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All elective, or non-emergent, surgeries qualify.\nWe have partnered with the Memorial Hermann Surgery Centers because their charity pricing was the most competitive and their facilities are first-rate. The location of the procedure would also be based on the surgeon’s specific preference and what facility can provide the surgery for the patient.\nIn order to qualify the patient must meet three requirements:\n- Citizenship: The Patient must either be a U.S. citizen with a social security number or be a permanent resident.\n- Proof of Financial Need: The patient must submit a copy of their most recent tax return. If no income is received, then a letter explaining their financial need will suffice. If the patient is on disability, they must sign an affidavit stating that they are not receiving income from other sources.\n- Surgical Need: The surgery must be deemed elective by the insurance provider or the hospital, including referral information and medical records.\nNumerous top surgeons of the greater Houston area have partnered with the Patient Benefit Foundation, and surgeon selection depends on the location of the patient and the type of procedure they are in need of.\nThe surgical fees for the medical facility and the cost of the anesthesia.
Having undesirable fat in numerous areas of your body can have a considerable effect on your health and self-confidence. While traditional weight reduction through exercise and diet plan is a great method to lose weight in general, even the very best exercises can't target issue areas like the belly, inner thighs, arms, and buttocks. Liposuction is a time tested treatment that is used to remove excess fat from particular areas of the body, permitting an individual to shape and contour their body to their taste. Is liposuction right for you? Learn now.\nPros of LiposuctionThere are numerous advantages to this cosmetic treatment, including:\n• Instantly obvious modifications. Unlike conventional weight reduction, liposuction produces modifications that are right away noticeable in the body. Some distinction is obvious immediately, and the preferred results are typically attained in just a couple of days.\n• Proven and safe. This cosmetic procedure has been performed by experienced surgeons all over the world for many years and the method has actually been improved over and again to be safe and reliable.\n• Recovery time is generally fast. The downtime required after having this type of procedure is normally 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 frequently return to work far more quickly than they expected and can return to living a healthy, active way of life.\n• Weight loss can be irreversible. With the best upkeep techniques, the fat that was gotten rid of during the liposuction procedure will not return.\n• Complete control over your body. With liposuction, an individual can have complete control over how they wish to look, beyond exactly what conventional diet and workout can supply. Providing individuals this power over their bodies enhances self-confidence and assistance people feel their best.\nWhile there countless advantages to liposuction, there are of course a few cautions that need to be taken into consideration prior to making the decision to move forward with the treatment.\nCons of Liposuction\nBefore having liposuction done, it is necessary to analyze the possible disadvantages of the treatment and identify if the advantages outweigh the risks in your specific case. Your specialist can help you learn more about the dangers associated with 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 performed under basic anesthesia, the procedure carries the exact same threats as any other kind of surgical treatment where general anesthesia is utilized. Hidden medical conditions may enhance these risks.\n• Unfavorable responses. Bruising, bleeding, and pain are all to be anticipated, nevertheless, in rare cases can trigger more considerable issues.\n• The potential to get the weight back. After having liposuction done, it is vital to preserve a healthy diet and exercise appropriately as recommended by your doctor. Failure to do so could result in gaining back the weight that was lost or potentially much more.\nThere are risks associated with liposuction, for many people, the benefits far outweigh them. Inform yourself about the treatment by having thorough conversations with your cosmetic surgeon and think about how liposuction has the potential to affect you as a distinct person. Just you and your cosmetic surgeon can figure out if liposuction will provide you with the results you are looking for within your expectations.\nLaser Liposuction procedure is a new non invasive procedure to loose unwanted bodyfat in Fountain Green UT\nLaser liposuction is a more recent, minimally invasive treatment that involves heating the fat cells to melting point and eliminating the melted fat through a small cannula. The procedure is typically done right in your doctor's workplace and is an exceptional alternative 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 procedure to weight loss in order to shape the body you've always wanted.\nContact a Specialist in your Fountain Green UT today.\nIf you're considering liposuction as a weight loss option, it is essential that you discuss your desires with a qualified cosmetic surgeon in your location. Your specialist will perform a complete exam and health history questionnaire to identify if liposuction can benefit you and assist you reach your physical and emotional objectives. Call today for an examination and learn more about how liposuction can assist you accomplish the body of your dreams.
Treatments are conducted using a topical anesthetic and the procedure often takes less than 30 minutes to complete. Hall about a couple of different treatment options. This non-surgical approach through injection of the botulinum A toxin is FDA-approved with age-defying results lasting 3 to 4 months in most patients. No guarantees or warranties are made regarding any of the information contained herein. There are lots of ways to reduce the appearance of fine lines and wrinkles or to delay them in the first place. There are also deeper peels that require general anesthesia in a surgical center. There are different treatment options available for this condition and the most common ones are listed below:\nLinea Cosmetic Surgery\nComplete heeling can take several weeks. How long does the treatment take? Botox works to smooth out wrinkles caused by repetitive muscles contractions that happen when you make facial expressions. During a lower blepharoplasty, your surgeon removes excess fat and muscle, along with sagging skin, for a smoother and more tightened appearance. This gel is almost identical to the hyaluronic acid substance found naturally in humans. There are also deeper peels that require general anesthesia in a surgical center.\nCrow's Feet around your eyes? Want solutions? Contact The Wise Center for Plastic Surgery\nNot only is every pair of eyes different, but so is how each set complements a face, as well as what specific signs of aging those eyes are actually showing over time. What is a Facial Plastic Surgeon? Home About Us Meet Dr. Are you ready to take the first step? Unfortunately, this technique will not reduce orbital muscle tension. Short of genetic manipulation and turning back the clock of aging, Dr.\nIndividual results may vary. Distinguishing between these two common eye issues is the first thing we must address with new patients. When it comes to plastic surgery, timing is important, especially for an Read on for our definitive guide to getting younger-looking eyes. This substance is injected through the skin into or close to the muscle. Ablative laser resurfacing is a procedure that removes the upper layers of skin, revealing newer, younger looking skin. Please be aware that results and benefits may vary from patient to patient taking into consideration factors such as age, lifestyle and medical history.
Multiple Exposures to Anesthesia May Increase Chance of ADHD\nMultiple exposures to anesthesia at a young age are associated with higher rates of attention deficit hyperactivity disorder (ADHD), according to researchers at the Mayo Clinic.\nChildren exposed to two or more anesthetics before age 3 had more than double the incidence of ADHD than children who had no exposure, says David Warner, M.D., a Mayo Clinic pediatric anesthesiologist and investigator on the observational study.\nThe researchers’ interest was piqued when studies began to suggest anesthesia used in surgery causes changes in the brains of young animals, Warner says.\n“We were skeptical that the findings in animals would correlate with kids, but it appears that it does,” he notes.\nThe new study examined results of an existing epidemiological study that looked at the educational records of children born between 1976 and 1982 in Rochester, Minn., and determined those who developed some form of learning disability or ADHD.\nAmong 341 cases of ADHD in those younger than 19, researchers traced medical records in the Rochester Epidemiology Project, a decades-long database of all patient care in Olmsted County, Minn., looking for exposure to anesthesia and surgery before age 3.\nWhat they found is that children who had no exposure to anesthesia and surgery had ADHD at a rate of 7.3 percent. The rate after a single exposure to anesthesia and surgery was approximately the same.\nBut for children who had two or more exposures to anesthesia and surgery, the rate of ADHD was 17.9 percent — even after researchers adjusted for other factors, including gestational age, sex, birth weight, and other health conditions.\nThe results of the study, however, do not mean that anesthesia causes attention deficit disorder, Warner says.\n“This is an observational study,” he says. “A wide range of other factors might be responsible for the higher frequency of ADHD in children with multiple exposures. The findings certainly do suggest that further investigation into this area is warranted, and investigators at Mayo Clinic and elsewhere are actively pursuing these studies.”\nSource: Mayo Clinic\nWood, J. (2015). Multiple Exposures to Anesthesia May Increase Chance of ADHD. Psych Central. Retrieved on May 1, 2016, from http://psychcentral.com/news/2012/02/03/multiple-exposures-to-anesthesia-may-increase-chance-of-adhd/34415.html
Physical exams are an imperative part of evaluating the health of your cat. We recognize the necessity of checking your cat nose to tail to ensure health problems are not overlooked.\nMicro-chipping is an implant placed under your cat's skin. A microchip is not a GPS tracking device. Instead, the chip can be scanned by a veterinarian or shelter if your cat ever becomes lost. We utilize HomeAgain Microchips.\nWe receive many inquiries regarding dental cleanings. It is not an unusual practice in the veterinary profession to anesthetize a cat to clean their teeth. We find this treatment rather extreme as our goal is to avoid anesthesia, especially when there are other options for maintaining your cat's oral health that is not as invasive or expensive.\nAt New England Cat Care, we utilize antibiotics therapy and Bartonella evaluations to diagnose and manage your cat's dental needs efficently. Surgery should only be considered in the event of a severe autoimmune disorder known as Stomatitis, if your has developed a "cavity" (referred to as FORL), or if your cat has broken a tooth.\nCommon techniques used to maintain your cat's dental health are: Bartonella testing, in-office calculus removal and antibiotics for gingivitis.\nKittens are the best! We know how important your newest family member is, and we want to help ensure your kitten is well cared for by providing you with the knowledge of how to care for your growing cat.\nVaccines generally begin at 8 weeks and are boosted at 12 weeks & 16 weeks.\nStandard deworming begins at 8 weeks.\nFecal screening performed at every kitten visit.\nSpay/Neuter performed at 6 months.\nVaccinations protect your cat from incurable, sometimes deadly, disease. New England Cat Care's duty is to educate you on the importance of properly vaccinating your cat. We design unique vaccine protocols based on your cat's risk factors. While we understand that some people are nervous about vaccines, we want to assure you that our protocols incorporate specific needs about your cat, we do not provide general vaccine recommendations. We understand that while vaccines are safe, they can create problems when misused.\nVaccines we recommend based on your cat's individual needs: Rabies, Distemper (FVRCP), Feline Bordetella, Leukemia\nInternal medicine is the foundation of New England Cat Care. We are at the forefront of managing disease in cats. Commonly, new clients contact us for a second opinion when their cat has developed a chronic illness. We practice on scientific principles for managing disease and work to discover ways through diet and medication to control chronic illness.\nWe provide diagnostic evaluations to complement our internal medicine care:\nUrinalysis, Blood work, X-rays, Ultrasound, Cardiac care and Blood pressure\nAt New England Cat Care, no surgery is considered "routine." We understand the risks involved with anesthesia, so to ensure your cat has a positive experience, we adhere to strict protocols our doctors have developed from their schooling & experience.\nSurgeries available but not limited to:\nLump Removal, Spay, Neuter, Wound Care and Urinary Obstruction\nWe cannot stress this enough - Age is not a disease! We are dedicated to your cat, no matter how old they are, and you will never hear our team brush over a medical issue just because your cat is older.\nOver the years, we have become the premier veterinarian to go to when your cat is in their golden years. The care for an older cat can be daunting and may require daily medication to help control disease, but we are here to provide your cat anything from disease management to palliative care.\nI'm a paragraph. Click here to add your own text and edit me. It's easy.
For over 30 years, we have been committed to creating near perfect legs by eliminating the sources of the varicose veins and spider veins. Our patented Veno-Merse® Technique, (3 U.S. patents, two patents from China), is designed to get to the source of the spider veins and varicose veins, to eliminate the leaks and the feeding vein that are responsible for them.\nLaser vein treatment will be an adjunct at the end of the treatment to complete the treatment. This method gives our patients more than 99% effectiveness after their treatments are finished.\nThe entire course of treatment is performed at the office with no major anesthesia and no disability or lengthy recovery times. Patients can fly back to their home country the same day.\nThere is a medical reason for the treatment of the varicose veins and also a significant cosmetic reason for their treatment. Treatment of the larger varicose veins are medical necessary to stop cramps, swelling and pain while the treatment of the smaller veins and spiders are cosmetically important to most patients.\nWhether you have developed spider veins from pregnancy, or you are suffering from varicose veins due to your age, weight or heredity, varicose vein therapy will improve your symptoms of pain and swelling and night cramps.\nMore than 50 million Americans suffer from varicose veins. Varicose veins cause a great majority of the spiders veins. In order to eliminate most of these spider veins, we have to eliminate BOTH the leaks and the feeding varicose veins responsible for the spider veins. Old techniques of varicose veins surgery (old fashioned stripping) may help patients with temporary relief from the feeling of heaviness and cramping in their legs but a majority of these patients will have a recurrence of their veins and spiders within a short time.\nPatients are often afraid to seek treatment, because they don’t want to deal with harsh procedures that leave them incapacitated for weeks and with permanent scars in their legs. Near perfect legs, mean a scar free leg with NO VARICOSE VEINS AND SPIDERS VEINS.\nWhen patients are seen for the treatment of their varicose veins and spider veins, they need to be thoroughly educated on what varicose veins and spider vein therapy entails. Learning about the causes of varicose veins and spider veins allows patients to evaluate all the available techniques for the treatment of their varicose veins and the spider veins. Since no major anesthesia is involved with our approach, patients will feel completely normal soon after the procedure. You will also learn the drawbacks and possible complications of Laser Closure techniques (EVLT) as well as VENUS closure.\nApproximately 40% of the patient we treat have had laser closure treatment (EVLT) or VNUS closure or old stripping before and yet the legs are covered with varicose veins and many spider veins. This is usually due to a missed secondary system in the thigh and or reopened leaks and veins in the upper thigh which were treated or a missed leak behind the knee or veins arising from pelvis(due to pregnancy). All sources have to be identified and closed to achieve an excellent outcome. End result in these group of patients will be a near perfect leg at the end, as well.\nCorrecting ALL of the responsible leaks and feeding varicose veins with the Veno-Merse® Technique and Sclerotherapy and lasers at the end, results in a thinner and smoother leg in a great number of our patients. This is due to a loss of swelling (edema) from years of varicose veins and fluid leakage from these veins. VENUS CLOSURE and LASER CLOSURE (EVLT) may not accomplish all these aspects.
Get News & Updates Directly To Your Inbox\nDownload the BCBSOK App. Your coverage information in the palm of your hand.\nFind A Doctor Or Hospital In Your Network.\nThis article is intended for PPO members enrolled in an employer health insurance plan.\nIf you need specialist care or medical services outside of those provided by your regular doctor, like lab work, X-rays or anesthesia, don’t hesitate to ask your doctor whether those services and providers are within your BCBSOK PPO network.\nBlue Cross and Blue Shield of Oklahoma PPO members should know that if an out-of-network health care provider bills more than the approved charge for covered services, you are responsible for the difference.\nThink about this scenario: Your physician has advised surgery for you. You’ve made certain that the surgeon is in your network, but have you checked the network status of your anesthesiologist?\nEven if your doctor or surgeon is in network, medical specialists who provide X-rays, lab tests or anesthesia services may not be a part of your provider network.\nWhen PPO members use health care providers that are out of their network, they are subject to balance billing. Balance billing means you pay the amount that is more than the allowable charges negotiated with in-network health care providers.\nThis applies any time you get services outside your provider network, including emergency services or referral services.\nMembers who get care from health care providers in their network will have lower out-of-pocket costs.\nAlways check to see if your specialist is in your network. You can use the online Provider Finder® tool or call the customer service number on your member ID card.\nIf your PPO coverage is through your self-funded employer’s plan, please check your summary plan description for details about how out-of-network services affect your benefits.\nYou can use the online Provider Finder® tool to look for network providers in your area.\nBlue Cross and Blue Shield of Oklahoma, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association\n© Copyright 2022 Health Care Service Corporation. All Rights Reserved.\nTelligent is an operating division of Verint Americas, Inc., an independent company that provides and hosts an online community platform for blogging and access to social media for Blue Cross and Blue Shield of Oklahoma.\nFile is in portable document format (PDF). To view this file, you may need to install a PDF reader program. Most PDF readers are a free download. One option is Adobe® Reader® which has a built-in screen reader. Other Adobe accessibility tools and information can be downloaded at https://access.adobe.com.\nPowered by Telligent
Having unwanted fat in various locations of your body can have a considerable effect on your health and self-confidence. While traditional weight-loss through workout and diet plan is a terrific way to lose weight in general, even the best exercises cannot target issue locations like the stomach, inner thighs, arms, and butts. Liposuction is a time checked treatment that is used to remove excess fat from specific locations of the body, permitting an individual to form and contour their body to their taste. Is liposuction right for you? Learn now.\nPros of Liposuction\nThere are lots of benefits to this cosmetic procedure, consisting of:\n• Right away obvious changes. Unlike standard weight-loss, liposuction produces changes that are immediately noticeable in the body. Some distinction is obvious right away, and the desired outcomes are normally attained in just a few days.\n• Proven and safe. This cosmetic procedure has been performed by skilled cosmetic surgeons all over the world for many years and the strategy has actually been improved over and once again to be safe and reliable.\n• Recovery time is normally fast. The downtime needed after having this kind of procedure is typically much less than what is required for other types of cosmetic procedures, including tummy tucks, breast reduction, and more. Individuals who have had the procedure can frequently return to work a lot more rapidly than they expected and can get back to living a healthy, active way of life.\n• Weight-loss can be permanent. With the right maintenance methods, the fat that was eliminated during the liposuction treatment will not return.\n• Complete control over your body. With liposuction, an individual can have complete control over how they wish to look, beyond what traditional diet and exercise can offer. Offering individuals this power over their bodies increases self-confidence and aid people feel their best.\nWhile there countless advantages to liposuction, there are naturally a couple of cautions that should be considered prior to making the decision to move forward with the procedure.\nCons of Liposuction\nBefore having actually liposuction done, it's important to analyze the prospective downsides of the procedure and determine if the benefits outweigh the dangers in your particular case. Your surgeon can help you find out more about the dangers connected with the procedure and can help you decide if moving on is the ideal thing for you.\n• Issues with basic anesthesia. Because liposuction is performed under basic anesthesia, the treatment brings the exact same threats as any other kind of surgery where general anesthesia is utilized. Hidden medical conditions might enhance these dangers.\n• Unfavorable responses. Bruising, bleeding, and pain are all to be expected, nevertheless, in uncommon cases can trigger more significant complications.\n• The prospective to gain the weight back. After having actually liposuction done, it is vital to keep a healthy diet and exercise properly as advised by your physician. Failure to do so could lead to acquiring back the weight that was lost or perhaps a lot more.\nAlthough there are dangers associated with liposuction, for many people, the advantages far outweigh them. Educate yourself about the treatment by having thorough discussions with your cosmetic surgeon and consider how liposuction has the possible to affect you as an unique individual. Only you and your specialist can determine if liposuction will provide you with the results you are looking for within your expectations.\nLaser Liposuction procedure is a new non invasive procedure to loose unwanted bodyfat in Kensal ND\nLaser liposuction is a newer, minimally intrusive treatment that involves heating the fat cells to melting point and removing the melted fat through a small cannula. The procedure is normally done right in your physician's office and is an outstanding choice 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've constantly wanted.\nContact a Specialist in your Kensal ND today.\nIf you're considering liposuction as a weight reduction solution, it's important that you discuss your desires with a qualified cosmetic surgeon in your area. Your cosmetic surgeon will perform a total examination and health history survey to identify if liposuction can benefit you and assist you reach your physical and psychological objectives. Call today for a consultation and learn more about how liposuction can help you achieve the body of your dreams.
The Department of Anesthesiology is staffed with globally trained, highly qualified and well experienced anesthesiologists having expertise in various fields of anesthesia, including Regional Anesthesia & Ultrasound-Guided Nerve blocks, Obstetric, Paediatric Anesthesia, Acute & Chronic Pain Management, Sleep Apnea & Bariatric Surgery and Intensive Care.\nThe aim & priority of the department of anesthesiology is the safety of patients, the standard of care, professionalism and the quality of anesthesia, by following world standard guidelines and protocols as well as their implementation in practice towards the care of our patients.\nIn the Pre-anesthesia Clinic, patients coming prior to surgery are seen, examined for fitness for anesthesia and if necessary, are referred to concerned physicians for further optimization, investigation and treatment.\nThe anesthesiologists are available round the clock for Epidural Pain Relief services during labour for childbirth if required, and to cover emergencies and cardiopulmonary resuscitation.\nOur expert anesthesiologists provide Ultrasound-Guided Nerve blocks for pain relief during and after surgery with adequate patients’ satisfaction, especially in orthopedics & plastic surgery.\nIn the Pain Management Clinic, patients with chronic pain conditions are seen, reviewed, investigated and treated with medication, interventional pain management techniques, electro analgesia & physiotherapy, as referred by our clinics for outpatients.\nOur Anesthetists provide anesthesia & sedation to hospital remote area patients, including CT scan, MRI & endoscopic procedures.\nOur Intensive Care Unit is also equipped with state of the art equipment and managed by a highly qualified staff to look after our patients who need high dependency or intensive care therapy.\nOur dedicated team of Anesthetists come from various parts of the world including Egypt, Iraq, Syria, Palestine, UK, Ireland, Canada, Germany, India, Pakistan & Uzbekistan. They can speak different languages and communicate well with patients of various nationalities.\nThe hospital has 7 operating theatres which are used for an extensive range of surgeries. The theatres are well equipped and staffed by highly experienced theatre nurses and technical support staff.\nThe anesthetic apparatus used are modern & updated versions including monitoring devices that match the best in western hospital care.\nMaintenance standards are consistently high and extensive checks are continually carried out to ensure quality control. Sterility is monitored regularly by the Department of Microbiology.\nAll theatre staff receive regular medical check-ups for early detection of any signs of infection. A modern Central Sterile Supplies Department provides the theatres with sterile equipment & instruments.\nFollowing surgery, patients are taken to the recovery area where a careful watch is kept on vital parameters by well trained & experienced staff prior to their return to the ward.\nA strict protocol is maintained throughout the entire area.\nThe Department of Anesthesiology provides services including:\n- Pre-anesthesia Assessment Clinic\n- Acute Pain Management with and without modern techniques of regional anesthesia (ultrasound- guided nerve blocks)\n- Chronic Pain Management Clinic\n- Epidural Analgesia for labour pain during childbirth\n- Intensive Care & Cater Anesthesia to all surgical subspecialties
• Memory and temporal-lobe function . The relative roles of novelty/familiarity versus verbal/nonverbal stimuli in learning and retention are not well known. In these experiments, we aim to disentangle these different factors by investigating the neuronal substrate in patients with left or right medial temporal-lobe dysfunction and in healthy individuals using fMRI and behavioral measurements.\n• Attention . In this project, we are teasing out the critical variables in a pair of matched verbal versus visuospatial attention tasks and determining the extent to which these are sensitive to lateralized temporal-lobe dysfunction.\n• Intracarotid anesthetic procedures (IAPs) . The intracarotid amobarbital procedure is an important part of a comprehensive investigation of patients who are candidates for surgical treatment of epilepsy. Owing to frequent and lengthy shortages of sodium amobarbital, we have initiated the use of a different anesthetic agent (etomidate), and with it we introduced a significant change in the procedure, such that now the time constraints are essentially abolished. We are also working towards development of a reliable fMRI protocol that will yield information currently sought in the IAP memory test.\n• Neuropsychological tests . Part of our work relates to development of or improvement of clinical neuropsychological tests. In our specialized setting, patients are usually tested more than once, such as before and after surgery, or at two or more intervals when a deterioration is suspected. In addition, a large proportion of our patients are francophone (and the others, anglophone). Therefore we develop our tests in equivalent alternate forms, to be used in retesting, and in both languages. Examples of our newer work include our test for subtle parietal-lobe dysfunction using haptic search, in collaboration with Viviane Sziklas and Marta Maximov, our test of right-hemisphere visuoperceptual functioning, and a test of social perception that we expect to be sensitive to frontal-lobe dysfunction.
One of the goals of sleep dentistry is to relieve your nervousness about an upcoming dental procedure. Seeking the professional opinion of your dentist will give you more information about sleep dentistry. Knowing more can help prepare you for your much-needed procedure. If you want to know when to talk to your dentist about sleep…\nWhat Everybody Ought To Know About Dental Sedation\nDental sedation might be just what you need to help you overcome the fear of going to the dentist's office. The mere thought of going to the dentist sends shivers through many people's spines, so you are not alone if you find yourself neglecting your oral health care because you are afraid of what will happen when you get to the clinic.\nSome people are afraid of having a painful experience, many are worried about what the dentist might find, while others are anxious about what their total bill will look like.\nIf you find yourself regularly putting off appointments because of your anxiety, talk to your dentist about what your options are. You might be a good candidate for dental sedation. This can help to keep you calm before and during your appointment.\nWho needs dental sedation?\nVisiting the dentist is a terrifying experience for people with dental phobia or anxiety. It is frightening enough to make these people avoid going to the dentist even if it means leaving oral health issues they are dealing with and not seeking treatment.\nThere are many things in a dentist's office that can be frightening. For one, it is easy to feel like you are not in control when you are in a dental chair as the dentist prods your mouth. Some of the equipment the dentist uses on your teeth can also be quite intimidating. If you find yourself on the verge of a breakdown before you even make it to the waiting room, you certainly need to consider dental sedation. There is a wide range of sedatives available that will keep you calm during your visits to the dentist.\nThere are a variety of techniques that dentists use to keep their patients relaxed. Your personal sedation plan will depend on the level of your anxiety. At times oral sedatives might be necessary for you to take 30 minutes before your appointment. Your dentist might also decide to use nitrous oxide (commonly known as laughing gas) to keep you relaxed during your treatment. There are also other dental sedatives that can be intravenously delivered to you.\nThese medicines will keep you relaxed during your appointment, leading to a more pleasant experience.\nAre dental sedatives just like anesthetics?\nAbsolutely not. Dental sedatives are simply drugs that help to keep you relaxed and calm during your treatment. A dentist only uses sedatives when the patient's dental anxiety is a serious issue that often has a significant impact on the afflicted person's oral health. People with dental anxiety can go even decades without seeing a dentist due to this issue. This can have significant effects on a person's oral health.\nAnesthetics, on the other hand, are drugs that help to numb parts of your body so that you can receive treatments. It is not uncommon for dentists to combine anesthesia with sedatives for certain treatments when working with an anxious patient.\nThink dental sedation might be what you need to overcome your fear of dentists?\nRequest a dental appointment here: https://pier210dental.com or call Pier 210 Dental Group at (530) 982-4077 for an appointment in our Auburn dental office.\nHave you been thinking about doing sedation dentistry for your next visit to the dentist’s office? If you have never used these methods before, you likely have a lot of questions. People often wonder whether sedation carries risks or could pose problems during or after the procedure. It is good to be aware of how…\nIf you are not sleeping well, a sleep dentist may be able to provide some relief. You should not have to endure long, sleepless nights, and your partner should not have to toss and turn either. A dentist specializing in helping with sleep disorders can prescribe effective treatments if snoring or sleep apnea is interrupting…\nMany dentists recommend dental sedation to patients who may have anxiety centered around a dental procedure or for a procedure that potentially causes discomfort.Of course, there are certain procedures that require sedation, such as oral surgery. However, there other times where it might also be helpful for the patient.The most obvious time dental sedation is…
A Mayo Clinic study finds no evidence that children given anesthesia before their third birthdays have lower IQs than those who did not have it. A more complex picture emerges among people who had anesthesia several times as small children: Although their intelligence is comparable, they score modestly lower on tests measuring fine motor skills, and their parents are more likely to report behavioral and learning problems. The findings are published in Anesthesiology.\nThe U.S. Food and Drug Administration warned in 2016 that prolonged or repeated sedation before age 3 may affect brain development. The warning was based largely on data from animals, which may or may not apply to children.\nMayo researchers studied 997 people born from 1994 through 2007 in Olmsted County, Minnesota, the home of Mayo Clinic's Rochester campus. They were grouped according to the anesthesia exposures they had before their third birthdays: 206 had two or more; 380 had one; and 411 had none. Ear, nose and throat procedures were the most common surgeries.\nThe researchers used the Rochester Epidemiology Project medical records database, brain function testing at ages 8-12 or 15-20, and parent reports to assess behavior and brain function. Beyond their anesthesia exposure, the three groups of patients were matched to be as similar as possible.\nIntelligence, memory, and several other measures of brain function were similar among the groups.\nHowever, those with multiple exposures to anesthesia had modest declines in fine motor skills, such as the ability to draw figures with a pencil, and how quickly they processed information when reading. Their parents reported more learning and behavioral problems, such as difficulty reading; behaviors consistent with attention deficit hyperactivity disorder; breaking rules; or displaying aggression, anxiety or social withdrawal.\nParents whose children had anesthesia once under age 3 reported more problems with mental skills known as executive functions - skills that help with memory, impulse control, planning and flexibility - but not with other behaviors.\n"For the majority of kids undergoing surgery, the results overall are reassuring," says lead author David Warner, M.D., a pediatric anesthesiologist at Mayo Clinic Children's Center. "About 80 percent of kids who need surgery under age 3 only need one, and it's relatively brief."\nSeveral other studies also show little evidence that a single anesthetic is associated with significant harm.\n"Although we do have some concerns about the children who are receiving multiple anesthetics, it's important to note that our results don't allow us to conclude that anesthesia itself is causing problems," Dr. Warner says, adding that other factors, such as the conditions that make surgery necessary, could contribute. "However, the fact that we found some problems in some of these children means that research in this area needs to continue, including further analysis of our data."\nIn the meantime, in most cases the benefit of surgery outweighs any risk, Dr. Warner says. However, the potential for problems may need to be part of the decision-making process when parents and surgeons discuss surgery, he adds.
The following clinical scenario highlights the importance of front-of-neck access (FONA) in perioperative anesthesia patient care:\nA patient presented to the emergency department with significant stridor secondary to a neck mass extending just below his mandible. His past medical history included atrial fibrillation for which he was taking coumadin. Imaging demonstrated that the mass was a neck hematoma secondary to an overdose of coumadin with an INR >6. Due to a high risk of excessive bleeding that resulted in a difficult tracheotomy and severe hypoxemia, the patient underwent an awake flexible bronchoscopic intubation. A double set-up with a FONA was prepared and the neck landmarks for localization of the cricothyroid membrane (CTM) were identified using both palpation and ultrasonography. However, during the bronchoscopic intubation attempt, the patient experienced complete airway obstruction and oxygen desaturation. Without delay, the anesthesia practitioner performed an emergency FONA by accessing the trachea through the CTM using a size 10 scalpel blade, inserting a bougie, followed by a size 6.0 internal diameter endotracheal tube (ETT). Successful cricothyrotomy was confirmed with positive end-tidal CO2, bilateral chest rises, and improved oxygen saturation to 96%. The patient was then transferred to the intensive care unit.\nWhat Anatomy Do I Have to Know to Perform a Front-of-Neck Access?\nAccess to the airway through the CTM requires a practical knowledge of the anatomy of the larynx, particularly the surface landmarks, and the important adjacent structures in the neck (also see Chapter 3).\nIn most adult males, the thyroid notch (“Adam’s apple”) is a prominent feature, which identifies the superior aspect of the thyroid cartilage. With the neck extended, palpation inferiorly from this point will often allow the practitioner to identify the inferior margin of the thyroid cartilage and the ringed-shaped cricoid cartilage below (Figure 14.1).\nAnatomy of the larynx and trachea: (A) the thyroid cartilage; (B) the cricothyroid membrane; and (C) the cricoid cartilage.\nBetween the inferior margin of the thyroid and cricoid cartilage is the CTM. The size of the membrane in adults is 22 to 33 mm wide and 9 to 10 mm high.1 Should landmarks be difficult to palpate, the level of the CTM can be estimated by the finger stacking technique (or four-finger technique)2: with the head and neck in neutral position, the fifth finger is placed in the suprasternal notch; with all fingers in juxtaposition, the location of the index finger will approximate the level of the CTM. In addition, skin creases (“Launcelott Creases”) in the anterior neck may also represent a useful visual landmark for estimating the level of the CTM. The study conducted at our institution demonstrated that with the head in the neutral position, in patients ...
Welcome to our new website and new dental blog. We couldn’t be happier that you are partnering with us on your journey toward a better smile. Part of that journey is taken in this regular dental blog. Here you will find helpful, insightful, and inspiring articles to help you live a life that can improve your dental health and smile. The other part of that journey is what we can do for you outside of the pages of this blog. Take a look at what you can receive as a patient of Dr. Rod Gleave.\nOur Dental Office\nGoing to the dental office should be something that you look forward to – at least, that is how we feel. With that in mind, we have set up our office to be warm, comfortable, and inviting for all of our patients. We offer complimentary water and Wi-Fi, along with overhead TVs and warm blankets. We also have magazines and books available if TV is not your cup of tea. For those patients who need more than just a few creature comforts to help them feel at ease, we also offer three forms of dental sedation to help calm your nerves. We have nitrous oxide and oral (pill) sedation, and we can arrange IV sedation (wonderful for oral surgery and dental implant procedures) for you as well. All of this is in an effort to make you comfortable so that you’ll look forward to your trips to the dentist and can get the care you need.\nOur Dental Services\nWe offer a comprehensive line of cosmetic and restorative dental services to benefit your smile. For those who need their mouths rebuilt, we can offer dental implants to replace severely damaged or missing teeth. You will not find a longer-lasting or more effective tooth replacement option than implants. We also repair teeth using dental fillings and root canal treatment. For your cosmetic needs, we offer dental veneers to hide chips and cracks, dental whitening to remove stains, and gum reshaping to give you the smile you have been looking for.\nCall our Salt Lake City, UT office today at (801) 262-0744 or use our online form to schedule your appointmentinstead.
Gastrotomy in Dogs\nA gastrotomy is a surgical incision created in the wall of the stomach that allows the surgeon to examine the inside of the stomach. While abdominal x-rays, ultrasound examination and endoscopy are less invasive methods of examination, gastrotomy has an important role in treatment of gastrointestinal problems.\nWhat Are the Indications for Performing a Gastrotomy?\nGastrotomy is most often indicated for treatment of stomach problems including removal of foreign objects and stomach tumors. This procedure can also be done to obtain a biopsy sample of the stomach, repair abnormalities in the outflow of ingested material due to a narrowed sphincter, or repair a rupture, ulcer or severe trauma to the stomach.\nWhat Preoperative Examinations or Tests Are Needed?\nPreoperative tests depend in part on the age and general health of the animal as well as the cause for the gastrotomy. Radiographs (x-rays) or abdominal ultrasound typically is done to diagnose the underlying illness prior to surgery. Often a complete blood count, serum biochemical test, a urinalysis, and possibly an EKG will be performed prior to surgery.\nWhat Type of Anesthesia is Needed?\nThis is a surgical procedure that involves opening the abdominal cavity. General anesthesia is needed to induce unconsciousness, complete control of pain, and muscle relaxation. In the usual case, the pet will receive a pre-anesthetic sedative-analgesic drug to help him relax, a brief intravenous anesthetic to allow placement of a breathing tube in the windpipe, and subsequently inhalation (gas) anesthesia in oxygen during the actual surgery.\nHow Is a Gastrotomy Done?\nFollowing anesthesia, the pet is placed on his back lying on the surgical table. The hair is clipped over the upper abdomen, the skin is scrubbed with surgical soap to disinfect the area and a sterile drape is placed over the surgical site. The incision is similar to a spay incision (midline). Your veterinarian uses a scalpel to incise the skin of the upper abdomen and to open the abdominal cavity. The stomach is isolated with sterile sponges and an incision is made. Any food or liquid is removed from the stomach to prevent abdominal contamination. The operation then continues; for example, the surgeon may remove a foreign object, a tumor, repair a rupture or take a biopsy sample. At the conclusion of the procedure, sutures (stitches) that dissolve over time are placed to close the incision in the stomach. The abdominal incision is then closed with one or two layers of self-dissolving sutures (stitches). The outer layer of skin is closed with sutures or surgical staples; these need to be removed in about 10 to 14 days.\nHow Long Does the Gastrotomy Take to Perform?\nThe procedure takes about 45 minutes to 1-1/4 hours to perform in most cases, including the needed time for preparation and anesthesia.\nWhat Are the Risks and Complications?\nThe overall risk of this surgery is low. The major risks are those of general anesthesia, bleeding (hemorrhage), postoperative infection and wound breakdown (dehiscence) over the incision. Other complications maybe be dependent on underlying cause of the surgery as well as other concurrent diseases. Overall complication rate is low, but serious complications can result in death or the need for additional surgery.\nWhat Is the Typical Postoperative Care?\nPost-operative medication should be given to relieve pain, which is judged in most cases to be mild to moderate and can be eliminated with safe and effective pain medicines. Home care requires reduced activity until the stitches are removed in 10 to 14 days. You should inspect the suture line daily for signs of redness, discharge, swelling or pain and monitor your pet's eating habits. For the first several days, a bland diet should be fed. The diet can then be slowly returned to normal. Signs of poor appetite, vomiting and obvious pain should prompt a call to your veterinarian.\nHow Long Is the Hospital Stay?\nThe typical stay following a gastrotomy is two to three days but will vary depending on the overall health of the pet and the underlying reason for the surgery.
