid the common dental conditions that cause tooth and gum disease. We approach prevention with comprehensive treatments based on the individual needs of our patients as their health changes with ageing.\n- Check-up and cleans\n- Diagnostic x-rays\n- Fluoride application\n- Fissure sealants\n- Sport mouthguards\nWe also address gum disease with specialised dental cleanings to eliminate infection and to promote healing.\nTooth-Coloured Restorative Dentistry\nMost patients will need a dental restoration at some point to repair a broken tooth or to treat decay.\nOur dental restorations are designed for longevity and aesthetics. We take a conservative approach to restorative dentistry and present all available options so patients can choose dentistry that is suited to their lifestyles and budgets.\n- Dental fillings\nSame-day CEREC crowns make it possible for you to leave the clinic with your final restoration in a single visit.\nOrthodontics for Children, Teens and Adults\nMisalignment contributes to the break down of teeth and increases the risk of teeth grinding and jaw joint pain.\nBy correcting misalignment, teeth feel more comfortable, are more attractive, and improve the fit and function of dental restorations.\nWe treat children, teens and adults with traditional orthodontics at our Avondale dental clinic.\nTeens and adults may qualify for treatment with Invisalign, and adults may be good candidates for Six Month Smiles.\nDental implants provide the most lifelike way to replace missing teeth. Implant dentistry replaces the entire tooth structure, including the root. Benefits of dental implants include maintaining healthy bone and long-term reliability.\n- Single dental implants\n- Implant bridges\n- Implant dentures\n- Bone grafting\n- Sinus lifts\nThe advanced training and experience of our dentists make it possible to have complete dental implant treatment in the comfort of our dental centre.\nFor patients who have difficulty getting numb, a strong gag reflex or dental anxiety, we offer both oral and IV sedation dentistry for improved comfort and wellbeing.\nPatients with lengthy procedures or who have surgery often opt for sedation.\nEmergency Dental Appointments\nIf you experience a toothache or a broken tooth, we welcome you to get in touch right away so that we can address your condition quickly. We also perform comfortable root canal treatment and extractions in the clinic.\nWe Welcome Your Smile\nOur dentists believe in working closely with our patients to ensure that we understand your goals for your smile. We never rush you in and out the door and value developing long-term relationships based on trust and respect. |
(A) Definitions: for the purposes of this rule:\n(1) "Delegate" means an authorized representative who is registered with the Ohio board of pharmacy to obtain an OARRS report on behalf of a dentist;\n(4) "Personally furnish" means the distribution of drugs by a prescriber to the prescriber's patients for use outside the prescriber's practice setting. Personally furnish does not include the administration of a drug,k as set forth in paragraph (B)(1) of rule 4715-3-01 of the Administrative Code.\n(5) "Reported drugs" means all the drugs listed in rule 4729-37-02 of the Administrative Code that are required to be reported to the drug database established and maintained pursuant to section 4729.75 of the Revised Code, including controlled substances in schedules II, III, IV, and V.\n(B) Standards of care: the accepted and prevailing minimal standards of care require that when prescribing or personally furnishing a reported drug, a dentist shall take into account all of the following:\n(1) The potential for abuse of the reported drug;\n(2) The possibility that use f the reported drug may lead to dependence;\n(3) The possibility the patient will obtain the reported drug for a nontherapuetic use or distribute it to other persons; and\n(4) The potential existence of an illicit market for the reported drug.\n(5) In considering whether a prescription for or the personally furnishing of a reported drug is appropriate for the patient, the dentist shall use sound clinical judgment and obtain and review an OARRS report consistent with the provisions of this rule.\n(C) OARRS Review: a dentist shall obtain and review an OARRS report to help determine if it is appropriate to prescribe or personally furnish an opioid analgesic, benzodiazepine, or reported drug to a patient as provided in this paragraph and paragraph (F) of this rule:\n(1) A dentist shall obtain and review an OARRS report before prescribing or personally furnishing an opiate analgesic or benzodiazepine to a patient, unless an exception listed in paragraph (G) of this rule is applicable.\n(2) A dentist shall obtain and review an OARRS report when a patient's course of treatment with a reported drug other than an opioid analgesic or benzodiazepine has lasted more than ninety days, unless an exception listed in paragraph (G) of this rule is applicable.\n(3) A dentist shall obtain and review an OARRS report when any of the following red flags pertain to the patient:\n(a) Selling prescription drugs;\n(b) Forging or altering a prescription;\n(c) Stealing or borrowing reported drugs;\n(d) Increasing the dosage of reported drugs in amounts that exceed the prescribed amount;\n(e) Suffering an overdose, intentional or unintentional;\n(f) Having a drug screed result that is inconsistent with the treatment plan or\n(g) Having been arrested, convicted, or received diversion or intervention in lieu of conviction for a drug related offense while under the dentist's care;\n(h) Receiving reported drugs from multiple prescribers, without clinical basis;\n(i) Traveling with a group of other patients to the dentist's office where all or most of the patients request controlled substance prescriptions;\n(j) Traveling an extended distance or from out of state to the dentist's office;\n(k) Having a family member, friend, law enforcement officer, or health care professional express concern related to the patient's use of illegal or reported drugs;\n(l) A known history of chemical abuse or dependency;\n(m) Appearing impaired or overly sedated during an office visit or exam;\n(n) Requesting reported drugs by street name, color, or identifying marks;\n(o) Frequently requesting early refills of reported drugs;\n(p) Frequently losing prescriptions for reported drugs;\n(q) A history of illegal drug use;\n(r) Sharing reported drugs with another person; or\n(s) Recurring visits to non-coordinated sites of care, such as emergency departments, urgent care facilities, or walk-in clinics to obtain reported drugs.\n(D) Patient care documentation: a dentist who decides to utilize an opioid analgesic, benzodiazepine, or other reported drug in any of the circumstances within paragraphs (C)(2) and (C)(3) of this rule, shall take the following steps prior to issuing a prescription for or personally furnishing the opioid analgesic, benzodiazepine, or other reported drug:\n(1) Review and document in the patient record the reasons why the dentist believes or has reason to believe that the patient may be abusing or diverting drugs;\n(2) Review and document in the patient's record the patient's progress toward treatment objectives over the course of treatment;\n(3) Review and document in the patient record the functional status of the patient, including activities for daily living, adverse effects, analgesia, and aberrant behavior over the course of treatment;\n(4) Consider using a patient treatment agreement including more frequent and periodic reviews of OARRS reports and that may also include more frequent office visits, different treatment options, drug screens, use of one pharmacy, use of one provider for the prescription or personally furnishing of reported drugs, and consequences for non-compliance with the terms of the agreement. The patient treatment agreement shall be maintained as part of the patient record; and\n(5) Consider consulting with or referring the patient to a substance abuse specialist.\n(E) Follow-up OARRS reports; frequency:\n(1) For a patient whose treatment with an opioid analgesic or benzodiazepine lasts more than ninety days, a dentist shall obtain and review an OARRS report for the patient at least every ninety days during the course of treatment, unless an exception listed in paragraph (G) of this rule is applicable.\n(2) For a patient who is treated with a reported drug other than an opioid analgesic or benzodiazepine for a period lasting more than ninety days, the dentist shall obtain and review an OARRS report for the patient at least annually following the initial OARRS report obtained and reviewed pursuant to paragraph (C)(2) of this rule until the course of treatment utilizing the reported drug has ended, unless an exception in paragraph (G) of this rule is applicable.\n(F) OARRS reports; time periods; adjoining states: for the purposes of paragraphs (C), (D), and (E) of this rule, when a dentist or their delegate requests an OARRS report in compliance with this rule, a dentist shall review and document receipt of the OARRS report in the patient record, as follows:\n(1) Initial reports requested shall cover at least the twelve months immediately preceding the date of the request;\n(2) Subsequent reports requested shall, at a minimum, cover the period from the date of the last report to present;\n(3) If the dentist practices primarily in a county of this state that adjoins another state, the dentist or their delegate shall also request a report of any information available in the drug database that pertains to prescriptions issued or drugs furnished to the patient in the state adjoining that county; and\n(4) If an OARRS report regarding the patient is not available, the dentist shall document in the patient's record the reason that the report is not available and any efforts made in follow-up to obtain the requested information.\n(G) Exceptions: a dentist shall not be required to review and assess an OARRS report when prescribing or personally furnishing an opioid analgesic, benzodiazepine, or other reported drug under the following circumstances:\n(1) The reported drug is prescribed or personally furnished to a hospice patient in a hospice care program as those terms are defined in section 3712.01 of the Revised Code, or any other patient diagnosed as terminally ill;\n(2) The reported drug is prescribed for administration in a hospital, nursing home, or residential care facility;\n(3) The reported drug is prescribed or personally furnished in an amount indicated for a period not to exceed seven days;\n(4) The reported drug is prescribed or personally furnished for the treatment of cancer or another condition associated with cancer; and\n(5) The reported drug is prescribed or personally furnished to treat acute pain resulting from a surgical or other invasive procedure or a delivery. |
Our Richmond Hill dentistry makes it easy and comfortable to have a tooth extracted, no matter what the reason. Visit us to learn how we cater to your unique needs and anxieties!Book Appointment\nThere can be various reasons why a tooth may need to be removed. Whether the reason is that it is fractured (and can't be repaired), infected, or crowded by other teeth, our Richmond Hill dental team has the expertise and experience to get that tooth removed with minimal discomfort. For your convenience, we offer sedation in the form of nitrous oxide (laughing gas).\nIf you require a tooth extraction, Dr. Martino will make sure you feel prepared and ready before any treatment. This includes taking appropriate X-rays, discussing treatment options, reviewing medical history, and reviewing pre- and post-operative instructions. Richmond Hill dentist Dr. Martino and the dental team prioritize the comfort of her patients, so rest assured that you are in good hands. For more information regarding sedation and dental anxiety, click here.\n* Please note that some extractions such as wisdom teeth extraction may be referred to a specialized oral surgeon.\nIf you are looking to get a tooth extracted by a dentist that prioritizes your safety and comfort, book an appointment today!.Book Appointment\nIf you have anxiety about getting dental work done, or if you're highly sensitive and worried about pain, Dr. Martino will always make the process as comfortable as possible.\nThe office is stunning and a great location in central Richmond Hill. Dr Martino (and her staff) are a joy to work with. Also, the cleaning was the best I've ever had.\nI have never been to another dentist that makes me feel comfortable when working on my teeth. She is very gentle and thorough from start to finish.\nThis dentistry is absolutely amazing. The office and all the equipment is very clean, brand-new, and fresh. It creates a feeling of being at a very modern dentistry. Also, the staff is super friendly and makes you feel like home.\nDr. Martino has been my dentist for 21 years, and over that time I've referred several friends and family members to her. She is pleasant and professional. Wishing her all the best at her new practice.\nDr. Martino is an amazing dentist. She is kind, makes you feel comfortable and always does a great job! It is a pleasure coming to see her and her staff always smiling!\nMy family and I have been seeing Dr Martino for many years and we have had amazing care & service. This new location is great and the staff are so friendly.\nI have no hesitation recommending Dr. Martino to anyone. She is very professional, caring and gentle dentist. She takes time to explain and suggest what is best to be done.\nA warm welcome as soon as you walk in. Convenient parking in busy Richmond Hill. Dr Martino is the best dentist in Ontario! Staff are attentive and highly capable.\nAlways a positive experience visiting Dr. Martino. She always lets you know what you need and we absolutely trust her professionalism. With the kids, she has a gentle, friendly approach. Our favourite dentist for over 20 years!\nHave a question or want to learn more? Drop us a line, we'd be happy to help.\nWe are gladly accepting new patients from Richmond Hill and surrounding areas, and we are looking forward to being the first choice for you and your family's dental care!\n10376 Yonge St. - Unit 109, Richmond Hill, ON L4C 3B8 |
Mood: vegas lucky\nNow Playing: Day 2918-Chapter 3... Happiness~My Silver Lining\nHAPPY NEW YEAR~2018!\nI like to call it the year of MANY silver linings!\nSheer happiness... YOURS for the taking!\nI can't say that we woke up this morning with a hangover. Alcohol related anyways. HA! But I sure am finally feeling the side effects from anesthesia and other strong narcotics that are slowly coming out of my body. Gastroparesis means not only a super slow, turtle pace digestion system. But it also means taking ten times longer than most folks when it comes to weaning anesthesia and other drugs out of your system. I may not fully feel the surgical cuts just yet. But I sure the heck feel the side effects of severe nausea that comes with anesthesia! Tis was not a very good day to kick off a new year. What I have been doing is a whole lot of resting. Enough sleeping that could last me for the remainder of the year! BAH. I feel for Eric once he goes back to work, on any anything but a normal sleep schedule. For the first 48-hours he barely got any sleep during and after surgery. Let's just say that we both finally were able to catch up on some serious sleep. Much needed rest for the body.\nWith a new year, comes with it, new resolutions.\nMy resolutions had already began a few days ago. I plan on sticking to mine this new year which involves continuing to close doors on relationships that no longer serve me well. Relationships that are clearly not healthy for me nor the rest of our little family. I also vowed to change how I respond to highly combative and hostile conflict. I promise you one thing. I will no longer take place in any sort of dysfunctional family behavior. It has now taken a permanent place... in the past. I will no longer subject myself to any unhealthy relationships of any sorts. That includes any ridiculous shenanigans that only lead to further overwhelming stress. I can not take back the past. But I can change the present and the future on what I will and will not allow as unhealthy in my life. Unhealthy for our entire little family.\nI also plan on making another huge and permanent change this new year. After over 15 years of having the same phone number. I will be changing my cell phone number. A private number in order to make sure that a peaceful life remains here on out for me and my future. I will be sending out a group text message for those once my number has been changed. This is just one of many positive changes that I plan on making for this new year. Cursing is also a thing of the past. Sure, we all slip up with choice words from time to time. But I have come to realize that those slipped words only come with a few that were not healthy as far as relationships in my past. When you rid of what no longer serves you well... you rid with it... behavior that no longer serves you well. Negativity, slip-up words and a lot of upside frowns.\nThis New Year 2018 is all about change for the better!\nHappiness is yours for the taking if you learn to open yourself up to what you truly deserve. All the happiness that life has to offer you! Never settle for less than what you deserve. Never compromise your self worth. Never, ever give anyone the chance or opportunity to steal away your beaming ray of light, a most beautiful smile and that undeniable sheer happiness!\nHAPPY NEW YEAR~HAPPY NEW YOU |
Tooth extractions are a very common procedure that can resolve a number of issues and help eliminate discomfort. There are several different reasons as to why a tooth extraction may be needed, which include extensive tooth decay, broken teeth, infections, and more. There are times when a filling or root canal can fix a damaged tooth; however, for cases that are more severe, then it is best to get a tooth extraction to protect your oral health. Keep in mind that extractions are only a last option if the tooth cannot be saved; however, our experienced team will assess your case and discuss the different treatment options that will work for you.\nIf you are experiencing severe tooth decay, broken teeth, infections, or other issues with your teeth, then feel free to contact our team for tooth extractions in Huntington Park. We will evaluate your case and determine what is the best option for you.\nThere are a number of conditions that can lead to a tooth extraction. Some cases may be treatable or avoidable if they are caught early on. However, if too much damage has already been done, then the only option may be a tooth extraction, which will eliminate pain and more damage, and will protect your oral health.\nHere are some common conditions that can lead to dental extractions:\nWhatever the reason may be, our team of skilled and experienced dental surgeons know what it takes to safely remove damaged teeth to make sure that your pain is eliminated and your oral health is protected. We have performed a large number of tooth extractions, and our goal is always to do so in a safe and efficient manner. You should never deal with the severe pain and swelling of a damaged tooth, as it can become infected over time and worsen.\nWhen it comes to tooth extractions, they are generally done under local anesthesia. This entails the side of the mouth to be numbed while it is being worked on. Then, once the anesthetic is administered, the dental surgeon will gently rock the tooth back and forth until it is removed. The other option may be to surgically extract it by making a small incision into your gums in order to gain access to the tooth. The surgical procedure is done when the tooth has broken off below the gum line. Between the two types of procedures, the surgical extraction is much more complex. If you are unsure whether you need a tooth extraction, our team will assess your affected tooth and determine which is the best route for you.\nDepending on the procedure in which you received, stitches may be present. Whether you have stitches or not, it is essential that you avoid eating solid foods for a few days. Your dental surgeon Huntington Park will give you detailed aftercare instructions to prevent any infections. Additionally, you should follow the instructions in terms of when to switch out your gauze, which will also prevent infections. You should brush and floss normally so bits of food do not get into the incision area. Lastly, if you experience any pain or discomfort, you may use over-the-counter medication, like ibuprofen.\nAt the Dental Community Clinic, we are highly experienced in bringing the best results to our patients. Your oral health is extremely important, and it can also affect your overall health if not taken care of. You should never put off a tooth extraction if it is needed, and it is important to know that it is one of the most common procedures done at our office for adults and children. In addition, if you are in need of a dental extraction, we also offer many services for tooth replacements. Our team can help you from start to finish. Feel free to give us a call and come in for a consultation today!\nOur office is equipped with the latest and most advanced technology and we are prepared to offer the best level of care and treatment by our experienced dentists and staff. |
Having undesirable fat in different areas of your body can have a considerable influence on your health and self-confidence. While conventional weight loss through exercise and diet plan is a great method to slim down overall, even the best exercises cannot target problem areas like the belly, inner thighs, arms, and buttocks. Liposuction is a time checked treatment that is utilized to remove excess fat from specific locations of the body, permitting an individual to form and contour their body to their preference. Is liposuction right for you? Learn now.\nPros of Liposuction\nThere are lots of advantages to this cosmetic treatment, including:\n• Instantly visible changes. Unlike conventional weight loss, liposuction creates changes that are instantly noticeable in the body. Some distinction is obvious right away, and the desired results are usually accomplished in just a couple of days.\n• Proven and safe. This cosmetic procedure has been performed by seasoned specialists all over the world for many years and the technique has been improved over and once again to be safe and efficient.\n• Recovery time is generally fast. The downtime required after having this kind of treatment is generally much less than what is needed for other types of cosmetic treatments, consisting of abdominoplasty, breast reduction, and more. People who have had the treatment can often go back to work a lot more rapidly than they expected and can get back to living a healthy, active lifestyle.\n• Weight reduction can be long-term. With the ideal maintenance strategies, the fat that was eliminated during the liposuction procedure will not return.\n• Complete control over your physique. With liposuction, an individual can have complete control over how they wish to look, beyond what conventional diet and exercise can provide. Providing individuals this power over their bodies increases self-esteem and aid individuals feel their very best.