Objective—To quantitate the dose and time-related\neffects of morphine sulfate on the anesthetic sparing\neffect of xylazine hydrochloride in halothane-anesthetized\nhorses and determine the associated plasma\nxylazine and morphine concentration-time profiles.\nAnimals—6 healthy adult horses.\nProcedure—Horses were anesthetized 3 times to\ndetermine the minimum alveolar concentration (MAC)\nof halothane in O2 and characterize the anesthetic\nsparing effect (ie, decrease in MAC of halothane) by\nxylazine (0.5 mg/kg, IV) administration followed\nimmediately by IV administration of saline\n(0.9% NaCl) solution, low-dose morphine (0.1 mg/kg),\nor high-dose morphine (0.2 mg/kg). Selected parameters\nof cardiopulmonary function were also determined\nover time to verify consistency of conditions.\nResults—Mean (± SEM) MAC of halothane was\n1.05 ± 0.02% and was decreased by 20.1 ± 6.6% at\n49 ± 2 minutes following xylazine administration. The\namount of MAC reduction in response to xylazine was\ntime dependent. Addition of morphine to xylazine\nadministration did not contribute further to the\nxylazine-induced decrease in MAC (reductions of\n21.9 ± 1.2 and 20.7 ± 1.5% at 43 ± 4 and 40 ± 4 minutes\nfollowing xylazine-morphine treatments for low-and\nhigh-dose morphine, respectively). Overall, cardiovascular\nand respiratory values varied little among\ntreatments. Kinetic parameters describing plasma\nconcentration-time curves for xylazine were not\naltered by the concurrent administration of morphine.\nConclusions and Clinical Relevance—Administration\nof xylazine decreases the anesthetic requirement\nfor halothane in horses. Concurrent morphine\nadministration to anesthetized horses does not alter\nthe anesthetic sparing effect of xylazine or its plasma\nconcentration-time profile. (Am J Vet Res 2004;\nObjective—To determine effects of cisapride and 5-hydroxytryptamine (5-HT) on the jejunum of horses.\nSample Population—Jejunal muscle strips from 8\nProcedure—Muscle strips were suspended in isolated\nmuscle baths. Isometric stress responses to 5-HT\nand cisapride, with and without specific antagonists,\nResults—Muscle strips incubated with atropine and\ntetrodotoxin responded to 5-HT and cisapride with an\nincrease in contractile force. The 5-HT caused a concentration-dependent increase in contractile amplitude,\nwith a maximum response (Emax) of 1,151 ± 214\ng/cm2 and a molar concentration that induces contractile\nforce equal to 50% of maximum response\n(EC50) of 0.028 ± 0.002 µM. Prior incubation with the\n5-HT2 antagonist ketanserin decreased the Emax (626\n± 147 g/cm2) and potency (EC50, 0.307 ± 0.105 µM) of\n5-HT. Prior incubation with the 5-HT3 antagonist tropisetron\ndecreased the efficacy (Emax, 894 ± 184\ng/cm2) to 5-HT. Cisapride also caused a concentrationdependent\nincrease in contractile amplitude, with an\nEmax of 331 ± 82 g/cm2 and an EC50 of 0.302 ± 0.122\nµM. Prior incubation with ketanserin decreased the\nEmax (55 ± 17 g/cm2) and potency (EC50, 0.520 ± 0.274\nµM) of cisapride.\nConclusion and Clinical Relevance—Stimulatory\neffects of 5-HT and cisapride on circular smooth muscle\nof equine jejunum are mediated primarily through\na noncholinergic effect. The effects of 5-HT are mediated,\nat least partially, by 5-HT2 and 5-HT3 receptors,\nwhereas the effects of cisapride are mediated primarily\nby 5-HT2 receptors. This may impact treatment of\nhorses with postoperative ileus. (Am J Vet Res\nObjective—To investigate accumulation of extracellular\nadenosine (ADO) by equine articular chondrocytes\nand to compare effects of adenosine kinase inhibition\nand adenosine deaminase inhibition on the amount of\nnitric oxide (NO) produced by lipopolysaccharide\nSample Population—Articular cartilage from\nmetacarpophalangeal and metatarsophalangeal joints\nof 14 horses.\nProcedure—Chondrocytes were cultured as monolayers,\nand cells were incubated with LPS, the adenosine\nkinase inhibitor 5'-iodotubercidin (ITU), or the\nadenosine deaminase inhibitor erythro-9-(2-hydroxy-3-\nnonyl)adenine hydrochloride (EHNA). Concentrations\nof ADO in cell supernatants were measured by use of\nreverse-phase high-performance liquid chromatography.\nEffect of inhibition of enzymatic metabolism of\nADO on induced NO production was evaluated by\nexposing cells to a combination of LPS and ITU or LPS\nResults—Articular chondrocytes accumulated extracellular\nADO when exposed to LPS or ITU.\nChondrocytes exposed to ITU accumulated ADO in a\ntime-dependent manner. Unstimulated chondrocytes\ndid not accumulate ADO. Similarly, EHNA alone did\nnot produce detectable ADO concentrations; however,\naddition of EHNA and ITU resulted in a synergistic\neffect on accumulation of ADO. Lipopolysaccharideinduced\nNO production was more effectively suppressed\nby exposure to ITU than to EHNA\nConclusions and Clinical Relevance—Equine articular\nchondrocytes release ADO in response to the\nproinflammatory stimulus of bacterial LPS. Inhibition\nof the metabolism of ADO increases accumulation of\nextracellular ADO. Autocrine release of ADO from\nchondrocytes may play a role in the cellular response\nto tissue damage in arthritic conditions, and pharmacologic\nmodulation of these pathways in joints of\narthritic horses could be a potential method of therapy.\n(Am J Vet Res 2002;63:1512–1519)\nObjective—To determine pharmacokinetics of azathioprine\n(AZA) and clinical, hematologic, and serologic\neffects of IV and oral administration of AZA in horses.\nProcedure—In study phase 1, a single dose of AZA\nwas administered IV (1.5 mg/kg) or orally (3.0 mg/kg)\nto 6 horses, with at least 1 week between treatments.\nBlood samples were collected for AZA and\n6-mercaptopurine (6-MP) analysis 1 hour before and\nat predetermined time points up to 4 hours after AZA\nadministration. In study phase 2, AZA was administered\norally (3 mg/kg) every 24 hours for 30 days and\nthen every 48 hours for 30 days. Throughout study\nphase 2, blood samples were collected for CBC determination\nand serum biochemical analysis.\nResults—Plasma concentrations of AZA and its\nmetabolite, 6-MP, decreased rapidly from plasma following\nIV administration of AZA, consistent with the\nshort mean elimination half-life of 1.8 minutes. Oral\nbioavailability of AZA was low, ranging from 1% to\n7%. No horses had abnormalities on CBC determination\nor serum biochemical analysis, other than 1 horse\nthat was lymphopenic on day 5 and 26 of daily treatment.\nThis horse developed facial alopecia from which\n1 colony of a Trichophyton sp was cultured; alopecia\nresolved within 1 month after the study ended.\nConclusions and Clinical Relevance—Overall, no\nadverse effects were observed with long-term oral\nadministration of AZA to horses, although 1 horse did\nhave possible evidence of immunosuppression with\nchronic treatment. Further investigation of the clinical\nefficacy of AZA in the treatment of autoimmune diseases\nin horses is warranted. (Am J Vet Res\nObjective—To determine pharmacokinetics and\nselected cardiopulmonary effects of fentanyl in isoflurane-anesthetized rhesus monkeys.\nAnimals—6 adult male rhesus monkeys.\nProcedure—Fentanyl (8 mg/kg of body weight, IV)\nwas administered to 6 monkeys anesthetized with\nisoflurane. End-tidal isoflurane concentration and\nesophageal temperature were kept constant, and\nventilation was mechanically assisted. Heart rate,\nrhythm, aortic blood pressure, and blood pH, gas, and\nfentanyl concentrations were determined before and\nfor 8 hours after administration of fentanyl.\nPharmacokinetics of fentanyl were derived by use of\nnoncompartmental methods based on statistical\nResults—Heart rate and mean arterial pressure\ndecreased transiently following fentanyl administration.\nMaximal decreases were observed 5 to 15 minutes\nafter administration. Arterial pH, PaCO2, and PaO2\nranged from 7.46 ± 0.04 to 7.51 ± 0.05 units, 29.2 ± 3\nto 34.6 ± 4.4 mm Hg, and 412.6 ± 105.3 to 482.9 ±\n71.2 mm Hg, respectively. The clearance, volume of\ndistribution area, volume of distribution steady state,\nmean residence time, area under the curve, elimination\nrate constant, and half-life were 32.5 ± 2.48\nml/kg/min, 9.04 ± 1.91 L/kg, 7.0 ± 1.2 L/kg, 218.5 ±\n35.5 min, 0.247 ± 0.019 mg/ml/min, 0.004 ±\n0.001/min, and 192.0 ± 33.5 min, respectively.\nConclusions and Clinical Relevance—Transient but\npotentially clinically important decreases in heart rate\nand mean arterial pressure were observed following\nfentanyl administration. Distribution and clearance\ndata were similar to those reported for dogs and\nhumans. (Am J Vet Res 2000;61:931–934)\nObjective—To determine the effect of a constant-rate\ninfusion of fentanyl on minimum alveolar concentration\n(MAC) of isoflurane and to determine the interaction\nbetween fentanyl and a benzodiazepine agonist\n(diazepam) and antagonist (flumazenil) in isoflurane-anesthetized\nAnimals—8 mixed-breed adult dogs.\nProcedure—Dogs were anesthetized with isoflurane\n3 times during a 6-week period. After a 30-minute\nequilibration period, each MAC determination was\nperformed in triplicate, using standard techniques.\nFentanyl was administered as a bolus (10 µg/kg of\nbody weight, IV) that was followed by a constant infusion\n(0.3 µg/kg per min, IV) throughout the remainder\nof the experiment. After determining isoflurane-fentanyl\nMAC in triplicate, each dog received saline\n(0.9% NaCl) solution, diazepam, or flumazenil. After\n30 minutes, MAC was determined again.\nResults—Fentanyl significantly decreased isoflurane\nMAC (corrected to a barometric pressure of 760 mm\nHg) from 1.80 ± 0.21 to 0.85 ± 0.14%, a reduction of\n53%. Isoflurane-fentanyl-diazepam MAC (0.48 ±\n0.29%) was significantly less than isoflurane-fentanylsaline\nMAC (0.79 ± 0.21%). Percentage reduction in\nisoflurane MAC was significantly greater for fentanyldiazepam\n(74%), compared with fentanyl-saline (54%)\nor fentanyl-flumazenil (61%). Mean fentanyl concentrations\nfor the entire experiment were increased over\ntime and were higher in the diazepam group than the\nsaline or flumazenil groups.\nConclusion and Clinical Relevance—Fentanyl\nmarkedly decreased isoflurane MAC in dogs.\nDiazepam, but not flumazenil, further decreased\nisoflurane-fentanyl MAC. Our results indicate that\ndiazepam enhances, whereas flumazenil does not\naffect, opioid-induced CNS depression and, possibly,\nanalgesia in dogs. (Am J Vet Res 2001;62:555–560)\nObjective—To evaluate the use of xylazine and ketamine\nfor total IV anesthesia in horses.\nProcedure—Anesthetic induction was performed on\n4 occasions in each horse with xylazine (0.75 mg/kg,\nIV), guaifenesin (75 mg/kg, IV), and ketamine\n(2 mg/kg, IV). Intravenous infusions of xylazine and\nketamine were then started by use of 1 of 6 treatments\nas follows for which 35, 90, 120, and 150 represent\ninfusion dosages (µg/kg/min) and X and K represent\nxylazine and ketamine, respectively: X35+K90\nwith 100% inspired oxygen (O2), X35+K120-O2,\nX35+K150-O2, X70+K90-O2, K150-O2, and X35+K120\nwith a 21% fraction of inspired oxygen (ie, air).\nCardiopulmonary measurements were performed.\nResponse to a noxious electrical stimulus was\nobserved at 20, 40, and 60 minutes after induction.\nTimes to achieve sternal recumbency and standing\nwere recorded. Quality of sedation, induction, and\nrecovery to sternal recumbency and standing were\nResults—Heart rate and cardiac index were higher\nand total peripheral resistance lower in K150-O2 and\nX35+K120-air groups. The mean arterial pressure was\nhighest in the X35+K120-air group and lowest in the\nK150-O2 group (125 ± 6 vs 85 ± 8 at 20 minutes,\nrespectively). Mean PaO2 was lowest in the\nX35+K120-air group. Times to sternal recumbency\nand standing were shortest for horses receiving\nK150-O2 (23 ± 6 minutes and 33 ± 8 minutes, respectively)\nand longest for those receiving X70+K90-O2\n(58 ± 28 minutes and 69 ± 27 minutes, respectively).\nConclusions and Clinical Relevance—Infusions of\nxylazine and ketamine may be used with oxygen supplementation\nto maintain 60 minutes of anesthesia in\nhealthy adult horses. (Am J Vet Res 2005;66:1002–1007)
This surgery has as an object the embellishment of the nose shapes, improving at the same time its functionality, correcting the deviation in the nasal septum. It is a procedure very similar to rhinoplasty, but a little more complex and delicate. In the Rhinoseptoplasty we can apply Local Anesthesia with sedation or General Anesthesia, depending on the case and will be hospitalized for one night. After the intervention, the patient will be plugged and will remain so for up to five days. After the first week of recovery, the points will be removed.\nInformación del tratamiento\nExpected results and risks\nAs for the results obtained, they will be immediate and definitive. About complications to arise, if there is, as in any surgery, risks, whether they are swelling, infection or bleeding, with problems to heal or some reaction to anesthesia, etc.\nThe specialist will make a small incision on the inside of the nasal wall, lifting the mucosa that covers it, thus accessing the bone that causes the problems. Then return the membrane to its place and close the incision, suturing it.\nCare after the intervention\nNasal plugs will be placed on the patient, who will keep them for 3 days. In the recovery process, avoid using glasses as much as possible during the first two weeks. You will not be able to stay in crowded areas or expose yourself to the sun’s rays. You must be careful with the bandage when performing cleaning actions, avoiding wetting or moistening.
Lister Clinic / Dr. Maphisa & Partners Inc. / Services & Prices / Gynaecology Clinic \| Women’s Health\nGYNAECOLOGY CLINIC \| WOMEN’S HEALTH\nLister Clinic® \| Dr. Maphisa & Partners Inc. EST. 2002\n“Go to the doctor, get a check-up, and get Pap smears regularly. Cervical cancer is very preventable, and if you catch it early, there are tons of ways to treat it as well.”\nPlease come to Dr. Maphisa & Partners Inc.\n3rd Floor, Lister Medical Centre\n195 Rahima Moosa (Jeppe) & Small Street\nWe occupy the entire 3rd and 4th Floors.\nWe are located on Corner Rahima Moosa (Jeppe) and Small Streets, Johannesburg.\nOur walk-in entrance is between McDonald’s and KFC.\nIf you would like us to send you our directions via WhatsApp or SMS, Please Click here.\nFor navigation directions via Google maps or Waze, Please Click here.\nIf you would like us to send you our directions to parking via WhatsApp or SMS, Please Click here.\nFor navigation directions to parking via Google maps or Waze, Please Click here.\n3rd Floor: Doctors \| Gynaecology Clinic & Women's Health\n4th Floor: Dentists \| X-Rays/Radiology\nAffordable Antenatal Care \| Pregnancy Sonar \| Antenatal Classes \| Confirmation of pregnancy & gestational age \| Estimated date of delivery \| 4D sonar \| Sex determination \| Antenatal profile \| Blood tests \| Completion of antenatal visit card \| Specialist & hospital referrals \| Referral for maternity & delivery\nAffordable Family Planning \| Emergency contraception \| Oral contraceptives \| Nordette \| Triphasil \| Injections \| Nur-Isterate \| Depo Provera \| Petogen \| Affordable IUD/Loop/Copper T \| Affordable Implants/Implanon \| Norplant \| Jadelle \| Hormonal & non-hormonal Intrauterine device/ IUD \| Patch \| Tubal ligation \| Vasectomy \| Other methods\nAffordable Wellness Tests \| Weight/BMI \| Blood Pressure \| Diabetes \| Cholesterol \| Pelvic examination \| Pap smear \| Breast exam \| Mammogram \| Prostrate examination & test/PSA \| FREE HIV testing & treatment \| STI screening & treatment \| Immunisations & vaccinations \| Gastroscopy \| Colonoscopy\nAffordable Safe & Legal Abortion \| Termination of pregnancy \| TOP \| Medical/pill abortion up to 9 weeks \| Same day surgical abortion up to 20 weeks \| MVA & post abortion care \| FREE sedation \| FREE family planning \| Affordable IUD/ loop/cop/copper T \| Affordable implants \| Implanon \| Gynaecology \| OBGYN\nAffordable Post Abortion Care \| MVA/Cleaning after miscarriage \| Womb scrub \| Dilatation & curettage \| D&C \| FREE sedation \| FREE family planning \| Affordable IUD/loop/copper T \| Affordable implants \| Implanon \| Gynaecology \| OBGYN
How can we help you?\nWhen you are taking care of your dental health, questions may arise, and they should. We want to be your partners as you work towards achieving and maintaining a beautiful smile. Our team is here to answer your questions and provide you with guidance for your dental health.\nWe've listed a few common questions we hear from our patients here. If you don't find the answer you need, call us at (321) 254-0306 and speak to a friendly and knowledgeable member of our team.\nThere is no age requirement for scheduling an appointment. We encourage new parents, in particular, to visit as early as possible. It may seem absurd to take your toothless little one into a dental office. However, this is a critical time in your child’s development. We view these types of appointments as important for two reasons:\n- Parent and guardian dental education is the main focus of the appointment. Most childhood dental issues can be prevented with the right habits that start even before your child begins to get teeth.\n- Early exposure and regular visits to the dentist can help your little one get comfortable in the dental chair. If any dental treatment is ever needed during your child’s development, it can mean the difference between a quick and easy fix and having to get sedated for treatment.\nBoth your pediatric specialist and the American Academy of Pediatric Dentistry (AAPD) state that your child's dental visit should be at one year of age, or at least six months after the first tooth comes in. There are many reasons to start dental care early on such as:\n- It allows your pediatric dentist to begin monitoring your son or daughter's oral health and development so they can detect any concerns at an early stage.\n- It helps your child acclimate to visiting the dentist and to understand that it's a safe and welcoming place.\n- This is an excellent time to ask questions about your son or daughter's oral development so you can make the most of your routine at home.\nHow to Prepare Your Child for The Dentist\nYou can prepare your child for his or her dental visits by talking about it beforehand in a positive way. Reading books or stories to them about visiting the dentist can also be helpful in preparing them for what's going to happen during their appointment. You might also consider bringing your child along with you to your cleaning and checkup so they can see what visiting the dentist is like.\nContact Our Melbourne Dental Clinic\nWe are happy to help! Contact our office for more information on preparing your son or daughter for their first dental visit.\nMost commonly, we will complete the exam and cleaning while the parent or guardian is in the dental chair and your child is sitting on your lap.\nKnee-to-knee is sometimes necessary. This process involves the parent or guardian and dentist sitting across from each other touching knees. The child lays on the parent or guardian’s lap as well as the dentist’s lap.\nIt is natural to have concerns about how your child will react to dental treatment. The dentist will be able to advise you on the best way to get your child back to a healthy smile.\nSedation Dentistry Available\nOur office is experienced at treating children and can complete most treatment without the use of sedation. However, our office does offer nitrous oxide sedation which, if necessary, can turn a nervous and anxious patient into a happy and cooperative patient.\n- We recommend that an adult brush your child’s teeth twice a day; in the morning and right before bed\n- Reduce sugary drinks and snacks throughout the day\n- As soon as your child is able to spit out toothpaste, we recommend switching to fluoridated toothpaste\n- Do not allow your child to sleep with a bottle containing milk, formula, or any other drink (with the exception of plain water)\n- Bring your child to regular dental checkups to help get them acclimated to the dental office and to ensure that any problems are caught early
Objectives: In this study, the effectiveness of bupivacaine and levobupivacaine was evaluated in spinal anesthesia.\nMaterials and methods: Applied lower extremity surgery under spinal anesthesia with bupivacaine and levobupivacaine, ASA I-III group, between 18-65 years patients were evaluated. The patients were divided into two groups according to used the local anesthetic drugs. Group B to 12.5 mg 0.5% bupivacaine + 10 mcg fentanyl (total 2.6 ml), Group L to 12.5 mg of 0.5% levobupivacaine + 10 mcg fentanyl (total 2.6 ml) was given. Patient demographics, clinical diagnoses, used local anesthetics dose and volume, duration of surgery, duration of sensory and motor block, hemodynamic parameters before and after the intervention, the first postoperative analgesic requirements, complications during and after treatment, patient satisfaction and surgical data were recorded.\nResults: 260 patients were included in the study. The demographic data were similar. The local anesthetic activity, in terms of hemodynamic parameters and duration of sensory block was not different between two drugs, but the motor block regression time was found to be longer in bupivacaine group.\nConclusion: Llevobupivacaine might be a good alternative to bupivacaine for spinal anesthesia because it causes less motor block than bupivacaine.\nThis is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
A patient with large retroperitoneal liposarcoma - a challenge for an anesthesiologist\nRetroperitoneal liposarcoma is a rare type of tumor characterized by slow growth and nonspecific symptoms, and is usually diagnosed at an advanced stage. Patients with huge retroperitoneal liposarcoma have a high risk of developing perioperative complications, and require special preoperative preparation and a carefully planned anesthetic approach. We present the case of a 57-year-old man, who was diagnosed with a huge retroperitoneal liposarcoma, 70 cm in diameter, weighing 30.4 kg and planned for surgical resection of the tumor under general anesthesia. Perioperative treatment and anesthesia for this patient were a great challenge for the anesthesiologist. However, due to preoperative preparation, monitoring and fluid replacement, hemodynamic and respiratory stability of the patient was maintained perioperatively.\nAntinori A, Antonacci V, Magistrelli P. Giant retroperitoneal liposarcoma. Am J Surg 2002;184:56–7. doi: 10.1016/s0002-9610(02)00880-2.\nBarbetakis N., Samanidis G., Samanidou E., et al. Primary mediastinal liposarcoma: A case report. J. Med Case Rep. 2007;1:161. doi: 10.1186/1752-1947-1-161.\nJ N Primrose, Soft tissue tumours. 3rd ed. F. M. Enzinger and S. W. Weiss. 1995. St Louis, Missouri: Mosby-Year-Book. British Journal of Surgery, Volume 82, Issue 10, October 1995, Page 1437. doi:10.1002/bjs.1800821050.\nDalal KM, Kattan MW, Antonescu CR, Brennan MF, Singer S. Subtype specific prognostic nomogram for patients with primary liposarcoma of the retroperitoneum, extremity, or trunk. Ann Surg. 2006;244(3):381–91.doi: 10.1097/01.sla.0000234795.98607.00.\nBrennan MF, Antonescu CA, Maki RG. Management of soft tissue sarcoma. New York (NY): Springer; 2013. doi: 10.1007/978-1-4614-5004-7.\nKotera A, Kouzuma S, Miyazaki N, Taki K, Esaki K. Anesthetic management of a patient with an ultra huge ovarian tumor. Masui. 2009 Jul;58(7):907-9. PMID: 19618834.\nZhang W.D, Liu D.R, Que R.S, et al. Management of retroperitoneal liposarcoma: A case report and review of the literature. Oncol Lett. 2015; 10 (1): 405–9. doi:10.3892/ol.2015.3193.\nBradley JC, Caplan R. Giant retroperitoneal sarcoma: a case report and review of the management of retroperitoneal sarcomas. Am Surg. 2002 Jan;68(1):52-6. PMID: 12467318.\nFeng D, Xu F, Wang M, Gu X, Ma Z. Anesthetic management of a patient with giant retroperitoneal liposarcoma: case report with literature review. Int J Clin Exp Med. 2015 Oct 15;8(10):19530-4. PMID: 26770605; PMCID: PMC4694505.\nOhashi N, Imai H, Tobita T, Ishii H, Baba H. Anesthetic management in a patient with giant growing teratoma syndrome: a case report. J Med Case Rep. 2014 Jan 27;8:32. doi: 10.1186/1752-1947-8-32. PMID: 24467840; PMCID: PMC3917373.\nNishiyama T, Hanaoka K. Same day drainage and removal of a giant ovarian cyst. Can J Anaesth. 1997 Oct;44(10):1087-90. doi: 10.1007/BF03019231. PMID: 9350369.\nShinohara H, Ishii H, Kakuyama M, Fukuda K. Morbidly obese patient with a huge ovarian tumor who was intubated while awake using airway scope in lateral decubitus position. Masui. The Japanese Journal of Anesthesiology. 2010 May;59(5):625-628.\nKondo T, Kusunoki S, Yasuuji M, Kawamoto M, Yuge O. Prevention of reexpansion pulmonary edema during resection of mediastinal tumor with atelectasis. Masui to sosei. 2006;42:39–41.\nMihara T, Kurahashi K. Re-expansion pulmonary edema (RPE) during surgery for intraabdominal giant tumor. Masui. 2008 Feb;57(2):191-6. PMID: 18277569.\nMorrison P, Morgan G. Removal of a giant ovarian cyst. Anaesthetic and intensive care management. Anaesthesia. 1987 Sep;42(9):965-74. doi: 10.1111/j.1365-2044.1987.tb05368.x. PMID: 3674358.\nSingh S, Bansal S, Kumar G, Gupta I, Thakur JR. Entropy as an Indicator to Measure Depth of Anaesthesia for Laryngeal Mask Airway (LMA) Insertion during Sevoflurane and Propofol Anaesthesia. J Clin Diagn Res. 2017Jul;11(7):UC01-UC03. doi: 10.7860/JCDR/2017/27316.10177. Epub 2017 Jul 1. PMID: 28893011;PMCID:PMC5583804.\nWon YJ, Lim BG, Kim YS, Lee M, Kim H. Usefulness of surgical pleth index-guided analgesia during general anesthesia: a systematic review and meta-analysis of randomized controlled trials. J Int Med Res. 2018 Nov;46(11):4386-4398. doi:10.1177/0300060518796749. Epub 2018 Sep 9. PMID: 30198405; PMCID:PMC6259411
Category : Anesthesiology Obstetrics & Gynecology Pediatrics\nThe book covers all aspects of anesthesia in newborns, neonates (under 28 days) and premature babies. These patients are highly vulnerable, very small in size and weight, at very high risk, and have high mortality and morbidity, which gets further aggravated by the medical diseases and congenital abnormalities these babies may suffer from.\nThe book provides knowledge that equips the anesthetists with the regional techniques used to provide both anesthesia and analgesia, including information about the drugs used, skills in providing neuraxial blocks, nerve blocks, etc., complications thereof and the specially designed equipment for these patients (IV cannula, endotracheal tubes, ryles tubes, laryngoscopes, SpO2 probes, monitors, incubators, warmers and heaters, mattresses, OT tables).\nThe book covers the pharmacology of drugs used, the effect of anesthetic drugs on the developing brain, pulmonary physiology, airway assessment and management, ventilation modes, getting IV and arterial access, preoperative workup, anesthetic management, and postoperative care. It includes care and concerns from both surgical and anesthesia aspects. It covers all the common surgical diseases along with some rare cases such as oncological concerns, palliative care, ethical concerns and pain management. The book also discusses the role and use of ultrasound. The chapter on anesthesia for short procedures includes common birth and neonatal care injuries. The book contains chapters on fluid therapy, blood and blood product transfusion guidelines and indications, resuscitation of a newborn and neonate, and neonatal rehabilitation to improve neonatal outcomes. It contains a dedicated chapter on why these babies are at a high risk of morbidity and mortality and contributing maternal factors. All the chapters are written by experts in their fields with vast experience.\nThis book bridges the gap in the knowledge of an anesthesiologist between anesthesia for children and adults and newborns, neonates and preterm babies.\n- Publisher: Springer Nature Singapore; January 18, 2023\n- Language: English\n- ISBN: 9789811954573\n- ISBN: 9789811954580
2,450 sf dental office for sale in a great area in NW Albuquerque, NM, located in a busy and large shopping plaza that contains large grocery store, gas station, restaurants and much more. That Plaza brings in more than 7,000 customer traffic daily. Nice custom homes and gated communities around the office.\nTHIS IS A LEASED SPACE AND IS A PART OF A LARGE & VISIBLE PLAZA ON A TWO MAIN STREETS INTERSECTION. THE REAL ESTATE IS NOT FOR SALE.\nThe office currently has 3 operatories (Pelton & Crane)and plumbed for three more, making it a potential 6-operatory dental office. The office is completely digital with three fixed X-ray machines in each room plus one Panoramic X-ray machine for the entire office. This office is 100% paperless and utilises OpenDental as dental software for patient record keeping. The office is wired and plumbed for Nitrous Sedation for all operatories.\nThere is a good size reception area, kids playroom, doctor’s office, staff breakroom, closet & utility room, autoclave room with fairly new Midmark autoclave sterilising machine, and 2 bathrooms for patients and staff. This office space is currently leased and had been a dental office for at least 15 years.\nThe office currently refers out all Endodontics, Oral Surgery that requires sedation, Braces and TMJ treatments.\nThe sale of the business will include all equipment, instruments, furniture, patient’s records and good will). The real estate is not for sale.\nThis is an established office offered at a non-established or new office fee.\nFor more info, please call/ text (5zero5)72zero-572six.\nIf no answer, please text (5zero5)61five-011three. Thanks.
CHAPTER 48 Management of Fear and Anxiety\nFear and anxiety of dental procedures are common emotions. The severity ranges widely, with mild apprehension being reported by 75% of the population,59 and severe anxiety, leading to avoidance of dental treatment, being reported by 4% to 21%.11,21,49 As shown in Table 48-1, the prevalence of fear and anxiety is not restricted to one culture but shows consistency internationally.11 Dental anxiety has not diminished but has remained stable over the past 50 years despite advances in the delivery of dentistry.61 It has also been shown that this fear begins in childhood and can persist throughout life, leading to avoidance of dental care and contributing to diminished oral health.23 Although mild fear may have only a minor effect on oral health, detrimental consequences for overall health can result if true phobia causes patients to avoid treatment despite significant symptoms.8,49\n\|COUNTRY\|\|PREVALENCE OF HIGH DENTAL FEAR AND ANXIETY\|\nData compiled by Chanpong B, Haas DA, Locker D: Need and demand for sedation or general anesthesia in dentistry: a national survey of the Canadian population, Anesth Prog 52:3-11, 2005.\nApproximately 40% of the population do not receive routine dental care, with apprehension being cited as the most common reason.4 These patients often require special nonpharmacologic or pharmacologic approaches to allow dental procedures to be done. Pharmacologic approaches involve drugs that produce effects ranging from minimal sedation to general anesthesia.\nDentistry has historically been at the forefront in the development of anesthetic techniques to manage fear and anxiety. As described in Chapter 17, two dentists, Horace Wells and William Morton, were largely responsible for the clinical introduction of general anesthesia. The first description of nitrous oxide (N2O) as a sedative, as opposed to a general anesthetic, appeared in a textbook on anesthesia for dentistry published in 1908.17 The modern form of N2O and oxygen sedation evolved in the 1940s and 1950s, and this practice has become a standard component of the predoctoral dental curriculum.3 Intravenous anesthesia with hexobarbital was pioneered by the English dentist S.L. Drummond-Jackson in the 1930s. Shortly after World War II, Harold Krogh and Adrian Hubbell developed the use of thiopental for oral surgery. Intravenous conscious sedation (now termed moderate sedation) was introduced by Niels Jorgensen in 1945.\nBehavioral or psychological techniques to manage anxiety in dental patients are unquestionably important, but their detailed description lies beyond the scope of this textbook. This chapter summarizes the pharmacologic approaches to the management of fear and anxiety in dental patients, with emphasis on the administration of minimal-moderate sedation. Complete understanding of this subject requires comprehension of the pharmacologic features of the specific drugs, which are described in other chapters.\nThe primary indication for pharmacologic methods of patient management is the presence of anxiety, fear, or phobia sufficient to prevent the delivery of needed dental care. Anxiety may be defined as a stress response to an ill-defined or anticipated situation46 and may consist of patterns of autonomic arousal with thoughts of fear and feelings of threat.54 Dental anxiety may be related to specific dental procedures or may be precipitated by a mere visit to the dentist’s office. Although anxiety of dentistry usually originates from past experiences as a child,40 it may develop in adulthood and not be associated with any previous adverse event.66\nFear is defined as an emotional response to a perceived immediate threat.24,57 Fear of dentistry may evolve from many sources, including past traumatic experiences, concerns about physical loss and disfigurement, observation of anxiety or fear in others, and exposure to frightening anecdotes by friends or the mass media.59 Specifically, fears of the anesthetic “shot” and dental “drill” are the most common.36,47 A phobia is a persistent and irrational fear that results in a compulsion to avoid a specific object, activity, or situation.\nA strong relationship exists between anxiety and pain. Expectation of pain contributes significantly to dental anxiety, and anxiety can reduce pain tolerance59 to the extent that normally innocuous stimuli, such as touch, may be interpreted as pain. Many cases of failed mandibular block are a result of patient anxiety.67 Anxiety can also contribute to adverse reactions in the dental chair; these are commonly misdiagnosed as either allergic or toxic reactions to the local anesthetic or vasoconstrictor. Comprehensive pain control requires an ability to manage fear and anxiety.\nOther potential indications for the use of pharmacologic methods for patient management include cognitive impairment, such as in mentally challenged patients or patients with Alzheimer’s dementia. These patients may be unable to cooperate sufficiently to permit treatment or perhaps even an adequate intraoral examination. Another indication is the presence of motor dysfunction, such as in patients with cerebral palsy or Parkinson’s disease, whose tremor or uncoordinated movements may be exacerbated by the anxiety of being in the dental office. Pharmacologic management may also be required for a pediatric patient who may not understand the treatment and is reacting normally for a young child. Traumatic or extensive dental procedures are additional potential indications when coupled with anxiety, the need to immobilize the patient, or inability to render the patient pain-free with local anesthesia. Finally, some patients cannot physiologically tolerate the stress that even a minimal amount of anxiety may induce; patients with ischemic heart disease, labile hypertension, or stress-induced asthma are included in this group. Any of the modalities defined subsequently—minimal sedation, moderate sedation, deep sedation, or general anesthesia—may be used to treat these patients.\nTo address the needs of fearful or anxious patients, the dentist must first be able to recognize or diagnose anxiety and fear. Discussion of how to identify these patients accurately is beyond the scope of this chapter but can be found in other excellent sources.24,48 The degree of anxiety should be determined as part of an appropriate history and patient evaluation. Observation of the patient and questions addressing possible anxiety caused by dentistry may aid in diagnosis. Patient interviews can identify specific concerns, such as fear of the injection of local anesthetic, the sound of the handpiece, or certain surgical procedures. Standardized measures of anxiety, such as the Corah scale,13 may be useful in quantifying the severity of anxiety.\nAfter identifying an anxious, fearful, or phobic patient, thought should be given to the optimal method of managing the patient. Initially, nonpharmacologic methods of anxiety reduction should be considered.41,54,57 Appropriate chairside manner is often all that is required; this includes use of basic behavioral modification, positive suggestion, and reassurance. This approach is valuable not only when used alone, but also when used with more specific therapies for anxiety reduction. Specific psychological interventions that may be helpful include desensitization and hypnosis. Although these techniques would not overcome poor chairside manner, they can effectively aid the dentist in achieving patient comfort.\nDespite effective chairside manner, many patients still wish to receive sedation or anesthesia. It has been reported that more than 50% of Americans classified as having high fear or anxiety preferred sedation for their dental care.21 The same study showed that three times as many subjects reported a preference for parenteral sedation or general anesthesia when undergoing dental treatment than were actually receiving these modalities.21 This same pattern was seen in a subsequent Canadian study in which patients were asked if they would prefer to have sedation or general anesthesia for each of five procedures.11 There were large differences in this preference compared with actual prevalence for each procedure—specifically, 3.8-fold difference for cleaning, 2.8-fold difference for restorative dentistry, 9.6-fold difference for endodontics, 15.9-fold difference for periodontal surgery, and 2.2-fold difference for extraction. The low preference/prevalence ratio for extractions suggests that dental patients have better access to sedation/anesthesia services for extractions than for other procedures. Extrapolation of these results suggests that nearly 25 million American adults are definitely interested in sedation or general anesthesia for dentistry regardless of the cost.\nAn absolute requirement basic to the success of patient management is effective local anesthesia. One cannot avoid this necessity in most invasive dental procedures unless complete general anesthesia is being administered. Even then, there may be benefits to the so-called preemptive use of local anesthetic.34,45,68 The dentist should not be misled into thinking that poor local anesthetic technique can be overcome by administering a sedative. Only when the anesthetic failure is strictly caused by anxiety67 would sedation be fully effective.\nThe approach to anxiety control should be individualized. It is as faulty to assume that every patient requires general anesthesia for the removal of impacted teeth as it is to assume that no patient requires anxiety control for a simple dental procedure or examination.\nThe ability to use a particular pharmacologic approach depends on the level of training of the dentist and the applicable laws and regulations.3 Education for minimal sedation, such as given through inhalation and oral administration, is within the realm of the predoctoral dental curriculum. More advanced forms, such as moderate sedation, given either orally or parenterally, usually require training at a postdoctoral or continuing education level, although some dental schools have shown that it can be part of a predoctoral program. The most advanced modalities—deep sedation and general anesthesia—require the most formal training. Education for advanced modalities entails a specific postgraduate program devoted to anesthesia (i.e., an accredited residency in dental anesthesiology or an accredited oral and maxillofacial surgery residency, which must include advanced training in anesthesia as part of its curriculum).\nBefore choosing pharmacologic adjuncts for patient management, the dentist should carefully review the patient’s medical history. In this context, the American Society of Anesthesiologists (ASA) Physical Status Classification System can be helpful (Box 48-1). This assessment tool can be used to estimate the patient’s overall ability to tolerate the stress of a planned procedure. It can also help determine the need for further patient evaluation and the degree of monitoring required for the procedure.\n\|I\|\|Normal, healthy patient\|\n\|II\|\|Patient with mild systemic disease\|\n\|III\|\|Patient with severe systemic disease that limits activity, but is not incapacitating\|\n\|IV\|\|Patient with incapacitating systemic disease that is a constant threat to life\|\n\|V\|\|Moribund patient not expected to survive 24 hr with or without operation\|\n\|E\|\|Emergency operation of any type; E is appended to the patient’s physical status\|\nASA I and II patients are usually suitable candidates for sedation or general anesthesia in the outpatient setting. Although outpatient general anesthesia is often inappropriate for ASA III patients, these same patients are at increased risk during stressful procedures when fear and anxiety are not adequately controlled. Techniques to control anxiety involving minimal, moderate, or possibly even deep sedation may be particularly valuable to ASA III patients because they reduce the release of endogenous catecholamines.18,20 ASA IV (and higher) patients are not candidates for sedation or anesthesia in the dental office.\nSeveral pharmacologic approaches can be used to manage fear and anxiety in dental patients. These are commonly referred to collectively as the spectrum of pain and anxiety control, which incorporates all major routes of administration and levels of central nervous system (CNS) depression.43 The route of administration is not synonymous with the level of CNS depression. A spectrum of fear and anxiety control as depicted in Figure 48-1 shows the range of sedation or anesthesia normally sought from the various routes and techniques of administration. In its simplest form, this spectrum is divided into techniques expected to leave the patient awake or to render the patient unconscious. These modalities correspond to sedation and general anesthesia. More recently, definitions of the various levels of sedation have been standardized to include the states of minimal, moderate, and deep sedation.3 The characteristics of these states and of general anesthesia are defined next and compared in Table 48-2:\nFIGURE 48-1 The spectrum of fear and anxiety control in dentistry. The range of central nervous system depression normally achieved by various techniques is illustrated by arrows. The depth of sedation or anesthesia induced by a given drug primarily depends on the dose administered, route used, and susceptibility of the patient.\nMinimal and moderate forms of sedation are not substitutes for appropriate chairside manner and use of behavioral techniques but are used to reinforce positive suggestion and reassurance in a way that allows dental treatment to be performed with minimal physiologic and psychological stress. These techniques should carry a margin of safety wide enough to render unintended loss of consciousness unlikely.55 Deep sedation or general anesthesia can be induced by many of the same drugs that induce moderate sedation. The resulting state depends on patient susceptibility, age, medical status, and degree of anxiety and the drug or drugs used and doses administered. Either deep sedation or general anesthesia may be indicated when lighter forms of CNS depression are insufficient to permit treatment.\nIf a separate trained anesthesia provider is not used to administer deep sedation or general anesthesia, a team approach is indicated. For this approach, at least three individuals must be in the operatory: the dentist (trained in anesthesia), the anesthetic assistant, and the operative assistant. Under the direction of the dentist, the primary functions of the anesthetic assistant are to assess the patient; monitor vital signs; record appropriate information; and, as required or permitted by relevant laws and regulations, establish intravenous access, administer medications, assist in the maintenance of a patent airway, monitor recovery, and assist in any emergency procedures. The primary functions of the operative assistant are to keep the operative field free of blood, mucus, and debris and to assist in the management of the dental procedure.\nReliable morbidity and mortality data for the different forms of sedation or general anesthesia are scarce, but several studies have shown that, overall, the techniques used in dentistry should be considered safe.22,39,42,51,69 Increased mortality is usually associated with inadequate training or inadequate monitoring of the patient.15,16,25,33,38 In a review of adverse events related to sedation in pediatric patients, the use of three or more sedating drugs was more strongly associated with adverse outcomes than was the use of only one or two.15,16 If the goal is minimal or moderate sedation, one must avoid administering excessive doses of a sedative to a patient who remains uncooperative while conscious because it could easily lead to a deepening of sedation in which airway patency and protective reflexes may be lost. Any subsequent lack of oxygenation can rapidly lead to a tragic result. Although the progression from moderate to deep sedation can be accomplished easily, it requires a significantly increased degree of practitioner training, patient monitoring, and physical resources (e.g., anesthetic equipment and supplies) to be performed safely.\nNumerous routes of administration can be used to achieve minimal or moderate sedation: inhalation, oral, intravenous, intramuscular, submucosal, sublingual, rectal, and intranasal. The first three are commonly used and are discussed in detail in this chapter, whereas the latter five are used less frequently and are reviewed only briefly here.\nThe intramuscular route provides an onset and uptake intermediate between that of oral and intravenous routes. There is a limited ability to titrate with this route, but it can be particularly advantageous for patients who are incapable of cooperating, such as cognitively impaired patients.6 Its use should be restricted to clinicians with training in at least parenteral moderate sedation.\nThe submucosal route is analogous to a subcutaneous injection given intraorally and shares many of the same characteristics as the intramuscular route. The submucosal route has no apparent advantage over any of the others, other than the fact that the dentist may be more comfortable giving an injection by this route. The sublingual (or transmucosal) route, restricted to drugs with high lipid solubility and available in suitable formulations, is similar to the oral route except that there is a more rapid absorption by the oral mucosa and no first-pass effect. The difference in recommended dosages can be large when comparing oral versus sublingual absorption depending on the extent of first-pass metabolism in the intestine and liver. The onset of effect after sublingual administration may take several minutes for some drugs and considerably longer for others.\nThe rectal route is not often used in dentistry, with the exception of pediatric patients. Disadvantages of this route include inability to titrate, inconsistencies in absorption, often poor patient acceptance, and inconvenience.\nThe intranasal route involves the topical application to the nasal mucosa and is characterized by a potentially rapid absorption and onset of action. It is sometimes used as an alternative to intramuscular injection for uncooperative children. Its benefits are diminished, however, by variable absorption (especially if the patient sneezes), the discomfort of mucosal irritation, and the potential for damage to the nasal mucosa.\nAs stated earlier, the route of administration is not synonymous with the depth of sedation. Any route has the potential to induce any degree of sedation or anesthesia. Management of an anxious patient can be discussed according to route of administration, however, because the inhalation and oral techniques are most commonly used for minimal and moderate sedation and are normally the first to be considered. The intravenous route is more likely to be selected to induce a greater depth of effect. Table 48-3 compares the routes of administration for sedation. Commonly used drugs, their routes of administration, and doses for minimal and moderate sedation are summarized in Table 48-4.\n\|DRUG\|\|ROUTE OF ADMINISTRATION\|\|APPROXIMATE DOSE*\|\n\|Midazolam\|\|Oral, IV\|\|0.03-0.1 (IV), 0.3-1 (oral)\|\nInhalation sedation refers to the administration of N2O and oxygen (N2O-O2) (pharmacologic features are described in Chapters 17 and 18). N2O-O2 inhalation is a technique of choice for dental procedures that require minimal-moderate sedation. The analgesia produced by N2
The American Health Council named Jose Alberto Rodriguez, DNP, APRN, CRNA to its Board of Nurses for his outstanding contributions to the nursing field. A Certified Registered Nurse Anesthetist (CRNA) at Yale University School of Medicine and Integrated Anesthesia Associates, LLC, Dr. Rodriguez collaborates with anesthesia attendings and multidisciplinary medical-surgical teams for the provision of anesthesia services. He has been in practice as an anesthesia provider for over two years. Dr. Rodriguez has spent over 13 years in the healthcare industry expanding his skills and knowledge in nursing. As an anesthesia provider and CRNA he provides anesthesia care for patients undergoing general surgery, obstetrics and gynecology surgery, neuro-skeletal and neuro-spine surgery, vascular and endovascular surgery, thoracic surgery, atrial fibrillation ablations, ventricular tachycardia ablations, atrioventricular nodal ablations, supraventricular ablations, electrophysiology studies, pediatric surgery, oral-maxillofacial surgery, comprehensive ear-nose-throat surgery, and robotic-assisted (da Vinci) colorectal, nephrology, and urology surgeries.\nA Dominican Republic native, Dr. Rodriguez grew up around farmlands. He attributes his nurturing demeanor to his humble upbringing. With a passion for nursing, Dr. Rodriguez relocated to the United States in 1999 to pursue his dream to heal and help others through nursing, as well as attain his academic goals. He enrolled at Housatonic and Gateway Community College, where he was named to the Dean’s List in 2001, 2002, and 2007. He earned an Associate Degree in Nursing in 2004 at Housatonic Community College and later earned a Bachelor of Science in Nursing degree from Southern Connecticut State University in 2008. In 2015, he earned a Doctor of Nursing Practice degree, an Advanced Practice Registered Nurse and Certified Registered Nurse Anesthetist (CRNA) certifications from Fairfield University, where he graduated with Magna Cum Laude honors.\nWhile obtaining his academic training, Dr. Rodriguez simultaneously served as a Registered Nurse at Bridgeport Hospital in 2004. He remained there for 10 years before accepting a CRNA role at Yale University School of Medicine in 2016 and later joining Integrated Anesthesia Associates in 2018. In that role, he is responsible for pre-operative, intra-operative, and postoperative anesthesia care. In addition, he provides inpatient pain management. He has the vital role of maintenance and restoration of a stable condition during and immediately following surgical, obstetrical, and diagnostic procedures. Furthermore, he provides Monitored Anesthesia Care and sedation for procedures outside of the operating room and conducts pre-anesthesia assessments and consultations for the preparation of patients for anesthesia.\nHe was nominated by his peers at Bridgeport Hospital for the Making a Difference Award in 2007 and 2012. He is a member of the American Association of Nurse Anesthetists and the Connecticut Association of Nurse Anesthetists. Among his many accomplishments, Dr. Rodriguez is proud of his loving wife and three children. With a successful career at hand — one that he attributes to his hard work, dedication, sacrifice, and passion for his profession — he plans to excel his career by fostering personal and professional growth and establishing a stable practice.\nShare this entry\nJose Alberto Rodriguez\nDNP, APRN, CRNA\nCertified Registered Nurse Anesthetist at Yale University School of Medicine\n- Founded in 1810, the Yale School of Medicine is a world-renowned center for biomedical research, education and advanced health care.\n- Among its divisions are one of the nation’s oldest schools of public health and the internationally recognized Child Study Center, founded in 1911.\n- Its Yale Cancer Center is one of 41 comprehensive cancer centers designated by the National Cancer Institute, and its Yale Center for Clinical Investigation was one of the first 12 institutions to launch the Clinical and Translational Science Awards program in 2006. Its 33 academic departments include 10 in the basic sciences, 18 in clinical fields, and 5 in public health.
We are committed to providing you with the highest quality of patient care. A clear understanding of our financial policy is important to our professional relationship. Should you have any questions regarding this financial policy, please ask our office manager for any clarification you may need.\n- All patients must complete the Patient Information Forms prior to seeing the doctor.\n- Full payment or co-payment / deductible is due at the time of service.\n- We accept cash, checks and credit cards.\n- Any bank charges for returned checks will be added to the balance.\n- Financing is available through CareCredit and Alphaeon.\n- Surgery cost complication insurance is available through BLIS. Dr. Kouros Azar is a BLIS approved surgeon (www.bliscompany.com). Becoming a BLIS Surgeon is a very selective process as determined exclusively by BLIS and means that Dr. Azar has met very high standards regarding outcomes and long term patient success. As a result of our approval by BLIS, we are able to participate in an innovative new insurance coverage which allows us to make a commitment to our participating self-pay patients that should a covered complication occur within certain time frames following surgery, our patients are not responsible for the costs associated with the care of that complication. For more information and details on the BLIS Protection Dr. Azar has available, please contact our office.\nWhen surgical procedures are scheduled, surgical fees will be discussed privately between you and our office manager. Surgical fees will be collected at the pre-operative appointment.\nDr. Azar is not contracted with any insurance companies, with the exception of Medicare. We file insurance claims as a courtesy to our patients. However, this does not release the patient/guarantor of his or her financial responsibility. Insurance coverage is a contract between you and your insurance company; we are not party to that contract. Because of this, it is the patient’s responsibility to be familiar with his or her insurance policy. We do our best to select in-network facilities and physicians, but this is not always possible. We encourage you to check the provider status prior to any procedure.\nSince the financial responsibility always resides with the patient, we want to keep you informed. If 30 days have gone by and your insurance company has not paid, you may wish to call the company directly to make sure your account is paid within 60 days. After 60 days, we will no longer pursue your insurance company, but will look to you, the patient, for immediate payment.\nAs a courtesy to our breast cancer patients, we will bill and accept insurance-company-allowed amounts on all procedures directly related to breast cancer. There will be an out-of-pocket expense, but we will do everything we can to minimize the amount.\nPLEASE READ CAREFULLY: YOUR INSURANCE COMPANY MIGHT NOT FULLY REIMBURSE YOU FOR HOSPITAL ADMISSIONS OR SURGICAL PROCEDURES.\nListed below are estimates for many of our cosmetic procedures. These estimates include Dr. Azar’s fee, the facility fee and the anesthesia fee. Dr. Azar’s fee includes the pre-operative appointment as well as 1 year of post-operative appointments.\nMost insurance companies do not cover the cost of cosmetic surgery. Because paying for cosmetic surgery out of pocket can be an obstacle for some patients, Dr. Azar offers financing through CareCredit. With CareCredit, you may be eligible for a no-interest or low-interest payment plan.\nWhen comparing costs of procedures, keep in mind that Dr. Azar only operates in accredited hospitals, which maintain a higher standard of safety than most office-based surgical centers and only uses medical doctors (M.D.s) who are specialists and board certified in anesthesiology NOT nurse anesthetists.\n- Liposuction of the abdomen $3,100 to $5,600\n- Liposuction of the flanks $3,100 to $5,600\n- Liposuction of the thighs $3,100 to $5,600\n- Liposuction of the neck/chin $1,700 to $4,000\n- Liposuction of the buttocks $3,100 to $5,600\n- Tummy Tuck $5,400 to $9,000\n- Lower Body Lift $12,000 to $17,000\n- Brachioplasty (Arm Tuck) $4,000 to $6,500\n- Thigh Lift $9,500 to $16,000\n- Gynecomastia Surgery (Male Breast Reduction) $4,500 to $8,000\n(Combining areas of liposuction may reduce overall fees.)\nBreast Enhancement Surgery\n- Breast Augmentation (saline) $5,500 to $7,000\n- Breast Augmentation (silicone) $6,500 to $10,000\n- Breast Implant Exchange (saline) $6,500 – $12,000\n- Breast Implant Exchange (silicone) $8,500 – $14,000\n- Breast Lift $6,600 – $9,100\n- Breast Lift with Implant $8,000 – $12,000\n- Breast Reduction $7,500 – $11,000\nFacial Cosmetic Surgery\n- Upper Blepharoplasty (eyelid tuck) $2,500 – $4,500\n- Lower Blepharoplasty (eyelid tuck) $3,000 – $5,000\n- Brow Lift $3,300 – $5,000\n- Mid-facelift $4,300 – $8,000\n- Facelift $14,900 – $17,400\n- Rhinoplasty $6,400 – $8,900\n- Neck Lift $8,900 – $11,400\n- Otoplasty (ear surgery) $4,300 – $6,800
ORIGINAL RESEARCH article\nSec. Obstetric and Pediatric Pharmacology\nProphylactic Phenylephrine Increases the Dose Requirement of Oxytocin to Treat Uterine Atony During Cesarean Delivery: A Double-Blinded, Single-Center, Randomized and Placebo-Controlled Trial\n- 1Department of Anesthesia, Hangzhou City Linping District Maternal and Child Care Hospital, Hangzhou, China\n- 2Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Bio-X Institutes, Shanghai Jiao Tong University, Shanghai, China\n- 3Department of Anesthesia, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, China\nPurpose: Studies involving mouse models and human uterine smooth muscle cells have shown that phenylephrine inhibits uterine contractions in non-pregnant mice and human in vitro cell via cyclic adenosine monophosphate (cAMP) signaling. However, there has been no limited exploration to date of the effect of phenylephrine on uterine contractions in clinical practice. This study aimed to compare the dose requirement of oxytocin with or without the infusion of prophylactic phenylephrine to prevent post spinal hypotension during cesarean delivery under combined spinal and epidural anesthesia.\nMethods: This was a double-blinded, single-center, randomized, control study. One hundred and sixty pregnant patients provided informed consent and were randomly allocated to the phenylephrine (phenylephrine infusion) and control (saline infusion) groups. Patients randomized to the phenylephrine group received an intravenous prophylactic phenylephrine infusion at a fixed rate of 0.5 μg/kg/min. The control group received a saline placebo at the same rate and used the same apparatus for delivery. After neonatal delivery and clamping of the umbilical cord, patients received a standard institutional oxytocin protocol. The primary outcome measure was the total dose of oxytocin administered during CD. Secondary outcomes including the proportion (%) of patients requiring a secondary uterotonic agent and estimated blood loss (EBL) in the first 24 h after surgery.\nResults: The median oxytocin dose administered was significantly higher in the phenylephrine group than in the control group [6.9 ± 2.5 international standardized units (IU) vs. 5.4 ± 2.4 IU, p = 0.0004]. The number of patients that required a secondary uterotonic agent was significantly higher in the phenylephrine group than in the control group (24.2% vs. 9.1%; p = 0.034). The EBL in the first 24-h postoperatively was similar between the two groups (467 ± 47 ml vs. 392 ± 38 ml; p = 0.22).\nConclusions: Prophylactic infusion of phenylephrine used to prevent post-spinal hypotension during CD was associated with a higher dose of oxytocin. This has important clinical implications, as the suboptimal use of oxytocin is associated with an increased risk of postpartum hemorrhage and increased maternal morbidity and mortality. Further studies are now needed to confirm these findings.\nHypotension is the most common side effect of spinal anesthesia during cesarean delivery (CD) and is associated with increased maternal and neonatal morbidity (NganKee, 2010; Gizzo et al., 2014). Treating or preventing post-spinal hypotension is therefore a care priority for obstetric patients. Phenylephrine is widely used by anesthesiologists worldwide for both the treatment or prevention of post-spinal hypotension and is associated with a lower incidence of fetal acidemia than ephedrine (NganKee et al., 2009; Heesen et al., 2014; NganKee, 2017; Kinsella et al., 2018).\nHowever, there are several adverse events associated with the routine use of phenylephrine during obstetric anesthesia; both bradycardia and a corresponding reduction cardiac output (CO) have been widely reported (NganKee, 2017; Kinsella et al., 2018). Norepinephrine, which has weak β-adrenergic receptor agonist activity, has been suggested as an alternative vasopressor, but has yet to be universally adopted (NganKee et al., 2015; Puthenveettil et al., 2019; Sharkey et al., 2019). Recent murine studies have demonstrated that phenylephrine inhibits uterine contractions in non-pregnant mice through cAMP signaling (Chen et al., 2018). In addition, in Chen et al. (2018) study, they also observed an increase in cAMP induced by phenylephrine in human uterine smooth muscle cells (HUSMCs), thus suggesting that phenylephrine may also exhibit antagonistic effects against uterine contractions in the human uterus. Although this was an in vitro trial and needs to be confirmed by in vivo studies, this effect is still worth the vigilance of obstetric anesthesiologists. Furthermore, there is a lack of evidence for this effect in clinical practice, the routine use of phenylephrine in obstetric anesthesia to prevent post spinal hypotension may increase the risk of uterine atony, and subsequent rates of postpartum hemorrhage.\nIn this randomised and controlled trial, we aimed to compare the dose requirement of intravenous oxytocin between patients receiving an infusion of prophylactic intravenous phenylephrine to those receiving a saline placebo control infusion under combined spinal and epidural anesthesia (CSEA). The primary outcome of this study was the mean dose of oxytocin in the perioperative period. The secondary outcome of this study was the estimated volume of blood loss, the use of secondary uterotonic agents and the side effects during CD. Our hypothesis was that prophylactic phenylephrine may increase the dose requirement of oxytocin to prevent uterine atony.\nMaterials and Methods\nEthical approval for this study (Ethical Committee No. LLSC-KYKT-2020-0013-A) was provided by the Ethical Committee of Hangzhou City Linping District Maternal and Child Care Hospital, Hangzhou, China (Chairperson Prof Yue-jian Shen) on February 1, 2020. The study was also registered on the Chinese Clinical Trial Register (ChiCTR2000030884) on March 16, 2020. The trial was conducted in a single center, Hangzhou City Linping District Maternal and Child Care Hospital. All patients involved in this study provided written, signed, and informed consent before inclusion. The first patient was enrolled in this study on the March 20, 2020.\nThis was a double-blinded, single-center, randomized, control study.\nPatients and Setting\nThe patient inclusion criteria were as follows: single pregnancy, at full-term (gestational age ≥37 weeks), American Society of Anesthesiologists Physical Status II, aged between 18 and 40 years old, undergoing elective CD and planning epidural anesthesia. The exclusion criteria included obesity (body mass index, BMI >35 kg/m2), height (<150 or >170 cm), active labor, early labor, diabetes mellitus or gestational diabetes, hypertension or pre-eclampsia, intrauterine growth restriction or fetal macrosomia, placenta previa, placenta conglutination, placenta implantation, significant co-existing maternal disease, any absolute contraindications to spinal or epidural anesthesia such as local infection or bleeding disorders, and cases with a sensory plane block that did not reach T6 or higher.\nPatients were randomly allocated to the phenylephrine intervention or placebo control group by using a randomization schedule generated by YH Shen using Microsoft Excel (Microsoft Corporation, Redmond, WA, United States); this investigator knew the patient groupings but did not participate in patient care or data collection. The randomization schedule was kept in numbered opaque envelopes, that were opened sequentially with each patient enrollment. All study participants were blinded to the study design and their randomised allocation. To maintain investigator blinding, phenylephrine and saline were prepared in identical 50-ml infusion syringes (lettered A or B) and the infusion rate was set at 50 ml/h (equal to 0.5 μg/kg/min in on our prior data) (Xiao et al., 2020).\nUpon arriving at the operating room, peripheral access was obtained using an 18 G intravenous cannula inserted into an upper limb vein. Oxygen was delivered via a nasal catheter at the rate of 3 L per minute. Standard monitoring was applied including a non-invasive blood pressure cuff, pulse oximeter, and electrocardiography leads (including a respiratory rate monitor). The patient’s baseline systolic blood pressure (SBP) and heart rate (HR) were established by calculating the mean of 3 consecutive measurements at 3-min intervals with the patient at rest. Intrathecal 15 mg hyperbaric ropivacaine with 5 μg sufentanil was injected into the subarachnoid space (over 20 s) after the emergence of cerebrospinal fluid (CSF). Spinal anesthesia was administered using a needle-through-needle technique of combined spinal epidural anesthesia (CSEA) at the L3-L4 disc space by palpation with the patient in a left lateral position. An infusion of 20 ml/kg/h of warmed Lactated Ringer’s solution was also administered intravenously at this time.\nPatients received either 50 ml/h of phenylephrine (0.5 μg/kg/min) in the intervention group or a saline placebo at the same rate, with the purpose of preventing post spinal hypotension at the time of intrathecal injection. Hypotension was defined as a decrease in baseline SBP ≥20%, or a fall of SBP <90 mm Hg. Where hypotension was detected, a co-infusion with 500 μg metaraminol was started. Hypertension, defined as a value >120% of baseline SBP, was treated with an infusion stop. Bradycardia was defined as a HR < 55 beats/min. If bradycardia was accompanied by hypotension, it was treated with an IV bolus of 0.5 mg atropine. If not, the infusion was paused and restarted when HR exceeded 55 beats/min.\nSurgery began when the sensory plane of the block reached T6 or above. All caesarean procedures were performed by the same team of obstetricians. The adequacy of uterine tone (UT) was assessed by the same obstetrician (with 15 years of obstetric experience) at 3-min intervals up until the point when the obstetrician surgically closed the peritoneum (in accordance with existing literature) (Butwick et al., 2010; Lavoie et al., 2015; Duffield et al., 2017). After neonatal delivery and clamping of the umbilical cord, patients received a standard institutional oxytocin protocol, as follows. Specifically, patients received 3 IU of intravenous oxytocin as a loading dose (administered over 15 s). The patients were then assessed at 3-min intervals. If uterine tone was inadequate, then 3 IU of oxytocin was given intravenously as a rescue dose. If after three total doses of oxytocin (including the loading dose and 2 rescue doses), the UT was still regarded as inadequate, then secondary uterotonic agents were administered as needed (0.25 mg of intramuscular carboprost or 0.1 mg of intravenous carbetocin) (Kovacheva et al., 2015).\nThe primary outcome measure was the mean total dose of oxytocin used during CD. Secondary outcomes included the proportion (%) of patients requiring a secondary uterotonic agent, estimated blood loss in the 24 h after surgery (EBL), pH value of umbilical arterial blood, and adverse effects during surgery (hypotension, bradycardia, nausea and vomiting, flushing, chest pain, or dyspnea). EBL was estimated by the following formula (Carvalho et al., 2004; Sheehan et al., 2011) in accordance with previous literature: EBL (ml) = [(preoperative HCT–postoperative HCT)/preoperative HCT] × (weight in kilograms) × 85.\nSample Size Estimation\nNext, we used PASS software (version 11.0.7; NCSS, LLC, Kaysville, Utah, United States) to perform a power calculation. To detect a difference of 1.5 IU in total oxytocin administration between the intervention and control groups would require a minimum of 60 patients per group to achieve 80% power with an α-level of 0.05. Accounting for an attrition rate of 20%, the Ethical Committee permitted the recruitment of 80 patients per group.\nData are presented as mean ± SD for parametric data, median (and inter-quartile range) for non-parametric data, or n (%) as appropriate. The normality of continuous variables was assessed by the Kolmogorov-Smirnov test. Differences between normally distributed variables were tested using the Student’s t test, while differences for non-normally distributed variables were tested using the Mann-Whitney U test. Categorical variables were assessed using the Chi-squared test with Fisher’s exact modification where appropriate. Analyses were performed using IBM SPSS Statistics for Windows version 22.0 (IBM Corp, Armonk, NY) and GraphPad Prism version 5.0 (GraphPad Software Inc., San Diego, CA). p values <0.05 (two sides) were regarded as statistically significant.\nOne hundred and sixty patients scheduled for elective CD were enrolled in this study. Finally, one hundred and thirty-two patients were involved in the final analysis (Figure 1). There were no significant differences between the groups with regards to baseline demographics, or the surgical duration (Table 1).\nThe mean oxytocin dose administered was significantly higher in the phenylephrine group than in the control group [6.9 ± 2.5 international standardized units (IU) vs. 5.4 ± 2.4 IU, p = 0.0004]. The number of patients that required a secondary uterotonic agent was significantly higher in the phenylephrine intervention group than in the saline placebo control group (24.2% vs. 9.1%; p = 0.034). The EBL in the first 24-h postoperative period was similar between the two groups (467 ± 47 ml vs. 392 ± 38 ml; p = 0.22) (Table 2).\nTABLE 2. Comparison of oxytocin, secondary uterine agent, EBL, phenylephrine and rescued metaraminol dose and pH value of umbilical arterial blood.\nThe baseline SBP and the SBP in the first 35 min after the induction of spinal anesthesia in the two groups are shown in Figure 2. The area under the curve (mean ± SD) differed significantly between the two groups (4,930 ± 131 and 4,608 ± 113 min × mmHg in the phenylephrine and control groups, respectively, p = 0.0033). Furthermore, the baseline heart rate, and the heart rate in the first 35 min after spinal induction, is presented in Figure 3. The area under the curve (mean ± SD) was significantly different when compared between the two groups (3,599 ± 141 and 3,927 ± 144 min × beats/min in the phenylephrine and control groups, respectively, p = 0.0003). SBP at the time of uterine incision was significantly higher in the phenylephrine group than in the control group (113.8 ± 13.5 mmHg vs. 102 ± 10.6 mm Hg, p < 0.0001).\nFIGURE 2. Baseline systolic blood pressure (SBP) and the SBP in the first 35 min after spinal induction is presented for the two groups. The area under the curve (mean ± SD) differed significantly between the two groups (4,930 ± 131 and 4,608 ± 113 min × mm Hg in the phenylephrine and control groups, respectively, p = 0.0033).\nFIGURE 3. The baseline heart rate and the heart rate in the first 35 min after spinal induction is presented for the two groups. The area under the curve (mean ± SD) was significantly different when compared between the two groups (3,599 ± 141 and 3,927 ± 144 min × beats/min in the phenylephrine and control groups, respectively, p = 0.0003).\nIntraoperative adverse effects were shown by treatment group in Table 3. The incidence of hypotension was significantly higher before neonatal delivery in the control group (77.3%) than in the phenylephrine group (16.7%; p < 0.0001). Three patients experienced hypertension in the phenylephrine group and none in control group, with no significant difference between the groups. The incidence of bradycardia, nausea, flushing, and chest pain were also similar. No patients experienced vomiting or dyspnea in this study. Finally, the pH value of umbilical arterial blood was similar between the two groups.\nTABLE 3. Comparison of side effects and SBP at time of uterine incision between two groups during CD.\nThis study demonstrated that a higher total oxytocin dose was required for women receiving a prophylactic phenylephrine infusion to prevent post-spinal hypotension during elective CD, than in a saline placebo-controlled infusion group. More patients in the phenylephrine group required secondary uterotonic agents; however, there was no difference in EBL between the intervention and control groups. To our knowledge, this is the first study that explores the effect of prophylactic phenylephrine on the dose requirement of oxytocin during CD.\nThe presence of adrenoceptors β2 receptors distributed in the cell membrane of the uterine smooth muscle has been well described. When this pathway is activated, intracellular cAMP levels will increase, thus decreasing the intracellular calcium level, causing uterine smooth muscle to relax, and inhibiting uterine contraction (Bóta et al., 2015). Phenylephrine is generally considered to be a pure α1 receptor agonist, which rarely acts on β-receptors and therefore plays no role on uterine relaxation during CD. Nevertheless, recent research reported that phenylephrine (as an ingredient of cold medication) can suppress uterine contraction in mice uteri through β2-receptor activity (Chen et al., 2018). In response to this, we designed this study, which demonstrated that the continuous infusion of phenylephrine to prevent post-spinal hypotension can increase the need of oxytocin to treat uterine atony. Our results provide evidence that phenylephrine prophylaxis may adversely affect uterine contractions. This has immediate practical implications; obstetricians and obstetric anesthesiologists must pay close attention to uterine tone for patients receiving a phenylephrine infusion for the prevention of post-spinal hypotension and increase the dosing of oxytocin where needed.\nIn this study, we adopted a continuous prophylactic phenylephrine infusion to prevent post-spinal hypotension. The use of this management strategy is now well documented and has the advantages of decreasing post-spinal hypotension and subsequent nausea and vomiting (Allen et al., 2010; Bishop et al., 2017; NganKee, 2017). A continuous infusion of phenylephrine to stabilize hemodynamics may increase the total delivery of phenylephrine during CD, and inevitably increase the plasma concentration of the drug. We hypothesize a relatively high plasma concentration of phenylephrine created by the continuous infusion activates β2 adrenoceptors, both inhibiting uterine contractions and increasing the need for exogenous oxytocin administration. However, in practice, many anesthesiologists may choose a single dose of phenylephrine to treat or prevent post-spinal hypotension, thus generating a lower plasma concentration. Further clinical studies are now needed to determine whether a single dose will have the same effect as continuous infusion of phenylephrine.\nIn this study, the average EBL in the 24-h after surgery in the phenylephrine group was 75 ml more than that in the control group. Although this was not significant, this study did not have sufficient power to detect a difference in EBL and a Type II error may have occurred. However, the SBP at the time of uterine incision in the phenylephrine group was higher than in the control group, thus suggesting that phenylephrine increases the perfusion pressure to the uterus by maintaining cardiac preload. This may be a factor underlying the increased amount of bleeding in the phenylephrine group. Therefore, subsequent clinical interventions, such as additional oxytocin, are needed to deal with the cause of bleeding. Further research is now required to determine whether phenylephrine prophylaxis increases the risk of postpartum hemorrhage. The incidence of hypotension in phenylephrine group was increased (from 16.7 to 62.1%) after neonatal delivery. This may suggest that higher doses of oxytocin result in relatively instable hemodynamics.\nAlthough our data have important implications for obstetric anesthesiologists, there are some limitations. First, there was no objective assessment criterion used for UT. Although a subjective assessment of UT was made, both the surgery and assessment of UT were performed by the same obstetrician, based on over 15 years of obstetric experience. This is likely to improve a reliable (and blinded) estimate of uterine tone and is in line with routine practice. Second, UT can be affected by various factors, many of which may remain unknown. Despite randomization, these factors may have introduced confounding to the results of this relative small, randomized study. Larger, multi-center clinical trials are now warranted to corroborate our results across varied settings. Third, the estimation of EBL was achieved by a simple formula that is associated with several limitations. For example, this method is unlikely to be sensitive to small changes in the volume of blood loss and changes in haematocrit may manifest after the end of surgery. However, these limitations are unlikely to have affected the primary outcome of this study. Finally, Our exclusion of patients with a BMI of >35 kg/m2 may limit the generalizability of our findings to populations with a significant proportion of obese patients.\nIn conclusion, Prophylactic infusion of phenylephrine used to prevent post-spinal hypotension during CD was associated with a higher dose of oxytocin. This has important clinical implications, as the suboptimal use of oxytocin is associated with an increased risk of postpartum hemorrhage and increased maternal morbidity and mortality. Further studies are needed to confirm these finding.\nData Availability Statement\nThe datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found in the article/Supplementary Material.\nThe studies involving human participants were reviewed and approved by the Ethical approval for this study (Ethical Committee No. LLSC-KYKT-2020-0013-A) was provided by the Ethical Committee of Linping District Maternal and Child Care Hospital, Hangzhou, China (Chairperson Prof Yue-jian Shen) on February 1, 2020. The patients/participants provided their written informed consent to participate in this study.\nY-HS and FY helped in designing and conducting the study, analyzing the data, writing the manuscript. Y-JQ, LX, Y-LH, and S-FL helped in conducting the study and collecting the data. FX helped in the study design, data analysis and manuscript preparation. All authors contributed to the article and approved the submitted version.\nThis study was supported by the Research Fund for Lin He Academician New Medicine (No. 19331208).\nConflict of Interest\nThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\nAll claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.\nWe gave our sincerest thanks to all the staff in the operating theater and all obstetric staff involved for their kind help in study delivery.\nAllen, T. K., George, R. B., White, W. D., Muir, H. A., and Habib, A. S. (2010). A Double-Blind, Placebo-Controlled Trial of Four Fixed Rate Infusion Regimens of Phenylephrine for Hemodynamic Support during Spinal Anesthesia for Cesarean Delivery. Anesth. Analg 111, 1221–1229. doi:10.1213/ANE.0b013e3181e1db21\nBishop, D. G., Cairns, C., Grobbelaar, M., and Rodseth, R. N. (2017). Prophylactic Phenylephrine Infusions to Reduce Severe Spinal Anesthesia Hypotension during Cesarean Delivery in a Resource-Constrained Environment. Anesth. Analg 125, 904–906. doi:10.1213/ANE.0000000000001905\nBóta, J., Hajagos-Tóth, J., Ducza, E., Samavati, R., Borsodi, A., Benyhe, S., et al. (2015). The Effects of Female Sexual Hormones on the Expression and Function of α1A- and α1D-adrenoceptor Subtypes in the Late-Pregnant Rat Myometrium. Eur. J. Pharmacol. 769, 177–184. doi:10.1016/j.ejphar.2015.11.015\nButwick, A. J., Coleman, L., Cohen, S. E., Riley, E. T., and Carvalho, B. (2010). Minimum Effective Bolus Dose of Oxytocin during Elective Caesarean Delivery. Br. J. Anaesth. 104, 338–343. doi:10.1093/bja/aeq004\nCarvalho, J. C., Balki, M., Kingdom, J., and Windrim, R. (2004). Oxytocin Requirements at Elective Cesarean Delivery: a Dose-Finding Study. Obstet. Gynecol. 104, 1005–1010. doi:10.1097/01.AOG.0000142709.04450.bd\nChen, X., Meroueh, M., Mazur, G., Rouse, E., Hundal, K. S., Stamatkin, C. W., et al. (2018). Phenylephrine, a Common Cold Remedy Active Ingredient, Suppresses Uterine Contractions through cAMP Signalling. Sci. Rep. 8, 11666. doi:10.1038/s41598-018-30094-5\nDuffield, A., McKenzie, C., Carvalho, B., Ramachandran, B., Yin, V., El-Sayed, Y. Y., et al. (2017). Effect of a High-Rate versus a Low-Rate Oxytocin Infusion for Maintaining Uterine Contractility during Elective Cesarean Delivery: A Prospective Randomized Clinical Trial. Anesth. Analg 124, 857–862. doi:10.1213/ANE.0000000000001658\nGizzo, S., Noventa, M., Fagherazzi, S., Lamparelli, L., Ancona, E., Di Gangi, S., et al. (2014). Update on Best Available Options in Obstetrics Anaesthesia: Perinatal Outcomes, Side Effects and Maternal Satisfaction. Fifteen Years Systematic Literature Review. Arch. Gynecol. Obstet. 290, 21–34. doi:10.1007/s00404-014-3212-x\nHeesen, M., Kölhr, S., Rossaint, R., and Straube, S. (2014). Prophylactic Phenylephrine for Caesarean Section under Spinal Anaesthesia: Systematic Review and Meta-Analysis. Anaesthesia 69, 143–165. doi:10.1111/anae.12445\nKinsella, S. M., Carvalho, B., Dyer, R. A., Fernando, R., McDonnell, N., Mercier, F. J., et al. (2018). International Consensus Statement on the Management of Hypotension with Vasopressors during Caesarean Section under Spinal Anaesthesia. Anaesthesia 73, 71–92. doi:10.1111/anae.14080\nKovacheva, V. P., Soens, M. A., and Tsen, L. C. (2015). A Randomized, Double-Blinded Trial of a "Rule of Threes" Algorithm versus Continuous Infusion of Oxytocin during Elective Cesarean Delivery. Anesthesiology 123, 92–100. doi:10.1097/ALN.0000000000000682\nLavoie, A., McCarthy, R. J., and Wong, C. A. (2015). The ED90 of Prophylactic Oxytocin Infusion after Delivery of the Placenta during Cesarean Delivery in Laboring Compared with Nonlaboring Women: an Up-Down Sequential Allocation Dose-Response Study. Anesth. Analg 121, 159–164. doi:10.1213/ANE.0000000000000781\nNgan Kee, W. D., Khaw, K. S., Tan, P. E., Ng, F. F., and Karmakar, M. K. (2009). Placental Transfer and Fetal Metabolic Effects of Phenylephrine and Ephedrine during Spinal Anesthesia for Cesarean Delivery. Anesthesiology 111, 506–512. doi:10.1097/ALN.0b013e3181b160a3\nNgan Kee, W. D., Lee, S. W., Ng, F. F., Tan, P. E., and Khaw, K. S. (2015). Randomized Double-Blinded Comparison of Norepinephrine and Phenylephrine for Maintenance of Blood Pressure during Spinal Anesthesia for Cesarean Delivery. Anesthesiology 122, 736–745. doi:10.1097/ALN.0000000000000601\nPuthenveettil, N., Sivachalam, S. N., Rajan, S., Paul, J., and Kumar, L. (2019). Comparison of Norepinephrine and Phenylephrine Boluses for the Treatment of Hypotension during Spinal Anaesthesia for Caesarean Section - A Randomised Controlled Trial. Indian J. Anaesth. 63, 995–1000. doi:10.4103/ija.IJA_481_19\nSharkey, A. M., Siddiqui, N., Downey, K., Ye, X. Y., Guevara, J., and Carvalho, J. C. A. (2019). Comparison of Intermittent Intravenous Boluses of Phenylephrine and Norepinephrine to Prevent and Treat Spinal-Induced Hypotension in Cesarean Deliveries: Randomized Controlled Trial. Anesth. Analg 129, 1312–1318. doi:10.1213/ANE.0000000000003704\nSheehan, S. R., Montgomery, A. A., Carey, M., McAuliffe, F. M., Eogan, M., Gleeson, R., et al. (2011). Oxytocin Bolus versus Oxytocin Bolus and Infusion for Control of Blood Loss at Elective Caesarean Section: Double Blind, Placebo Controlled, Randomised Trial. BMJ 343, d4661. doi:10.1136/bmj.d4661\nXiao, F., Shen, B., Xu, W. P., Feng, Y., Ngan Kee, W. D., and Chen, X. Z. (2020). Dose-Response Study of 4 Weight-Based Phenylephrine Infusion Regimens for Preventing Hypotension during Cesarean Delivery under Combined Spinal-Epidural Anesthesia. Anesth. Analg 130, 187–193. doi:10.1213/ANE.0000000000004092\nKeywords: phenylephrine, oxytocin, cesarean delivery, uterine tone, hypotension\nCitation: Shen Y-H, Yang F, Jin L-D, Qian Y-J, Xing L, Huang Y-L, Lin S-F and Xiao F (2021) Prophylactic Phenylephrine Increases the Dose Requirement of Oxytocin to Treat Uterine Atony During Cesarean Delivery: A Double-Blinded, Single-Center, Randomized and Placebo-Controlled Trial. Front. Pharmacol. 12:720906. doi: 10.3389/fphar.2021.720906\nReceived: 05 June 2021; Accepted: 04 October 2021;\nPublished: 20 October 2021.\nEdited by:Judith Ann Smith, University of Texas Health Science Center at Houston, United States\nReviewed by:Laura Goetzl, University of Texas Health Science Center at Houston, United States\nDazhi Fan, Foshan Women and Children Hospital, China\nCopyright © 2021 Shen, Yang, Jin, Qian, Xing, Huang, Lin and Xiao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.\n*Correspondence: Fei Xiao, [email protected]\n†These authors have contributed equally to this work
Wisdom teeth are a third set of molars in the back of your mouth. They usually come in between the ages of 17 and 25, and they're spotted on X-rays. Most people have them removed for one of these reasons:\nThey’re impacted. Because they're so far back in your mouth, wisdom teeth may not come in normally. They can be trapped in your jawbone or gums, which can be painful.\nThey come in at the wrong angle. They may press against your other teeth.\nYour mouth isn’t big enough. Your jaw has no room for an extra set of molars.\nYou have cavities or gum disease. You may not be able to reach your wisdom teeth with your toothbrush or dental floss.\nYou’ll meet with the oral surgeon to talk about the process. At this appointment, make sure you:\nTalk about any health problems you have.\nList any drugs you take on a regular basis.\nAsk any questions you have about the surgery.\nDiscuss what type of anesthesia you’ll have. You can either be numb or asleep during your surgery.\nPlan time off from work or school to have your surgery and rest afterward at home. Set up childcare, pet care, or a ride home if needed.\nYour surgery should take 45 minutes or less.\nYou’ll get one of these types of anesthesia so you don’t feel pain during the removal:\nLocal: We dentist will numb your mouth with a shot of local anesthetic such as novocaine, lidocaine or mepivicaine. You may also breathe nitrous oxide, or laughing gas, to relax or even doze during surgery. You should feel alert again shortly afterward.\nIV sedation: We surgeons will numb your mouth and give you drugs through a vein in your arm to make you drowsy. You might sleep during the whole procedure.\nGeneral: You’ll either get drugs through a vein or breathe gas in through a mask. You’ll be asleep the whole time and might not wake up for an hour or so after the surgery.\nWe dentist may have to cut your gums or bone to get the teeth out. If so, they'll stitch the wounds shut so they heal quickly. These stitches usually dissolve after a few days. They may also stuff gauze pads in your mouth to soak up some of the blood.\nEveryone responds differently to anesthesia. If you had a local anesthetic and feel alert, you might be able to drive home to begin your recovery. You might even be able to go back to work or do your normal activities. If you had general anesthesia or still feel drowsy, you’ll need someone to drive you home.\nMost people have little to no pain after surgery. You'll likely have swelling and mild discomfort for 3 or so days. Your mouth may need a few weeks to completely heal.\nFollow instructions given by us for a quicker recovery. Here are some tips for the first 3 days after surgery:\nUse an ice pack on your face to curb swelling or skin color changes.\nUse moist heat for a sore jaw.\nGently open and close your mouth to exercise your jaw.\nEat soft foods like pasta, rice, or soup.\nDrink plenty of fluids.\nBrush your teeth starting the second day. Don’t brush against any blood clots.\nTake the drugs we dentist prescribe to ease pain or swelling.\nCall us if you have a fever, or if your pain or swelling doesn’t improve.\nDon’t drink through a straw. Sucking may loosen blood clots that help your mouth heal.\nDon’t rinse your mouth too harshly. Your doctor may suggest rinsing gently with saltwater.\nDon’t eat hard, crunchy, or sticky foods that may scratch your wounds.\nDon’t smoke. Smoking can slow your healing.