\nWhile there are numerous benefits to liposuction, there are of course a couple of cautions that should be thought about before making the decision to move on with the treatment.\nCons of LiposuctionBefore having liposuction done, it is very important to examine the potential drawbacks of the treatment and determine if the benefits surpass the threats in your specific case. Your cosmetic surgeon can assist you find out more about the dangers connected with the procedure and can help you decide if moving forward is the right thing for you.\n• Issues with basic anesthesia. Because liposuction is performed under basic anesthesia, the procedure carries the exact same risks as any other kind of surgery where general anesthesia is utilized. Hidden medical conditions might increase these risks.\n• Negative responses. Bruising, bleeding, and discomfort are all to be expected, nevertheless, in unusual cases can cause more considerable issues.\n• The prospective to gain the weight back. After having liposuction done, it is important to maintain a healthy diet and exercise effectively as advised by your doctor. Failure to do so could cause getting back the weight that was lost or perhaps much more.\nAlthough there are threats related to liposuction, for lots of people, the advantages far exceed them. Educate yourself about the treatment by having extensive conversations with your specialist and consider how liposuction has the potential to affect you as an unique person. Only you and your cosmetic surgeon can identify 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 Augusta Kansas\nLaser liposuction is a newer, minimally invasive treatment that involves heating the fat cells to melting point and getting rid of the melted fat through a small cannula. The procedure is generally done right in your doctor's workplace and is an excellent alternative for individuals who have less than 500 ml of fat to eliminate from any one location. Laser liposuction can be a safe, complementary treatment to weight loss in order to shape the body you've always desired.\nContact a Surgeon in your Augusta Kansas today.\nIf you're considering liposuction as a weight reduction option, it is necessary that you discuss your desires with a qualified cosmetic surgeon in your area. Your cosmetic surgeon will carry out a total test and health history questionnaire to determine if liposuction can benefit you and help you reach your physical and emotional objectives. Call today for an examination and find out more about how liposuction can assist you achieve the body of your dreams. |
randomized study in Chinese and Caucasian subjects\nBACKGROUND: This study compared efficacy and safety of the selective relaxant binding agent sugammadex (2 mg/kg) with neostigmine (50 μg/kg) for neuromuscular blockade (NMB) reversal in Chinese and Caucasian subjects. METHODS: This was a randomized, active-controlled, multicenter, safety-assessor-blinded study (NCT00825812) in American Society of Anesthesiologists Class 1-3 subjects undergoing surgery with propofol anesthesia. Rocuronium 0.6 mg/kg was administered for endotracheal intubation, with 0.1-0.2 mg/kg maintenance doses given as required. NMB was monitored using TOF-Watch(®) SX. At second twitch reappearance, after last rocuronium dose, subjects received sugammadex 2 mg/kg or neostigmine 50 μg/kg plus atropine 10-20 μg/kg, according to randomization. Primary efficacy variable was time from sugammadex/neostigmine to recovery of the train-of-four (TOF) ratio to 0.9. RESULTS: Overall, 230 Chinese subjects (sugammadex, n = 119, neostigmine, n = 111); and 59 Caucasian subjects (sugammadex, n = 29, neostigmine, n = 30) had evaluable data. Geometric mean (95% CI) time to recovery to TOF ratio 0.9 was 1.6 (1.5-1.7) min with sugammadex vs 9.1 (8.0-10.3) min with neostigmine in Chinese subjects. Corresponding times for Caucasian subjects were 1.4 (1.3-1.5) min and 6.7 (5.5-8.0) min, respectively. Sugammadex 2 mg/kg was generally well tolerated, with no serious adverse events reported. There was no residual NMB or recurrence of NMB. CONCLUSION: Both Chinese and Caucasian subjects recovered from NMB significantly faster after sugammadex 2 mg/kg vs neostigmine 50 μg/kg, with a ~5.7 times (p < 0.0001) faster recovery with sugammadex vs neostigmine in Chinese subjects. Sugammadex was generally well tolerated. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00825812. |
In This Article\nDental emergencies may arise at any time anywhere and may cause immense pain and prevent you from efficiently doing your daily tasks. This is why it is important for you to have basic knowledge regarding dental emergencies and where to find the nearest emergency dentist if the need arises. Teeth may easily become damaged and start to pain due to an accident, injury, infection, or disease and may require emergency dental care. If you find yourself in a situation where you need an emergency dentist, you should rush to the closest dentist, or schedule a dentist appointment online. This article will give you an overview of what exactly a tooth extraction is, why it is done, how much it costs, what is the procedure, and how you can prepare for your dentist appointment.\nWhat Is An Urgent Care Tooth Extraction?\nA urgent care tooth extraction, also known as tooth extraction or tooth pulling, is a procedure in which the teeth are removed from the dental alveolus (socket) in the alveolar bone. It is a straightforward procedure, and the majority of the procedures can be performed easily and quickly under the effects of local anesthesia. Local anesthetics block pain, but mechanical pains are still felt. Tooth extraction procedure might be complex for some depending on the tooth’s position, the shape of the tooth roots, and the integrity of the tooth.\nReasons for teeth removal by Houston uptown dentists?\nTooth extraction is a popular solution for teens and adults who need to get their wisdom teeth removed. However, there are many other reasons why tooth extraction service may be required, including excessive tooth decay, crowding of the teeth, uncontrolled cavities, and tooth infection. To get proper braces, one may require tooth extraction of one or more teeth to make space for other teeth. People who are about to have an organ transplant or are undergoing chemotherapy may also require tooth extraction.\nCost of a Tooth Extraction at a Dentist Office Close To Me?\nTooth extraction done by Houston uptown dentists may cost between $75 and $200 per tooth. The price may be higher, depending on the type of anesthesia administered. However, it is important to note that the above-mentioned cost may vary widely depending on factors such as your location, location of the emergency dental clinic, and the market rate. The cost of removal of an infected tooth is usually higher and falls between $800 and $4,000.\nI need an emergency dentist now- How to prepare for a tooth extraction\nTo make your dentist appointment for a tooth extraction smooth and successful, you should know beforehand what to expect. When you go for your dentist appointment, the dentist will thoroughly examine your mouth and may also take an X-ray in order to understand the condition of your teeth better. He will then take your medical history because it may influence the type of treatment you receive so you must honestly tell your dentist whatever he or she asks. You should also tell them about medications you currently use, including vitamins, supplements, and over-the-counter drugs.\nThis is very important because for instance if you are using an intravenous drug called bisphosphonate, the dentist may postpone the tooth extraction to avoid complications. Inform your dentist if you have a medical condition including diabetes, liver disease, thyroid disease, hypertension, renal disease, congenital heart defect, weak immune system, damaged heart valves, and a history of bacterial endocarditis.\nIt is better if your medical conditions are treated before tooth extraction is performed. The dentist may also prescribe certain antibiotics if you have a weak immune system, infection, or a specific medical condition.\nThe procedure of an Urgent Care Tooth Extraction\nThere are two types of urgent care tooth extraction procedures, including simple tooth extraction and surgical tooth extraction. The dentist will decide which one is best for you depending upon whether your tooth is visible or impacted.\nSimple tooth extraction\nIn this procedure, the dentist will use a local anesthetic to numb the region around your teeth. Next, with the help of a tool called the elevator, he will loosen the tooth and remove it using forceps.\nSurgical tooth extraction\nIn this type of tooth extraction, you will receive either local anesthesia intravenous anesthesia, or both. If your dentist administers general anesthesia, you will remain unconscious throughout the procedure. Intravenous anesthesia makes you feel calm and relaxed. Next, the dentist will make a small incision on your gum, remove the bone around your tooth and extract the tooth.\nFAQS about Weekend Dentist\nWhere do I get emergency dental care services?\nYou can get emergency dental care services at URBN Dental. URBN Dental is a dental office, which provides highly recommended economical dental care services. The team of professionals at URBN Dental provides immediate attention and care. They can help with lowering your dental pain and other symptoms of a dental emergency while also caring for your oral health. Schedule an appointment or show up for a visit; we will gladly cater to your needs.\nHow to see a dentist in an emergency?”\nDental emergencies can be scary and difficult to handle. They require urgent dental care. If you experience such a situation, call your dentist immediately, who will be able to help you out? Otherwise, make an emergency appointment to see an emergency dentist that is available on the same day or after hours. You can get hold of emergency dentists for your emergency at URBN Dental. URBN Dental provides walk-in emergency dental services, so visit this dental office in case of emergencies.\nSchedule Dentist Appointment for Your Dental Emergency at the Best Weekend Dentist – URBN Dental\nIf you are looking for an “emergency dentist near me” or “emergency extraction dentist near me,” you have come to the right place. At URBN dental we provide our customers with highly recommended facilities and services. Don’t miss out, book an appointment now to avail our services.\nSudden trauma or accident may damage your tooth and may require an urgent care tooth extraction. Tooth extraction is one of the solutions for a dental emergency that may arise anytime anywhere. If you find yourself in a situation where you need an emergency dentist, you should rush to the closest dentist, or schedule a dentist appointment online. A dental extraction is a procedure in which the affected tooth is removed from the socket in the alveolar bone. It is used to treat infected, damaged, decaying teeth as well as crowding of the teeth and uncontrolled cavities.\nTooth extraction costs between $75 and $200 per tooth, whereas a complex tooth extraction may cost higher between $800 and $4,000. The cost varies widely depending on different factors such as your location and local market rates. When you go for your dentist appointment, the dentist will thoroughly examine you, take your medical history, and then move onto the surgical procedure. It is important that you tell him correctly about your current medical conditions as they may influence the tooth extraction procedure.\nLet the dentist know if you have diabetes, hypertension, thyroid disease, renal disease, a congenital heart defect, and other conditions. The dentist will perform either simple tooth extraction or surgical tooth extraction depending on whether your tooth is visible or not. If you are looking for an “emergency dental office near me” or “emergency extraction dentist near me,” you have come to the right place. Book your appointment at URBN dental to avail highly recommended dental services. |