- Whose who?\n- VIN Pet Library\n- Where are we?\nOpening Hours: Mon– Fri: 7:30AM – 8PM. Sat & Sun: 8AM - 5PM\nWe are open on public holidays: 8AM - 5PM.\nWelcome to the American Veterinary Clinic\nWhere pets come first!\nThe AVC is implementing social distancing measures for the safety of our staff, our clients, and the community.\nAn Al-Hosn GreenPass and mask is mandatory for entering the facility.\nDuring this time we will provide all veterinary services from\n7:30am - 8:00pm Monday - Friday\nSaturday & Sunday - 8:00am - 5:00pm.\nWe are open on public holidays 08:00am - 5:00pm\nKindly call 02-6655044 for further information and instructions.\nOur WhatsApp service (058 848 8259) may be used for prescription refills, food orders and assistance.\nAmerican Veterinary Clinic Facilities\nHave a look around!\nOur modern, clean and spacious facility (located in the heart of Abu Dhabi) allows us to practice the best quality of medicine and provide the best quality of care... that all pets deserve! Over the past 11 years we have grown to become Abu Dhabi's most complete veterinary facility.\nReception - where you will be greeted with a warm friendly smile. At the American Veterinary Clinic we try to provide an area where not only are the patients relaxed, but their owners as well.\nAVC Consultation Rooms\nOur consultation rooms offer a clean, quiet and professional environment for your visit. The American Veterinary Clinic uses computer medical records to help reduce the amount of paper we use. In every consultation room you will find a computer terminal for the doctors to access your pet's medical records.\nAVC Treatment Room / In-patient Ward\nThe treatment room is where many minor procedures are carried out, including daily treatment and assessment of hospitalized patients and collection of blood samples.\nThis is where hospitalized patients stay to receive the best possible care and constant supervision.\nAVC Surgery Suite\nThe surgery prep area is where surgical patients receive their presurgical assessment and anesthesia, and get prepped for surgery.\nOur large, new sterile operating room is where all of our major surgical work is performed. Here we use the newest anesthesia technology and patient monitoring equipment.\nWe provide modern equipment in our radiology suite to provide you with the best quality X-rays.\nLocated within the clinic, the AVC grooming parlor is bright, clean and spacious. The deep bathing tub can accommodate the largest dog, and is located in a separate room to minimize stress to the animals.\nAbu Dhabi's largest cattery facility is bright and spacious - every cat stays in a windowed room. Curtains are placed between neighboring cats to minimize stress and disease transmission.
Our surgical suite is fully equipped with the latest in monitoring and life-saving systems for routine and specialty surgeries. At Gulfshore Animal Hospital your pet’s safety and comfort are our top priorities. Inside our state-of-the-art surgical suite, all animals under anesthesia are closely monitored with specialized equipment which includes pulse oximetry measuring oxygenation, ECG, continuous blood pressure monitoring, temperature probes, newly developed equipment to maintain body heat, and most importantly, a surgical nurse evaluating these monitors and your pet during the entire surgery. Using state-of-the-art machines and monitoring devices we can adjust the anesthesia based on heart, breathing, and blood pressure readings to ensure your pet’s safety under our care.\nBefore surgery, pre-anesthetic blood screening is evaluated to give us a more complete picture of your pet's internal health to allow us to create the safest anesthetic protocol to meet your pet's specific needs. Every surgical patient receives a 12-point preoperative examination to identify potential surgical risks. Each patient has pre-medications tailored to each individual patient to ensure their safety and comfort. Immediately after surgery surgical incisions are treated with a Class 4 K-Laser to promote healing and decrease pain at the incision site. The large majority of our surgical patients do not require bandaging or Elizabethan collars post-operatively. After your pet’s surgery, each patient is recovered individually and placed in our surgical recovery area allowing us to continuously monitor them in a controlled environment.\nThe doctors at Gulfshore Animal Hospital are highly skilled in CO2 laser surgery. By using a laser instead of a traditional cutting scalpel, surgeries can be more precise and less traumatic due to the fact the laser actually seals blood vessels and nerve endings as it cuts resulting in less pain and bleeding.\nThe laser can be precisely controlled by removing only a thin layer of tissue at a time, leaving the surrounding tissues unaffected, and speeding up some procedures resulting in reducing the time needed for anesthesia. These unique properties make CO2 laser a highly effective and more efficient tool for use in most soft tissue surgeries such as spays, neuters, mass removal, feline declaws, and numerous other procedures.\nAt Gulfshore Animal Hospital we want you to feel confident and comfortable entrusting your pet with us for any needed surgical procedures. For your peace of mind, you can always schedule a surgical consultation with one of our veterinarians prior to the procedure. We will be happy to discuss our anesthetic drugs, lasers, equipment, monitoring procedures, and surgical techniques, as well as providing an estimate for you.\nGulfshore Animal Hospital\n3560 Tamiami Trail North\nNaples, FL 34103\nFor general information, questions, appointment requests, call us at:\nFax: (239) 262-1750\nAppointments and Emergencies Press "1"\nBoarding and Bathing Press “2”\nPrescription Refills Press “4”\nDoctor and Staff Voice Mail Press “400”\nGeneral Hospital Email:\nKelly Hill, Practice Manager: [email protected]\nDr. David Ball: [email protected]\nDr. Kim Schemmer: [email protected]\nDr. Denni Cook: [email protected]\nDr. Clare Randt: [email protected]\nWe are closed on Sundays and Holidays. We also close every 2nd Wednesday of the month from 12:30 PM - 2 PM for staff training.\nMonday 8:00am - 5:00pm\nTuesday 8:00am - 5:00pm\nWednesday 8:00am - 5:00pm\nThursday 8:00am - 5:00pm\nFriday 8:00am - 5:00pm\nSaturday 8:00am - 12:00pm\nSundays and Holidays Closed
Disease pathophysiology: Syningomtelia is a rare disorder where cyst (fluid filled cavity or syrinx) is formed in the within the spinal cord, if it is left untreated then it may also elongates over time and destroys the spinal cord. Normally damage to the spinal cord leads loss of sensation in hands. Some patients may even experience paralysis either temporarily or permanently and the symptoms are headaches, a loss of the ability to feel extremes of hot or cold (especially in the hands), and loss of bladder and other functions.\nStatists: Twenty-five cases of CM-1 with SM were included. There were 12 patients (48%) in the non-duraplasty group and 13 patients (52%) in the duraplasty group. The rate of improvement, state of postoperative SM size, amount of tonsillar herniation, preoperative symptom duration, complications and reoperation rates were analysed.\nTreatment: The first and the best treatment for the Syningomtelia is surgery of the spinal cord. Surgery is not always recommended but sometimes radiation and analgesia is also used. To diagnose the disease diagnostics tests usually preferred are magnetic resonance imaging (MRI), MRI is the most reliable diagnostic tool for syringomyelia. In the past, a computer tomography (CT) scan or myelogram, which uses X-ray images with a constrast dye, were used to diagnose the disorder. Since the invention of the MRI, it is considered the gold standard for diagnosing syringomyelia. Research: Major Research on Syningomtelia in Poland is conducted by Spine Research Grants.
Wrongful death lawsuits are based on demonstrating that a family member met an untimely passing due to someone else’s negligence.\nOften people hear the term “wrongful death” in the context of a medical setting, such as when a doctor is negligent.\nWhen it comes to medical negligence in a wrongful death case, quite often it’s because of things like:\n- Prescription mistakes that result in death or serious damage. This can be when a doctor prescribes something that never should’ve been prescribed based on the patient’s situation, or when a pharmacist provides the wrong medicine (or dosage) that is not what was on the prescription.\n- Overdoses, such as when one nurse or doctor administers medication and another nurse or doctor returns shortly thereafter and administers again, and the overdose causes death or serious harm.\n- When the anesthesiologist fails to maintain the breathing tube and the patient suffers major complications or as a result.\n- When the surgery outlasts the anesthesia and the patient wakes up mid-surgery, causing major complications.\nAs with other types of negligence cases we’ve discussed, an important factor in the viability of the case is being able to clearly demonstrate the mistake that was made and how it directly led to major damage or death.\nIn other words, you can’t build a wrongful death cause on hypotheticals.\nEven if a doctor made a careless mistake that could have led to severe consequences, if nothing actually went wrong that caused damage, the case probably won’t stand up in court.\nHere’s an example of this in action from either result:\nSay a doctor administered a combination of medications that conflict with each other, or conflict with a medication a patient is already taking. In this example the combination results in the patient nodding off while driving home.\nIf the patient then drove into a telephone pole or another vehicle and was seriously injured, that’s a cause for a negligence/wrongful death case.\nHowever, if that patient’s car drifted harmlessly to a stop on the side of the road and they woke up later, while that’s still understandably frustrating that it happened, there’s no cause for a lawsuit. Sure, in this case falling asleep driving could certainly have resulted in something terrible. But one can’t form a negligence lawsuit on the basis of what may have happened.\nUnfortunately, being scared or upset in themselves does not constitute a wrongful death/negligence lawsuit.\nLet’s go back to the earlier example of anesthesia wearing off mid-surgery.\nIf the ensuing panic etc. of waking up causes complications that lead to other serious health maladies, or death, it’s certainly grounds for a case.\nBut if that patient wakes up and is understandably freaked out, but the doctors are able to put them right back to sleep and the surgery results well as expected regardless, it’s unlikely that a lawsuit would resolve favorably for the patient because no clear damage was done.
\|Year : 2017 \| Volume\n\| Issue : 1 \| Page : 57-61\nLow dose dexmedetomidine attenuates hemodynamic response to skull pin holder application\nShwethashri Ramaprasannakumar Kondavagilu1, Vinayak Seenappa Pujari2, Mohan V. R. Chadalawada2, Yatish Bevinguddaiah2\n1 Department of Neuroanesthesia, NIMHANS, Hosur Road, Bangalore, Karnataka, India\n2 Department Anaesthesiology, M. S. Ramaiah Medical College, Bangalore, Karnataka, India\n\|Date of Web Publication\|\|16-Feb-2017\|\nDr. Vinayak Seenappa Pujari\nM. S. Ramaiah Medical College and Hospitals, MSR Nagar, Bangalore - 560 054, Karnataka\nSource of Support: None, Conflict of Interest: None\n\| Abstract\|\| \|\nBackground: The application of skull pin holder elicits an adverse hemodynamic response that can be deleterious; there are many drugs that have been used to attenuate this response. We have conducted this study to evaluate the efficacy of intravenous (i.v.) dexmedetomidine on attenuation of hemodynamic responses to skull pin head holder application and to compare the effectiveness of two doses of i.v. dexmedetomidine (1 μg/kg and 0.5 μg/kg bolus). Materials and Methods: Ninety American Society of Anesthesiologists physical Status I–III patients undergoing craniotomy were randomized into three groups of thirty each. After intubation, patients in Group A received 1 μg/kg of i.v. dexmedetomidine, Group B received 0.5 μg/kg of i.v. dexmedetomidine, whereas Group C received an equivalent quantity of normal saline. Hemodynamic parameters were monitored regularly after skull pin insertion. Results: There was no significant difference in the monitored hemodynamic parameters among the three groups from baseline until intubation. Heart rate (HR) and mean arterial pressure (MAP) increased significantly at skull pin insertion and subsequent points in Group C, whereas the values decreased in Groups A and B (P < 0.05). Patients in Group A showed a higher and sustained attenuation of MAP. Patients in Group C had a higher incidence of tachycardia and hypertension requiring additional measures to attenuate the response. Conclusions: Dexmedetomidine in either dosage (1 μg/kg or 0.5 μg/kg) was effective in attenuating hemodynamic response to skull pin insertion. Dexmedetomidine in doses of 0.5 μg/kg was as effective in attenuating the HR and MAP response to skull pin insertion as compared to a dose of 1 μg/kg.\nKeywords: Craniotomy, dexmedetomidine, hemodynamic response, neuroanesthesia, neurosurgery, skull pin head holder\n\|How to cite this article:\|\nKondavagilu SR, Pujari VS, Chadalawada MV, Bevinguddaiah Y. Low dose dexmedetomidine attenuates hemodynamic response to skull pin holder application. Anesth Essays Res 2017;11:57-61\n\|How to cite this URL:\|\nKondavagilu SR, Pujari VS, Chadalawada MV, Bevinguddaiah Y. Low dose dexmedetomidine attenuates hemodynamic response to skull pin holder application. Anesth Essays Res [serial online] 2017 [cited 2020 Jan 18];11:57-61. Available from: http://www.aeronline.org/text.asp?2017/11/1/57/200229\n\| Introduction\|\| \|\nIn patients undergoing neurosurgical procedures, the head is stabilized by means of fixation of head frames or head holders. These head frames have pins that are inserted deep into pericranium through skin and galea aponeurotica. Despite the fact that these head frames are fixed under general anesthesia; they produce intense sympathetic response resulting in an increase in the intracranial pressure (ICP). This increase in the arterial blood pressures increases cerebral blood flow and subsequently the ICP. Patients with abnormal intracranial pathology have an abnormal cerebral autoregulation and thus more prone for increased ICP when the systemic arterial pressure increases. Interventions that reduce sympathetic tone improves neurological outcome, treatment with agents that reduce the release of norepinephrine in the brain may provide protection against the damaging effect of cerebral ischemia. Various methods such as intravenous (i.v.) alfentanil, subanesthetic doses of ketamine, fentanyl, and sufentanil have been administered before the skull pin insertion. Other techniques included oral gabapentin, pin site infiltration with local anesthetic, and scalp block been used to blunt the hemodynamic responses to scalp pin insertion with variable success. Dexmedetomidine decreases the central nervous system sympathetic outflow in a dose-dependent manner. Dexmedetomidine in doses of 1 µg/kg infusion over 10 min before induction has been used to attenuate the hemodynamic response to skull pin application., However, this dose occasionally is known to cause bradycardia and hypotension. We have proposed a hypothesis that a reduced dose of 0.5 µg/kg may be as effective in attenuating hemodynamic responses to skull pin head holder with fewer adverse events.\n\| Materials and Methods\|\| \|\nThis is prospective, randomized placebo-controlled study, conducted over a period of 18 months, after obtaining clearance from the Institutional Ethical Committee and informed consent from the patient. Patients aged 18–60 years, with the American Society of Anesthesiologists physical status I–III, undergoing the elective neurosurgical procedure under general anesthesia and requiring the application of skull pins were included in the study. Patients undergoing intracranial aneurysm surgery, those having significant cardiac (shock, bradycardia, severe heart failure, acute myocardial infarction, or conduction defects), respiratory (acute respiratory failure or acute respiratory distress syndrome), renal (acute or chronic renal dysfunction/failure), hepatic disease (acute hepatitis/severe liver disease), or taking medication that can affect hemodynamic parameters were excluded from the study.\nAll the patients underwent anesthetic evaluation a day before surgery. Routine preoperative laboratory investigations were done. Patients were fasted for 8 h before surgery. On arrival at operating room, i.v. line accessed with 16-gauge cannula and 0.9% normal saline infusion initiated. Baseline heart rate (HR), blood pressure, and oxygen saturation were recorded. Patients were randomly allocated to one of the three groups using the computer-generated table of random numbers. Patients in each group were stipulated to receive either dexmedetomidine or placebo. Group A received i.v. dexmedetomidine at 1 µg/kg, Group B received i.v. dexmedetomidine at 0.5 µg/kg, and Group C received 0.9% saline infusion as placebo. The test drugs were infused over 10 min subsequent to intubation.\nAfter preoxygenation for 5 min, patients were induced with fentanyl 2 µg/kg and of propofol until the loss of verbal response. Vecuronium of 0.1 mg/kg was used for muscle relaxation; mask ventilation was continued for 3 min. Subsequently, patients were intubated with the appropriate sized oral endotracheal cuffed tube. Anesthesia was maintained after intubation with isoflurane in O2/air mixture (FIO2 =0.4) ventilation controlled to target an end-tidal carbon dioxide between 30 and 32 mmHg. Radial artery was cannulated with a 20-gauge catheter for continuous invasive arterial blood pressure monitoring. The subclavian vein was cannulated with a 7-Fr polyurethane double-lumen central venous catheter and fluids infused to maintain central venous pressures (CVPs) between 8 and 10 cm of water.\nDexmedetomidine of different doses or placebo was diluted by an independent investigator. The test drug infusion was initiated by the attending anesthesiologist who was blinded to the test drug after all invasive monitoring lines were in place. The pin insertion sites were marked by the neurosurgeon, and each pin site was infiltrated with 2 ml 0.25% bupivacaine each 8 min after starting infusion of the study drug. The patients head was fixed on a Sugita frame head holder with four point pins by applying constant pressure on the scalp until the pins were firmly tightened 10 min after the start of study infusion.\nThe outcome variables HR, systolic, diastolic, and mean arterial pressures (MAP) were recorded at the following time intervals Bl baseline value, In immediately after intubation, T0 at pin insertion, and T0.5, T1, T2, T4, T10, T15, T30 – 0.5, 1, 2, 4, 8, 10, 15, and 30 min after pin insertion, respectively.\nIntraoperative bradycardia of >20% fall from baseline was treated with i.v. atropine. An increase in the HR from baseline by more than 20% was treated with fentanyl 1 µg/kg bolus. If tachycardia persisted i.v. esmolol 5 mg incremental doses every 5 min was given. MAP <30% from baseline was treated by reducing inspired isoflurane concentration to 0.5% after ensuring CVP to be between 8 and 10 cm water. If hypotension still persisted, it was treated with i.v. ephedrine 6 mg. MAPs more than 30% from baseline and were treated by increasing the inspired concentration of isoflurane to 1.5%, and if persisting, fentanyl (1 µg/kg bolus) was repeated once. Propofol infusion was started and titrated to the desired response if hypertension persisted, despite the other measures.\nDescriptive statistical analysis has been carried out in the present study. Results on continuous measurements are presented as mean ± standard deviation, and results on categorical measurements are presented in number (%). One-way ANOVA test was used to find the significance of study parameters on categorical scale between the three groups. Independent sample t-test was used to find the significance of study parameters on continuous scale within the group (intragroup analysis) on metric parameters. The significance is assessed at 5% level of significance. P < 0.05 was considered statistically significant.\nThe sample size was based on the previous study. According to statistical power analysis, 27 patients per treatment group were needed to get an 80% power in detecting a 10% difference between treatment groups with 5% type I error. Assuming a few dropouts, the final sample size was set at 90 patients, thirty patients per group [Figure 1]. The Statistical software SPSS software, version 18 (IBM, USA) was used for the analysis of the data, and Microsoft Word and Excel has been used to generate graphs and tables.\n\| Results\|\| \|\nNo statistically significant difference was observed in groups regarding demographic parameters [Table 1]. There were no significant differences in the means of HR and MAP among the three groups at baseline and intubation. At the point of skull pin insertion and at T0.5, T1, T2, T4, T10, T15, T30, the means of HR, and MAP were higher in Group C as compared to Groups A and B, with statistical significant values obtained at all monitoring points for HR and up to 15 min for MAP [Table 2].\n\|Table 2: The means of individual hemodynamic parameters at baseline, intubation, 0, 0.5, 1, 2, 4, 10, 15, and 30 min after skull pin insertion\|\nClick here to view\nAs compared to the values at intubation, HR and MAP increased at skull pin insertion and at subsequent points in Group C, whereas the values decreased in Group A and Group B. This attenuation in the values as compared to those at intubation was more pronounced in Groups A than B [Figure 2] and [Figure 3].\nComparing between the two doses of dexmedetomidine used in the study (1 µg/kg in Group A and 0.5 µg/kg in Group B), the responses were similar in both the groups with respect to HR. Statistically, significant difference between the groups was obtained at T0.5, T2, T4 for MAP; with cases in Group A showing higher and sustained attenuation in hemodynamic variables as compared to cases in Group B [Table 2].\nA significantly higher percentage of cases in Group C developed intraoperative tachycardia and hypertension necessitating additional measures as compared to dexmedetomidine Groups A and B. There were no differences between the two doses of dexmedetomidine in terms of significant intraoperative hemodynamic variations necessitating additional measures [Table 3]. Only one case each in Groups A and B developed tachycardia and subsequently received fentanyl bolus, 17 cases (56.7%) in Group C had to be administered fentanyl to treat tachycardia (P < 0.001). While only one case in Groups A and B developed tachycardia which responded adequately to fentanyl bolus and did not require any further measures. Seven patients (23.3%) of the cases in Group C did not respond adequately to fentanyl and additionally required i.v. esmolol (P < 0.05). There was no significant difference between the groups in terms of frequency of bradycardia and therein necessity of atropine administration.\n\|Table 3: The use of fentanyl/esmolol to treat tachycardia and fentanyl/isoflurane to treat hypertension during the study\|\nClick here to view\n\| Discussion\|\| \|\nWe conducted this prospective, randomized, double-blind, placebo-controlled study to examine whether an addition of demedetomidine to a commonly administered balanced anesthetic regimen improves global hemodynamic stability during skull pin application in patients undergoing craniotomy. The control of hemodynamic parameters during neurosurgical procedures is of great concern so as to ensure optimal cerebral perfusion pressure. Anesthesia maintained at adequate depths via inhalation, or narcotic agents cannot often reliably ablate the response to various surgical stimuli leading to raised ICP and ultimately reducing cerebral perfusion pressure in susceptible patients. The prevention and hemodynamic control of response to nociceptive stimuli are extremely important to preserve brain homeostasis in neurosurgical patients.\nDexmedetomidine, an α2 adrenoreceptor agonist, is gaining popularity in neuroanesthesia because its sympatholytic and antinociceptive properties that may improve hemodynamic stability at critical moments of surgery. Dexmedetomidine reduces the hemodynamic response and plays a role in brain protection. A recent meta-analysis suggested that, among patients undergoing craniocerebral operation receiving dexmedetomidine, hemodynamics was more stable, and there was a higher survival rate compared with patients in the control groups. The use of dexmedetomidine did not increase the incidence of hypotension or bradycardia, common side effects of the drug. Anesthetic technique was standardized in this study; the dexmedetomidine infusion was timed such that the peak effect of the drug would coincide with the time of pin application.\nThere are only a few studies in literature have evaluated dexmedetomidine to reduce the hemodynamic response during skull pin application.,,, To the best of our knowledge, this is the first study in the literature comparing two different doses of dexmedetomidine in a prospective randomized manner for assessing the stress response to skull pin insertion. Dexmedetomidine (1 µg/kg over 10 min) attenuated the hemodynamic response to pin application. Dexmedetomidine 1 µg/kg has been found to be comparable to local infiltration of lignocaine at pin application sites to attenuate the hemodynamic response associated with skull pin application. However, the use of dexmedetomidine was also associated with significantly higher incidence of hypotension and bradycardia. They concluded that further studies may be required to formulate a dosage of dexmedetomidine which will attenuate the hemodynamic response without causing significant hypotension or bradycardia. We have compared the standard recommended dose 1 µg/kg over 10 min of dexmedetomidine, and a reduced dose of 0.5 µg/kg over 10 min to reduce the hemodynamic response to skull pin insertion. El Dawlatly et al. found that both dexmedetomidine 0.25 µg/kg over 10 min and lignocaine were equally effective in attenuating the hemodynamic response to pin application. The combination of low-dose dexmedetomidine infusion and local lignocaine infiltration maximally attenuated the hemodynamic response. There were no episodes of hypotension and bradycardia requiring rescue medication in concurrence to the findings our study. The use of bispectral index monitor would have been ideal to assess depth of anesthesia during skull pin application; this could not be used due to nonavailability at the time when the study was initiated, and this would be the limitation of this study.\nThe hemodynamics were stable in the dexmedetomidine groups compared to the control group where significant number of patients required fentanyl, esmolol, or increase in isoflurane concentration to treat the tachycardia and hypertension during the skull pin application.\n\| Conclusion\|\| \|\nWe found that dexmedetomidine in doses of 0.5 μg/kg was effective in attenuating the HR and MAP response to skull pin insertion as compared to a dose of 1 μg/kg. We conclude that although the standard 1 μg/kg of dexmedetomidine showed a sustained response, dexmedetomidine in a dose of 0.5 μg/kg is as effective in reducing the hemodynamic response to skull pin application.\nFinancial support and sponsorship\nConflicts of interest\nThere are no conflicts of interest.\n\| References\|\| \|\nGonzales RM, Masone RJ, Peterson R. Hemodynamic response to application of neurosurgical skull-pin head-holder. Anesth Rev 1987;14:53-4.\nEngberg M, Melsen NC, Herlevsen P, Haraldsted V, Cold GE. Changes of blood pressure and cerebral arterio-venous oxygen content differences (AVDO2) with and without bupivacaine scalp infiltration during craniotomy. Acta Anaesthesiol Scand 1990;34:346-9.\nPaulson OB, Strandgaard S, Edvinsson L. Cerebral autoregulation. Cerebrovasc Brain Metab Rev 1990;2:161-92.\nZhang Y, Kimelberg HK. Neuroprotection by alpha 2-adrenergic agonists in cerebral ischemia. Curr Neuropharmacol 2005;3:317-23.\nSmith F, van der Merwe C, Becker P. Attenuation of the haemodynamic response to placement of the Mayfield skull pin head holder: Alfentanil versus scalp block. South Afr J Anaesth Analg 2002;8:4-11.\nAgarwal A, Sinha PK, Pandey CM, Gaur A, Pandey CK, Kaushik S. Effect of a subanesthetic dose of intravenous ketamine and/or local anesthetic infiltration on hemodynamic responses to skull-pin placement: A prospective, placebo-controlled, randomized, double-blind study. J Neurosurg Anesthesiol 2001;13:189-94.\nJamali S, Archer D, Ravussin P, Bonnafous M, David P, Ecoffey C. The effect of skull-pin insertion on cerebrospinal fluid pressure and cerebral perfusion pressure: Influence of sufentanil and fentanyl. Anesth Analg 1997;84:1292-6.\nMisra S, Koshy T, Unnikrishnan KP, Suneel PR, Chatterjee N. Gabapentin premedication decreases the hemodynamic response to skull pin insertion in patients undergoing craniotomy. J Neurosurg Anesthesiol 2011;23:110-7.\nArshad A, Shamim MS, Waqas M, Enam H, Enam SA. How effective is the local anesthetic infiltration of pin sites prior to application of head clamps: A prospective observational cohort study of hemodynamic response in patients undergoing elective craniotomy. Surg Neurol Int 2013;4:93.\nGeze S, Yilmaz AA, Tuzuner F. The effect of scalp block and local infiltration on the haemodynamic and stress response to skull-pin placement for craniotomy. Eur J Anaesthesiol 2009;26:298-303.\nUyar AS, Yagmurdur H, Fidan Y, Topkaya C, Basar H. Dexmedetomidine attenuates the hemodynamic and neuroendocrinal responses to skull-pin head-holder application during craniotomy. J Neurosurg Anesthesiol 2008;20:174-9.\nPaul A, Krishna HM. Comparison between intravenous dexmedetomidine and local lignocaine infiltration to attenuate the haemodynamic response to skull pin head holder application during craniotomy. Indian J Anaesth 2015;59:785-8.\nDoblar DD, Lim YC, Baykan N, Frenette L. A comparison of alfentanil, esmolol, lidocaine, and thiopental sodium on the hemodynamic response to insertion of headrest skull pins. J Clin Anesth 1996;8:31-5.\nTaittonen MT, Kirvelä OA, Aantaa R, Kanto JH. Effect of clonidine and dexmedetomidine premedication on perioperative oxygen consumption and haemodynamic state. Br J Anaesth 1997;78:400-6.\nGrille P, Biestro A, Fariña G, Miraballes R. Effects of dexmedetomidine on intracranial hemodynamics in severe head injured patients. Neurocirugia (Astur) 2005;16:411-8.\nWenjie W, Houqing L, Gengyun S. Effects of dexmedetomidine on outcomes following craniocerebral operation – A meta-analysis. Clin Neurol Neurosurg 2014;125:194-7.\nBekker A, Sturaitis M, Bloom M, Moric M, Golfinos J, Parker E, et al.\nThe effect of dexmedetomidine on perioperative hemodynamics in patients undergoing craniotomy. Anesth Analg 2008;107:1340-7.\nEl Dawlatly AA, Abdullah K, Al Watidy S, Jamjoom Z, Murshid WR, Delvi B. Effect of small dose intravenous dexmedetomidine and/or local anaesthetic infiltration on haemodynamic responses to skull pin placement. Pan Arab J Neurosurg 2006;10:29-33.\n[Figure 1], [Figure 2], [Figure 3]\n[Table 1], [Table 2], [Table 3]\n\|This article has been cited by\|\n\|\|Dexmedetomidine for craniotomy under general anesthesia: A systematic review and meta-analysis of randomized clinical trials\n\| \|\|Li Wang,Jiantong Shen,Long Ge,Miguel F. Arango,Xueli Tang,Jessica Moodie,Brieanne McConnell,Davy Cheng,Janet Martin \|\n\| \|\|Journal of Clinical Anesthesia. 2019; 54: 114 \|\n\|[Pubmed] \| [DOI]\|\n\|\|The Effect of Intravenous Infusion of Dexmedetomidine to Prevent Bleeding During Functional Endoscopic Sinus Surgery: A Clinical Trial\n\| \|\|Seyed Mohammad Reza Gousheh,Ali Reza Olapour,Sholeh Nesioonpour,Mahboobeh Rashidi,Shahrzad Pooyan \|\n\| \|\|Anesthesiology and Pain Medicine. 2017; In Press(In Press) \|\n\|[Pubmed] \| [DOI]\|
Track topics on Twitter Track topics that are important to you\nCesarean deliveries are the most commonly performed surgery in the United States and account for 32.9% of all births.8,9 The ASA recommends the use of neuraxial opioids of post-cesarean analgesia partly because respiratory depression in the obstetric population, as measured by intermittent respiratory rate and pulse oximetry, is reported to be low (0-1.2%).10,11 Respiratory depression lacks a standard definition,12 but the most sensitive means of detecting respiratory depression is hypercapnia.1,3 Two recent studies using continuous hypercapnia (>50mmHg PaCO2) monitoring demonstrated higher rates of respiratory depression (17.8-37%) in healthy, non-obese women receiving intrathecal opioids for post-cesarean analgesia.13,14 In addition, supplemental opioids are required in the majority of women receiving intrathecal morphine and may increase the risk of respiratory depression.11,14 Anesthesiologists debate whether neuraxial opioids or intravenous patient controlled opioid analgesia (PCA) are the safest practice for postoperative analgesia in obese parturients following cesarean delivery. The ASA recommendations to employ neuraxial analgesia post-cesarean delivery does not differentiate between non-obese and obese women who now make up 30.3% in US women of child-bearing age.2 Obesity has been described as a risk factor for respiratory depression in those receiving opioids via any route of opioid administration,11,15, 17 but whether obesity itself is the risk factor or associated co-morbidities such as sleep apnea is debated.\nStudies are conflicting whether intrathecal opioids or patient controlled intravenous opioids cause more respiratory depression. Several studies have documented the incidence of respiratory depression with IV PCA; the rates range from 0.19% to 5.2%, which are equivalent or higher than those reported for intrathecal opioids. (Hagle 16). Dalchow et al. demonstrated higher rates of hypercapnia in patients receiving intrathecal opioid compared with those receiving intravenous opioid via patient controlled analgesia in nonobese women following cesarean delivery. (Dalchow)\nThe Topological Oscillation Search with Kinematical Analysis (TOSCA) monitor allows a noninvasive method to measure transcutaneous carbon dioxide levels, with relative accuracy compared to arterial carbon dioxide monitoring.4-7 No studies have examined transcutaneous carbon dioxide levels in obese women following cesarean delivery using any form of postoperative analgesia. We propose a randomized controlled trial using continuous transcutaneous carbon dioxide monitoring to evaluate the degree of respiratory depression in obese women receiving neuraxial opioid compared to intravenous opioid via PCA for post-cesarean analgesia.\nTwo studies have demonstrated high rates of hypercapnia in non-obese women following administration of intrathecal morphine for cesarean delivery in the postpartum period. (Dalchow, Bauchat) Dalchow et al. demonstrated higher rates of hypercapnia in women receiving intrathecal diamorphine than intravenous morphine delivered via patient controlled analgesia. It is unclear whether intrathecal morphine causes more or less respiratory depression than intravenous opioid delivered via patient-controlled analgesia in obese women.\nThis study will add to the understanding of respiratory function in the immediate postpartum period in obese women using opioids via intrathecal or intravenous routes. This study will better inform guidelines for the postpartum analgesic route of choice in the obese obstetric population and allow us to make recommendations for the detection and prevention of respiratory depression after opioid administration in the obstetric population.\nObjective is to examine the transcutaneous carbon dioxide levels in obese women using either intrathecal morphine or intravenous patient-controlled hydromorphone for post-cesarean analgesia.\nThe hypothesis is carbon dioxide levels will be significantly higher in obese women receiving intrathecal morphine versus obese women receiving intravenous patient controlled intravenous hydromorphone.\nIntrathecal Morphine, Intravenous hydromorphone\nPrentice Womens Hospital\nPublished on BioPortfolio: 2017-09-15T00:23:21-0400\nIntroduction: Cesarean section (C/S) is usually performed under spinal with preservative free morphine for pain relief, but the investigators have a severe shortage of this formulation of...\nIntrathecal (IT) opioids are commonly administered with local anesthetic during spinal anesthesia for post-Cesarean delivery analgesia. Traditionally, IT morphine has been used but the use...\nThe purpose of this research study is to determine which opiate pain medication (morphine or hydromorphone (Dilaudid)) is more effective in the treatment of acute pain in patients presenti...\nTreatment of postoperative pain with hydromorphone (a strong analgesic) using patient-controlled analgesia with target-controlled infusion compared to conventional patient-controlled analg...\nBoth morphine and hydromorphone are pain medications commonly used after surgery. It is thought at our institution that hydromorphone causes less side effects but this has not been studie...\nThe lack of knowledge of the accurate conversion ratio (CR) between intravenous (IV) and oral hydromorphone and opioid rotation ratio (ORR) between IV hydromorphone and oral morphine equivalent daily ...\nTo determine if preoperative pregabalin could decrease 24-h postoperative morphine consumption after spinal anesthesia with intrathecal morphine compared with placebo.\nThe use of intrathecal morphine therapy has been increasing. Intrathecal morphine therapy is deemed the last resort for patients with intractable chronic non-cancer pain (CNCP) who failed other treatm...\nEffective postoperative pain control reduces postoperative morbidity. In this study, we investigated the effects of intrathecal morphine, ketamine, and their combination with bupivacaine for postopera...\nIntrathecal morphine (ITM) has been used in hopes of providing good postoperative analgesia in cardiac surgery. Little is known about its use in isolated aortic valve replacement surgery.\nA narcotic analgesic that can be used for the relief of most types of moderate to severe pain, including postoperative pain and the pain of labor. Prolonged use may lead to dependence of the morphine type; withdrawal symptoms appear more rapidly than with morphine and are of shorter duration.\nAn opioid analgesic made from MORPHINE and used mainly as an analgesic. It has a shorter duration of action than morphine.\nA nonsteroidal anti-inflammatory agent with potent analgesic and antiarthritic properties. It has been shown to be effective in the treatment of OSTEOARTHRITIS; RHEUMATOID ARTHRITIS; ankylosing SPONDYLITIS; and in the alleviation of postoperative pain (PAIN, POSTOPERATIVE).\nPain during the period after surgery.\nAbdominal symptoms after removal of the GALLBLADDER. The common postoperative symptoms are often the same as those present before the operation, such as COLIC, bloating, NAUSEA, and VOMITING. There is pain on palpation of the right upper quadrant and sometimes JAUNDICE. The term is often used, inaccurately, to describe such postoperative symptoms not due to gallbladder removal.\nAsthma COPD Cystic Fibrosis Pneumonia Pulmonary Medicine Respiratory Respiratory tract infections (RTIs) are any infection of the sinuses, throat, airways or lungs. They're usually caused by viruses, but they can also ...\nDepression is a serious mental health condition, where sad feelings carry on for weeks or months and interfere with your life. The symptoms include feeling unhappy most of the time (but may feel a little better in the evenings), loosing interest in lif...
Benefits of a Facelift\nA facelift can turn back the clock on your appearance by as much as ten or 15 years. Over time our skin loses its elasticity and the effects of sun exposure, gravity, and stress on the face show up in the form of wrinkles, sagging deep folds, and fat deposits. Gawley Plastic Surgery offers traditional facelifts and is an expert in the endoscopic facelift.\nHelp us help you!\nWe want you to get the most out of your consultation. If at all possible, it is best to make arrangements for small children to stay home rather than having them join us for your appointments.\nThe traditional facelift addresses the lower two-thirds of your face and neck, removing excess skin and fat and tightening the muscles. The result is a smoother, firmer, more youthful appearance. A traditional facelift can correct:\n- Loose skin\n- Fat deposits\n- Creases below the lower eyelids\n- Mid-face sagging\n- Creases around the mouth\n- Double chin\nThe endoscopic facelift is minimally invasive and virtually scar less. This method uses tiny incisions and a miniature camera in lifting the cheeks and upper face. The endoscopic facelift can correct:\n- Sagging brow\n- Frown lines\n- Sagging mid-face\n- Sagging cheeks\n- Cheek folds\n- Lines around the mouth\nChoosing Your Procedure\nBoth the traditional and endoscopic lifts can be performed alone or in combination with other procedures, such as the brow lift or eyelid surgery.\nDuring your initial consultation, one of our surgeons will evaluate the condition of your skin and your overall health. After listening to your goals and concerns, they will recommend the combination of procedures that will best achieve the results you desire.\nClick here to learn more about:\nIn most cases, Gawley Plastic Surgery does not recommend the mini-lift, also known as the lunch-time lift. It is a quick procedure, but the results are not long-lasting. We will sometimes make exceptions for patients who understand the limitations of the mini-lift but want a fresher look for a special occasion, such as a wedding. However, our surgeons warn that patients should beware of surgeons who advertise the lunch-time lift as having comparable results to more extensive facelift techniques.\nIf you are interested in a facelift in the Scottsdale and Phoenix, Arizona area, one of our surgeons can help you decide which type of procedure is right for you. Please read our Frequently Asked Facelift Questions and call or email us today to schedule your initial consultation.\nFacelift Frequently Asked Questions\nDoes a facelift require general anesthesia?\nAlthough general anesthesia is a safe form of anesthesia where the patient is brought to a controlled level of unconsciousness, most facelift procedures do not require that you undergo it. Most of the lower facelift and neck lift procedures can be performed under IV sedation, also known as conscious or twilight sedation. The level of sedation with this is lesser than the general anesthesia and you will have a sense of time. With this form of anesthesia, the feeling of tiredness and nausea is also lesser. However, there are instances when general anesthesia would be in your best interests and your surgeon will determine this during your initial consultation. If you have chronic back or neck pain, suffer from any medical issue or are undergoing multiple procedures then it would be best that you get general anesthesia.\nWhat Is The Best Age To Have A Facelift?\nAge is an important consideration when determining your candidacy for a facelift and most surgeons do not like to perform the procedure on those under the age of 30. However, it also depends on how you feel about yourself within your age group and your lifestyle factors affecting your facial appearance. Factors like excessive drinking, smoking, exposure to pollution and stress can also accelerate the aging process. On average, the optimal age for getting a facelift has been 45 to 50 with most patients falling within the range of 35 to 65 years. The goal of the surgery is to maintain and preserve your facial appearance and that is why, the sooner your aging signs are addressed, the more enduring your results will be. When you are 60 or older, the facelift can leave very noticeable changes to your face.\nHow soon can I drive after a facelift?\nThe vast majority of our facelift patients do not require any prescription pain medication as we strive to truly minimize your discomfort. If you do end up using the prescription pain medications, for your safety and the safety of others it is advised not to drive for a minimum of 24 hours. Depending on how you respond to medications, it may take even longer before you are safe to drive.\nAdditionally, swelling and compression wraps worn after surgery may obstruct your peripheral vision and interfere with your ability to drive. Most patients will feel comfortable driving after one week as the swelling typically starts to subside after 3-5 days. Every patient is unique and your surgeon will give you specific care to optimize what is best for you.\nHow long before you can fly after a facelift?\nMany of our patients fly in from out of state as our surgeons are recognized as some of the premier plastic surgeons in the country. Ideally, we would like you to stay in town for 10-12 days after surgery so we can ensure a quick, safe recovery. When you fly after your surgery, it can increase your risks for complications. The stress on your body while recovering from surgery can result in a decreased ability to resist infections and airplane travel does have a somewhat increased risk.\nYou may be allowed to take a short flight before your healing is complete, but you will be advised to wear leg compression garments. However, if you are at risk for blood clot development, you will be asked to wait longer before you can fly.\nTaking longer flights after your surgery can increase your risk of developing a blood clot, such as a Deep Vein thrombosis (DVT) or Pulmonary embolism (PE). In fact, any travel over four hours increases this risk. Certain precautions (like leg compression garments and getting up and walking on the flight) may help increase venous flow, therefore, decreasing your risk of developing a blood clot. You should speak with your surgeon to assess your risk level in developing a blood clot up to 90 days following any surgery.\n“I am so impressed with the level of care I received at this office. Dr Gawley is amazing and so is his staff. I highly recommend this office and everyone in it. – A. G. ” Read More Testimonials\nThe Gawley Blog\nFacial rejuvenation is truly individualized and the procedures need to be customized and tailored to suit your individual concerns and cosmetic goals. Depending on your anatomy, your desires, and your facial aging, you may benefit from one of the three […] Continue reading
Pope Francis taken to hospital with respiratory infection\nThursday, 30 March 2023 (11:04 IST)\nPope Francis has been told to stay in hospital for a few days for treatment after doctors diagnosed a respiratory infection, the Vatican announced on Wednesday.\n"Pope Francis is touched by the many messages received and expresses his gratitude for the closeness and prayer," the Vatican said.\nOn Wednesday morning, Francis held his weekly general audience on St. Peter's Square in front of thousands of worshippers.\nThe 86-year-old pontiff was taken to Gemelli University Hospital in Rome in the afternoon for what was initially called a scheduled visit. But soon after, his appointments for Thursday were called off.\nReporters and press photographers were posted outside the hospital by late Wednesday.\nThe Vatican did not elaborate on whether the pope would be back in time to celebrate the busy Holy Week events that are due to begin this weekend with Palm Sunday.\nWhat do we know about the pope's health?\nThe pope had been complaining of breathing difficulties in the past few days. Vatican spokesperson Matteo Bruni said that he did not have COVID-19.\nFrancis got through the worst phases of the coronavirus pandemic without any public announcements of having contracted the virus.\nThe pope, who usually speaks in a whisper, earlier in his life had part of one lung removed due to a respiratory infection. He has said he resisted undergoing knee surgery because he didn't respond well to general anesthesia during a 2021 intestinal surgery.\nFrancis had to cancel or postpone activities several times last year due to knee pain. In a 2022 interview, he admitted that he needed to slow down because of his health.\nThe Argentine-born Jorge Maria Bergoglio this month marked 10 years as head of the Catholic Church.\nHe led his predecessor Benedict XVI's funeral this January, after the first living handover of papal power in centuries.
RN PRN PREOP PHASE II GMCL(Job Id 6244)\nJob ID: 6244\nDate posted: 02/19/2019\nThis job posting is no longer active\nWork Type: PRN\nDepartment: PREOP PHASE II GMCL\nShift/Hours: 1pm-1130pm, 2-3 days per week\n: PRN Facility: GWINNETT MEDICAL CENTER Other information:\nDepartment: PREOP PHASE II GMCL Shift/Hours\n: 1pm-1130pm, 2-3 days per week\nIf you are an experienced Perianesthesia Nurse looking for a Nursing Career that offers you the opportunity to collaborate with an outstanding Interdisciplinary Health Team, You Need Not Look Further! Our Preoperative Department is the place for you! Our Nurses assess patients and prepare them for their surgical procedure. They assist physicians with examinations and special procedures. Not to mention provide proficiency in utilizing computer skills in obtaining patient information just to name a few.\nRegistered Nurse requires a Current State of Georgia Nurse Licensure. Pre-Op, PACU or ICU experience, ACLS, PALS certifications REQUIRED.\n* ASSOCIATE DEGREE\n* REG RN-GA STATE\n* ADVANCED LIFE SUPPORT
What is an Ankle Tenotomy?\nAnkle tenotomy is a surgical procedure to lengthen the Achilles tendon enabling the ankle to flex upward and allowing the heel to be placed flat on the floor. It is indicated in patients that have an abnormally developed Achilles tendon or one that has become shortened and difficult to stretch. The surgery is done to restore the normal range of motion of the ankle.\nWhat are the Indications for an Ankle Tenotomy?\nIt is commonly indicated in the treatment of the below conditions when conservative measures such as physical therapy and splinting have failed:\n- Clubfoot: A developmental disorder where the child is born with one or more abnormally short ankle muscles which turn the feet inward. Ankle tenotomy is usually performed after the Ponseti method to treat clubfoot.\n- Contractures: Muscles become stiff after a period of immobilization\nHow is an Ankle Tenotomy Procedure Performed?\nAnkle tenotomy is performed under local anesthesia. A knife is inserted into the skin at the region of the tendon and cuts are made. As the cut edges draw apart, the tendon lengthens and heals in this position. For more severe cases, your child's doctor may expose the tendon through an incision under general anesthesia and cut the tendon, which is then joined by sutures to form a lengthened tendon. Casts are then applied with the tendon in the correct anatomic (stretched) position. After two to three weeks, your child's doctor will remove the cast and order physical therapy to improve ankle strength and keep the tendon stretched.\nWhat are the Complications of Ankle Tenotomy?\nAs with all surgical procedures, ankle tenotomy may be associated with certain complications such as nerve and blood vessel damage, infection, over-lengthening of the tendon or shortening of the tendon as your child grows which may require a second surgery.
"Many patients mistakenly believe that they should wait for the cataract to mature before it is removed, when in fact it is advisable to do so as soon as it affects vision and quality of life".\nDR. SARA LLORENTE GONZÁLEZ SPECIALIST. OPHTHALMOLOGY DEPARTMENT\nHow are cataracts treated?\nThe cataract operation is phacoemulsification with topical anesthesia.\nCataract is the opacification of the crystalline lens. The crystalline lens is a transparent tissue inside the eye that is shaped like a lens and is used to focus at a distance and at close range.\nOver the years, it loses some of its effectiveness, requiring the patient to read with glasses and, subsequently, loses transparency.\nIt produces loss of vision and is the main cause of curable blindness. Four out of ten people over 60 years old suffer from this disease. Cataracts are more frequent in people with diabetes.\nDo you need our help?\nContact with us\nWhen is cataract surgery indicated?\nIn most cases, the operation is recommended when cataracts prevent you from leading a normal life. It is not advisable to wait for total loss of vision, since there is a greater possibility of complications during surgery.\nThe operation is also indicated if the ophthalmologist detects that the cataract is hardening or progressing too quickly.\nWhat are the most common symptoms?\n- Blurred vision.\n- Loss of color intensity.\n- Distorted vision.\n- Worsening of distant vision.\nDo you have any of these symptoms?\nYou may need cataract surgery\nHow is cataract surgery performed?\nThe usual technique for intervening in cataracts is phacoemulsification with topical anesthesia.\nOnce the eye is anesthetized -in many cases simply with eye drops or anesthetic drops-, a small incision is made in which the crystalline lens, already disintegrated by ultrasound, is removed.\nFinally, a folding lens is inserted, which is placed in the same place as the crystalline lens. Hospitalization is not necessary due to the short duration of the operation and the rapid recovery.\nThe cataract operation takes about 15 minutes and only requires an incision about three millimeters in size that does not need sutures. After the operation, it is not necessary to wear a blindfold or rest and the patient can resume his normal life the same day of the operation.\nAlthough the time frame for vision recovery is variable, in general the patient begins to see well a few hours after the operation.\nThe only post-operative advice is to avoid intense physical effort and apply anti-inflammatory drops to the eye for a few weeks.\nThis surgery hardly presents any complications, so the subsequent problems that may hinder the recovery of vision are due to other ocular pathologies.\nIn this sense, it is essential to perform a thorough preoperative examination to know the real state of the eye.\nWhere do we do it?\nIN NAVARRA AND MADRID\nThe Department of Ophthalmology\nof the Clínica Universidad de Navarra\nEquipped with the latest technology, the Department of Ophthalmology has the necessary equipment, both technical and human, to offer comprehensive and specific assistance to each patient.\nWe are one of the few centers that have a microsurgery laboratory for the improvement of clinical practice.\nOrganized in specialized units\n- Cornea and eye surface\n- General Ophthalmology\n- Refraction defects\n- Pediatric ophthalmology\nWhy at the Clinica?\n- More than 25 years of experience.\n- Experts in the diagnosis and treatment of ocular pathologies.\n- With the security and guarantee of a prestigious hospital.
Our Plano TX plastic surgical procedure practice intertwines science and artwork to make beautiful, purely natural effects for our individuals. We can make your desires a reality. From minimal cosmetic enhancements to big facial reconstruction - and all the things in between. In depth facial plastic operation providers suitable for YOU.\nRhinoplasty strategies are performed with community anesthesia, together with either intravenous sedation or possibly a common anesthetic, being an outpatient method. The Procedure would require several hours.\nRhinoplasty is performed by means of possibly an open up or shut approach. Inside the open technique, a little incision is built across the columella, as well as the pores and skin is lifted from the nose, exposing the fundamental bone and cartilage framework. This tactic presents good visualization of the framework For additional complex issues. Within the closed approach, small incisions are created Within the nostrils plus more limited accessibility is obtained for the framework. For both method, the pores and skin is divided through the supporting framework. Sculpting in the framework is then done by minimizing the help or augmenting the assistance with grafts. The nasal bones might be altered by fracturing them. The nasal pores and skin is then redraped in excess of the nose.\nRhinoplasty can lessen or improve the measurement of one's nose, alter the form in the suggestion or the bridge, slim the span of your nostrils, or change the angle among your nose and your higher lip. It might also correct a delivery defect or personal injury, or aid ease some respiratory troubles.\nCurrently being not happy Together with the sizing or shape of one's nose might be a source of diminished self-esteem, social anxiety and even shame. Your nose is a vital defining element of your face and little alterations may make a considerable effect on restoring stability to the facial visual appearance. If you're unhappy with the looks within your nose, our rhinoplasty professional may help. A rhinoplasty technique can proper most of the considerations you will have, which includes creating your nose more symmetric and proportional to the remainder of your experience and bettering nasal respiratory.\nRhinoplasty strategies are carried out with nearby anesthesia, together with either intravenous sedation or a normal anesthetic, as an outpatient course of action. The Procedure will require quite a few hrs.\nRhinoplasty is executed by means of possibly an open or closed approach. From the open tactic, a little incision is manufactured through the columella, along with the pores and skin is lifted from the nose, exposing the underlying bone and cartilage framework. This technique presents excellent visualization with the framework For additional complicated challenges. In the closed strategy, smaller incisions are created In the nostrils and much more limited obtain is gained on the framework. For both method, the pores and skin is divided in the supporting framework. Sculpting in the framework is then carried out by cutting down the aid or augmenting the support with grafts. The nasal bones website might be altered by fracturing them. The nasal skin is then redraped in excess of the nose.\nRhinoplasty can lower or boost the dimension of one's nose, change the condition with the suggestion or even the bridge, slender the span of your nostrils, or alter the angle among your nose along with your upper lip. It could also suitable a start defect or damage, or help ease some respiration difficulties.
The Mall - Advanced Dental Care\nPall Mall, Manchester, M2 4DU\nBiography for Andrew McLean\nAfter graduating in 1991 in Manchester, Andrew went on to spend six years educating others on the ins and outs of surgical dentistry and the use of sedation back at the hospital.\nAndrew has continued to develop and advance his dental skills over the years through further training. This dedication to improve and progress his skills is harboured by many of the team members at The Mall Advanced Dental Care in Manchester where he operates.\nFor ten years, Andrew practised his skills and expertise in Cheshire at a private clinic, but is now to be found in the modern and warm setting of The Mall Advanced Dental Care.\nBack to The Mall - Advanced Dental Care
There are, of course, permanent scars as a result of this surgery. Every effort will be made to conceal or to make them as inconspicuous as possible. There may be discoloration and swelling in the\nPain following a facelift is actually very minimal. However, you will be given prescriptions for pain medications at your preoperative appointment one week prior to the surgery. You should have these filled and ready for\nDrains are sometimes used to remove excess blood from the surgical areas. You will be given care instructions after surgery and they are usually removed at the first appointment postop.\nImmediately following the procedure you will have a full facial wrap covering your forehead, neck, and head. This wrap is used to minimize swelling, bruising and bleeding will left in place for 24-48 hours postoperatively.\nNo, you may not drive for a 24-hour period following sedation of any kind. You will need a responsible friend or family member to take you home and care for you for at least the\nThere is a circulating nurse who will greet you, perform preoperative assessment, and prepare you for the day. You will then meet with your Certified Registered Nurse Anesthetist who will start your IV and answer\nCosmetic procedures such as this are performed in our office surgical suite. We have a separate preoperative area, full anesthesia capabilities in our main operating room, and comfortable post anesthesia care unit with private bathroom\nAs Dr. Lambruschi would say, “I could rush…” but seriously, the length of the procedure depends on many variables, but usually takes all morning. You can typically expect a 3-4 hour surgical time, with a\nMAC anesthesia or monitored anesthesia care is provided by a Certified Nurse Anesthetist. Having anesthesia personal present ensures your safety and comfort throughout the procedure. The cost for this is included in your surgical fees.
Dr. DENNIS J. MCNICHOLL\nBoston, Massachusetts Map\n\|Practice:\|\|BRIGHAM & WOMEN'S HOSPITAL\|\n\|Med. School:\|\|University Of New England, College Of Osteo Medicine\|\n\|Online Appt. Scheduling:\|\|Unknown\|\n\|Accepting New Patients:\|\|Y\|\nProfile updated 21/10/13 Submit profile update Subscribe to profile updates\nDr. DENNIS J. MCNICHOLL has an excellent overall rating on RateMDs.com.\nNew! - Questions and answers about this doctor\nAnesthesiologist-related: pain relief for surgery, anesthesia\nThe following ratings and comments have not been substantiated by RateMDs.com.\nCaring, professional, confident and post surgery follow up was impressive.\n\|\|21/10/13\|\|SYSTEM: First Name changed from "DENNIS" to "DENNIS J."\|
Hot Cannabis Medicine Marijuana, A Gift From Above By Michael Jacobs 9 months ago 729views0 0 The marijuana plant has been used since ancient times to treat many conditions and ailments. Recently, marijuana has been more in the news because of the number of states legalizing it for medicinal and recreational purposes. Both the medical community and society at large are divided as to whether the plant has any actual medicinal use. Medical science does recognize that the plant has some curative and palliative properties.There are hundreds of cannabinoids in marijuana, but the two most often used for medical purposes are tetrahydrocannabinol (THC) and cannabidiol (CBD). While THC gives users that “high” feeling, it also has medicinal uses. CBD does not give a user that “high” but has several medicinal uses. Historical Use of MarijuanaThe history of medical marijuana is long. It has been used since ancient times. Its use possibly dates as far back as 2737 B.C., where, according to Chinese legend, Emperor Shen Neng prescribed marijuana to treat conditions such as gout, rheumatism, malaria and even poor memory. The first recorded physician to use cannabis as an anesthetic during surgery was also Chinese – Hua Tuo ground the plant into a powder and mixed it with wine for a patient prior to surgery. In fact, the Chinese word for anesthesia, “mázui,” literally means cannabis intoxication.In the late 1700s, Irish doctor William O’Shaughnessy recommended marijuana for the treatment of rheumatism and nausea, two conditions it is still used to treat today.What Are the Benefits of Medical Marijuana?Medical marijuana is shown in a jar at The Joint Cooperative in Seattle, Washington January 27, 2012. Efforts to legalize marijuana for recreational use are gaining momentum in Washington state and Colorado, despite fierce opposition from the federal government and a decades-long cultural battle over America's most commonly used illicit drug. Photo taken January 27, 2012 REUTERS/Cliff DesPeaux (UNITED STATES - Tags: HEALTH SOCIETY) ORG XMIT: LOA03What are some of the benefits of medicinal marijuana? Medical research indicates that vaporizing marijuana may cut down the number of seizures in people with epilepsy. People who suffer from multiple sclerosis also find relief from stiffness, spasms, and pain.Another potential benefit of medical marijuana is that it may help reverse the carcinogenic effects of tobacco and increase lung capacity. This revelation comes from a study published in the Journal of the American Medical Association. Researchers tested the lung function of 5,115 people over 20 years. Tobacco smokers lost lung capacity while marijuana smokers gained capacity.Additionally, a study also found that marijuana may help slow the progression of Alzheimer’s disease. THC has been found to slow the formation of amyloid plaques by blocking the enzyme in the brain that creates them. These are the plaques that kill brain cells in patients with the condition.Cannabis Cures Cancer: A Myth or Reality?Does cannabis actually cure cancer? Studies aren’t so clear on this one. However, research has discovered that CBD may help stop the spread of cancer. CBD can turn off a gene called Id-1. Cancer cells make more copies of this gene than non-cancer cells, helping the disease spread. There have also been studies performed in the U.S., Spain, and Israel that suggest some compounds found in marijuana might be able to kill cancer cells.It is very important to note that currently only 6% of cannabis studies analyze its medicinal uses.While the use of marijuana as a medicinal treatment is still hotly debated, it is clear that more research is needed. Recent studies clearly indicate that the compounds found in the plant do provide some medical benefit. However, just how much benefit and whether it outweighs the potential side-effects and risk is yet to be seen.
Dermal Fillers in Phoenix\nMost of us lose volume in our face as we age causing our temples, cheeks and eyes to hollow out, our lips to thin, our jaw lines, cheeks and necks to sag, and wrinkes to appear. With time, we look gaunt, skeletonized and well, just old. Volume in a face is a marker of youth—loss of volume, aging. None of us are immune.\nFacelifts, eyelifts, and brow lifts tighten and lift sagging eyelids, eyebrows, cheeks, necks and jowls but do not replace lost volume. Cheek and chin implants restore volume very effectively to these facial areas, but require surgery with an associated downtime. Fat transfer from the abdomen or thighs to the face is often used to restore volume, however, to date the durability of the beneficial effect is both unpredicatable and unreliable. Repeated fat transfers are often required to sustain the improvement.\nDermal fillers such as Restylane, Restylane Lift, Voluma, and Bellafill when injected under the skin have been used to restore facial volume with great success over the past many years. Complications are few, downtime nil, and results pleasing, While fillers don’t, in general last as long a surgery, they can substantially make you look much better for quite a while. They can even be used to fill out a volume depleted face after a facelift.\nReflating the Volume Depleted Face\nAfter 4 syringes of Lyft\nWhat are Dermal Fillers?\nThe dermal fillers we commonly use are of two different types, the ones consisting of hyaluronic acid— Restylane, Restylane, Lift, Restylane Silk, Voluma, and the PMMA filler, the longer lasting Bellafill.\nHyaluronic acid is a normal constituent of our skin, subcutaneous tissue, and connective tissue. When natural hyaluronic acid is specially treated and injected under the skin, this modified hyaluronic acid attracts and holds water, adding volume to the area injected, lasting until the body degrades it, anywhere from six to eighteen months after injection. The increase in volume that results from implanting one of these fillers under the skin improves overlying facial creases and wrinkles, enlarges lips, making the face appear more youthful.\nBellafill is an injectable dermal filler composed of microspherules of polymethylmethacyrlate (PMMA), suspended in bovine (derived from cow) collagen with a small amount of lidocaine (local anesthetic) added. Orthopedic surgeons have been using PMMA safely and effectively for decades in joint replacement surgery. Unlike the other fillers, the PMMA is not readily absorbed by the body and forms a far more lasting scaffold for collagen production wherever it is injected. That is, the benefits of Bellafill injections are extremely durable, lasting many years. Like many of the other non permanent dermal fillers, Bellafill is FDA approved for improving nasolabial folds (smile lines). This product has been used successfully for years in Europe and Canada.\nHow Do We Use Dermal Fillers?\nOur goal with filler is to add volume to your face, restoring your more youthful contours. We implant them to improve facial wrinkles and creases such as the nasolabial fold (the crease between the nostrils and the corner of the mouth), frown lines (especially in conjunction with neuromodulators such as Dyport or Botox), and wrinkles on the cheeks. These products are particularly useful to enhance and augment the cheeks, lips, temples, and fill vertical wrinkles above the upper lip. We inject dermal fillers under the skin in the lower eyelids to eliminate dark circles, hollowness, and to hide bags there. For many patients, the improvement after dermal filler injections is not only satisfying, but also quite dramatic.\nHow Are Dermal Fillers Implanted? How Long Does The Procedure Take? It Is Painful?\nDermal fillers come in pre filled syringes and are injected just underneath the skin using very fine needles or cannulas into the area to be improved. Prior to injecting a dermal filler, we often numb the area to be filled with topical anesthetic cream. As we inject the area, we can also chill the overlying skin with an iced roller resulting in additional anesthesia. This combination of topical anesthesia and cold reduces any pain from the injections to a minimum. Additionally, all the fillers we use contain local anesthetic, so that after a few passes the area to be enhanced is totally numb. The implantation of a dermal filler takes between 20 and 45 minutes depending on how many syringes are used.\nWhen Will I See Improvement From Dermal Fillers And How Long Will It Last?\nYou will see improvement from a dermal filler immediately after it is injected. On average with hyaluronic acid filler, this improvement will last about 6 to 18 months. After the first two or three injections, most patients find they can go increasingly longer intervals without reinjection. Bellafill lasts much longer up to seven years.\nIs There Any Downtime Following Dermal Filler Implantation?\nNo! You can return to your normal activities without restriction following the dermal filler implantation procedure as soon as you wish. The area injected, particularly the lips, may be swollen and numb similar to visit to the dentist. The numbness will disappear in one or two hours.\nAre Dermal Fillers Safe? Are There Any Side Effects?\nAll the dermal fillers we use are either FDA approved for filling facial wrinkles, for augmenting volume, or both. Many have been used for almost a decade here and much longer in Europe. They are exceedingly safe products with few side effects. Occasional bruising, swelling, lumpiness, and/or tenderness at the implantation site can happen but all disappear within a few days. Allergies to these products are very rare. As for any cosmetic procedure done around the mouth and particularly to the lips, we customarily provide a prescription for an antiviral agent to prevent any outbreak of cold sores (oral herpes virus).\nHow and Where are the Different Fillers Used?\nWe like to use Restylane in the “troughs” that many people have under their lower eyelids. Restylane here is exceedingly effective in blending the lower eyelids with the upper cheek concealing the lower lid bags and giving a more youthful look. In this location, a single injection of filler can last many years. We also use Restylane to shape and elevate the eyebrows and it is extremely effective to improve the contours of the nose.\nThis product is particularly useful for improving fine vertical wrinkles above and below the lips.\nRestylane Lift (formerly known as Perlane L) is our “go to” filler. We use it in most every area of the face: to plump up lips, to augment the cheeks, to fill in the nasolabial folds (folds from the nose to the corner of the mouth), the marionette lines (the folds from the corner of the mouth down to the jawline), to elevate the jowls, to restore a youthful jawline, and fill in hollow temples.\nVoluma is approved for use to elevate the cheeks restoring youthful volume there. It is a wonderful product when used as indicated and lasts about 12-18 months.\nWe use Bellafill much like we use Restylane Lift, to improve almost any area of the face except directly in the lips or under the eyes. It is an extremely long lasting product and because of that, we can slowly build up the facial volume by using prior Bellafill implantations as a scaffold or foundation for additional injections, knowing that the prior enhancement will remain.\nSome people are allergic to the bovine collagen component of Bellafill, therefore a skin test (a tiny amount of this product, injected under the skin of the forearm) is required prior to the initiation of Bellafill injections. We provide these skin tests for no charge.\nWhat to Do and What to Expect After a Filler Treatment\nIt is helpful to apply ice packs to the treated area(s) for several hours to reduce any potential swelling and bruising, both of which can occur. Should any swelling or bruising appear over the first few days after a treatment, rest assured that it will resolve quickly. Expect some achiness in the areas treated, especially a low grade headache if the temples are filled. This can easily be remedied by over-the-counter analgesics such as extra strength acetominophen (Tylenol) or ibuprofen (Motrin). Make-up can be applied in an hour or two after a treatment.\nSmall palpable lumps can occur in the injection area and to avoid these, we ask you to gently massage the treated areas 5 minutes morning and evening for about a week after the treatments. Persistent lumps while possible are very infrequent.\nIf Bellafill was used, initial filling of the treated areas will start to recede in three to four weeks almost back to where you started as the bovine collagen component of it is resorbed. Soon after the PMMA, starts stimulating collagen formation and the area starts to reinflate. After about 8-12 weeks this process is complete and what you see in the mirror will last many years.\nHow Much Do Dermal Fillers Cost?\nWe price all our fillers by the syringe with discounts offered if more syringes are purchased. Some smaller areas such the lips, lower eyelids, nasolabial folds, etc. may only require only one syringe or two syringes. However, to adequately rejuvenate a volume-depleted face, multiple syringes are usually needed to make a noticeable difference. At the time of consultation, we will go over in detail where and how much filler we should use to give you the result you desire. If you have to, it is always best to wait until you can afford enough filler to do the job rather than try to get by with too little and end up disappointed.\nShould you want to see if fillers are right for you, please fill in the form below.
Otley CC, Nguyen TH. Safe and Effective Conscious Sedation Administered by Dermatologic Surgeons. Arch Dermatol. 2000;136(11):1333-1335. doi:10.1001/archderm.136.11.1333\nTo review the experience with conscious sedation administered by dermatologic surgeons at an academic medical center.\nRetrospective medical chart review.\nOutpatient dermatologic surgery unit at an academic medical center.\nFifty episodes of conscious sedation in 37 patients undergoing dermatologic surgical procedures.\nIntravenous and inhaled conscious sedation was administered with strict monitoring during procedures.\nMain Outcome Measures\nEfficacy was subjectively recorded by the administering physician and complications were recorded.\nAdministration of conscious sedation by dermatologic surgeons was associated with good to excellent sedation with minimal complications. Extensive preparation and training were necessary, and strict guidelines devised by a conscious sedation task force were followed. Emergency preparedness was high, although it was not used.\nConscious sedation can be safely and effectively administered by dermatologic surgeons in a hospital-based outpatient surgical unit after extensive training. Emergency preparedness is essential, and conservative guidelines should be followed.\nMANY PROCEDURES performed by dermatologic surgeons are painful. Local anesthesia provides excellent relief in most cases. However, several clinical scenarios exist in which adjuvant sedation proves beneficial for patients and surgeons alike. A prime indication is procedures in which extensive local anesthesia is necessary and is associated with the pain of numerous injections. Facial laser procedures can cause significant discomfort, either during the procedure or during the administration of extensive regional nerve blocks and local anesthesia. In addition, patients with significant anxiety, including apprehensive children, may benefit from the sedative and anxiolytic effects of conscious sedation.\nConscious sedation is defined as a medically controlled state of depressed consciousness in which patients retain their protective reflexes, maintain their airway independently, and respond to physical and verbal stimulation.1 Conscious sedation is intermediate in the spectrum of sedation, which ranges from anxiolysis and analgesia to general anesthesia. The key characteristics of conscious sedation are that it is of rapid onset, is titratable to an individual patient's desired level of sedation, and is associated with significant depression of consciousness, relief of anxiety, and analgesia. Retrograde amnesia of any pain associated with procedures is an additional benefit of conscious sedation. The effects of the medications most commonly used for conscious sedation are reversible with pharmacological antagonists.\nWhen performed in accord with established safety guidelines, conscious sedation has proven safe and effective in alleviating patient discomfort and anxiety.2,3 However, extensive training, specialized monitoring equipment, and dedicated nursing personnel are required for safe administration. Emergency preparedness is essential, as is current training in basic life support and advanced cardiac life support. Use of conscious sedation by the nonanesthesiologist is usually limited to American Society of Anesthesiologists (ASA) class I and II patients, who are healthy or who have only mild systemic disease.1\nWe review herein our experience with the administration of conscious sedation by dermatologic surgeons within a surgical dermatology unit at an academic medical center.\nWe retrospectively reviewed 50 episodes of conscious sedation administered to 37 patients by dermatologic surgeons. Patients ranged in age from 4 to 76 years. The sedation of any patient presenting with an acute illness was postponed until the illness had resolved. Preoperative evaluation included review of medical, surgical, and anesthesia histories; medications; and allergies. Physical examination of all patients included cardiopulmonary and airway assessment. Only patients with stable comorbid medical conditions (ASA class I or II) received conscious sedation in the dermatology unit. All patients received verbal preoperative sedation instructions, and postsedation instructions were provided in written and verbal form to the patient and responsible chaperone. Patients were prohibited from driving until the day after sedation.\nThe clinical indications for the dermatologic surgical procedures included the management of skin cancer, benign cutaneous neoplasms, vascular malformations, aging face syndrome, warts and molluscum, acne scarring, keloid, androgenic alopecia, hidradenitis, angiofibromas of tuberous sclerosis, and benign familial pemphigus. Dermatologic surgical procedures performed included excisional surgery, cutaneous biopsy or extensive curettage, pulsed dye laser therapy, carbon dioxide laser resurfacing or ablation, and hair transplantation surgery.\nConscious sedation was administered in all cases in accord with guidelines recommended by our institutional pediatric and general conscious sedation task forces as well as with published guidelines.2,3 A registered nurse, dedicated solely to the monitoring and management of sedation, was with the patient from the beginning of the procedure until complete recovery. The patient's vital signs were continually monitored and documented, including blood pressure and pulse oximetry, and consciousness was assessed every 5 to 15 minutes. All patients were allowed to recover in the surgical room until they had achieved sufficient consciousness to pass standard discharge criteria and to be safely discharged in the care of a chaperone.2 Patients were advised against operating vehicles or hazardous machinery and making significant decisions for the remainder of the day.\nThe quality of sedation was graded on a subjective scale (excellent, good, fair, or poor) by the surgeons (C.C.O. and T.H.N.). Excellent sedation was associated with absent or minimal anxiety or discomfort; good, with mild anxiety or discomfort; fair, with moderate anxiety or discomfort; and poor, with anxiety or discomfort that appeared unmitigated by the sedation.\nA variety of medication combinations, dosages, and routes were used, customized to the individual patient's needs. Representative sedation regimens included intravenous midazolam hydrochloride and fentanyl citrate, combination intravenous lorazepam and meperidine hydrochloride, and combination oral midazolam and nitrous oxide via nasal mask. Total medication dosages varied widely, depending on patient response. The following dosages are total dosages, often administered for an extended period. Dosage ranges were midazolam hydrochloride, 1 to 9.25 mg, fentanyl citrate, 100 to 500 µg, lorazepam, 1 to 4 mg, and meperidine hydrochloride, 37.5 to 175 mg, all intravenously; and 25% to 50% nitrous oxide via nasal mask with 7 L per minute of oxygen. In most cases, local anesthesia or regional nerve blocks were administered as well. In many cases, the conscious sedation was used in part to sedate the patient before administration of extensive local anesthesia by injection. Conscious sedation was also performed for its amnesic effect, which was significant with high doses of midazolam. All medications were administered in combination. Single-agent anxiolysis with benzodiazepines or narcotics was not considered conscious sedation.\nThe quality of conscious sedation was judged by the dermatologic surgeons (C.C.O. and T.H.N.) to be excellent in 43 cases, good in 5, and fair in 2. Intravenous combination sedation with midazolam and fentanyl was universally excellent, whereas sedation of pediatric patients with combination oral midazolam and inhaled nitrous oxide was helpful although less thoroughly sedating.\nWith regard to complications, 2 patients experienced mild to moderate nausea with the administration of nitrous oxide, none had vomiting, and no other patients experienced any identifiable complications. All transient hypoxemic episodes were rapidly reversible with physical and verbal stimulation of the patient. There were no hypotensive episodes, and no respiratory or cardiopulmonary resuscitation was necessary. The administration of sedation did not result in complications associated with the primary surgical procedure in any case.\nPatients expressed a high degree of satisfaction with their sedation, and, on follow-up visits, many reported a moderate degree of amnesia regarding their procedure.\nA 66-year-old woman with aging face syndrome presented for full-face carbon dioxide laser resurfacing. After preoperative evaluation and under continuous monitoring, the patient received intravenously 2 mg of midazolam hydrochloride and 100 µg of fentanyl citrate. Bilateral, supraorbital, infraorbital, and mental nerve blocks were placed, and the peripheral facial skin was anesthetized with 0.2% lidocaine hydrochloride with 1:500,000 epinephrine. Immediately before laser resurfacing, the patient's level of consciousness had returned to normal, and we administered 1 mg of midazolam hydrochloride and 50 µg of fentanyl citrate; the entire procedure was then performed. There were no complaints of discomfort. The patient was monitored until stable and was discharged in the care of a driver. Outcome was judged as excellent with no complications, and the patient was very pleased with the effect of the sedation.\nA 44-year-old woman with extensive facial telangiectases received pulsed dye laser therapy. After preoperative evaluation and under continuous monitoring, the patient received intravenously 2 mg of midazolam hydrochloride and 100 µg of fentanyl citrate, which provided an excellent level of sedation and allowed the patient to undergo the procedure with complete comfort. Outcome was judged as excellent with no complications, and the patient was very pleased with the sedation.\nA 43-year-old man with androgenic alopecia presented for hair transplantation. After preoperative evaluation and with continuous monitoring, a total of 175 mg of meperidine hydrochloride and 4 mg of lorazepam was administered intravenously in divided doses. Local anesthesia with 0.5% lidocaine hydrochloride with 1:200,000 epinephrine was administered. The outcome was excellent, with no complications and a high degree of patient satisfaction.\nA 5-year-old girl with a 4-cm changing congenital nevus presented for excisional surgery. After preoperative evaluation and with continuous monitoring, the patient received 15 mg of midazolam hydrochloride solution mixed in a grape drink. After 15 minutes, she became mildly sedated, and 45% nitrous oxide was administered via nasal mask. Local anesthesia was given without discomfort. The nitrous oxide was discontinued and the procedure was completed without complication. The patient and her parents were pleased with the effect of the sedation.\nConscious sedation is rapidly gaining acceptance as a humane and reliable method of reducing pain and anxiety in patients undergoing many types of medical procedures. It is now standard practice for patients undergoing gastrointestinal endoscopic procedures to receive conscious sedation to alleviate discomfort. Such sedation is currently administered by a range of medical practitioners, including anesthesiologists and nurse anesthetists as well as non–anesthesiology-trained physicians, with excellent safety profiles.4 Because of the potential for cardiorespiratory depression associated with administration of combinations of intravenous benzodiazepines and narcotics, emergency preparedness is essential when these medications are administered.\nWe underwent extensive training in preparation for administration of conscious sedation, including complete review of the literature and consultation with a conscious sedation task force and a pediatric intensive care anesthesiologist regarding optimal regimens for specific age groups and procedures. Certification in basic life support, advanced cardiac life support, and pediatric advanced life support was renewed. Practical observation of the administration of conscious sedation was obtained in other subspecialty areas. Established institutional guidelines for the safe administration of conscious sedation were followed. Our experience with the administration of conscious sedation by dermatologic surgeons indicates that this can be safely administered after extensive education and training and with appropriate precautions. We wish to emphasize that our approach to sedation is conservative, which likely explains the absence of significant complications. In fact, administration of oxygen was not necessary in any of our cases, whereas during our observational experience in other subspecialties, oxygen was noted to be administered periodically.\nConscious sedation was administered within a hospital-based outpatient surgical center with resuscitation equipment and intubation capabilities immediately available. Standards of care for administration of conscious sedation in the outpatient setting have been established and reviewed.5 The administration of conscious sedation should be restricted to facilities that are in compliance with these standards, which may exclude many office-based settings not specifically equipped for sedation.\nThe use of conscious sedation was satisfying for both patients and physicians, and our patients were pleased with its anxiolytic and analgesic effects. The responses of adults were generally predictable, with patients who regularly consumed alcohol requiring slightly higher doses of benzodiazepines. Combination intravenous midazolam and fentanyl was optimal for adults undergoing short procedures such as carbon dioxide or pulsed dye laser, whereas lorazepam and meperidine were well suited for longer procedures such as hair transplantation.\nThe responses of children were somewhat less predictable. Combination oral midazolam and inhaled nitrous oxide usually provided good sedation, but the sedation provided was not as intense or as uniform. There was clearly an optimal time after the administration of oral midazolam, generally 15 to 30 minutes, when anxiolysis was optimal and nitrous oxide was well received. The amnesia associated with conscious sedation was substantial and was appreciated by the patients.\nConscious sedation allowed us to administer local anesthesia and perform anxiety-provoking procedures without significant patient discomfort or distress. With adequate preparation, personnel, and monitoring equipment, conscious sedation administered by the dermatologic surgeon can be a useful, safe, and effective therapeutic modality. Extensive training and emergency preparedness, however, are essential.\nAccepted for publication July 31, 2000.\nReprints: Clark C. Otley, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (e-mail: [email protected]).