Mary Dillon, MD\nDr. Dillon specializes in anesthesia.\nDr. Dillon, MD offers these procedures:\nEducationDr. Dillon received a Bachelor’s degree from the University of Wisconsin in Madison and completed medical school at Thomas Jefferson Medical College in Philadelphia. She then went on to an internship in general surgery at Pennsylvania Hospital, a residency in orthopedic surgery at Eastern Virginia Medical School, and an anesthesia residency back at Thomas Jefferson. Dr. Dillon also completed a pediatric anesthesia fellowship at Children’s Hospital of Philadelphia.\nGreat job by all! Really friendly and knowledgeable staff. Thanks to all for making it such a good experience. A very efficient “operation facility”. Please recognize Dr. Mary Dillon, Kristin, CRNA, Kristin the pre-op R.N., and Jennifer the OR RN. Ann J. Sep 2019\n2019 MEDARVA Patient Choice Award\n2020 MEDARVA Patient Choice Award\nStony Point Surgery Center\n8700 Stony Point Parkway, Suite 100\nPhone: (804) 775-4500 |
Are there any medications that would interfere with my recovery after a tummy tuck? I'm just wondering if I need to temporarily stop using my prescriptions to do this. Also, will drinking alcohol affect my recovery?\nWhich Medications Could Interfere with Recovery After a Tummy Tuck?\nDoctor Answers (6)\nMedications before surgery\nIn general, patients should avoid blood thinners such as aspirin and certainly teel your doctor about any herbal medications you take. Your surgeon should give you a list of do's and don'ts.\nMedications and post-op\nYou should review all your medications that you are taking with your doctor. In general, I tell patientsw to avoid alcohol post-op because often patients are given pain meds and they may potentiate the effects.\nMedications that could interefere with cosmetic surgery of tummy\nThis is not a simple answer and most plastic surgeons will provide you with a list of medications to avoid as well as review the current medications you are currently on and advise you regarding cessation or discontinuation around your surgical date.\nWeb reference: http://www.bodysculptor.com/\nYou might also like...\nMedications to avoid after a tummy tuck\nAfter a tummy tuck, patients must pay close attention to the recovery process. Patients should avoid blood centers such as aspirin and herbal medications. A tight compression garment will also assist the patient and recovering from such a procedure. The compression garment will help reduce the amount and limit the amount of discomfort. On our website, we have a full list of medications that patients should avoid before and after their surgery. You are welcome to the website and download a copy for yourself.\nWeb reference: http://www.miamiaesthetic.com/abdominoplasty_photos.htm\nReview your meds and any supplements with your surgeon a couple weeks prior\nThere are numerous medications that may interact with anesthesia and complicate your recovery. Most surgical practices will give you a lengthy list of medications and supplements to avoid. You should bring a list of the medications you are taking to your surgeon. Some medications or supplements that effect bleeding need to be stopped or modified weeks prior to surgery.\nYou should also inform your surgeon of any herbs or over the counter medications you take.\nThere are numerous medications that affect surgery\nThere are numerous medications that affect surgery, from the more abvious ones which affect your ability to clot (like aspirin), to medications that can have dangerous interactions with the meds we use for anesthesia. You should go over this carefully with your surgeon. also, be aware of ant over the counter meds and herbal medications you are taking as these can have deleterious effects as well.\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. |
To save time during your appointment, you can fill out these forms at home and then bring them with you.\nPlease note: These documents are in Adobe® PDF format. They require Adobe Reader to be viewed.\nTHE FIRST STEP\nContact us to schedule a free consultation. During your consultation, our Patient Care Coordinator will educate you about the surgery you’re interested in, the process of preparing for surgery, and the recovery involved. We understand that this can be seen as an intimidating process, but we make a special effort to ensure that all of our patients feel as comfortable as possible.\nOnce you arrive at Beverly Oaks Surgery, you will check in with our front office staff and fill out the necessary paperwork for your visit. This will give us information regarding your medical history so we can ensure you are a candidate for surgery.\nNext, you will be introduced to our patient care coordinator, Marcella Altamirano. She is highly experienced in cosmetic and weight loss surgery and will personally take you through the consultation process. Marcella will discuss your goals with you, answer your questions, and make recommendations regarding your procedure. She will also provide you with a quote sheet, and information regarding available financing plans and after-care facilities.\nIf you feel confident in moving forward with your surgery after meeting with Marcella, we will schedule an appointment for you to meet your doctor, be examined, and further discuss your procedure and goals.\nPREPARING FOR YOUR SURGERY\n- Do NOT take aspirin or anti-inflammatory drugs (i.e. Motrin, Advil, Aleve) two (2) weeks before surgery and two (2) weeks after surgery, unless instructed otherwise by your physician.\n- Do NOT smoke for at least 24 hours prior to surgery. It is best to avoid smoking one (1) week before surgery and two (2) weeks following surgery.\n- Your physician may request pre-operative testing (EKG, lab work, medical clearance). These tests must be completed at least seven days prior to the day of your surgery.\n- FAX pre-op test results to the surgery center pre-op department at (818)-986-9089 You will NOT be permitted to drive after surgery.\n- You must have a responsible adult with you during your visit at the surgery center AND to drive you home.\n- Someone MUST be available to stay with you for the first 24 hours after discharge.\n- If you are under 18 years of age, a parent or legal guardian MUST accompany you to the center and REMAIN on the premises during surgery. A pre-op nurse will call before your surgery to review your medical history.\n24 HOURS BEFORE SURGERY\nDo NOT eat or drink after midnight prior to surgery (unless instructed otherwise), including gum, candy and throat lozenges.\nDo NOT smoke for at least 24 hours before surgery.\nA staff member will call you the day before your surgery to confirm the assigned arrival time to the surgery center.\nMORNING OF SURGERY\nTake all medications as prescribed with a SIP of water (unless otherwise instructed).\nBathe or shower as usual. Avoid heavy lotions or moisturizers. You may brush your teeth.\nDo NOT wear make-up, body piercings, jewelry or hair spray. Leave all valuables at home.\nWear comfortable clothing, elastic waist shorts (no zipper), sports bra (except for shoulder surgery), and shoes that are easy to remove. For shoulder and arms patients, bring an XL button-down shirt to go over your sling.\nBring your reading glasses or if you wear your contact lenses, bring your case to remove them before surgery.\nBring your completed paperwork (if you printed it from our website), driver’s license, insurance card, medication list and co-pay, if required.\nYou will meet your Anesthesiologist on the day of your surgery and together you will choose the best type of anesthesia for you. The type of anesthesia you choose will be determined by your personal preference, the type of surgery you are having, and your medical history. Your anesthesia care team includes your Anesthesiologist and your Nurse Anesthetist. They will work with your surgeon to make the best decisions for your care.\nIMMEDIATELY FOLLOWING YOUR SURGERY\nAfter your surgery, you will be taken to the recovery area.\nA nurse will provide you or your responsible adult with written discharge instructions. It is important that you follow these and any special instructions from your physician.\nWhen you have recovered from the anesthesia, you will be discharged from the Surgery Center to the care of a family member or friend. You may not drive yourself home.\n- A surgery center staff member will call you the day after your surgery to see how you are doing.\n- At any time, if you have a question regarding your incision or pain control, please call your surgeon’s office. |
Ephedrine Shows Synergistic Motor Blockade When Combined with Bupivacaine or Lidocaine for Spinal Anesthesia in a Rat Model\nDjalali AG, Wang JC, Perez-Valdivieso JR, Danninger T, Fritsch G, Zurakowski D, Gerner P.\nFrom the *Department of Anesthesia, Stanford University School of Medicine, Stanford, California; †Pain Research Center, Department of Anesthesia, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts; ‡Department of Anesthesia and Critical Care, Clinica Universidad de Navarra, University of Navarra, Spain; §Department of Anesthesiology, Perioperative Medicine and Critical Care Medicine, Paracelsus Medical University, Salzburg, Austria; and Departments of Anesthesia and Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.\nRevista: Anesthesia and Analgesia\nFecha: 04/03/2013Anestesia y Cuidados Intensivos\nEphedrine is a direct/indirect vasoactive drug. In addition, it also possesses intrinsic local anesthetic properties, mainly due to its sodium-channel blockage. We investigated whether ephedrine demonstrates a synergistic effect with bupivacaine and lidocaine when injected via a spinal catheter into the spinal space of rats.\nSpinal catheters were surgically placed in 47 rats (n = 8 per group; 7 rats were excluded.) Bupivacaine, lidocaine, and ephedrine in various concentrations and constant volumes (60 μL) were injected into the spinal catheters to determine the equipotency of each drug. Ephedrine in combination with either bupivacaine or lidocaine was then injected into the spinal catheters.\nEphedrine demonstrated statistically significant synergistic effects with bupivacaine as well as with lidocaine in fixed combinations. The combination index reflecting a synergistic effect was 0.792 (95% confidence interval: 0.665-0.919) for ephedrine + bupivacaine and 0.663 (95% confidence interval: 0.532-0.794) for ephedrine + lidocaine.\nEphedrine combined with either bupivacaine or lidocaine acted synergistically to block motor function and has the potential to reduce the amount of local anesthetic needed for spinal block. The synergistic effect of ephedrine in combination with local anesthetics is an interesting pharmacological phenomenon that warrants further clinical evaluation.\nCITA DEL ARTÍCULO Anesth Analg. 2013 Mar 4\ntal vezLE INTERESE\nLa Clínica es el hospital privado con mayor dotación tecnológica de España, todo en un único centro.\nLos profesionales de la Clínica realizan una labor continuada de investigación y formación, siempre en beneficio del paciente.\nConozca por qué somos diferentes a otros centros sanitarios. Calidad, rapidez, comodidad y resultados. |