Total amount: € 0,00\nHOW TO ORDER\nA Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care\nMinerva Anestesiologica 2016 February;82(2):180-5\nDesflurane and sevoflurane use during low- and minimal-flow anesthesia at fixed vaporizer settings\nMaria HORWITZ, Jan G. JAKOBSSON\nDepartment of Anesthesia and Intensive Care, Institution for Clinical Sciences, Karolinska Institutet, Danderyds, University Hospital, Stockholm, Sweden\nBACKGROUND: The pharmacokinetics for sevoflurane and desflurane makes them suitable for low-flow anesthesia. The aim of the present study was to assess the use of desflurane and sevoflurane at constant vaporizer settings and fixed low fresh gas flows.\nMETHODS: One hundred ASA 1-2 patients undergoing elective laparoscopic surgery were randomized into 4 groups (25 patients each): a fixed fresh gas flow 1.0 or 0.5 L/min with desflurane (D1.0 and D0.5) or sevoflurane (S1.0 and S0.5) throughout anesthesia. A fixed vaporizer setting, sevoflurane 6% and desflurane 18% was used during wash-in. Time to reach 1 and 1.5 minimum alveolar concentration (MAC), emergence and gas consumption from start to end of surgery was studied.\nRESULTS: Time to reach 1 MAC age adjusted desflurane or sevoflurane was D0.5 8.5±1.7, D1.0 3.7±0.7, S0.5 15.2±2.4 and S1.0 6.2±1.3 minutes, respectively (P<0.001), and times to increase from 1 to 1.5 MAC differed also significantly. Desflurane anesthesia was associated to significantly shorter time to extubation 6.7±2.3 vs. 10±2.3 minutes for sevoflurane (P<0.001). The amount of agent consumed g/min. was significantly reduced for both 0.5 L/min groups: 30% less for desflurane and 19% for sevoflurane.\nCONCLUSIONS: We found an almost twice as rapid wash-in with desflurane and expectedly faster emergence. Gas consumption was lower at 0.5 L/min than it was at 1 L/min for both gases studied however most pronounced for desflurane. Desflurane has clear advantages for minimal fresh gas flow anesthesia.
Baxter has a long history in playing a key role in surgical anesthesia. We are a leading manufacturer of modern inhaled anesthesia and the first company to offer all three of the most commonly used modern inhaled anesthetics for general anesthesia. Our products include anesthetic gases,or inhaled anesthetics, and anesthesia-related critical-care drugs.\nWhen it comes to anesthesia and critical care, product quality and consistency are critical. Baxter services our customers by using a fully automated distribution control center, which dispenses our products with a high level of efficiency.
BETTER WORLD BOOKS BOOSTS BOOKS FOR BELIZE\nBooks for Belize, Inc., a nonprofit organization, was formed in 2012 by […]\nC. H. Davy Ed Cheng\nDavy Ch Cheng\nTirone E. David\nHello, I'm an eBook!\nATTENTION: This item is an eBook. It can be read on iOS, Android, MAC and PC's with a supported eReader. It is not a physical book. eBooks are available via download immediately after you've checked out.\nShipped from other seller\nPROFESSIONAL & ACADEMIC bookst\nWritten by eminent cardiac anesthesiologists and surgeons, this handbook is a complete, practical guide to perioperative care in cardiac surgery. The book addresses every aspect of cardiopulmonary bypass management and fast-track and traditional cardiac anesthesia and describes all surgical techniques, with emphasis on postoperative considerations. Close attention is also given to routine care and management of complications in the cardiac surgical recovery unit.\nCoverage includes up-to-date information on cardiac and neurologic monitoring, off-pump surgery, new devices for anastomosis, robotic surgery, and neurologic complications and outcomes. Tables, algorithms, and 15 appendices summarize key facts, protocols, and clinical decisions.\nOur best deal on used books 3 for $10 and just $3 each additional book. Shop and Save\nA great last-minute present. Exactly what they want to read. Order Gift Certificates »\nWe match every book you purchase with a book donation. Learn more »\nSign up now to get news, sales and special promotions!\n© Better World Books (BetterWorldBooks.com)
Miniature vehicles are helping a Wilmington, Delaware, clinic ease fear before surgery and cut down on medication.\nFour-year-old D’Juan Roane-Kirby was quietly coloring with a purple crayon in an outpatient surgery clinic in Wilmington, Delaware.\nDJ, as Taneha Kirby-Roane calls her son, was waiting to have some dental work done — fillings and crowns for some bad cavities.\n“He’s coloring his giraffe,” said Kirby-Roane. “Staying focused, trying to keep him calm a little bit.”\nDJ was going to have general anesthesia during the procedure. The clinic, part of Christiana Care Health System, offers that service for young children and patients with special needs who aren’t able to endure the stress of dental surgery. Even toddlers sometimes need major dental work.\nBut getting ready to go into the operating room can be especially terrifying for kids this age.\n“There’s a lot of anxiety going into surgery, even as an adult, so you can imagine there’s anxiety as a child as well,” said Debbie Gigliotti, the nurse manager at the clinic.\nThe most anxious children need to be given the sedative drug midazolam to calm them down before they’re separated from mom or dad to go to the operating room, said Gigliotti.\nAnd that moment of separation is hard on parents too.\n“You know, there goes your little one off to the operating room where you have no control over what happens to them,” Gigliotti said.\nParents bringing their kids in for surgery often have concerns about the anesthesia or sedative medications they will get. While midazolam has a long record of safe use in children, some doctors are looking for ways to treat preoperative anxiety without the drug.\nThe Christiana Care clinic is stocked with a variety of activities for calming kids’ nerves; there’s coloring supplies, stickers, and movies.\nNot long ago, the clinic staff upped the ante, introducing a special toy that they say cuts down on medication and puts everyone on a more joyful road to surgery: a pint-sized BMW convertible.\nKids get to drive the electric Power Wheels-sized car from their waiting room to the operating room, giving families something to look forward to in the scary transition.\n‘You need to do something for the child’\nChildren between the ages 8 months and 5 years tend to experience the highest levels of anxiety before surgery, said Zeev Kain, an anesthesiologist and professor at the Yale School of Medicine who has been doing research on preoperative anxiety since the mid-’90s.\nThis distress before medical procedures presents a problem “not only because it causes hardship to the kids and parents,” Kain said, but “because the higher your anxiety before surgery, the more delayed your recovery after surgery is.”\nThat means delayed healing, more pain, and more nightmares later on, he said.\nKain said treatment with midazolam can safely prevent the bad outcomes of preoperative anxiety with minimal side effects, but some doctors believe that avoiding the use of the drug is preferable.\nRegardless of whether doctors use midazolam or toy cars, Kain said, it’s important to nip preop anxiety in the bud.\n“You need to do something for the child,” he said.\nAfter staff at the Christiana Care clinic started using the car a couple years ago, they noticed that they didn’t need to use midazolam to sedate children before dental surgery as often as before. They began collecting data on this.\nThe clinic’s medical director, Stephen Tanner, said that the rate of medication with the drug decreased by about 70 percent.\n“Not only is it a great experience for the kids and a great distraction, it also keeps us from having to give them medicine that patients may not necessarily need,” Tanner said.\nTanner, who was DJ’s anesthesiologist, is known as the clinic’s “garage keeper.” He talks up the cars as he prepares patients and families for the trip to the operating room.\nAs DJ’s big moment draws nearer, he’d put down the crayons and was starting to get antsy, twisting and turning in parent Kirby-Roane’s lap.\nTanner came in to tell his patient about the car he’ll get to drive, and a little while later used a remote control to wheel over DJ’s ride. He kept control with the remote to avoid any fender benders on the way to the OR.\nA nurse checked DJ’s “license and registration” — that would be his hospital bracelet — and DJ hopped into the car.\n“Just push that button, and you going’,” Tanner told him.\nThe car whirred and whined as DJ got going, sputtering at first as he got the hang of the controls.\nBut then he was cruising — right past a set of double doors where Kirby-Roane must wait. DJ didn’t even seem to notice.\nKirby-Roane let out some laughter as the whirring of the mini convertible faded and her son disappeared around a corner.\n“That was too cute,” she said. “That was awesome.”
SPINE MentorTM is a virtual reality training simulator for minimal invasive spine surgery\nThe SPINE Mentor offers true-to-life training of Minimally Invasive Spine Surgeries.\nThe combination of realistic materials, physical spine model and advanced virtual reality capabilities enables to simulate a full procedure with a high accuracy and realistic sensation.\nThe simulator is suitable for anesthesiologists, orthopedic surgeons, and pain medicine surgeons.\nSee the product brochure here
Professor of Anesthesia (CE)\nSection Chief, Emergency Critical Care/AnesthesiaContact Information\nUniversity of Pennsylvania\nSchool of Veterinary Medicine\nDept of Clinical Studies\nNew Bolton Center\n382 West Street Road\nKennett Square, PA 19348\nAbitur (High School Majors: Biology & Social Sciences) Gymnasium Wuppertal, Germany, 1981\nDVM Free University of Berlin, Germany , 1988\nDr Med Vet (Pharmacology & Toxicology) Free University of Berlin, Germany , 1991\nDescription of Research Expertise\nPharmacology of hemoglobin-based blood substitutes\nPathophysiology of and treatment modalities for hemorrhagic shock\nMicrocirculation and tissue oxygenation\nPharmacology of analgesics and modern techniques of regional analgesia\nDescription of Clinical Expertise\nEquine Anesthesia and Analgesia in general\nBalanced Anesthesia in the Equine\nInhalant anesthesia in the equine and its impact on pulmonary gas exchange and hemodynamic function\nRegional Anesthesia and Analgesia in the Equine\nLarge Animal Anesthesia\nCaniglia AM, Driessen B, Puerto DA, Bretz B, Boston RC, Larenza MP : Perioperative analgesia following epidural anesthesia versus femoral and sciatic nerve blocks: a comparison in anesthetized dogs undergoing hindlimb orthopedic surgery J Am Vet Med Assoc in print 2012.\nColumbano N, Secci F, Careddu GM, Sotgiu G, Rossi G, Driessen B: Effects of lidocaine constant rate infusion on sevoflurane requirement, hemodynamic function, and post-operative analgesia in dogs undergoing ovariectomy under opioid-based balanced anesthesia. Vet J in print 2012.\nWojtasiak-Wypart M, Soma LR, Rudy JA, Uboh CE, Boston RC, Driessen B: Pharmacokinetic profile and pharmacodynamic effects of romifidine hydrochloride in the horse J Vet Pharmacol Therap 2012.\nSlack JA, Boston R, Driessen B, Reef V : Effect of routine general anesthesia on plasma cardiac troponin I concentrations in healthy horses Vet Cardiol 13: 163-169, 2011.\nDriessen B, Zarucco L, Kalir B, Bertolotti L: Contemporary use of acepromazine in the anesthetic management of male horses and ponies: a retrospective study and opinion poll Equine Vet J 43(1): 88-98, July 2011.\nZarucco L, Driessen B, Scandella M, Cozzi F, Cantile C : Positive end-expiratory pressure reduces anesthesia-induced atelectasis and improves gas exchange in propofol-anesthetized and mechanically ventilated sheep. Can J Vet Res 74: 305-313, 2010.\nTerry R, McDonnell SM, van Eps AW, Soma LR, Liu Y, Uboh CE, Moate PJ, Driessen B: Pharmacokinetic profile and behavioral effects of gabapentin in the horse. J vet Pharmacol Therap 33(5): 485-494, Oct 2010.\nBauquier SH, Dusavage S, Driessen B: Anaesthesia and ventilation strategy in a horse undergoing pulmonectomy. Equine Vet Educ 22: 231-236, 2010.\nZarucco L, Driessen B, Scandella M, Cozzi F, Cantile C: Sensory nerve conduction and nociception in the equine lower forelimb during perineural bupivacaine infusion along the palmar nerves Can J Vet Res 74: 305-313, 2010.\nStaffieri F, Bauquier SH, Moate PJ, Driessen B*: Effects of inspired oxygen concentration on pulmonary gas exchange in anesthetized horses mechanically ventilated with helium/oxygen gas mixture Equine Vet Journal 41: 747-752, 2009.
If the thought of visiting the dentist causes severe anxiety, you should consider visiting a sedation dentist for a better experience. Some people have severe fears surrounding the dentist office, which is often known as a dental phobia. Many patients even fear a simple dental cleaning. If you would rather suffer a toothache than visiting the dentist, we can help you have a more relaxing, stress-free visit. A sedation dentist can take away your fears, de-stress you, and make you feel comfortable in the dentist chair. We provide sedation techniques for every appointment, even if it is just a teeth cleaning.\nLevels of Sedation\nA sedation dentist provides a variety of useful sedation techniques to help patients relax. With the use of medication and a comforting bedside manner, we calm patients. There are different levels of sedation we administer, depending on how extreme the level of anxiety. Minimal sedation is the most common form that we use for dental cleanings, fillings and crowns. While the patient is under minimal sedation, he or she will be calm and comfortable. The patient will be almost sleepy, but will still be able to respond when spoken to.\nModerate sedation is similar to mild or minimal sedation, but a little stronger. If a patient is put under moderate sedation, then he or she will still be able to speak and interact, but will most likely not remember much of the visit. Deep sedation and general anesthesia put one into a deep sleep. We normally reserve deep sedation and general anesthesia for oral surgeries or extremely severe cases of dental phobia.\nForms of Sedation\nA sedation dentist can provide sedation through a variety of means. Nitrous oxide, also known as laughing gas, is combined with oxygen and administered through a mask over the nose to initiate mild to moderate sedation. Laughing gas produces a euphoric, relaxed feeling while allowing one to respond to and speak to the dentist. We also provide minimal to moderate sedation through oral medications. Patients will take the oral medication before the appointment in a liquid or pill form.\nWe use and carefully monitor IV sedation for moderate to deep sedation during root canal treatments. We can also administer general anesthesia through IV. We will use local anesthetics in conjunction with most of these sedation methods to ensure that one does not feel discomfort during the procedure or treatment.\nCandidates for Sedation\nThose who need to visit a sedation dentist include:\n- Those who are stressed or anxious.\n- Those who feel sad or upset about visiting the dentist\n- Those who have a low pain threshold or sensitive teeth\n- Children or adults with attention deficits or high energy, who have a hard time sitting still for long periods\n- Those who need extensive dental work like several fillings or crowns, root canal treatment, or dental implants\nPatients with medical complications should receive permission from a doctor before sedatives are administered. If you are concerned about how medications will react with sedation, talk with our sedation dentist office or your physician to learn more. Visit our office for a new and improved opinion of dental care today.\nDental anxiety is a serious medical issue that affects about 20 percent of people in the U.S. This often results in the person finding every excuse in the world to avoid showing up for dentist …\nDo you love drinking soda and wonder what your Hollywood dentist has to say about this habit? For decades, health officials have warned the general public about the dangers of consuming sodas. Dentists have also …\nPracticing good oral hygiene not only maintains your oral health, but it also impacts your overall health — which is why the American Dental Association recommends brushing your teeth at least twice a day and …\nWhen you go to the dentist and they tell you that you need oral surgery, do you need to visit another specialist? How do you if your dentist can perform the procedure themselves?Let us go …
A: Blepharoplasty and Brow lifting is performed on men and women of all adult age groups. The excess wrinkled skin of the upper and lower eyelids are examined along with a basic history and physical exam performed at the initial complimentary consultation. This quickly and easily determines the need for upper eyelid, lower eyelid, or brow surgery. This initial evaluation will allow the surgeon to determine what is required to best address the region as a whole, and explain which combination of procedures will have the best results.\nA: Patients usually need only the first two days after surgery to ice the area consistently. After these first two days, work can be resumed within appropriate limits, but sutures remain in place for one week. This procedure is performed under general anesthesia as directed by our board certified anesthesiologists, here at the Philadelphia Surgi Center. As a result, patients feel tired and worn out for a few days after surgery.\nA: Most patients will actually begin to exercise their legs and abdomen as early as 2 weeks. Keeping blood pressure under control after surgery is very important, so early exercise is not recommended. As long as you discuss your exercise plans with the doctor, a safe regimen can be “worked out”.\nA: The swelling associated with Blepharoplasty and Brow lifting create more discomfort than pain. The area is often described as “tight” feeling. Ice therapy at home after surgery for two days is required in order to sooth this sensation. The appropriate prescriptions are provided at the preoperative visit.\nA: The skin of the eyelids and brow are excellent locations for healing much like the rest of the face. The eyelid and brow incisions are created along hairlines, natural skin creases and lash lines. They are consistently the most transparent of all cosmetic scars.\nA: Patients see 10 years of improvement that usually lasts for 10 years as well. We often see patients that have had eyelid surgery 10 and even 20 years prior to choosing a Facelift. It is this long lasting result that maintains the youthful appearance that these patients desire until they decide to ultimately address the tissues and skin of the neck and jowls.
\|A way to help you make a difference in how you feel about yourself and the world around you.\|\n(we're moving!) San Jose, CA\nDr. Zachariah specializes in Facelift, Eyelid Surgery (Blepharoplasty) and Laser Resurfacing for San Jose, Palo Alto, Mountain View, Los Altos, Los Gatos, and San Francisco residents. Unlike most other surgeons in the area, Dr. Zachariah has completed additional specialized training in facial plastic surgery during a prestigious post-residency fellowship.\nThe natural aging process, genetic influences, exposure to the sun and other factors cause the skin to wrinkle and sag. In the younger individual, the face is firm and smooth due to fatty tissue directly beneath the skin. The tissue, which fills out the contours of the face, gives it an even, rounded appearance. As an individual ages, the skin begins to sag and fit more loosely. Skin folds become more prominent, particularly around the chin, on the jaw line and on the neck.\nFaceliftRhytidectomy or face lift can now correct some of these conditions and give people the youthful appearance they desire. This procedure involves the tightening of facial and neck skin and muscles and the removal of excess skin. Often a rhytidectomy is done in conjunction with other facial cosmetic surgeries.\nCosmetic Surgery of the EyesBlepharoplasty can correct sagging eyelids, pouches beneath the eyes and excess folds around the eyes. This surgical procedure involves the removal of excess skin and fat on upper and lower eyelids and is often done in conjunction with other surgical procedures.\nBlepharoplasty can be performed in the office, an outpatient surgical facility or a hospital and it can be done under general or local anesthesia. Following natural lines and creases, fine incisions are made from the inner to outer edge of the eyelid. In some cases, the incisions can be made inside the eyelid to conceal scars. Strenuous exercise must be avoided for several weeks following surgery.\nLaser TreatmentsThe laser is specifically designed to produce an intense but gentle burst of light that is optimized for performing laser "skin peels" and other corrective procedures such as facial scar revisions and laser treatment of pigmented lesions. The laser allows non-traumatic and precise treatments that provide consistent results. In most cases, treatments are performed with intra-venous sedation and local anesthesia and makeup can be applied within four to ten days, depending on your skin's response to the treatment.
Sep 06, 2017 · Breast reconstruction surgery is a highly individualized procedure, and like most other surgical procedures, its cost can vary greatly. In fact, the cost of surgery can range from $3,000 to $9,000. When deciding whether or not to undergo breast reconstruction, it is important to understand all of the aspects that make up the cost of surgery.Author: Eldar Gaziev. Feb 06, 2014 · Tubular Breast Surgery Costs. For both procedures, this cost approaches $10,000 in our practice when done at the same time; this is the approximate cost for the surgeon's fee, surgery facility fee, cost of silicone gel implants, and anesthesia fees. If you only need implants, this cost is approximately $5000.\nHow much does breast reconstruction cost? Breast reconstruction costs can vary. A surgeon's cost for breast reconstruction may vary based on his or her experience as well as geographic location. Breast reconstruction costs may include: Surgeon's fee; Hospital or surgical facility costs; Anesthesia fees; Prescriptions for medication; Post. The American Cancer Society provides a detailed overview of breast reconstruction. Typical costs: Without health insurance, breast reconstruction using implants typically costs $5,000 to $15,000 per breast, for a total of $10,000 to $30,000 if both breasts are reconstructed.\nWhat Does Breast Reconstruction Cost? According to the American Society of Plastic Surgeons, the average surgeon’s fee for breast reconstruction surgery in the United States is about $3,000 to $4,000. How much does breast reconstruction cost? The two most common questions among breast cancer patients considering breast reconstruction are "how much does breast reconstruction cost?" and "will my insurance cover it?" The good news is that even though breast reconstruction is performed by plastic surgeons, it is NOT considered cosmetic surgery.
Strip Hair Transplant in Los Angeles\nThere are two different methods of performing the procedure, strip harvesting or Follicular Unit Extraction (FUE). This page is dedicated to explaining the strip harvesting method and listing a series of frequesntly asked questions. Please scroll down for FAQ.\nDr. Sean Behnam has perfected his strip hair transplant procedures such that patients have minimal downtime, minimal scarring, and most importantly, great results. Hair transplant is more than just a medical procedure, it’s an artistic process that must be carefully planned and executed. Dr. Behnam takes pride in his thorough hair loss examination as well as his one surgery a day philosophy. The advantage of strip hair transplant over F.U.E is that a patiient can usually get more grafts/hair in a single procedure. Also, strip procedures are less expensive.\nOften patients who are considering hair transplant are scared of the scar that might be left from a strip procedure. Those patients have seen pictures of patients who have had procedures that left a wide scar. Those scars were usually a result of old techniques. Dr. Behnam goes through great lengths to make sure his patients have the smallest scar possible. Most of his patients, depending on density, can cut their hair down to one half of an inch without the scar being visible. Patients who cut their hair shorter than a half of an inch are probably better candidates for F.U.E.\nEach follicular unit or hair graft has 1 to 4 hairs. Using current techniques, at the end of the hair transplant procedure, patients can leave with only a headband. Patients can wash their hair the next day.\nThere are many aspects to a successful hair transplant. A natural looking hair transplant involves planting hair grafts in a manner to present natural hair line and natural looking hair growth.\nThe way Dr. Behnam creates the recipient sites determines the aesthetic look of the transplant. He carefully sets the angle at which the new hair grows and determines the distribution and density of the grafts. This is a critical aspect of hair transplant surgery that requires considerable experience, surgical skill and a keen aesthetic sense.\nOur free hair transplant consultation page also gives you ample information about the procedure and what to expect.\nLos Angeles Hair Transplant\nThe images above show a mastery in the art of refinement, blending, balance, proportion, and shading. Dr. Sean consider all aspects of every hair transplant- natural variation in color, texture, and direction.\nDr. Sean dedicates a full day to each surgery. These are outpatient surgeries that do not require general anesthesia. A local anesthetic is sufficient. Patients are provided lunch and a relaxing atmosphere. The building is a Class A Medical building and the equipment is State of the art.\nYes, Dr. Behnam has performed over 1,000 cases successfully.\nDoes the result look natural?\nYes, no one will notice any work was done. People just notice you have more of your own natural hair.\nA patient who had the hair line transplanted. As demonstrated, there are natural protrusions to the hairline, making it look natural. Also, the single hair follicles are placed at the hairline so it does not look pluggy.The image above belongs to a gentleman who had 2315 grafts hair transplanted in one session.\nYes, Dr. Behnam creates a natural non-pluggy hairline, guaranteed.\nAs long as you keep your hair at least 1 inch long, the donor area can be covered very well by your existing hair immediately after the procedure. Some people can wear their hair even shorter.This is because Dr. Behnam uses a special technique called the trichophytic closure to sew the back of the scalp once the strip is removed.\nTrichophytic closure refers to a specific closure method such that the hair grafts grow into the scar. During the actual procedure, special cut is made on the bottom edge. The two edges are then brought together. A few months after when the wound has healed, the hair should actually grow at the level of the scar and camouflage it. Dr. Behnam uses the trichophytic closure on every patient.\nThe 3 steps of the the trichytic closure. (top picture) Once the strip is remove, a special cut is made on the bottom edge. This way as the hairs grow out, the hair grow into the level of the scar ( middle and bottom picture)\nNo. it’s all local anesthesia. Dr. Sean uses a proprietary technology for a pain free procedure.\nWe stand behind our work. We guarantee that the transplant looks natural and non-pluggy. Please look at the picture below. The hairline looks very natural. No one can notice this person had a hair transplant.\nAfter the hair transplant procedure, hair starts growing by about 3 months. They will grow 1 inch every 3 months. So, by the 10 to 12 months, you will see about 2 to 3 inches of hair growth. In general, it will take a good one year to see the full result.\nNo, there are no hidden fees. We are very upfront with our costs. We present you with all the cost atthe consultation. We do not overcharge or have any surprise charges on the day of the procedure.\nYes, we use the hair from the back of scalp. The hair in this area is permanent, meaning that it does not thin out in about 90% of the population. In order to find whether you are a candidate, Dr. Behnam will analyze your scalp using a video microscope as well as densitometer at the consultation.\nYes, we specialize in all kinds of hair color. We have special microscopes and special lights that we utilize during our procedure thatmakes it possible to perform hair transplantation on grey hair.\nThe image above belongs to a gentleman with grey hair who had a hair transplant. The left is the before picture and the right is the picture taken one year after hair restoration.\nYes. There is no general anesthesia used. You may also sleep during the procedure or watch a movie.\nYes, there are two hotels adjacent to the practice. For those from out of the city, we will cover your hotel stay.\nYes, the women in the below picture had over 1,800 grafts placed to thicken the midscalp and the front.\nThe hair transplant procedure is performed in our beautiful office in Santa Monica.
Ahmed Al-Niaimi, MD, FACOG, FACS\nDr. Al-Niaimi is the head of surgical quality outcome for the department of OBGYN and the chair of the Quality Improvement and Review committee at the University of Wisconsin-Madison School of Medicine and Public Health. Dr. Al-Niaimi's research interests include optimization of health outcomes, such as postoperative complications and the effect of patient medical comorbidities and surgical techniques on surgical and oncologic outcomes. He has published in numerous peer-reviewed journals and has been active in presenting research at national conferences. He is also involved in many national courses as an instructor of surgical techniques for gynecologic oncologists.\nTony Ambrozie, MBA\nMr. Ambrozie is the senior vice president and chief digital officer at Baptist Health South Florida, where he is leading organization-wide digital transformation to optimize the patient and clinician experience. He is a proven leader in the technology and digital space with a keen focus on using technology to enhance the consumer experience. Prior to spending the past two decades focused on large business operations, he launched his technology career as the cofounder of a software development startup specializing in building unique, small business applications. Mr. Ambrozie holds a dual MBA and MS in information management from the W.P. Carey School of Business at Arizona State University and an MS in electrical engineering from the University Politehnica of Bucharest.\nKathy Beydler, RN, MBA, CNOR, CASC\nMs. Beydler has been a perioperative nurse, manager and director for more than 30 years. She has served as the administrator of large and small surgery centers and hospitals, and is currently the principal consultant at Whitman Partners, a search firm dedicated to placing directors of surgical services in facilities nationwide. Ms. Beydler is a skilled and experienced leader with a passion for teaching perioperative professionals and achieving excellence in patient care.\nKim Ann Brown, RN, BSN, CASC, CAIP\nKim Brown, RN, BSN, CASC, CAIP, is the ASC Director of ASC Surgical Ventures, LLC d/b/a OSMC Outpatient Surgery Center in Elkhart, Indiana. She is responsible for management of all aspects of the environment of care, personnel, materials/equipment, education and administrative duties as well as for planning, organizing and directing all activities of the facility according to its policies, procedures, philosophy and objectives. She participates in financial and cost-containment decisions and ensures the facility meets all related local, state, federal and accrediting-body rules and regulations. Kim coordinates and directs patient care in the facility. She started her career as a charge nurse and clinical project coordinator in a small ASC in 1997 and has continued as an ASC supervisor, peri-operative nurse, director of nursing and now as an ASC director building a new total joints surgery center.\nCasey Duhart, BS, M.Ed., JD\nMs. Duhart is the chief labor and employment counsel for Acadia Healthcare Company in Franklin, Tenn. In that role, she provides legal advice and counsel regarding allegations of discrimination, harassment, retaliation and wrongful discharge claims brought under federal and state employment laws and regulations. Ms. Duhart earned her JD, cum laude, from the University of Tennessee College of Law where she served as editor-in-chief of the Tennessee Law Review and received the Susan B. Anthony Award for academic achievement and a commitment to enhancing the legal rights of women. She holds a master’s degree in education from Armstrong Atlantic State University and received her Bachelor of Science degree, summa cum laude, from Landmark Baptist College.\nThomas W. Durick, MD\nDr. Durick is an assistant professor of anesthesiology at The Ohio State University College of Medicine. He specializes in outpatient anesthesia, neuroanesthesia and ambulatory surgery center administration. Previously, he was the medical director and acting administrator of a busy surgery center in the San Francisco Bay area. He has given multiple presentations about a wide range of topics, including cost containment in the operating room, quality improvement, prevention of OR fires, outpatient anesthesia specialization, prevention of complications in anesthesia and neuromuscular blockades.\nAnn Geier, MS, RN, CNOR(E), CASC\nMs. Geier has worked in the ASC industry for over 30 years and has been responsible for every aspect of financial and clinical operations in ambulatory surgery centers. She has been a surveyor for Accreditation Association for Ambulatory Health Care (AAAHC) since 2006. Currently, she is chief nursing officer for Ambulatory Healthcare Strategies, which provides administrative oversight and consulting services to ambulatory surgery facilities. Her extensive clinical background is in the operating room, where she served in every capacity. She is an active member of AORN and ASCA and served on the Board of Directors of AAAHC. She is currently a member of AAAHC’s surveyor administration committee. Ms. Geier serves on the BASC board of directors and serves as president of BASC, which oversees CASC and CAIP certifications.\nMatthew Goldshore, MD, PhD, MPH\nDr. Goldshore is the deputy director of the Center for Surgical Health at Penn Medicine in Philadelphia. He is a general surgery resident at the University of Pennsylvania planning on a career in pediatric general, thoracic and fetal surgery. He graduated from the University of Texas at Austin with degrees in biochemistry and secondary science education. After a short time teaching high school chemistry in Austin, Dr. Goldshore earned his master of public health degree at the George Washington University School of Public Health. After completion of his MPH, he started medical school at GWU, then took a leave of absence to pursue his PhD in perinatal epidemiology in the Department of Population, Family and Reproductive Health at The Johns Hopkins Bloomberg School of Public Health.\nJinlei Li, MD, PhD\nDr. Li is an associate professor in the department of anesthesiology at Yale University and program director of regional anesthesia and acute pain medicine at Yale New Haven Hospital. She is a board-certified anesthesiologist who performs a range of peripheral nerve blocks for acute and subacute pain management in the perioperative arena. Dr. Li has a research interest in developing new opioid-sparing regional anesthesia protocols to facilitate faster recoveries and better functional outcomes in joint replacement patients. Her innovative work in managing post-op pain has been instrumental in advancing Yale’s outpatient total joints program.\nMs. Lodato is chief of wellness for the department of surgery at Mount Sinai Health System in New York City. She is a member of the second international cohort of the Mindfulness Meditation Teacher Certification Program sponsored by the University of California, Berkeley’s Greater Good Science Center. Ms. Lodato uses firsthand insights into the resilience required to manage fast-paced, high-stress environments she acquired through her previous experience in executive positions within Silicon Valley corporations.\nPaige McMillan, MHA\nMs. McMillan is the vice chair of administration and finance in the department of surgery at Mount Sinai Health System in New York City. Ms. McMillan is responsible for the financial operational and strategic activities of the department of surgery in support of the clinical, research and education missions of the Mount Sinai Health System. Before joining Mount Sinai, Ms. McMillan served in progressive leadership roles in The Johns Hopkins Sidney Kimmel Cancer Center for more than six years. She received her Bachelor of Arts degree from The College of William and Mary and her Master of Health Administration from The Johns Hopkins University Bloomberg School of Public Health.\nCarrie Morales, MD\nDr. Morales is the associate deputy director of the Center for Surgical Health at Penn Medicine in Philadelphia. She is a resident in the division of plastic and reconstructive surgery at the University of Pennsylvania. Dr. Morales graduated from Tufts University in 2015 with majors in biology and child development and received her medical degree from the Perelman School of Medicine at the University of Pennsylvania in 2021. She has spent dedicated research time at the NYU Department of Population Health on an NIH stroke disparities study and as a craniofacial research fellow in the Children’s Hospital of Philadelphia’s Division of Plastic and Reconstructive Surgery.\nJig Patel, ST, CRCST, CHL, CIS, CER\nMr. Patel, who has worked in the perioperative service arena since 2004 in a wide variety of roles, currently serves as the sterile processing educator/quality assurance manager for UCLA Health in Los Angeles. He is also a part-time professor for Skyline College in San Bruno, Calif.\nSheri Prentiss, MD, MPH, CPS/A, CPE, FACPE\nDr. Sheri is a proven visionary, author and highly sought-after physician leader. She is a board certified occupational and environmental medicine physician and public health expert. As a breast cancer survivor, Dr. Sheri brings a unique perspective to her impassioned work in advocacy, preventive care and health awareness. After a partial mastectomy, a lymph node dissection, 15 rounds of chemotherapy and 33 rounds of radiation, she was left with clinically disabling lymphedema of her right arm and hand, and she can no longer perform hands-on treatment of patients. Despite it all, she has increased her service to patients in unprecedented ways including her tenure as Susan G. Komen’s 3-Day National Spokesperson.\nLee Rubin, MD, FAAOS, FAAHKS, FAOA\nDr. Rubin is an associate professor of orthopedic surgery and chief of the division of adult reconstruction within the department of orthopedics and rehabilitation at the Yale School of Medicine. He is also chief of the Center for Musculoskeletal Care’s total joint replacement program at Yale New Haven Hospital. Dr. Rubin performs more than 300 hip and knee replacements annually, caring for patients with a wide array of joint pathology and disease complexity. He is an active member and fellow of the American Association of Orthopaedic Surgeons, the American Association of Hip and Knee Surgeons and the American Orthopaedic Association.\nMs. Scotti is a nationally touring comedian and motivational speaker with more than four decades of on-stage experience and television appearances on Comedy Central, Showtime and NBC. She was a quarterfinalist on the eleventh season of “America’s Got Talent” and a fan favorite whose three appearances on the show currently have more than a million views each on NBC’s YouTube channel. Ms. Scotti is currently starring in the critically acclaimed documentary “Julia Scotti: Funny that Way,” a film that just wrapped up a successful national film festival tour. A former teacher, Ms. Scotti’s motivational speaking strikes a perfect balance between heartfelt honesty, emotional and empathetic understanding, and hilarious observational comedy. One of the most moving and engaging speakers on the circuit, she talks bluntly about what it’s like to be different and how to find the resilience to overcome even the most seemingly insurmountable obstacles.\nDavid Shapiro, MD, CASC\nDr. Shapiro is an anesthesiologist from Florida who has had extensive experience serving as a department chair, medical director and board member of several ambulatory surgery centers. He currently serves on the boards of both the Florida Society of Ambulatory Surgery Centers and the Ambulatory Surgery Center Association (ASCA) and is a past president of ASCA. Additionally, he is a Board member of the Ambulatory Surgery Center Quality Collaboration, which develops, measures and publicly reports national ASC quality data. Dr. Shapiro is also a board member and officer of the Accreditation Association for Ambulatory Health Care (AAAHC), an organization for which he conducts healthcare facility surveys on behalf of AAAHC and Medicare. He serves on the board of the Facility Guidelines Institute and participates as a member of their Health Guidelines Review Committee.\nNancy Yen Shipley, MD\nDr. Nancy Yen Shipley, aka NancyMD, is a board-certified, sports fellowship-trained orthopedic surgeon in private practice in Portland, Oregon, and the team physician for the U.S. Ski and Snowboard Team. In addition to running her successful practice, Dr. Shipley is an avid podcaster and host of “The 6%,” a podcast dedicated to women who thrive in traditionally male dominated fields. She is also a writer and speaker who is passionate about helping women level up their personal and professional lives from good to genius, as a creator and curator of engaging written, video and live content.\nAshish Sinha, MD, PhD, DABA, MBA, FASA\nDr. Sinha is a professor of anesthesiology at Loma Linda University & Riverside University Medical Center in Southern California. He is also an adjunct full professor at University of California Riverside. His research interests include obesity, medical errors, trauma, PONV and difficult airway management. Dr. Sinha currently serves on the Outpatient Surgery Magazine Editorial Board and has participated in the OR Excellence Conference in past years. He is a high-volume publisher and a prolific national and international speaker with more than 600 CME lectures delivered in 60 countries on six continents.\nMr. Snow began his career at the Walt Disney World organization in 1979 as a frontline attractions operator. As he advanced through the company, he learned and applied the skills needed to run a world-class, service-driven organization. Mr. Snow launched a division of the Disney Institute responsible for consulting with some of the world’s largest companies. He also spent several years with Disney University, teaching corporate philosophy and business practices to cast members and the leadership team. While there, he coordinated the Disney Traditions program, which is universally recognized as a benchmark in corporate training. In his last year with Walt Disney World, Dennis’ leadership performance ranked in the top 3% of the executive team. Mr. Snow is now a full-time consultant who helps organizations achieve goals related to customer service, employee development and leadership.\nRaDonda Vaught is a former nurse at Vanderbilt University Medical Center in Nashville, Tenn. When Ms. Vaught was convicted and criminally charged in March 2022 for a fatal medication error, the case made national news and shocked the healthcare community. Healthcare professionals were worried that the criminalization of medical mistakes would impact the transparency needed to discuss errors and prevent future patient harm. Ms. Vaught is currently meeting with Tennessee lawmakers to promote the passage of legislation that would grant healthcare providers immunity from prosecution when revealing medical mistakes and discussing the root causes of these events.