Plainfield Surgery Center is an ideal alternative for surgical procedures that does not require an overnight hospital stay. We provide cost-effective, high quality care in a comforting and professional environment. We utilize advanced medical technology and state-of-the-art equipment to ensure each patient receives exceptional care\nWho We Are\nLet us introduce ourselves\nOur dedicated and skillful medical staff all practice in the community. Every member of our staff recognizes the importance of your individual needs. Your surgeon is available for questions and concerns during your recovery.\nThe dedicated staff of Board Certified and Board-Eligible surgeons, anesthesiologists, nurses, and technicians represent multiple specialties, including:\n- General Surgery\n- Otolaryngology (ENT)\n- Plastic Surgery\nOur facility is accredited by the Accreditation Association for Ambulatory Health Care (AAAHC). The AAAHC promotes advanced, high-quality care through providing a voluntary survey-based accreditation to ambulatory organizations, such as Plainfield Surgery Center. |
Jump to section\nExploratory laparoscopy is a surgical technique for viewing the internal structures of the abdominal cavity by passing a scope through a keyhole incision. Minimally invasive, the technique of exploratory laparoscopy is widely used in veterinary and human medicine. Conducted by an experienced veterinarian, a laparoscopic-guided organ examination permits precise and accurate site localization of a variety of internal organs. Direct visualization allows the personnel to excise a biopsy to ascertain a correct diagnosis, accurate prognosis, and specific therapy without the need for invasive exploratory surgery. Exploratory laparoscopy holds superiority over other non-invasive tests including MRI, x-ray and ultrasounds. Lastly, exploratory laparoscopy is the only available and practical means of repeated direct examination of the abdomen viscera with minor surgical intervention.\nPreparing the dog for exploratory laparoscopy begins with a fasting period between 12 and 24 hours with fresh water available up till three hours before. The urinary bladder, stomach and colon should be empty prior to the procedure. General anesthesia is required to complete the exploratory laparoscopy.\nExploratory laparoscopy is a method in which small incisions are made on the abdomen wall and instruments are inserted through specially designed ports. The procedure is granted visualization through the help of a camera is also introduced through one of these specialized ports. All ports are made on the dog’s midline. The exploratory portion of the procedure depends on the area the veterinarian wishes to view and the need for biopsied tissue.\nFollowing the exploratory laparoscopy, the laparoscope will be removed and CO2 gas will be allowed to escape from the abdominal cavity. The instruments and ports will be removed, allowing the veterinarian to close the abdominal openings using a single mattress suture pattern consisting of non-absorbable suture material.\nExploratory laparoscopy is an effective procedure to directly visualize a problem that is affecting a dog internally. Exploratory laparoscopy proves to be the most effective form of diagnostic technique to visually confirm an internal complication.\nFollowing an exploratory laparoscopy, the canine will have some form of exercise restrictions to prevent the sutures from breaking. An Elizabethan collar will likely be worn to prevent manipulation of the incision sites. Depending on the findings of this diagnostic test, the veterinarian may schedule a surgery date or decide a treatment plan for the canine.\nThe cost of an exploratory laparoscopy in dogs greatly depends on the hospital in which the exam is conducted and the abnormality found. On average, dog owners can expect to pay between $500 to $1,000 to have a canine exploratory laparoscopy.\nExploratory laparoscopy does require general anesthesia, which may not be suitable for chronically ill patients. Like all forms of surgery, no matter how minimally invasive, the procedure does pose some risk for infection. If appropriate after care protocols are put in place and followed, the risk for infection is minimal.\nThe need for an exploratory laparoscopy cannot always be prevented, as internal problems often are a result of unknown causes. However, foreign body entrapment is a possible need for exploratory laparoscopy and can be prevented by monitoring the dog. Appropriate chew toys and supervised outdoor time will limit the possibility of a foreign body trapped in the gastrointestinal system.\n*Wag! may collect a share of sales or other compensation from the links on this page. Items are sold by the retailer, not Wag!.\n0 found helpful\nI have a small ShiPoo that is 9 months old. He has failed to gain much weight, and has been at 5 pds 8 Oz since he was 5 months old. Went in for a neuter and his liver enzymes were elevated, so the vet wouldn’t do neuter due to higher risk. After further testing and ultrasound, they found he has a liver abnormality. Either shunt or micro vascular dysplasia. My question is...is there any way to diagnose either of these conditions without spending thousands of dollars? Is exploratory laparoscopy an option instead of the expensive dye test? Any thoughts are appreciated. Thanks!\nApril 30, 2018\nDr. Michele K. DVM\nThose two conditions can be very difficult to diagnose, unfortunately, and may take further diagnosis. To have an exploratory laparottomy, he would need an anesthetic, which may be something that your veterinarian is trying to avoid. Some dogs do respond to medical management of these diseases, and that may be something to talk with your veterinarian about. Without knowing more about Blake's specific condition, it would be best to trust your veterinarian as to the best route of testing to go, but y ou can certainly discuss the pros and cons with them. I hope that everything goes well for him.\nApril 30, 2018\nWas this experience helpful?\n© 2021 Wag Labs, Inc. All rights reserved.\nDownload the Wag! app\nDownload the Wag! app |
Ketamine Clinical Trials\nPharmacokinetic-pharmacodynamic modeling of S(+)-ketamine in healthy volunteers.\nTo see complete record on www.trialregister.nl, please visit this link\nOrganisation Name: N/A\nOveral Status: Planned\nStart Date: 2007-02-01\nLead Sponsor: N/A\nBrief Summary: The NMDA-receptor antagonist ketamine, at relatively low-dose, is a potent analgesic. It is used in the perioperative setting as well as in chronic pain, for example in the treatment of neuropathic pain and pain from malignancies. We are currently assessing ketamine’s analgesic efficacy in CRPS type 1 patients in an experimental study (protocol P05.100).\nDespite its wide use, relatively little is knows about ketamine’s pharmacokinetics –PK– and pharmacodynamics –PD– or the link between the two. For example, there is no knowledge on the link parameter ke0, which is an estimate of the drugs onset and offset-times. Knowledge of ketamine’s PK and PD is needed to be able to fully understand clinical ketamine data in patients, such as CRPS type 1 patients. Furthermore, it will enable the optimization of infusion schemes and hence the treatment of patients on ketamine.\nKetamine is a racemic mixture. Recently the S(+) form became available (Ketanest). In contrast to the racemic mixture, S(+)-ketamine shows less psychomimetic side effects. This is the reason that the S(+) form is now widely used with the racemic mixture rapidly loosing market.\nIn this study we will assess the pharmocokinetics and pharmacodynamics of intravenous S(+)-ketamine in healthy volunteers. This will result in a pharmacokinetic/pharmaco-dynamic (PK/PD) model which may be used to predict S(+)-ketamine concentration and pain relief after intravenous infusion.\nThe PK of S(+)-ketamine will be studied by obtaining arterial blood samples at regular times after iv infusion. The PD of S(+)-ketamine will focus on pain relief and the side effect profile, with special emphasis on psychomimetic side effects and blood pressure.\nThe design of the study is placebo-controlled, single-blind, randomized cross-over.\nAims of the study:\n1) To obtain pharmacokinetic parameters of S(+)-ketamine;\n2) To study the pharmacodynamic effects of intravenous S(+)-ketamine on experimental pain;\n3) To study the pharmacodynamic effects of intravenous S(+)-ketamine using Bowdle scales.\nTotal execution time in seconds: 0.096001863479614 |
To use all functions of this page, please activate cookies in your browser.\nWith an accout for my.chemeurope.com you can always see everything at a glance – and you can configure your own website and individual newsletter.\n- My watch list\n- My saved searches\n- My saved topics\n- My newsletter\nMethylnaltrexone (MTNX) is one of the newer agents of peripherally-acting μ-opioid antagonists that act to reverse some of the side effects of opioid drugs such as constipation without affecting analgesia or precipitating withdrawals. Because it contains a permanently charged tetravalent nitrogen atom, it cannot cross the blood-brain barrier, and so has antagonist effects throughout the body, counteracting effects such as itching and constipation, but without affecting opioid effects in the brain such as analgesia.\nIn December of 2005, Wyeth and Progenics entered into an exclusive, worldwide agreement for the joint development and commercialization of methylnaltrexone for the treatment of opioid-induced side effects, including constipation and post-operative ileus (POI), a prolonged dysfunction of the gastrointestinal (GI) tract following surgery. Under the terms of the agreement, the companies are collaborating on worldwide development. Wyeth received worldwide rights to commercialize methylnaltrexone, and Progenics retained an option to co-promote the product in the United States. Wyeth will pay Progenics royalties on worldwide sales and co-promotion fees within the United States.\nMethylnaltrexone is being developed in subcutaneous and oral forms to treat opioid induced constipation (OIC) and an intravenous form for POI.\nProgenics and Wyeth are conducting two global phase 3 clinical trials in POI, targeting an NDA submission in this indication in early 2008. An oral formulation for OIC in patients with chronic pain currently is under development with an anticipated NDA submission in late 2009 or early 2010.\n|This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Methylnaltrexone". A list of authors is available in Wikipedia.| |
A breakthrough in women’s health – the Juliet is an Er:YAG 2940 nm laser incorporating a unique treatment protocol delivering two passes to the vaginal area to stimulate collagen and revitalize the vaginal tissue to address symptoms associated with vaginal atrophy and vaginal relaxation syndrome.\nWomen’s bodies change due to childbirth, menopause, surgical procedures or breast cancer therapies. These changes cause many women to experience or suffer from many side effects such as:\n- Vaginal Relaxation Syndrome – reduced elasticity in the vagina\n- Loss of sensation during sex\n- Genitourinary Syndrome of Menopause (GSM)\n- Vaginal atrophy associated with vaginal itching, dryness, burning, bleeding, irritation\n- Discomfort, pain or bleeding during intercourse\n- Urinary urgency – from sneezing, laughing, exercise, yoga, running\n- Recurrent urinary tract infections\n- Vulvovaginal skin color changes\n- Labia laxity\nCustomized Treatment Using:\nCustomized Treatment Using:\nFREQUENTLY ASKED QUESTIONS\nThe Juliet treatment is a new, non-surgical in-office procedure that uses laser technology to improve intimate wellness by reducing vaginal dryness or discomfort that can occur around menopause. The Juliet laser also restores tone and flexibility to the vaginal wall and can help reduce dyschromia and remodel the vulvar area.\nVaginal childbirth and the natural aging process can lead to loss of vaginal sensation and tone. The Juliet laser treatment stimulates the production of collagen right where it’s needed, remodeling tissue fibers and restoring flexibility and shape.\nThe Juliet treatment is a two-step process. The first pass stimulates the production of collagen, strengthening the structure of the tissue. The second pass revitalizes the tissue through gentle heating. Patients report reduced discomfort, and improved vaginal lubrication, tone and flexibility.\nThe Juliet treatment remodels the labia while reducing skin pigmentation, resulting in improved skin texture and tone.\nMost patients have reported improvement in as little as one treatment; however, three treatments are recommended. Treatments are administered every 4 weeks, and the same protocol is utilized.\nThe treatment is not painful and generally doesn’t require anesthesia; however, a mild topical anesthetic may be applied, especially when treating the introitus (vaginal opening) and vulvar vaginal area.\nImprovement can be observed immediately after the first treatment and will continue to improve several months after the last treatment. Three treatments may be needed for optimal results.\nAfter the final treatment, patients should expect to come back annually for a maintenance treatment.\nWe recommend you refrain from sexual intercourse, heavy physical exercise and activities such as swimming or sauna for three days after the treatment.\nJuliet is right for any woman seeking a fast, non-surgical and discreet procedure that enhances sexual functioning and provides a better sexual experience. It is for women who want to feel more confident about their feminine health or seek vaginal cosmetic improvement.\nBecause the Juliet treatment is non-hormonal, it is an ideal option to restore vaginal health in women who have undergone breast cancer treatment. Ask your doctor for further information. |
So around a year ago, President Obama signed a law meant to end chronic shortages of lifesaving drugs. However, a critical lack of generic drugs continues. This is being called a “preventable crisis” and it’s harming patients, even leading to death in the case of botched anesthesias. The New York Times does not believe the law will be effective, in part because it addresses the symptoms but not at all the disease.\nScarce or unavailable drugs include anesthetics, chemotherapeutic agents, antibiotics, nutrients for malnourished infants, painkillers and even intravenous solutions, according to the New York Times. Physicians without access to proper meds have been improvising treatments with less desirable or more expensive substitutes.\nWhat were some of the effects?\nOne study reported in an issue of The New England Journal of Medicine last December found children with Hodgkin’s disease were at greater risk of relapse because the most effective generic, mechlorethamine, wasn’t available. Propofol, the preferred anesthetic for many surgical procedures, is scarce because there’s just one supplier of the generic in the United States in full production.\nAnd, the deadly outbreak of fungal meningitis, first identified last September in Tennessee, was triggered by these same shortages. In this case, a steroid painkiller wasn’t readily available from a plant with proper regulation. This led to a large purchase of painkillers from the now bankrupt New England Compounding Center, which, because it was a so-called compounding pharmacy, was not held by the Food and Drug Administration to the same stringent standards as regular drug manufacturers. As a result, 63 people were killed and 749 sickened, according to the Centers for Disease Control and Prevention.\nWhy is that scarcity occurring in a “free-market” economy?\nThe economic root cause is simple: purchasing organizations have squeezed manufacturers’ operating margins to razor-thin levels. Select suppliers are awarded exclusive contracts in return for exorbitant (and undisclosed) “administrative,” marketing and other fees. Now there are only one or two suppliers for many generics. Further, these manufacturers have crimped investment in maintenance and quality control, which has resulted in adverse F.D.A. inspections and even the closing of plants.\nHow did we get here?\nThis “perverse” system was created in 1987 when Congress enacted the Medicare “safe harbor.” This was a kick-back program which exempted these same buying organizations from criminal prosecution for accepting the unfair windfalls. In 2002 the New York Times investigated these anticompetitive practices, leading to Congressional hearings to determine whether or not they needed to implement greater federal regulation. Antitrust lawsuits and more government investigations and exposés followed. However, the effects are still lingering.\nREAD THE COMPLETE NEW YORK TIMES ARTICLE\nHow would we sum up this report?\n“These cartels have undermined the laws of supply and demand,” says MARGARET CLAPP, MICHAEL A. RIE and PHILLIP L. ZWEIG, co-writers of the article. Once more, the journalists dig up proof of what we’ve suspected all along. However, this raises the stakes on our typical outcry. In this case, needless deaths occurred as a result of bureaucratic intervention. This isn’t something to be taken lightly. |
Frenchie Bulldog Owners need to educate themselves on this topic....\nFrench Bulldogs cannot tolerate certain methods of Anesthesia as some other breeds. Due to their flat faces, they do require more monitoring and careful sedation procedures such as needing to be tubed at all times. My Vet removes the tube once the dog wakes up, never before.\nNEVER allow a Vet to give your French Bulldog ACE aka ACEPROMAZINE AND PROMACE. Acepromazine is a tranquilizer and depresses the central nervous system. Dogs can die from this medication, research it. I had a dog (not a frenchie) that almost died from this medicine because her blood pressure dropped so low DURING SURGERY, a simple routine spay, could have been deadly because of this medication. Please Google this med and make sure your Vet does not use this. Here is a link discussing Ace and Boxers and how dangerous this drug is: http://www.boxerworld.com/forums/dog-health-issues-questions/108701-need-know-info-before-your-dog-has-surgery-sedative.html\nA "frenchie family" of ours from another state down south, who owns 2 of our babies, has been a Vet for 10 years and she says this is an old school drug, many Vets do not use ACE and they do not use it in her practice because there are safer drugs. Again... do your research.\nASK ASK ASK QUESTIONS....\nIf your Vet gets mad, find another one. Some Vets are not caught up or may simply just not know that brachycephalic breeds (flat faced breeds) have special needs... from not using injectilbles, to special tubing, etc...\nI can't stress this enough... DO YOUR RESEARCH,\ndiscuss all anesthesia procedures and protocols with your Vet if\nyour French Bulldog needs to go under general anesthesia for any reason.\nIts better to be informed, than to risk your dogs life. When our Frenchies\nare put under it is with a mild sedative and Propofol, but I will say my\ndogs have never been under for more than 45 minutes or so... so longer\nmore intensive surgeries may be different. My vet puts the dog completely\nunder and intubates for any procedure so the airway is protected via intubation\nalways... We have never had one die under anesthesia with my Vets protocols,\nTHANK GOD :) Your best bet is to find a Vet who specializes or has\nplenty of experience with the brachy breeds.\nRead this great article from Dr Lori Hunt DVM:\nAll the best to everyone!\nLil Debbie after\nher surgery... isn't she a cutie... still groggy and tongue a little dry\nafter tube removal.... And next in the car having a vanilla Mc Donalds\nlittle treat about 3 hours later on our way home... Life is hard\nfor these frenchies :)\nAll Star Disclaimer: We do not claim to be veterinarians & by listing any information on this page we are not giving medical advice. We do not claim that the information herein will guarantee that this correct with anyone else's French Bulldog. Please do not use our pages or links to attempt to diagnose or treat your pet. A licensed veterinarian is the best source of health advice for an individual pet. Remember that different veterinarians often disagree about the best treatments for pets. There are often several perfectly acceptable ways to treat the same condition. Just find the right Vet and ask a lot of questions!!!! We place these articles here for the public to read, as information, not FACTS. Along with our OPINION, we find many information online, through web sites and other sources of information and list it to inform others what we have read and what we think is important regarding French Bulldog Health concerns. If we state certain methods we have used or use on or have experienced with our own dogs, we do not wish to infringe these methods on anyone else, it is solely our opinion and nothing else. By reading, and/or using the material contained herein, reader or user of this information fully understands the above and again agrees to utilize this information at your own risk.\n*All Star French Bulldogs*\n*French Bulldog Breeders - French Bulldog Puppies - AKC Champion Bloodlines*\n!!! AKC REGISTERED FRENCH BULLDOGS FOR SALE - BORN & RAISED IN THE USA !!!\nAll Star French Bulldog Puppies for sale from AKC Champion Bloodlines*\n[Back To Top]\nOur Site Map: |
RootsAir From Costa Rica, joined Feb 2005, 4187 posts, RR: 38 Posted (9 years 5 months 4 days 15 hours ago) and read 3130 times:\nA friend of mine has undergone his 12th operation (!!!)and is only aged 22. This led me to make a poll to see how many operations my fellow a.netters have undergone. for what concernes me I've only had two surgeries when I was small.\nA man without the knowledge of his past history,culture and origins is like a tree without roots\nLentigomaligna From , joined Dec 1969, posts, RR:\nReply 2, posted (9 years 5 months 4 days 14 hours ago) and read 3116 times:\nJust once---a laparotomy plus several weeks in hospital for a ruptured (not diagnosed for 2 weeks) and abscessed appendix and resultant sepsis. I was under for 4-5-ish hours I think, not that I can say I was "awake" very soon after.\nSA7700 From South Africa, joined Dec 2003, 3431 posts, RR: 25\nReply 5, posted (9 years 5 months 4 days 14 hours ago) and read 3110 times:\nAIRLINERS.NET CREW HEAD MODERATOR\nI have had 8 operations. Four (4) times I underwent bilateral myringotomies with the insertion of ventilation tubes, due to otitis media. After that my "wisdom" teeth were removed, followed by a tonsillectomy at age 21. Two years ago I underwent a septoplasty, septum perforation repair and turbinectomies. The last procedure was in 2005 when I underwent LASIK to correct my vision.\nOut of the 8 operations, my dad operated me 6 times, being an Ear-, Nose-and Throat surgeon. Yes, it is allowed in South Africa should you wonder about medical doctors operating their own family members.\nWhen you are doing stuff that nobody has done before, there is no manual – Kevin McCloud (Grand Designs)\nJAGflyer From Canada, joined Aug 2004, 3698 posts, RR: 3\nReply 8, posted (9 years 5 months 4 days 14 hours ago) and read 3091 times:\nWisdom tooth removal (under conscious anesthesia) Not really an "operation" but there was cutting and blood involved. Thankfully the anesthesia worked and I don't remember anything between having the IV inserted and walking to the recovery area.\nSupport the beer and soda can industry, recycle old airplanes!\nCadet985 From United States of America, joined Mar 2002, 1876 posts, RR: 4\nReply 9, posted (9 years 5 months 4 days 13 hours ago) and read 3077 times:\nI've been "under the knife a lot." Let's see...2 eye surgeries, ear surgery, 2 brain operations (not kidding), about 4 "non-surgical procedures" for my back, and one major back surgery. So if you count the "non-surgical procedures," (which were done in an operating room), I've had 10 operations in my 20 years of life.\nJafa39 From , joined Dec 1969, posts, RR:\nReply 12, posted (9 years 5 months 4 days 13 hours ago) and read 3066 times:\nNope, no surgery although i may have to have an operation on my throat soon due to suffering from "Singers Throat" which is a larf as i can't sing but I give a lot of presentations and basically talk for a living and I have nodules on my vocal chords.\nI once had to have part of my scalp sewn back on after a garage door came down on me as I walked under it...does that count? I have a "Nike Tick" scar on the top of my head!\nBradWray From United Kingdom, joined Jun 2005, 650 posts, RR: 1\nReply 14, posted (9 years 5 months 4 days 12 hours ago) and read 3058 times:\nI have only had one, My tonsills removed. A good thing as I will never again get tonsilatius but it was during the 2002 FIFA World Cup so my mood was not good. I had to watch Brazil beat England on a 5 Inch LCD monitor supplied by the hospital! |