A facelift is an excellent cosmetic surgery procedure for people looking to revitalize their looks and give themselves a youthful look. It helps tighten sagging skin, erase wrinkles, smooth out fine lines, and correct jowls. Its effects are often long-lasting, with many patients enjoying a refreshed and rejuvenated appearance for years. Learn how facelifts work to determine if it’s the right procedure for you.\nUnderstanding How a Facelift Works\nStep 1: Consultation With a Qualified Cosmetic Surgeon\nA comprehensive consultation is always the first step in any cosmetic surgery procedure. During your consultation with a qualified surgeon, you will discuss your medical history, medications you may be taking, and your skin goals. The surgeon will explain the process, take before photos, answer any questions you may have, and discuss the risks associated with a facelift.\nYou may ask for before and after photos of previous clients to determine the results you can expect. If you’re not a good candidate for this procedure due to pre-existing medical conditions or anesthesia intolerance, your doctor may suggest alternate treatments.\nStep 2: Preparing for the Facelift Cosmetic Surgery Procedure\nLike any other surgery, a facelift requires proper preparation for a safe and successful outcome. Your surgeon may ask you to stop smoking or taking certain anti-inflammatory drugs to avoid the risk of excessive bleeding or bruising. You may also need to maintain a healthy diet and drink plenty of fluids to help your body and skin heal faster. Since anesthesia is usually used during a facelift, you’ll need to organize someone to drive you home after the procedure and help you with tasks at home for several days.\nStep 3: Anesthesia Administration\nSince a facelift involves cutting into the skin, your cosmetic surgeon uses anesthesia to reduce pain and keep you comfortable during surgery. Anesthesia may be administered intravenously through your arm or in the form of gas breathed through a mask. The type of anesthesia will depend on the extent and complexity of your procedure and your surgeon’s preference. You may ask for an explanation of the risks associated with each option to understand how to prepare.\nStep 4: The Facelift Cosmetic Surgery\nA traditional facelift is the most common technique used to make your face look younger. It involves making incisions along the hairline, around the ears, down near the jawline, and on the lower scalp. Through these incisions, your surgeon uses various tools to lift facial skin, tighten underlying muscles and tissue, remove or redistribute excess fat, and trim away excess skin to avoid sagging once the procedure is complete.\nAfter the surgery, your surgeon will close the incisions with skin adhesives or sutures. A traditional facelift may involve some bruising and swelling in the face. These usually subside within a few days, and you can expect some medications from your doctor to help reduce any discomfort. Compare your before and after photos to see the dramatic impacts of a facelift. When you work with an experienced cosmetic surgeon, you can expect natural-looking and long-lasting results.\nStep 5: Recovering From a Facelift\nHow you take care of yourself during the recovery period can determine the success of your facelift. Your surgeon will tell you when to remove the bandages and what pain medications you may need. Ask them when it’s most suitable to resume strenuous activities to avoid injuries that may affect the results. As part of your recovery routine, you may also need to eat a healthy diet, drink lots of water to moisturize your skin, avoid sun exposure, and get enough rest. If you notice anything out of the ordinary, contact your doctor immediately.\nStep 6: Follow-up Visits\nA follow-up appointment may be necessary to evaluate the results of your facelift. The surgeon assesses your face and determines if additional corrective surgery is needed. Depending on your age, lifestyle habits, and skin condition, you may need to get another facelift in a few years. When you take good care of your skin, you can enjoy the results of your facelift for many years. Follow your doctor’s instructions and enjoy the youthful and refreshed look that comes with a successful facelift.\nAsk Your Doctor About a Facelift Today\nFacelift cosmetic surgery can give you a younger and more rejuvenated face, improving your appearance and boosting your confidence. Partner with a qualified, experienced cosmetic surgeon for high-quality, safe results. Don’t be afraid to ask questions and get the information you need to make an informed decision.
1. What is anesthesia?\nAnesthesia is a medicinal therapy that relieves discomfort during operations such as surgery, diagnostic and screening tests, dental treatments, and tissue sample removals. It enables patients to receive procedures that help them to get a better and longer lifespan. Anesthetics are medications that doctors employ to cause anesthesia. Scientists have created a variety of anesthetic medicines with varying effects. General, local, and regional anesthetics are among these medications. Regional and local anesthetics offer numbness to the body parts and enable patients to stay conscious throughout the surgery, whereas general anesthetics render patients unconscious.\n2. What are the three types of anesthesia?\nThere are several types of anesthesia. All of this is done to make you relaxed and pain-free throughout medical treatments. The 3 -forms of anesthesia are the following:\n1. General Anesthesia: It is most typically used for major surgeries like heart surgeries, hip and knee replacements, and a variety of cancer-related surgical procedures. Many of these procedures are life-saving and would be impossible to perform without the use of general anesthesia.\n2. Local Anesthesia: It is often administered as a single injection of medication that numbs a limited number of body parts. It’s used for things like taking a skin biopsy, healing a fractured bone, and sewing a deep incision. During the treatments, you will be conscious and attentive and feel little pressure. However, you will not experience pain within the treated region.\n3. Regional Anesthesia: It is a method of pain control used during operations that numbs a wide portion of the body. The medicine is administered using an injection or a tiny tube known as a catheter. It is issued when a simple local anesthesia injection is insufficient, and the individual should be conscious.\n3. Is taking anesthesia painful?\nYou don’t experience pain under general anesthesia since you are fully unconscious. A mix of intravenous medicines and breathed gases are often used in general anesthesia. So, the anesthetized brain does not react to pain sensations or reflexes.\n4. How long does the anesthesia last?\nAnesthetic medications might remain in your bloodstream for around 24 hours. When you have undergone sedation or general or regional anesthesia, you should avoid travelling or working until the medicines have cleared your system. You must resume usual tasks after the local anesthetic until your healthcare professional recommends so.\n5. Will anesthesia put you to sleep?\nGeneral anesthesia, administered to the patients while undergoing major surgeries, induces unconsciousness or takes them to sleep.\n6. Can you wake up during anesthesia?\nAround one or two persons out of every 1,000 can be partly conscious when under general anesthesia and undergo inadvertent intraoperative consciousness. Therefore, it is very unusual to suffer discomfort, although it can happen. Anesthesia awareness (waking up) throughout surgery refers to the patient’s ability to recollect their environment or an incident connected to the procedure when under general anesthesia.\n7. What happens if you don’t wake up from anesthesia?\nA delay in awakening from anesthesia is referred to as delayed emergence. This condition may arise in exceptional circumstances. Patients may suffer delayed emergence, which occurs when they take longer than planned to awaken from anesthesia. Some medicines provided to the patient may need to be reversed in certain situations. In other cases, where reversal medicines are unavailable, we have to wait for the medication to wear off over time. Moreover, a breathing tube may be required in rare cases till the patient is conscious enough to breathe on their own.\n8. Why are eyes taped during surgery?\nTo prevent corneal damage throughout general anesthesia, the eyes must be protected with tape. Moreover, to hold the eyelids entirely closed throughout anesthesia, little pieces of adhesive tape are routinely employed. This has been demonstrated to lower the likelihood of a corneal abrasion.\n9. How long does it take to wake up from anesthesia? / How quickly do you wake up from anesthesia?\nMost patients are conscious immediately following surgery but stay sleepy for some hours afterward. It may take nearly a week for the body to clear the medications from the system, although most individuals will see no impact after roughly 24 hours.\n10. What are the four stages of anesthesia?\nThe stages of anesthesia are classified into four phases:\n1st stage: Introduction: The first phase begins from the time it is administered until you go sleeping. You will remain calm and can chat for some time. You will have slow breathing when you lack the capacity to sense pain.\n2nd Stage: Excitement / Delirium: The second phase can be risky; therefore, the anesthesiologist wants the patients to get through it as soon as possible. You may have uncontrollable reflexes, a rapid pulse, and erratic breathing. Also, you could vomit, causing choking or breathing difficulty.\n3rd Stage: Surgical Anesthesia: Surgery is possible at this point. Without the assistance of machinery, your eyes stay constant, your muscles entirely rest, and you might also stop breathing. The anesthesiologist maintains this situation until the operation is finished.\n4rth Stage: Overdose: If you are sedated for too long, your mind will discontinue signaling your lungs and heart to function. It is uncommon in contemporary technology, yet it may be devastating.\n11. Does your heart stop under general anesthesia?\nMany of the body’s natural autonomic activities are suppressed by general anesthesia. This encompasses those that regulate respiration, blood circulation, heartbeat, and digestive tract motions.\n12. How do I prepare for anesthesia?\nGeneral anesthesia works by relaxing the muscles in the airways and digestive system, preventing acid and food from flowing into the lungs from the stomach. Therefore, remember to follow your doctor’s advice regarding not eating or drinking anything before operations. In addition, patients need to fast six hours before the surgical procedure.\n13. What are the risks of anesthesia?\nA few of the uncommon but potentially serious adverse effects of general anesthesia include:\n- 1. Injury around the injection area.\n- 2. Breathing difficulties.\n- 3. Infection.\n- 4. Temporary nerve injury.\n- 5. Allergic reactions like asthma attacks.\n- 6. Having discomfort during surgery.\n- 7. Mouth, lips, teeth, or tongue injury.\n14. How does anesthesia feel?\nGeneral anesthesia is a mixture of medicines that puts you to sleep in preparation for an operation or another medical treatment. You don’t experience pain when under anesthesia since you will be fully unconscious.\n15. Do you breathe on your own under general anesthesia?\nNo. After you’ve been knocked unconscious, the anesthesiologist will insert a breathing tube into your nose and mouth to ensure appropriate breathing throughout the treatment.\n16. How many hours can a person be under anesthesia?\nBased on anesthetic medicine, anesthesia might last anywhere from 45 mins to 4 hours. While local anesthetic could last for an hour or two, general anesthesia often lasts 3-4 hours.\n17. Why do they give you oxygen before anesthesia?\nOffering pure oxygen breathing under general anesthesia is safe. It simplifies and secures anesthesia and can minimize clinical complications like surgical area infection and postoperative hypoxia.\n18. Should I be scared of general anesthesia?\nIt’s natural to be scared of the future. However, there is nothing to worry about in this situation because the death rates linked with general anesthesia are relatively low, especially for cosmetic surgical operations. Generally, general anesthesia is relatively safe, and most people get through it without incident.\n19. How do doctors wake you up after anesthesia?\nThere are no medications available to bring individuals out of anesthesia. So when the doctors complete the procedure, the anesthesiologist stops the medicines that put the person to sleep and waits for them to regain consciousness and wake up on their own.\n20. How do I overcome my fear of anesthesia?\nTo overcome your fear of anesthesia, you need to follow the below tips:\n- 1. Before your operation, discuss your concerns with your doctor.\n- 2. Remain healthy while preparing for surgery.\n- 3. Know the related things and follow doctors’ instructions.\n- 4. Make yourself distracted on the day of surgery.\n- 5. Speak with the healthcare staff.\n- 6. Get a friend or family member to discuss your worries.\n21. Why do I cry when I wake up from anesthesia?\nThere is a medicine named Sevoflurane, a gaseous that doctors routinely employ to keep patients sleeping. When that drug is administered, there is a greater prevalence of crying. Many individuals may cry after waking up from general anesthesia because they are confused and puzzled when the medications’ impacts wear off. Stress associated with surgery might even cause crying during anesthesia.\n22.Why does your breath smell after anesthesia?\nMost people have suffered flavor and smell abnormalities after undergoing general anesthesia. In addition, bad breathing smell occurs due to the use of numerous drugs, including anesthetic agents, throughout treatments.\n23. Can you control what you say after anesthesia?\nOnce the anesthetic comes into effect, you will usually have little or no knowledge of whatever you say. Therefore, you may say anything you didn’t intend to utter and later will forget or be unable to recall it after regaining consciousness.\n24. Why do you act weird after anesthesia?\nSome people behave strangely and experience long-term repercussions following anesthesia. Drowsiness, decreased response times, difficulties focusing, retaining new knowledge, and completing complicated activities are also symptoms.\n25. What are the side effects of anesthetic?\nFeeling ill is a typical side effect that can happen after an anesthetic:\n- 1. Dizziness and faintness\n- 2. Shivering or cold\n- 3. Headaches\n- 4. Itching\n- 5. Bruising and discomfort\n- 6. Having difficulties peeing\n- 7. Aches and pains\n26. What is the price of anesthesia?\nThe cost ranges from Rs.2500 to Rs.60,000, depending on the treatment chosen.\n27. Which medicine is used for anesthesia?\nIsoflurane, Sevoflurane, desflurane, and nitrous oxide are the most often used medications in anesthesia. In addition, nitrous oxide is a frequent adjuvant gas, rendering it one of the longest-lasting medications in use today.\n28. Does your heart stop under general anesthesia?\nNo, during general anesthesia, the heart doesn’t generally stop. The sole exception is a heart bypass operation, in which the heart is purposely slowed with specialized drugs so that the surgical team may operate safely.\n29. What are the four types of anesthesia?\nThe four basic types of anesthetic used throughout surgery and other operations are as follows:\n1. General anesthesia\n2. Regional anesthesia\n4. Local anesthesia\n30. How is anesthesia given?\nThe anesthesia is normally administered by the anesthesiologist in the intravenous line of the arm. The doctor may also offer a gas to breathe using a mask sometimes. Kids may usually sleep after wearing the mask. Moreover, the anesthesiologist may put a catheter or tube into the mouth and down the windpipe after you have fallen unconscious or sleep.\n31. What causes death under anesthesia?\nThe following are the most prevalent causes of anesthesia-related deaths:\n- 1. Cardiovascular failure is caused by hypovolaemia in addition to anesthetic overdosages like thiopentone, benzodiazepines, opioids, or regional anesthesia.\n- 2. Hypoventilation and hypoxia can occur due to unrecognized oesophageal intubation, anesthetic equipment failure, complicated intubation, or desire for gastric contents.\n- 3. Cancerous hyperthermia\n- 4. Human carelessness, including a lack of attentiveness or mistakes in medication administration.\n32. Is anesthesia the same as death?\nProviding anyone medication to keep them unconscious as they eventually die is not the same as giving somebody medication to end their own life. Therefore, general anesthesia is permitted, although euthanasia is prohibited in many nations, including the United Kingdom.\n33. How does anesthesia knock you out so fast?\nAnesthesia acts by inhibiting nerve impulses in the brain and body. For example, it inhibits your brain’s ability to absorb discomfort and recall what happened throughout your operation.\nFrequently Asked Questions on Diseases\n1. Is anesthesia Given During Piles Surgery?\nYes, anesthesia is given during piles or hemorrhoid surgery, also known as Hemorrhoidectomy. Pile surgery can be performed under local anesthesia, spinal anesthesia, or general anesthesia. When local anesthesia is utilized, the anesthesiologist administers IV medicines that cause the patient to sleep during the operation and not experience pain or remember anything. To numb the spine and buttocks, anesthesia is administered into the spinal canal during this surgery. This type of anesthesia is quite safe.\nLooking For Piles Surgery at You City ?\n2. Is anesthesia Given During Gynecomastia Surgery?\nYes, most individuals are treated under general anesthesia during gynecomastia surgery. However, in some circumstances, anesthesia combined with oral sedation is effective. Depending on the circumstances, the surgery might take one to two hours. You will be sleeping during the procedure if you get general anesthesia. Or, you will be conscious, and the area where the surgery will be performed will be inert so that you won’t feel any discomfort. In the majority of situations, general anesthesia is the safe pick.\nLooking For Gynecomastia Surgery at You City ?\n3. Is Anaesthesia Given During Cataract Surgery?\nCataract surgery is nearly always conducted as an outpatient surgery. It generally includes local anesthesia and systemic sedation provided by an anesthesiologist. You are normally conscious during the procedure. The doctors administer eye drops comprising a numbing drug (local anesthesia) to prevent the nerves within your eye from transmitting pain signals to the brain. Along with the anesthetic eye drops, lidocaine (a local anesthetic) can sometimes be administered into your eye. This may lessen discomfort after and during the procedure.\nLooking For Cataract Surgery at You City ?\n4. Is Anaesthesia Given During Liposuction Surgery?\nLiposuction surgery can be done under either general or local anesthesia. The patient is conscious throughout liposuction using local anesthesia but sleeps throughout the surgery with general anesthesia. Although large-volume liposuction may be performed using any anesthesia approach, experts highly advise using general anesthesia. The normal method of anesthesia induction is performed, with propofol being one of the most often used medications.\n5. Is Anaesthesia Given During Hernia Surgery?\nIntravenous sedation is the most frequent anesthesia used during outpatient hernia surgery. Patients are given a mixture of many distinct IV medicines beginning before and lasting until the operation’s completion. Although open hernia surgery can be performed under regional (spinal), general, or even local (sedation) anesthesia, laparoscopic hernia surgery is always performed under general anesthesia.\n6. Is Anaesthesia Given During Gallstone Surgery?\nThe gallbladder is removed when you’re under general anesthesia so that you remain unconscious and do not experience any pain. However, you will not be conscious throughout the process because it is conducted under general anesthesia. Anesthesia is administered through a vein in the arm. Once the medications have taken effect, your medical team will implant a tube down your gullet to assist you with breathing.\n7. Is Anaesthesia Given During Varicose Veins Surgery?\nYes, anesthesia is needed for varicose vein surgery. However, a substantial majority of varicose vein procedures have been carried out under general or regional anesthesia. Regional anesthesia has the benefits of preventing patients from feeling pain and preventing doctors from being distracted by the movement of the person’s lower extremities throughout the surgery.\n8. Is Anaesthesia Given During Lipoma Surgery?\nDetermined by the size and area of the tumor, lipoma excision can be conducted using general anesthesia or sedatives. Local anesthesia will be administered to the sufferers to inert the surgical area. You may experience pushing or pressure with local anesthesia, but you won’t have to deal with discomfort or pain. Patients may be administered general anesthesia if their lipoma is severe or deep.\n9. Is Anaesthesia Given During Kidney Stone Surgery?\nUreteroscopy or kidney stone surgery is a minimal-invasive method of treating kidney and ureter stones. It is normally done with general anesthesia and can last between one to three hours. This operation is normally performed as an outpatient treatment in the surgery room under spinal or general anesthesia.\n10. Is Anaesthesia Given During Circumcision Surgery?\nCircumcision is a surgical procedure that removes the skin covering the tip of the penis. Anesthesia is frequently used, which implies that you will be asleep all through treatment. It can also be performed with a local anesthesia injection, which numbs the penis and adjoining region. In certain situations, spinal anesthesia will be applied, which will make the patients unable to experience anything under the waist.\nLooking For Circumcision Surgery at You City ?\n11. Is Anaesthesia Given During Fissure Surgery?\nLateral internal sphincterotomy is a surgical procedure used to assist cure an anal fissure that has not responded to medication or other therapies. It is the most often used surgical method for anal fissure healing. The treatment can be conducted using spinal or general anesthesia for the patient. In addition, local anesthesia may be utilized in a competent patient. However, the surgeons do not usually advise it.\n12. Is Anaesthesia Given During Fistula Surgery?\nFistula surgery is possible under spinal, general, or local anesthetic. Generally, anal fistula surgery is often performed with general anesthesia. Furthermore, due to its related vasodilatory benefits and fistula patency levels, regional anesthesia has been advocated as the optimal anesthesia technique for arteriovenous fistula surgery.\n13. Is Anaesthesia Given During Pilonidal Sinus Surgery?\nYes, diverse anesthesia approaches such as spinal, local, and general anesthesia may be utilized to prepare individuals for pilonidal sinus surgery. The treatment is performed under general anesthesia by one of the expert anesthesiologists. As a result, most individuals experience numbness instead of discomfort in the area of operation post-surgery. This makes the patients comfortable when they are discharged from the hospital.\n14. Is Anaesthesia Given During Mole Removal Surgery?\nYes, a small amount of anesthesia is administered to sedate the region before removing the top surface of the mole. Next, the doctor will inject local anesthesia that will remain inert on the spot in a matter of minutes. Your surgeon will next burn, excise, or freeze the region based on the mole type and the treatment method necessary. You might feel some pressure, but the anesthesia should keep you comfortable.\n15. Is Anaesthesia Given During Hydrocele Surgery?\nOutpatientOutpatient clinics are frequently used for hydrocele repair procedures. General anesthesia is used throughout the surgery to keep you unconscious and pain-free. Furthermore, hydrocele surgery can be conducted with local anesthesia, reducing the morbidity associated with more painful anesthetic procedures.\n16. Is Anaesthesia Given During Frenuloplasty Surgery?\nYes, the frenuloplasty will be performed with local anesthesia. Local anesthesia will be administered to the root of the penis to sedate it so that the frenuloplasty may be performed painlessly.\n17. Is Anaesthesia Given During Varicocele Surgery?\nYes, anesthesia is administered in varicocele surgery. An open varicocelectomy is frequently conducted as an outpatient procedure using spinal or general anesthesia. It can also be undertaken using or without intravenous sedation, along with local or regional blockage.\n18. Is Anaesthesia Given During Hair Transplant?\nHair transplantation treatments need extensive intervals of anesthesia. Whatever approach is utilized, it is generally combined with local anesthesia and sedatives to keep you comfortable and relaxed. The scalp will be pain-insensitive. However, you may feel some pulling or pressure.\n19. Is Anaesthesia Given During Vaginal Tightening Surgery/ Vaginoplasty?\nA vaginoplasty or vagina tightening surgery joins the individual muscles and removes excess skin. Although the surgery may be performed under local anesthesia, many patients choose to have it completed with general anesthesia. A vaginoplasty takes one or two weeks to heal from, without any use of tampons or intimacy for around eight weeks.\n20. Is Anaesthesia Given During Hysterectomy Patient?\nYou may choose general anesthesia during Hysterectomy, which renders you asleep during treatment. Moreover, regional anesthesia, commonly known as an epidural block or spinal block, may be an alternative. Regional anesthesia will suppress sensations in the bottom part of the body throughout a vaginal hysterectomy.\n21. Is Anaesthesia Given During PRP Surgery?\nYes, anesthesia is administered throughout the PRP procedure. However, administering local anesthetics to relieve pain throughout PRP injections may undermine PRP’s therapeutic effects. Lidocaine and Ropivacaine are two local anesthetics widely in use for PRP treatments.\n22. Is Anaesthesia Given During Hymenoplasty?\nThroughout Hymenoplasty surgery, an anesthetic is administered. Because it is done using local anesthesia, it is painless. If you are concerned about the process, you might choose to rest by using a sedative throughout it. During the first week after the operation, you may have little pain and discomfort as the anesthesia wears off.\n23. Is Anaesthesia Given During Labiaplasty?\nLabiaplasty operations can be done under local anesthesia in the office. However, for comfortability, to simplify the surgical method, and possibly to enhance results, these operations are commonly performed using general anesthesia.\n24. Is Anaesthesia Given During Rhinoplasty?\nSince rhinoplasty is less intrusive than thoracic, abdominal, or other operations, the patient just needs enough anesthesia to be completely asleep and so relaxed and immobile throughout the treatment. Before surgery, consult your surgeon about which form of anesthetic is best for you.\n25. Is Anaesthesia Given During Knee Replacement Surgery?\nKnee replacement treatment is often conducted using general anesthesia (you are unconscious during the operation), spinal anesthesia, or epidural (you are conscious and have no sensation below the waist).\n26. Is Anaesthesia Given During Joint Replacement Surgery?\nGeneral anesthesia is frequently utilized for painful surgery, like a knee replacement. For joint replacement surgery, two forms of anesthesia may be chosen. These are general anesthesia and spinal anesthesia.\n27. Is Anaesthesia Given During Shoulder Replacement Surgery?\nYes, regional anesthesia is administered throughout shoulder replacement surgery. The ideal sort of regional anesthesia is to inert the arms’ nerves about an inch just above the collarbone, around where the nerves escape the neck. The anesthesiologist will provide some medication to help you calm down before numbing the skin location.\n28. Is Anaesthesia Given During Heart Surgery?\nHeart bypass surgery can last 3 to 6 hours and is done under general anesthesia. During that period, you may be linked to a bypass machine, which conducts lungs and heart tasks while the doctor works and the heartbeat is not functioning.
Centers of Excellence\nFind a Service Location\nIs weight loss surgery for you? Get your questions answered during a free information session.\nAnother minimally invasive procedure that helps diagnose problems in the gall bladder, bile ducts, liver and pancreas is performed at WakeMed. Endoscopic retrograde cholangiopancreatography (ERCP) uses an endoscope – a lighted thin tube with a camera on the end – to travel into the abdomen to view these organs and ducts.\nFind a Doctor\nYour throat will be numbed using an anesthetic spray. Under light sedation, the tube is inserted through the mouth and is guided down the esophagus to the stomach and duodenum (top of the small intestines). A small cannula will be threaded through the scope into the bile and pancreatic ducts. A contrast is released retrograde, meaning backwards, filling the region with a material that highlights these areas.\nX-rays are then taken of the ducts. If a problem – such as a gallstone, growth, scar tissue or other issue causing an obstruction or narrowing – is found, it may be treated at the time of the procedure. In some cases, a metal or plastic stent may be inserted to provide support and open a narrowing in a duct.\nERCP is also useful in diagnosing pancreatitis, pancreatic cancer and other abnormalities in the region.\nLearn what to expect from Endoscopic Retrograde Cholangiopancreatography\n3000 New Bern Ave.\nRaleigh, NC 27610
Enhanced Recovery After Surgery in Kidney Transplant Donors\n“Enhanced Recovery After Surgery in Kidney Transplant Donors”\nEnhanced recovery after surgery (ERAS) pathways are designed to optimize perioperative management, improving patient outcomes and satisfaction through multimodal techniques. Living kidney transplant donors are typically healthy individuals who undergo laparoscopic nephrectomy. The most significant hindrance to discharge to return to activities of daily living is frequently return of bowel function and postoperative pain. Through a randomized controlled trial design, we will evaluate the effectiveness of implementing an ERAS pathway. We hypothesize that preoperative patient optimization through exercise, carbohydrate loading, and counseling on expectations, in addition to multimodal pain management strategies which limit opioids would allow faster recovery, early bowel function, decreased postoperative pain, increased patient satisfaction and shorter length of stay. The study population will include a total of 42 patients (age 18-80) who are American Society of Anesthesiologists (ASA) Physical Status (PS) 1-3, undergoing living donor nephrectomy. Our primary outcome measures will be postoperative opioid consumption. Secondary outcome measures are: postoperative pain score, time to return of bowel function, ambulation, first oral intake postoperatively, and patient satisfaction scores. Other objectives include reducing readmissions, shorter hospital length of stay and decreased operative complications, including nausea, vomiting and wound infection.\nProcedure - multimodal pain management\nRegional anesthesia techniques, specifically rectus sheath and transabdominal plane blocks, for pain management will be performed.\ngoal directed fluid management\nIntraoperatively fluids will be administered based on hemodynamic parameters, in addition to clinical judgement.\npreoperative carbohydrate loading\nPatient's nutrition will be optimized preoperatively by administering carbohydrate drinks, and limiting fasting time.\nProcedure - Donor nephrectomy\nAll patient will have laparoscopic nephrectomy procedure with transplant surgery.\nProcedure - regional anesthesia\ntransabdominal plane and rectus sheath nerve block\nEnhanced Recovery After Surgery in Living Donor Kidney Transplant Donors
This doctor has no availability on ZocDoc.\nQualifications and Experience\nAwards and Publications\nDr. Linda Renella Salmon grew up in Edgebrook. She received her Bachelor of Science in Dentistry (B.S.) from the University of Illinois in Chicago. She continued her studies at the University of Illinois, College of Dentistry and received her Doctor of Dental Surgery (D.D.S.) degree in 1996.\nSince graduating from dental school, Dr. Salmon has been in private practice and aggressively pursuing postgraduate education to keep her on the cutting edge of technology.\nDr. Salmon is happily married with two daughters that keep her very busy. She also keeps active skiing, scuba diving and maintaining regular workouts.\nDr. Salmon has achieved the dedication, hard work and confidence to treat her patients in all areas of general family dentistry. She is a certified Invisalign® dentist for invisible braces and is certified for aesthetic dentistry. Her aesthetic training was done in San Francisco at the Pacific Aesthetic Continuum. Examples of the training from this aesthetic facility have been seen on Oprah Winfrey's makeover shows.\nDr. Salmon has trained with some of the world's best sedation dentists. She is one of the first woman sedation dentists in Chicago.\nShe is very active in many dental organizations and was honored with the David Award for Dental Excellence in 1998 from the Italo American National Union Foundation.\nVerified Patient Reviews\nAlthough the girl who performed cleaning did an excellent job. Linda Salmon was extremely rude. Staff is helpful and friendly.\nWonderful experience for my 5 year old today.\nToday they had an emergency so appointments were running late, but I'm glad she accommodates emergency because you never know when its your turn.\nI loved the hygenist. The dentist was great. The entire office eas great!!\nDr. Salmon didn't receive my appointment from ZocDoc, but she stayed late and did the cleaning herself. She was very thorough and gentle.\nI was a new patient with Dr. Salmon and had gone in for TMJ pain as well as a cleaning. Her office staff is lovely and the equipment is state of the art. Was quite pleased until I encountered Dr. Salmon. She was abrupt and curt with her staff as well as distant and very removed during her encounter with me. She spent the first half of my appt. reasoning and reentering all the questions that were already documented in my file. She then looked at the scan of my jaw that her staff had taken before meeting her. She prescribed me a pretty heavy medication for it. I asked if it would react with some of the other meds I was on and she told me it shouldn't but just take at night to be sure since my other mess were taken in the morning. All this while NEVER EVER taking a look inside my mouth. Really? Then I had my teeth cleaned by her hygienist who again was lovely. She commented that my teeth looked great and she didn't see anything to be concerned with but Dr. Salmon would be in to follow up. Dr. Salmon finally looked into my mouth, did the fastest exam I have ever had and told me I had a cavity that needed to be filled. Then left with her usual poor bedside manner. The oddest part was when she came to say goodbye and tell me how nice it was to meet me as I was checking out at the front desk after acting like she could care less when I was in her chair. Very odd. Have no desire to go back to her or recommend her.\nVery professional team.
Physicians Anesthesia Service (PAS) Joins U.S. Anesthesia Partners\nU.S. Anesthesia Partners, Inc. (USAP), the nation’s leading Anesthesia-focused physician services organization, today announced its newly formed partnership with Physicians Anesthesia Service (PAS), the largest group of anesthesiologists serving the Seattle, WA, metro area.\nPAS has been providing quality anesthesia services to the Seattle community for over 40 years. The practice’s 120 anesthesia providers--many with sub-specialty training in cardiac, pediatric, regional anesthesia and intensive care medicine--provide anesthesia service ranging from care of the most medically complex inpatient to outpatients in ambulatory facilities.\nThrough their partnership with USAP, PAS physicians will retain local control over their clinical governance and operations, and continue to provide quality, patient-focused perioperative care services to the surgeons, facilities and communities they serve. PAS joins other high-performing practices that have found joining USAP enables them to remain clinically independent while becoming part of a larger organization built specifically to elevate the performance of anesthesia practices.\nDr. David Lavitt, CEO of PAS, views this new partnership as a unique opportunity.\n“We at PAS are excited to join USAP. It is apparent USAP has been thoughtfully designed to create a culture of collaboration that builds trust and empowers clinicians to strive for excellence,” said Lavitt. “As USAP-Washington, we will have access to best anesthesia practices that will facilitate quality-based, data-driven care for our patients.\nThis opportunity also goes beyond USAP’s IT infrastructure and business intelligence. It is a chance for us to be relevant in the evolving national dialogue as advocates for both patients and physicians. As governmental policies change and payer and facility affiliations evolve, anesthesiologists must be part of the discussion. As USAP-Washington, our voice will be heard. We gain these benefits while remaining a Washington-based practice and maintaining our clinical governance. We will continue to provide an exceptional customer experience and work to be the anesthesia practice of choice for healthcare facilities throughout the state---- with the overriding vision that our patients are first and foremost in all we do.”\nUSAP CEO Kris Bratberg said that PAS fits well with USAP’s goal of building the premier anesthesia practice in the country.\n“We are building a unique organization for the specialty of anesthesiology. Quality groups like PAS are seeking a partner that can provide them with the support, expertise and infrastructure needed to succeed in a very demanding environment,” said Bratberg. “By partnering with USAP, PAS will benefit from the significant investments USAP has made in infrastructure to support its practices and the high caliber business leadership team we have built.”\nDr. Richard Dutton, USAP Chief Quality Officer, said that USAP gives premier anesthesia practices the best of both worlds: the ability to shape the future of their specialty while remaining independent in their local decisions.\n“Hospitals continue to require a more sophisticated level of service from their anesthesiology groups, in addition to high quality clinical care,” said Dutton. “Government payers are requiring increasingly robust data reporting to maintain current levels of reimbursement, and commercial payers will not be far behind. Affiliating with USAP gives top-tier practices a stronger voice at the table while allowing them, as USAP partners, to participate in the success of a larger organization.\nUSAP represents the best opportunity for high performing anesthesia groups to strengthen their practices while retaining clinical independence,” Dutton said.\nRopes & Gray LLP provided legal counsel to USAP. BMO Capital Markets served as financial advisor to PAS and Garvey Schubert Barer provided legal counsel to PAS. Terms of the transaction were not disclosed.\nAbout U.S. Anesthesia Partners\nUSAP is a majority physician-owned, physician-services organization dedicated to providing high-quality anesthesia and pain management services. USAP partners with high quality groups of anesthesiologists, providing the capital resources, infrastructure and business expertise needed to position them for continued success. USAP’s physician partners maintain clinical governance of their practices and collectively own over 50 percent of USAP.\nUSAP’s affiliated physician groups share operational and clinical best practices, helping to facilitate the delivery of consistent, high quality services for patients, surgeons, facilities and payers. The company’s approximately 3,500 team members serve healthcare communities in Florida, Texas, Colorado, Nevada and Washington. USAP’s capital partner is Welsh, Carson, Anderson & Stowe, an investment firm with significant experience investing in and building leading healthcare companies. Visit http://www.usap.com to learn more.