Healthy Pets = Happy Pet Parents\nAdvancements in veterinary medicine have allowed surgical procedures to be much safer than ever before. If your pet needs surgery, you can rest assured that pre-anesthetic testing, advanced monitoring equipment, and the safest gas anesthetics will allow for an uneventful surgical procedure.\nWhen your pet is admitted to our hospital for surgery, several steps are taken before the actual surgery. First, your pet’s attending doctor will do an examination- listening to heart and lungs, to determine if there are any current issues that would prevent us from proceeding with surgery. Then blood is drawn for pre-anesthetic testing. This tells us if the liver, kidneys, blood count, etc., are within normal limits. If all is well, a technician will administer pre-medications to reduce pain, calm your pet and reduce the amount of anesthesia needed. Then a short-acting drug is given to allow your pet to fall asleep. At that point, a breathing (trachea) tube will be placed and a gas anesthesia/oxygen mix will be administered directly into the lungs. Monitors will be attached to your pet showing heart rate, blood pressure, carbon dioxide exhaled and oxygen saturation. Anesthesia can be adjusted accordingly, and the monitors also indicate if the pet is having any difficulties during the procedure before serious problems occur.\nThe American Animal Hospital Association requires that our surgeries be performed in a sterile surgery suite. The doctors are masked and gowned, and your pet’s surgery site is prepped and scrubbed. Your pet is constantly monitored during the procedure and when the surgery is complete, the gas anesthesia is turned off and only oxygen is administered. Because the gas anesthetic is delivered directly to the lungs, your pet will wake up fairly quickly. At that point the breathing tube is removed, and the pet is breathing on its own.\nYour pet continues to be monitored by our trained staff during the recovery period, and your pet can usually be released later the same day! Owners are often amazed that their pet walks out to greet them on their own with little indication that they have been under general anesthesia.\nTypes of surgeries performed at Olathe Animal Hospital:\n- Spay (ovariohysterectomy) & Neuter (orchiectomy)\n- Orthopedic procedures\n- Femoral Head & Neck excision (FHO) for hip dysplasia\n- Patellar luxation repair\n- Fracture repair\n- Abdominal procedures\n- Cystotomy (bladder stone removal)\n- C-section (delivery of puppies)\n- Foreign body removal from GI tract\n- Soft tissue procedures\n- Mass removals (lumpectomies)\n- Laceration repair\n- Abscess repair\n- Hematoma repair |
Statistics from Altmetric.com\nFrom DRC to DAR\nLast fall, I had the extraordinary opportunity to spend two months at Muhimibili Hospital in Dar Es Salaam, teaching in the first emergency medicine residency in Tanzania. During this time, I was reminded of what a privilege it is to be a physician, and how lucky I was to grow up in a country where the path to medical school was straightforward, my life relatively stable, and my work, although stressful and chaotic, secure. This month, the view from here features an interview with an inspiring young physician who has travelled a far more dangerous and circuitous path. Dr Mudenga Mutendi Muller describes his experiences in a hospital during the war in Goa, assuring safety for his family, then leaving his home country to begin EM training in Tanzania. More of our interview can be heard in our podcast at: https://soundcloud.com/bmjpodcasts/drc-to-darone-physicians-journey-to-emergencymedicine/s-5ck7t\nAn old medication raises new possibilities–and questions\nMethoyxflurane, an inhaled anaesthetic agent used in the 1960's and 1970's, has analgesic properties at sub-anaesthetic doses and has been used for pain management in Australia in pre-hospital and emergency care for many years. However, there are few randomized trials and it is not licensed in the US or UK. This month, Coffey et al report the findings of a multicenter placebo-controlled trial of methoyxflurane for pain in ED's in the UK. Readers may ask why a comparison to placebo was necessary and how the results should be interpreted when other active agents exist. In a related commentary, Simon Carley and Richard Body discuss the issues.\nYou are getting sleepy–aren't you? (Editor's choice)\nOral midazolam for sedation of young children needing laceration repairs is unreliable, and has led many of us to IV or IM ketamine. But what about combining oral midazolam and oral ketamine? A double blind randomized trial by Barkan et al found that children given both agents had deeper sedation, and required less IV sedation, than those administered midazolam alone, although VAS scores for the two groups, as assessed by the investigators and parents, were not different. Another arrow in the quiver for pediatric sedation? Perhaps, but be aware that the children receiving both ketamine and midazolam stayed nearly an hour longer in the ED.\nThat CT scan may not be what parents want after all…\nTwo young parents bring their only child into the ED after he fell off a chair and hit his head. They are worried. After examining the child, you consult your head injury guidelines and, using your best bedside manner, make a recommendation to the parents. Have you convinced them? It depends. Seriken et al found that among parents of young children with minor head injuries, those with more education were less reassured at the end of the visit, and mothers were less reassured than fathers. Interestingly, parents whose child had a CT were no more reassured than those that didn't, while neurosurgical consultation had a positive impact. The study was conducted in Turkey, but its findings hit home with me.\nIts not about catching babies\nA review of 66 obstetric cases retrieved by physician-led helicopter teams in Sydney reveals some staggering data on the skills needed for these critical transports. Two thirds of cases involved haemorrhage, followed by eclampsia. Nearly all patients required mechanical ventilation; retrieval physicians intubated in 23 cases and established central lines in 30 patients. The authors conclude that “Exhaustive training in obstetric emergencies may not reflect the learning needs of physicians in services such as ours” and propose a training curriculum.\nIs it time to put mannitol on the bottom shelf? (Reader's choice)\nMannitol has been the go-to osmotic agent for lowering intracranial pressure (ICP) in head trauma for nearly a century, but its primacy is being challenged by hypertonic saline. In a meta-analysis confined only to randomized studies of these agents for traumatic brain injury, Rickard et al found no significant difference in ICP-lowering ability, although the trend favored hypertonic saline. So is it time to shelve the mannitol? Unfortunately, more study is needed.\nHow happy are patients with Emergency Care Practitioners?\nEmergency Care Practitioners (ECP) are nurses and paramedics with advanced training who work in a variety of care settings in the UK. O'Keefe et al report on a postal questionnaire sent to patients seen by either an ECP or more typical provider in these settings, which found that more patients seeing ECP's were highly satisfied than those who saw the usual type of care provider. Although the study is limited by a modest response rate (38%), its findings are consistent with several studies of nurse practitioners and physicians’ assistants in other countries.\nA starting point for ruling out scaphoid fractures\nYou know the drill. A patient has fallen on an outstretched hand, they have snuff box tenderness—and a negative X-ray. Plan: immobilize and repeat X-ray in 10 days. Perhaps. In a prospective study of 154 patients with wrist injuries and negative films, Bergh et al found that they could combine 3 exam findings into a clinical scaphoid score that predicted all 13 scaphoid fractures found on MRI. Caution: The NPV of 96% is hopeful, but will vary with prevalence of fracture. And the rule still needs validation in another population of patients and physicians.\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. |
"The U.S. Food and Drug Administration today approved Eloctate, Antihemophilic Factor (Recombinant), Fc fusion protein, for use in adults and children who have Hemophilia A. Eloctate is the first Hemophilia A treatment designed to require less fre"...\nInform patients of the risks associated with Argatroban Injection as well as the plan for regular monitoring during administration of the drug. Specifically, inform patients to report:\n- the use of any other products known to affect bleeding.\n- any medical history that may increase the risk for bleeding, including a history of severe hypertension; recent lumbar puncture or spinal anesthesia; major surgery, especially involving the brain, spinal cord, or eye; hematologic conditions associated with increased bleeding tendencies such as congenital or acquired bleeding disorders and gastrointestinal lesions such as ulcerations.\n- any bleeding signs or symptoms.\n- the occurrence of any signs or symptoms of allergic reactions (e.g., airway reactions, skin reactions and vasodilation reactions).\nLast reviewed on RxList: 2/21/2017\nThis monograph has been modified to include the generic and brand name in many instances.\nAdditional Argatroban Information\nArgatroban - User Reviews\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. |
Anesthesia services for routine gastrointestinal endoscopic procedures\nThese services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.\nPrior authorization is not required. However, services with specific coverage criteria may be reviewed retrospectively to determine if criteria are being met. Retrospective denial may result if criteria are not met.\nAnesthesia services for routine upper and/or lower gastrointestinal endoscopic procedures are generally covered subject to the indications listed below and per your plan documents.\nIndications that are covered\n- Minimal sedation.\n- Moderate (conscious) sedation during standard upper or lower gastrointestinal (GI) endoscopy is covered as a component of the endoscopic procedure (e.g., therapeutic endoscopy, colonoscopy) when administered to an average-risk patient (i.e., American Society of Anesthesiologists Physical Status Classification System - Class I or II). This does not apply to minimal sedation (anxiolysis), monitored anesthesia (i.e., deep sedation), or general anesthesia. For routine endoscopic procedures and screenings among patients without risk factors or significant medical conditions, moderate sedation is considered a sufficient level of sedation.\n- Other types of anesthesia services including general anesthesia, monitored anesthesia (i.e., deep sedation) and monitored anesthesia care (MAC) may be considered medically necessary during routine upper and/or lower gastrointestinal endoscopic procedures when there is documentation by the operating physician and/or the anesthesiologist of any of the following situations:\n- Patient’s condition requires unusually prolonged or therapeutic endoscopic procedure requiring deep sedation e.g., endoscopic retrograde cholangiopancreatography (ERCP), balloon enteroscopy, foreign body extraction from the upper gastrointestinal tract, percutaneous endoscopic gastrojejunostomy and direct percutaneous jejunostomy, esophageal stenting, endoscopic mucosal resection of the upper gastrointestinal tract, esophageal ablation procedures, endoscopic ultrasound of the upper GI tract or colonic stenting. The combination of an upper endoscopy and colonoscopy is not a prolonged procedure requiring an anesthesia service.; or\n- Documented high risk of intolerance to standard sedatives including but not limited to:\n- patient is on chronic narcotics or benzodiazepines, or\n- patient has a neuropsychiatric disorder, or\n- patient has a history of idiosyncratic reaction to sedatives, or\n- patient has a neurodevelopmental impairment; or\n- Patients less than 18 years of age; or\n- Neurologic, psychological, or developmental disorder necessitating deeper sedation for procedure compliance; or\n- Has failed previous endoscopic procedure using moderate (conscious) sedation; or\n- Increased risk of complications due to a severe comorbidity (American Society of Anesthesiologists [ASA] class III physical status or greater).\nIndications that are not covered\nThe routine assistance of an anesthesiologist or Certified Registered Nurse Anesthetist (CRNA) for patients not meeting the above criteria (#3) who are undergoing standard upper and/or lower gastrointestinal endoscopic procedures is considered not medically necessary and is not covered.\nMonitored anesthesia (deep sedation) and general anesthesia (deep sedation) is not covered for all other indications.\nAmerican Society of Anesthesiologists (ASA) Physical Status Classification System:\nASA Physical Status 1: A normal healthy patient\nASA Physical Status 2: A patient with mild systemic disease\nASA Physical Status 3: A patient with severe systemic disease\nASA Physical Status 4: A patient with severe systemic disease that is a constant threat to life\nASA Physical Status 5: A moribund patient who is not expected to survive without the operation\nMinimal sedation (anxiolysis) is an induced state of altered cognition whereby cognitive function and coordination may be impaired, but airways remain patent (i.e., open/unobstructed) and protective airway reflexes remain intact. The patient is also able to maintain a normal response to verbal commands and physical stimulation. Sedatives that induce minimal sedation include, but are not limited to, benzodiazepines (e.g., diazepam [valium]; lorazepam [ativan]), GABA agonists (zolpidem [Ambien®]; zopiclone [Imovane®] and computer-assisted personalized sedation (SEDASYS®).\nModerate (conscious) sedation is an induced state of sedation characterized by a minimally depressed consciousness such that the patient is able to continuously and independently maintain a patent airway, retain protective reflexes, and remain responsive to verbal commands and physical stimulation. Drugs that induce moderate sedation include, but are not limited to, combination benzodiazepine (e.g., midazolam [Versed®]) and an opioid (e.g., fentanyl) and computer-assisted personalized sedation (SEDASYS®).\nMonitored anesthesia care (MAC) may include varying levels of sedation, anxiolysis, and analgesia. Based on the American Society of Anesthesiologists' (ASA) standard for monitoring, MAC is to be provided by qualified anesthesia personnel who provide or medically direct a number of specific services such as administration of sedatives, analgesics, hypnotics, anesthetic agents or other medications as necessary. Anesthesia care becomes general anesthesia if the patient loses consciousness and the ability to respond purposefully.\nMonitored anesthesia (deep sedation) is an induced state of sedation characterized by depressed consciousness such that spontaneous ventilation may be inadequate. The patient is unable to continuously and independently maintain a patent airway and experiences a partial loss of protective reflexes and ability to respond to verbal commands or physical stimulation. Drugs that induce deep sedation include, but are not limited to, propofol (Diprivan®) or dexmedetomidine (Precedex™).\nGeneral anesthesia is a drug-induced loss of consciousness whereby patients are not arousable even with painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway and ventilation may be required. Cardiovascular function may also be impaired. Drug administration can be either via intravenous injection (IV) or inhalation induction. Commonly used IV agents include etomidate, ketamine, sodium thiopental, and propofol. A commonly-used agent for inhalation induction is sevoflurane.\nIf available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.\nAnesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum\nAnesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum\nCPT Copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.\nThis information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.\n- ASGE Ensuring Safety in the Gastrointestinal Endoscopy Unit Task Force: Calderwood, A. H., Chapman, F. J., Cohen, J., Cohen, L. B., Collins, J., Day, L. W., & Early, D. S. (2014). Guidelines for safety in the gastrointestinal endoscopy unit. Gastrointestinal Endoscopy, 79(3), 363-372. http://doi.org/10.1016/j.gie.2013.12.015\n- Cohen, J. Alternatives and adjuncts to moderate procedural sedation for gastrointestinal endoscopy. In: UpToDate. Saltzman, J. R. & Joshi, G. P. (Eds), UpToDate, Waltham, MA. (Accessed on April 6, 2017.)\n- Cohen, J. Overview of procedural sedation for gastrointestinal endoscopy. In: UpToDate, Saltzman, J. R. & Joshi, G. P. (Eds), UpToDate, Waltham, MA. (Accessed on April 6, 2017.)\n- Cohen, L. B., Delegge, M. H., Aisenberg, J., Brill, J. V., Inadomi, J. M., Kochman, M. L., & Piorkowski Jr., J. D. (2007). AGA institute review of endoscopic sedation. Gastroenterology, 133, 675–701.\n- Standards of Practice Committee: Lichtenstein, D. R., Jagannath, S., Baron, T. H., Anderson, M. A., Banerjee, S., Dominitz, J. A., … Vargo, J. J. (2008). Sedation and anesthesia in GI endoscopy. Gastrointestinal Endoscopy, 68(5), 815-826. doi:10.1016/j.gie.2008.09.029\n- Singh, H., Poluha, W., Cheang, M., Choptain, N., Inegbu, E., Baron, K., Taback, S. P. (2011). Propofol for sedation during colonoscopy. Cochrane Database of Systematic Reviews, 2011(8), 1–63. |
IMPORTANT: Read the application instructions keenly, Never pay for a job interview or application.\nGet a free C.V. review by sending your C.V. to [email protected] or click the following link. Submit C.V.! use the subject heading REVIEW.\nMSF anesthesiologists are teachers and trainers, and are there to help people manage pain in sometimes unbearable circumstances.\nThe role of an MSF anesthesiologists is incredibly varied: you might find yourself training local staff in the middle of a refugee camp hospital or managing anesthesia with very basic resources for complex obstetric surgeries – all in the course of a day.\nOur anesthesiologists often work across various departments; supporting surgery, maternity and going wherever else they are needed.\nAs an anesthesiologists you would be responsible for ordering and managing materials to manage the anesthesia needs of an entire hospital, mentoring and support for local staff learning basic anesthesia, planning and implementing anesthesia management training workshops. You will also support pain management for all departments in the hospital/health centre\n- Master’s degree in anesthesiology\n- Proven experience in anesthetics – experience of Paediatric and obstetric anesthesia is particularly useful\n- Full registration\n- Ability to work with limited resources\n- Availability for a minimum period of six weeks to a maximum of six months\n- Minimum of three months travel or work experience in developing countries\n- Ability to work in unstable environments\n- Adaptable and able to work in a team\n- Flexible and able to manage stress\n- Able to provide training and supervision to others\n- Fluency in English is essential\n- A good command of the French and/or Arabic language is highly valuable\n- Specialization in tropical medicine and/or a sub- specialization or experience in ICU\n- Desirable skill/s: Regional blocks, pain management/palliative care. |
Laser Dentistry An Overview\nDr. Cappy Sinclair and Dr. Mark Reichley are dedicated to improving the patient experience at Coastal Cosmetic & Implant Dentistry in Virginia Beach, as well as the longevity and quality of your results. They have incorporated laser dentistry as part of their general dentistry offerings. Laser dentistry addresses periodontal disease without the pain, side effects and down time associated with traditional treatments and procedures. The Waterlase dental laser enables Dr. Sinclair and Dr. Reichley to treat and repair damaged or diseased gum tissue due to gum disease that may have previously required oral surgery. This innovative system is minimally invasive and replaces the traditional dental drill.\nBenefits of Laser Dentistry\nA dental laser can be used to remove soft tissue, “cutting it away” without the use of a scalpel by vaporizing tissue with light energy. There is no need for anesthesia because the interaction of the water/air spray and the laser beam allows the system to remove soft tissue with pinpoint accuracy. Although the treatment will not be completely pain free, anesthesia will no longer be necessary. The WaterLase dental laser uses 100 pulses per second. This allows Dr. Sinclair or Dr. Reichley to cover more surface area that a typical dental drill. This means that they can complete more dental work in a single visit.\nPatients who experience dental anxiety often enjoy laser dentistry. Laser dentistry is less invasive, virtually painless and requires no sutures. It also eliminates the sounds of a typical dental drill that is sometimes the cause of a patient’s anxiety. The nature of the laser actually promotes healing and stimulates the body’s natural ability to regenerate healthy tissues.\nNot only is the WaterLase dental laser more effective, but it’s also safer. WaterLase uses single-use disposable tips so there is no chance for cross-contamination in the mouth. It can perform highly precise dental services leaving more of the natural tooth structure in tact. That also lowers the chance of future damage and breakage to the tooth.\nThis provides several key benefits for patients including:\n- Less downtime\n- Minimal bleeding\n- Less pain and discomfort, reducing the need for anesthesia\n- Immediate results\n- Avoid the use of stitches\n- Highly precise\n- Minimize the risks of infection |
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