Post Operative Care After Laparoscopic Surgery\nOctober 29th, 2017\nMost likely after simple laparoscopic surgery, you will get to go home the same day as your laparoscopic surgery. There are some cases of major minimal access surgery, however, when you may have to spend the night in the hospital. This all depends on your type of surgery which your surgeon will explain to you.\nAfter most of the laparoscopic surgery, you may not be very hungry for few hours. You may be nauseated from the effect of general anesthesia or medicines given to you during anaesthesia and surgery. Drink fluids as desired. As you will have IV fluid there you should take fluid according to desire only Water and ginger ale, both sipped very slowly through a straw, helped to get over nausea and pain abdomen.\nIf you feel hungry than only you should take light meal otherwise it should be avoided. You could try chicken broth or any light soup, toast, crackers and Popsicles. Jell-O, applesauce and very light sandwiches Be sure to stay away from anything that is spicy or acidic, and be careful of having dairy right away as it can distend the bowel may result to pain abdomen.\nFruits and vegetables along with pasta with a little olive oil were foods you will be able to start eating a few days after surgery.\nWhat to expect during post-op:\nAfter Laparoscopic Surgery for first few days will be tiring. You will still be coming off the trauma of surgery and anesthesia, so you really will not want to do anything tyring. You may be in pain from the CO2 insufflated into abdomen during surgery. Laying flat on back help relieve some of this pain on shoulder and abdomen. Keep your heating pad close by. You also may have a sore throat from the endotracheal tube in your throat to help you breathe. Throat lozenges helped clear this up quickly!\nAfter Laparoscopic Surgery it also is crucial that you get up every once in a while and walk around slowly. This will help get the gas flowing and even help with your bloated belly. Being bed-ridden can prolong your recovery time, so it is important to make sure you move around with some support. Of course, this will depend on exactly what you had done. It is also important that you do not overdo it otherwise you may feel fainting attacks. Rest is just as important as movement, so be sure to follow your doctor’s post-op instructions.\nUnless told otherwise, you should avoid walk up and down the multiple stairs. Be sure to go slow and have a helping hand nearby. Remember, you cannot drive right even after minimal access surgery and can only drive once you have stopped taking narcotics and you feel strong enough.\nDepending on how your laparoscopic surgery went, you will not be able to have sex after two to six weeks. Your doctor will be able to tell you exactly how long. Your first period after surgery most likely will be horrendous. If you are taking pain meds, you will likely have constipation. Taking a stool softener with your pain medicine may help make this less painful and keep things flowing.\nNo comments posted...
Hair loss or alopecia is a common problem that affects both men and women and can be caused by stress, illness, certain medical treatments or genes. While some of these factors are temporary or can be reversed, many patients suffer from permanent hair loss.\nThis may trigger some personal issues. In those cases a hair transplantation can help both men and women who suffer from baldness or thinning hair.\nThe methods of hair replacement or transplant depend on the area where the hair falls or is thinned and the desired final appearance. In all cases, hair follicles are taken from an area of the body and moved to the area where they are missing.\nMost times, the surgeon will use local anesthesia for both the donor area and the implant recipient. There are cases in which sedation or general anesthesia is also called. The donor area will be surgically removed and the incision will be hidden from the existing hair.\nThe surgeon will divide the scalp patch taken in hundreds or even thousands of tiny segments, each containing one or more hair. These scalp pieces will then be transplanted into the areas where the hair is missing or where it gets scared. A less common procedure involves transferring a scalp strip containing hundreds of hair follicles to the area where it is missing.\nA general feature of hair transplantation is that maintaining the integrity of the scalp and minimizing trauma during this process is a fine work that lasts between two and eight hours, depending on how much hair is transplanted or transferred.\nThe type of your hair and the area where it lacks influence the choice of the donor area and the volume of hair that is needed.\nThe sampling method consists of extracting a hair scalp, generally from the occipital area, which is divided into smaller groups that will be implanted in the affected areas. There is no risk of a visible scar because the area where the scalp is removed will be covered by the newly grown and proximal hair.\nSmall groups of hair grafts are taken from the entire head and implanted in the desired areas. Since those come from a donor area on the back of the scalp, this technique has several advantages :\nRemove a hairless scalp section and replace it with a piece of hair-bearing skin. This procedure is used to cover a considerable area of baldness and to create a normal hair growth band. If the skin is intact, the hair grows immediately and does not last for months until signs of development.\nIn some cases, an alternative or additional hair transplantation solution is used. The procedure involves removing a section of the ballet and pulling the hairline forward to fill the uncovered point. The technique is repeated one or more times later, with the purpose of reconstructing the area of cavities. If more hair is needed, a hair transplant operation may be used.\nThe aesthetic surgeon’s efforts are to carefully analyse where to take healthy hair follicles so that the scar remains unclear. Taking a scalp strip will leave a linear scar in the occipital area. Otherwise, you can choose from multiple areas where skin grafts and scars have been extracted as a pen point; they can be easily hidden from hair. If after hair transplantation and scalp reduction happens to lose hair, scars will be visible.\nDo you have more questions or are you suffering from hair loss issues ? Then feel free to to contact our friendly team that will answer all your queries. Furthermore they can also offer a free and non binding hair analysis. So don’t hesitate if you want to benefit from Dr. Balwi and Elithairtransplant’s expertise for a successful and affordable hair transplant in Turkey !\nAsk now for a free, non-binding hair analysis. Our experts are at your disposal 24/7!
Dear Help Squad,\nI am having some problems with Advocate General Hospital in Park Ridge and their vendors on an uninsured but doctor-recommended surgical procedure my son had recently. Since it was not covered by my health provider, I asked them for a written quote on what it would cost, or even a range (within $5,000) in writing, which they refused to provide. All I could get from them verbally is that it would cost between $8,000 and $10,000 if there were no complications. The bill came in at almost $17,000 (and there were no complications).\nMy question: Can you help me? This is a lot of money for us and although I am sure I would win in court, the lawyer fees will probably be quite high.\nThanks in advance for your consideration,\nMike, The Northern Suburbs\nHelp Squad received this letter back in October, and we have been working on this case ever since.\nWe finally have some results.\nWe spoke with Mike shortly after we got his letter. First he explained why the cost of his 16-year-old son’s surgery was so much higher than predicted. The hospital admitted that they double booked the doctor who was performing Mike’s son’s surgery, and that since Mike’s son was already under general anesthesia, they had to keep him under until the doctor was able to get to him, resulting in double the amount of needed anesthesia.\nDespite being extremely alarmed upon hearing the fact that his son was kept under anesthesia longer than he needed to be, Mike paid the hospital $8,800 shortly after he received the bill, which was for roughly $17,000, but lowered to $13,000 if he paid cash within 30 days.\nMike said he called the hospital approximately 15 times and left messages over the next few weeks to try to have the $5,000 difference removed. Instead of responding, the hospital turned the account over to various collection agencies, including the Des Plaines-based collection agency, Medical Recovery.\nEnter Help Squad.\nWith Mike on the line, we called Medical Recovery and spoke with someone named Nicole, who wouldn’t give us her title, and who also told us there was no manager we could speak with at the company.\nMike told Nicole he would pay Medical Recovery $1,000 to have the debt cleared, and Nicole told us she would get back to us. After 12-15 phone calls, all in which we left messages for Nicole, neither Help Squad nor Mike ever heard back from her.\nSo, last week, we decided to get to the bottom of this by going to the top.\nHelp Squad finally tracked down management at Medical Recovery, Michael Gerlach, and another executive who said his name was Steve.\nThe two assured us they would look into it, and they did.\nWithin a couple of days, Mike got a call from James Hobbs, director of customer service for Advocate Lutheran General.\nAfter their discussion, Hobbs agreed to adjust Mike’s bill so that no payment is due!\nWhile we commend Hobbs and Advocate Lutheran General for doing the right thing, the whole ordeal has left Mike with some problems. He is now being chased by two collection agencies, and his credit report has been affected.\nA few days ago, Mike sent an e-mail to Hobbs asking for the hospital’s assistance in the removal of his debts from the collection agencies. Help Squad left four messages for Hobbs and didn’t hear back. However, we want to make it clear that it doesn’t mean Hobbs is ignoring Mike’s letter.\nWe are so happy that your hospital bill is cleared, but we are sorry that you might be facing some credit issues in the future that are not your fault. We do want to let you know how glad we are that your son is healthy and doing well. We know that like any parent, you realize that is the most important factor in all of this.
I am having an outpatient surgery on Thursday. My dr (gyn) told me I will be asleep, but given the short duration of the surgery (1 hr) and that the procedure is relatively non-invasive, I am assuming I will be having a MAC (sp?) rather than general. I have had many outpatient surgeries and one major sugery, but have never been so scared about undergoing the anesthesia before, since I now have high BP. Has anyone here had surgery since you've been diagnosed with HBP? Do you know how they monitor your BP during sugery, and does the anesthesia cause BP to increase? I am taking BP med, but still my BP ranges 140-160 over 90-110. I do not talk to the anesthesiologist until the night before the surgery. Any input would be greatly appreciated.\nI am in that category you talk about. I recently had a 7-1/2 hour cardiac bypass, and a 2-hour carotid endarterectomy, (both under general anesthesia). I don't know how they monitored my BP during the bypass, but during the endarterectomy, I just had an automated BP cuff. My sedation during the endarterectomy was not "deep", I didn't wake up with a breathing tube and ventilator.\nI cannot say if the anesthesia causes BP to increase.... however, the general case with sedation is that it is like sleep, in which the blood pressure goes down. Deep sedation causes the need for a breathing-tube, as well, because the respiration is depressed.\nI am relatively certain that your BP will be monitored and well-controlled with injectables during the surgery and the post-op recovery period.\nThe cardiac bypass is done on 360,000 people annually in the US. I would be willing to bet that 90% of them have HBP.\nTFkeel, Thanks for your reply. It made me feel much better.\nLast night, after I did the treadmill and my breathing exercises (I hadn't done the breathing in awhile), my BP went down to 132/75, but this morning was up to 155/111. I did a little searching on the internet last night... I didn't realize that part of an anesthesiologist's job is to monitor your BP during surgery and give meds to lower it if necessary.\nI really appreciate your response. My stress level has gone way down!\nThanks for the replies. I wanted to give everyone an update and pass along the information I have learned recently, for others with HPB who might be undergoing surgery in the future.\nIn a nutshell, my surgery was cancelled. In my pre-op interview, I expressed my concerns over my BP not being controlled lately. 30 min later, got a call from my dr saying the medical director of the surgery center cancelled the surgery and wants a clearance letter from my cardiologist, and my BP under control, before they will do the surgery. (I already had the clearance from cardio, but not in written form, and this was before BP had gone higher). Now, my dr wants to have the surgery done at the hospital instead of the surgery center. In speaking to an anesthesiologist, this is what I have learned. If your BP is not properly under control, it is very dangerous to undergo general anesthesia, because you will be at greater risk of heart attack, stroke and blood loss. Even though the anesthesiologist does monitor your BP during surgery and can medicate you to lower it, you are still at an increased if your blood pressure is not under control before the surgery begins, because it is the instantaeous rise (before the anesthesiologist can see the increase, give the medicines and have them work to lower it) that you might cause you to have a stroke, etc. They did seem most concerned about the diastolic - I was told anything over 110 is enough to cancel surgery.\nSo, I am now on a new med and have already seen good improvement with lower numbers (125/82 last night), but am going to play it safe and get consistently low numbers for awhile before rescheduling the sugery.
Though one of the most common skin concerns for women, cellulite has also historically been one of the most difficult to treat.Luckily, there are now several treatment options that can effectively remove cellulite, including the latest Avéli® cellulite treatments.\nSee what makes Avéli stand out from other methods of cellulite reduction to help you decide if it could be the best fit for you.\nKnock Out Cellulite In a Single Treatment\nExpect to enjoy final results around one month after your Avéli treatment.One of the biggest perks of minimally invasive Avéli cellulite reduction is that you’ll only need a single treatment session to see maximum results. Many other similar cellulite treatments require several appointments spaced a few weeks apart in order to achieve full results.\nNo Surgery Necessary\nAvéli works by cutting the tight bands of connective tissue that pull against underlying fat cells, creating dimples on the surface. But because this procedure utilizes very small incisions and is therefore minimally invasive, your Avéli treatment won’t require surgery or extensive downtime.\nAdditionally, a local anesthetic is used, so you won’t have to worry about the risks or side effects associated with general anesthesia during a surgical procedure.\nEasily Pair with Other Devices for Body Contouring\nWhile Avéli itself only treats cellulite dimpling and won’t address skin laxity or stubborn fat, it pairs nicely with other nonsurgical treatments such as CoolSculpting® or EMSCULPT® to achieve your desired result – all without a single surgery.\nReady to take the first step toward getting smoother, more even skin with cellulite reduction? Call our Plymouth office at 612-213-1111 or get in touch online to schedule a consultation today.
Dr. George Doodnaught: woman recalls forced oral sex during surgery\nA woman complained to her anesthesiologist about his forcing oral sex during surgery, but he told her it was a hallucination, she says.\n\|Report an Error\|\nShare via Email\nA 50-year-old woman says she was forced into oral sex during surgery by anesthesiologist Dr. George Doodnaught, but was too embarrassed to report him to authorities.\nThe new widow went to North York General Hospital for a right hip replacement on Feb. 2, 2010.\nShe testified Thursday she awoke during surgery and saw Doodnaught standing next to her face.\n“He said he was putting a catheter inside me and he told me he liked the way I looked and shaved,” she told prosecutor Susan Kim.\nDoodnaught added, “Would you like to see mine?” she said.\nHe undid his hospital pants, forced oral sex and fondled her breasts, said the woman, who can only be identified as L.N.\nAfter the operation she told Doodnaught she needed to see him next morning, she testified.\nThe 64-year-old married father of five has pleaded not guilty to 21 counts of sex assault involving 21 women, age 25 to 75, all but one under surgery at North York General between 2006 and 2010.\nThe day after the operation, L.N. said she told her hospital roommate and text-messaged two girlfriends, trying to joke, saying: “I felt I was giving a doctor a blow job.”\nShe said she felt silly. “He’s a doctor. You don’t do things like that.”\nDoodnaught came to her room as requested, and she told him she felt she had given him oral sex.\n“He said I was dreaming and it couldn’t have happened. He said he put the catheter inside me and I stuck his thumb in my mouth.”\nShe said she tried to move on, so didn’t report it until she learned Doodnaught was charged with other alleged sex assaults.\nShe denied lawyer Brian Greenspan’s suggestion she told people, “I’m coming on to my anesthesiologist.”\nGreenspan suggested she tried to put Doodnaught’s thumb in her mouth but failed because she wore an oxygen mask.\n“Did I have a mask on?” she asked.\nThe trial continues Friday.\n- Fahmy case takes another surreal twist as prosecutor calls charges spurious\n- Scarborough's creaking SRT gets a makeover\n- David Clarkson trade massive weight off Maple Leafs: Arthur\n- Six young people from Quebec may have joined jihad groups: media report\n- Via Rail defendant shrugs off secular law: DiManno\n- Roundtable on missing, murdered aboriginal women 'a beginning'\n- What outraged teachers have to say about report cards: Porter\n- Video Cruz, Palin serve up red meat at GOP conference
Flashcards in Anesthesia and PD Deck (25):\nWhat are the four cardinal signs/symptoms of Parkinson's Disease?\n1. Tremor (gets better with a directed movement)\n4. Postural Instability\nWhat does rigidity indicate?\nPathology in the contralateral basal ganglia\nWhat is the most common way to differentiate between PD and atypical parkinsonism?\ngive L-DOPA and look for patient improvement\nWhy do we adminsiter carbidopa with Levo-DOPA during PD therapy?\nhelps prevent the side effects of L-DOPA therapy that make it impossible to use: prevents the conversion of L-DOPA to dopamine in the bloodstream (which causes terrible nausea and other really unpleasant side effects). q\nOther than L-DOPA and dopamine receptor agonists, what kinds of drugs can we use to treat Parkinson's disease?\nMAO inhibitors to prevent dopamine degradation- selegiline and resagiline\nor COMP inhibitor (just 1)\nWhat should I be cautious about in terms of barbituate administration?\ncontraindicated in patients with acute intermitant porphyria\nWhat should I be careful about with propofol?\nsupports bacterial growth and can cause sepsis\npotential allergy issues (maybe)\nnot terribly forgiving\nWhat is one advantage of propofol?\nlow context-sensitive half time\nWhat should I be careful about with ketamine?\nintracranial pressure and pulmonary artery pressure: careful in trauma pts or pts with weak arteries\n(can be used in pregnant women, esp. with an emergency C-section)\nWhat is the only anesthetic that mimics sleep?\nWhat is one of the most important and underappreciated goals of anesthesia?\nreduce surgical stress response: long-term implications\nWhere does anesthesia act?\nbrain AND spinal cord\nspinal cord may be especially important for restricting movement.\nWhat is the myer-overton hypothesis and what are the problems with it?\nhypothesis: anesthesia works by changing the membrane, based on correlation between lipid solubility and potency and based on the fact that efficacy is reduced under conditions of high atmospheric pressure. Problem is that the correlation between lipid soulbuility and potency does not always hold true, and high atmospheric pressure increases stress on the body... a condition that ALWAYS decreases the efficacy of anesthesia\nWhat are three advantages of inhalational anesthesia?\neasy to administer\neasy to eliminate\nlittle metabolism to toxic substances\nWhat determines brain concentration of an inhaled anesthesia? What factors determine the speed with which a patient is roused following inhalational anesthesia?\nAlveolar concentration determines brain concentration.\nTissue distribution in vascular beds, muscle, and fat, increase the amount of time that it takes for anesthesia to wear off.\nWhat is the MAC?\nalveolar concentration of an inhaled anesthetic that is needed to prevent movement in 50% of patients.\nHow do local anesthetics work?\nbind sodium channels to prevent channel activation. this blocks sodium influx and prevents depolarization- you can't get an AP.\nWhen is local anesthesia dangerous? Why/what happens?\nwhen it gets to other parts of the body, like the heart and brain, where it can cause heart block, bradycardia, CV collapse, CNS depression, coma, and death at high doses.\nWhat happens with low doses of local anesthesia poisoning?\nanti-arrhythmic effects on heart\nseizure in brain\n4 stages of anesthesia?\nI: sedation, amnesia, analgesia\n2. loss of consiousness, excitement, instability, airway hyperactivity\n3. surgical anesthesia\n4. medullary suppresion, CV collapse, death\ntry not to spend time in stage 2 (or 4).\nwhat is context senstive half time, and what does it highlight about the use of IV anesthetics?\ncontext sensitive half time is the time it takes for the concentration of the a drug to fall to 1/2 of what it was in the central compartment (central compartment is the site of action- the brain) it DEPENDS ON THE AMOUNT OF INFUSION TIME.\nreflects the fact that redistribution of the drug is the most important thing in terms of when it leaves the site of action- more important than metabolism or elimination.\nWhat is the MOA for most anesthetics (barbiturates, benzodiazepines, propofol)?\ninteract with the GABAa receptor\nincrease the chance that GABA will bind its receptor\nmore bound GABA means more Cl ions\nmore Cl ions --> hyperpolarization of the neuron\ninhibition of the AP.\nketamine is an exception\nWhat is the effect of most anesthesia on the CV system?\npressure decrease, cardiac output decreased, vascular resistance decreased, venodilation increased. Ketamine is the opposite.\nWhat is the effect of most anesthesia on respiration?\nusually causes respiratory depression (ketamine is an exception; dexmedetomidine also doesn't seem to suppress ventilation).
What is Awake (Avelar) Tummy Tuck?\nThe Awake Tummy Tuck technique was introduced by Dr. Juarez Avelar, MD in 1999. The Awake Tummy Tuck combines abdominal liposuction with excision or surgical removal of the excess skin on the lower abdomen. The liposuction is performed using tumescent anesthesia. Tumescent anesthesia is a form of local anesthesia where a special fluid is pumped into the surgical area. The fluid numbs the area as well as reducing bleeding and bruising. This allows the liposuction and later the excess skin removal to be done comfortably with the patient awake. Since the patient is awake, the term Awake Abdominoplasty or Awake Tummy Tuck has become popular. The end result is a flat stomach with no excess skin.\nWhy have an Awake Tummy Tuck?\nSimply put, anyone who has a significant abdominal bulge should consider an Awake Tummy Tuck. Abdominoplasty or tummy tuck gives the very best result of any abdomen reducing cosmetic procedure a smooth, flat stomach. Thermage works well with limited amounts of loose skin. Liposuction can greatly reduce fat and size, and when SmartLipo is used it can give excellent results. However, when a large bulge or a large amount of loose skin is present, tummy tuck should always be considered as an alternative. Awake Tummy Tuck has several advantages over conventional procedures:\n- Use of local anesthesia avoids the potential complications of general anesthesia.\n- Use of liposuction with skin reduction allows more complete removal of abdominal fat and often a more natural and sleeker look.\n- Use of local anesthesia and liposuction as part of the tummy tuck reduces downtime to essentially that of liposuction.\n- Avoiding sewing of the abdominal musculature reduces the pain and recovery time.\n- Use of a closed suturing technique to close the incision all but eliminates post operative wound care.\n- Use of a closed suturing technique promotes a thin less noticeable scar.\nWhen compared to other, less aggressive methods of abdominal reduction, tummy tuck gives the flattest result and can handle the most excess abdominal tissue.\nWhat are the steps leading to the Awake Tummy Tuck?\nIt is important to understand what you will experience when you undergo an Awake Tummy Tuck procedure. The procedure usually proceeds in this manner:\nYou will come in for consultation to determine if Awake Tummy Tuck is a good procedure for you. After discussion and evaluation, Awake Tummy Tuck is chosen as the best procedure. Pre-Operative evaluation is scheduled for you.\nPrior to your pre-operative evaluation, you will be given some written materials to review. These include:\n- Written consents for liposuction and Awake (Avelar) Abdominoplasty\n- Instructions for the day of surgery.\n- Medication instructions.\n- Written prescriptions for your post-operative period.\n- Some written information to help you post-operatively and during recovery\nDr. Johnson performs the preoperative evaluation. This includes blood work done in our office a review of your medical history and a directed physical exam. On rare occasions some additional tests like more blood work or an EKG may be needed. Once it is determined that you are a good candidate the procedure is scheduled. The pre-operative evaluation can be done on the day of the surgery but we prefer to do it a few days ahead of time. We often do the pre-operative evaluation on the same day as your initial consultation.\nYou are now ready for your procedure.\nWhat will happen during the Liposuction portion of the Awake Tummy Tuck?\nWe do most of our Awake Tummy Tuck procedures in the morning. When you arrive you can expect the following:\n- After arrival for your Awake Tummy Tuck, you will be taken to the preparation room. Dr. Johnson will meet with you before you are given any medications. At that time he can address any remaining questions you may have\n- Dr. Johnson will mark you for the liposuction portion of the procedure. The tummy tuck portion will be marked later.\n- We will take you before the procedure pictures.\n- You will be given some oral medications and a typically a shot. These medicines are a sedative, a pain medication, and a medicine to prevent nausea. Sometimes an IV will be started.\n- Next, you will be taken to the procedure room and placed on the table. You will be placed on a monitor to display your vital signs during the procedure. The surgical area will be cleaned with a solution to sterilize the skin.\n- Using a small needle, the locations for the incisions for liposuction will be numbed. The ¼ inch incisions will be made using a scalpel. These incisions will later be used for your drains after the abdominoplasty.\n- The entire abdominal area will be infiltrated with tumescent fluid. We do this by pumping the fluid through a cannula into the tissue. The fluid consists of:\n- Normal saline water with the same amount of salt as our bodies.\n- Lidocaine a local anesthetic\n- Sodium bicarbonate increases the effectiveness and safety of the lidocaine.\n- Epinephrine increases the effectiveness of the lidocaine and decreases bleeding and bruising.\n- The fatty layer of the abdomen is then suctioned to remove the fat. In the lower abdomen, we remove more fat than a normal liposuction to facilitate the excision of excess skin. For a video of abdominal liposuction using tumescent fluid click here.\nYou will then be ready for the abdominoplasty portion of your Awake Tummy Tuck.\nWhat will happen during the abdominoplasty portion of the Awake Tummy Tuck?\nWhile you are still on the table and mildly sedated we will proceed with the second portion of your Awake Tummy Tuck. The abdominoplasty or tummy tuck potion proceeds in this manner:\n- While continuing on the table and monitor your abdomen is once again cleaned with special soap for sterilization. This cleaning is even more thorough. The abdominal area is draped to create a sterile field for Dr. Johnson to work.\n- Next Dr. Johnson will mark the areas for removing (excising) the excess skin.\n- Your umbilicus or belly button is next removed and a suture placed so it can easily be found later.\n- The upper incision to remove excess skin is made. A final check of the size of the skin being removed is confirmed. Then the lower skin incision is made and the excess skin is removed. We place this on a tray and photograph it.\n- The upper and lower edges of the excised skin are now brought together in the center and sutured in place. All of the sutures used to close the skin are underneath the skin. This eliminates the need to remove sutures later on. This method of closing the wound also tends to produce a thin scar.\n- Occasionally a patient will have enough skin removed to require special sutures called retention sutures to be placed. These sutures are on the outside and will be removed in 3-4 weeks.\n- Once the center of the wound is closed Dr. Johnson will determine the correct spot for your umbilicus. Once determined a new incision is made and the umbilicus sutured into its new home.\n- Next, the entire wound is sutured closed. After suturing special skin glue is used to seal and protect the wound. This makes the wound essentially carefree.\n- Finally drains are placed below the skin and sutured into place. To see video of the abdominoplasty portion of the Awake Tummy Tuck click here.\nNow you are done. After dressings are placed over the drains and you are in your compression garment to decrease swelling, you may go home.
Removal of Nasal Adhesions\nRemoval of nasal adhesions is a procedure to separate scar tissue within the nose that has become connected, or fused. Fused tissue is called an adhesion. Adhesions in the nose are also called synechiae. Adhesions are a common, usually minor, complication of nasal or sinus surgery and nasal packing. They also may develop because of trauma (for example, nose-picking or cocaine use) and such conditions as syphilis, tuberculosis, lupus, or sarcoidosis.\nAdhesions form when two moist, opposing surfaces inside the nose heal together, causing a scar. They often form between the septum, which separates the nostrils, and one of the wavy structures inside the nose (inferior turbinate). Adhesions can make breathing difficult.\nThe procedure to remove adhesions usually is done in the doctor's office under local anesthesia. The doctor may apply an anesthetic to the skin, using spray or cotton, and inject local anesthetic. In rare cases, general anesthesia may be used.\nThe doctor may use a thin, lighted instrument (endoscope) to see into the nasal passages. He or she may use surgical scissors, a laser, or an instrument called a microdebrider to separate the fused tissue. The microdebrider has a rotating tip that shaves and removes inflamed tissue.\nWhat to Expect After Surgery\nYour nose should heal in 7 to 10 days.\nAfter surgery, a spacer or splint may be placed in your nose for a few days to several weeks. This helps prevent another adhesion from forming. You should avoid blowing your nose while the spacer or splint is in place. Your doctor will probably suggest you use an ointment, such as bacitracin/polymyxin (for example, Polysporin), to keep your nose moist and prevent infection while the splint is in place.\nA small amount of bleeding or drainage is normal. Your doctor will tell you how to clean your nasal passages using a saltwater (saline) solution. Sneezing is common after nasal surgery, especially if you have allergies. You may be given an antihistamine (one that will not make you sleepy) to reduce the sneezing. These medicines also may reduce swelling and the likelihood that adhesions will return.\nYou also may use a nasal anti-inflammatory (corticosteroid) spray. Although there is little evidence about the use of these sprays, some doctors think they may help prevent another adhesion from forming.\nWhy It Is Done\nThe procedure removes debris and tissue that have formed adhesions in the nose.\nHow Well It Works\nThis procedure removes adhesions that form in the nasal passages.\nThe most serious risks are heavy bleeding and infection. Call your doctor if pus drains from your nose, because this is a sign of infection.\nStreptococcus and staphylococcus bacteria appear normally in some people. Packing the nose after surgery in people who have these bacteria increases the risk of toxic shock syndrome. Call your doctor immediately if you have any of the following symptoms:\n- A fever of 38.3°C (101°F) or higher\n- A headache\n- A rash that looks like sunburn\n- Signs of very low blood pressure, such as dizziness or fainting\nThere also is a risk that adhesions could return.\nWhat to Think About\nThis procedure is more likely to succeed if you follow your doctor's instructions for post-surgery care.\nA doctor needs special training to use a laser.\nOther Places To Get Help\nPrimary Medical Reviewer Adam Husney, MD - Family Medicine\nAnne C. Poinier, MD - Internal Medicine\nSpecialist Medical Reviewer Donald R. Mintz, MD - Otolaryngology\nCurrent as ofMay 4, 2017\nTo learn more about Healthwise, visit Healthwise.org.\n© 1995-2018 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.
The impact of polymorphic cytochrome P450 CYP2D6 enzyme on oxycodone's metabolism and clinical efficacy is currently being discussed. However, there are only spare data from postoperative settings. The hypothesis of this study is that genotype dependent CYP2D6 activity influences plasma concentrations of oxycodone and its metabolites and impacts analgesic consumption.\nPatients received oxycodone 0.05 mg/kg before emerging from anesthesia and patient-controlled analgesia (PCA) for the subsequent 48 postoperative hours. Blood samples were drawn at 30, 90 and 180 minutes after the initial oxycodone dose. Plasma concentrations of oxycodone and its metabolites oxymorphone, noroxycodone and noroxymorphone were analyzed by liquid chromatography-mass spectrometry with electrospray ionization. CYP2D6 genotyping was performed and 121 patients were allocated to the following genotype groups: PM (poor metabolizer: no functionally active CYP2D6 allele), HZ/IM (heterozygous subjects, intermediate metabolizers with decreased CYP2D6 activity), EM (extensive metabolizers, normal CYP2D6 activity) and UM (ultrarapid metabolizers, increased CYP2D6 activity). Primary endpoint was the genotype dependent metabolite ratio of plasma concentrations oxymorphone/oxycodone. Secondary endpoint was the genotype dependent analgesic consumption with calculation of equianalgesic doses compared to the standard non-CYP dependent opioid piritramide.\nMetabolism differed between CYP2D6 genotypes. Mean (95%-CI) oxymophone/oxycodone ratios were 0.10 (0.02/0.19), 0.13 (0.11/0.16), 0.18 (0.16/0.20) and 0.28 (0.07/0.49) in PM, HZ/IM, EM and UM, respectively (p = 0.005). Oxycodone consumption up to the 12th hour was highest in PM (p = 0.005), resulting in lowest equianalgesic doses of piritramide versus oxycodone for PM (1.6 (1.4/1.8); EM and UM 2.2 (2.1/2.3); p<0.001). Pain scores did not differ between genotypes.\nIn this postoperative setting, the number of functionally active CYP2D6 alleles had an impact on oxycodone metabolism. The genotype also impacted analgesic consumption, thereby causing variation of equianalgesic doses piritramide : oxycodone. Different analgesic needs by genotypes were met by PCA technology in this postoperative cohort.\nCitation: Stamer UM, Zhang L, Book M, Lehmann LE, Stuber F, Musshoff F (2013) CYP2D6 Genotype Dependent Oxycodone Metabolism in Postoperative Patients. PLoS ONE 8(3): e60239. https://doi.org/10.1371/journal.pone.0060239\nEditor: Balraj Mittal, Sanjay Gandhi Medical Institute, India\nReceived: December 7, 2012; Accepted: February 23, 2013; Published: March 28, 2013\nCopyright: © 2013 Stamer et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.\nFunding: The authors have no support or funding to report.\nCompeting interests: The authors have declared that no competing interests exist.\nWhile morphine represents the standard analgesic in a postoperative setting, other opioids might be also suitable or even advantageous. Oxycodone has been marketed since 1917 and has found widespread use for the treatment of chronic pain, specifically since a controlled-release formula is available. An intravenous formula is now on the market or has been re-launched in several countries. However, intravenous oxycodone is not a standard opioid for postoperative pain management in most countries, including Germany.\nAs polymorphic cytochrome P450 enzymes (CYP) are involved in the metabolism, a pharmacogenetic impact on oxycodone's efficacy is discussed –. Formation of the active metabolite oxymorphone depends on CYP2D6, whereas N-demethylation by CYP3A via the major pathway produces noroxycodone, a metabolite with weak antinociceptive properties. Both metabolites, oxymorphone and noroxycodone, are further degraded to noroxymorphone by CYP2D6 and CYP3A.\nPrevious experimental trials have demonstrated an impact of CYP2D6 and CYP3A genotypes and enzyme activity on oxycodone's pharmacokinetics, pharmacodynamics and safety in volunteers . In contrast, there are sparse data from postoperative settings and these have not confirmed genotype specific oxycodone consumption and analgesic efficacy . However, surgeries resulted only in minor to medium pain intensities and no difference in opioid consumption could be detected . One might speculate that the impact of genotypes on oxycodone therapy is considerably more profound after major surgeries, which necessitate higher postoperative opioid doses. Thus, possible genotype associated differences in opioid needs may become detectable.\nThe hypothesis of this study is that oxymorphone plasma concentrations measured during the crucial early postoperative period after major surgeries vary according to CYP2D6 genotypes with an impact on analgesic consumption. In order to translate pharmacogenetic findings into clinical practice, CYP2D6 genotype dependent equianalgesic doses were calculated and compared to piritramide, which is the standard opioid used in Germany. Its metabolism is not dependent on CYP2D6 activity. Thus, equianalgesic intravenous piritramide : oxycodone doses might be helpful for clinicians as there is little experience with oxycodone in a postoperative setting in many countries.\nApproval for this prospective, observational association study was obtained from the institutional review board of the Medical Faculty of the University of Bonn. One-hundred-thirty-one patients scheduled for elective major abdominal surgery or thoracotomy gave written informed consent and were instructed in the details of the study, the use of the patient-controlled analgesia (PCA) device and the numeric rating scale for pain intensities (NRS: 0 denotes no pain, 100 denotes worst pain imaginable). Exclusion criteria were alcoholism, drug dependence, use of CYP3A inducing or inhibiting substances, clinically relevant compromised kidney or liver function, psychiatric diseases, epilepsy, contraindication for the use of study medications, known opioid intolerance, laparoscopic surgery, perioperative epidural analgesia, serious perioperative complications and changes in anesthetic procedure. Preexisting medication was documented and discontinued only for the day of surgery with the exception of drugs necessary for major co-morbidity, e.g. cardiac and pulmonary diseases.\nClinical Study Protocol\nGeneral anesthesia was conducted according to a standardized protocol , : propofol 2–3 mg/kg, fentanyl 0.15 mg and cis-atracurium for induction and remifentanil, isoflurane and cis-atracurium for maintenance of anesthesia. About 30 minutes before termination of anesthesia oxycodone 0.05 mg/kg i.v. (oxycodone hydrochloride: Oxygesic® injekt, Mundipharma, Germany) was given with a maximum intraoperative dose of 5 mg. Additionally, dipyrone 1 g i.v. or in case of contraindications to dipyrone acetaminophen 1 g i.v. was infused. Patients' genotypes were unknown during the clinical part of the study.\nProphylactic antiemetic treatment before emergence of surgery was performed in high risk patients for postoperative nausea and vomiting (Apfel's validated risk score ≥3, ) according to the department's protocol. After emergence from anesthesia, patients were transferred to the postoperative anesthesia care unit (PACU). The analgesic regimen in the PACU consisted of further doses of oxycodone 1–2 mg if pain scores were >40 at rest. For subsequent analgesic treatment on the general ward, patients could self-administer intravenous bolus doses of 1 ml corresponding to oxycodone 1 mg via a patient-controlled analgesia (PCA) device (Injektomat®-CP PACOM, Fresenius AG, Bad Homburg, Germany) with a lock-out time of eight minutes and no background infusion. If pain management via oxycodone PCA had to be terminated prematurely due to lacking efficacy or side effects, e.g. emesis which could not be controlled by antiemetic medication, the analgesic regimen could be changed to the standard treatment piritramide. Dipyrone 5 g/day and in case of contraindications acetaminophen 4 g/day was infused i.v. as basic non-opioid analgesic regimen in all participants. This is according to the hospital's standard procedure and complies with the national guidelines of a multimodal analgesic regimen .\nDuring the 48-hour study period following initial opioid administration, pain scores under rest and exercise/coughing were recorded by the patients using the NRS. Nausea and vomiting (absence or presence) were assessed regularly and treated with antiemetics if needed. Observation time points were hourly up to the eighth hour, at the twelfth hour, and then every six hours up to the forty-eighth hour. Opioid consumption was documented, and the analgesic consumption administered via the PCA device was transferred to an electronic data base. As individual experience and subjective estimation of pain and side effects might differ considerably between investigators and patients, an additional questionnaire was completed by the patients after 48 hours. The questions considered overall patient assessment of pain management and whether the quantity of analgesics was sufficient.\nBlood samples were drawn at 30, 90 and 180 minutes after opioid administration. After centrifugation, blood cells and plasma were frozen separately at -80°C. All laboratory analyses were performed after enrollment of the last patient, and the laboratory staff were blinded to the patients' data.\nGenotyping for CYP2D6 3, 4, 5, 6, 7, 8, 10, 41 and gene duplication/multiduplication as well as for CYP3A53 (rs 776746, G6986A) was performed by PCR and real-time PCR as described previously , . All alleles with no indicators for one of the genetic variants investigated were categorized as “wild-type” (wt). For translation of the genotypes into a qualitative measure of phenotype, CYP2D6 activity score of each subject was calculated as the sum of the values assigned to each single allele . Alleles 3,4,5,6,7,8 were assigned a value of 0, alleles 10,41 a value of 0.5, the wt allele a value of 1, and wtxN a value of 2 . Four CYP2D6 activity groups were compared: activity score 0 representing poor metabolizers (PM); activity score 0.5–1 representing heterozygous subjects carrying one non-functional allele or a combination of a non-functional with an allele showing reduced function (HZ/IM); activity score of 1.5–2 representing extensive metabolizers or a combination of wild-type allele and reduced function allele (EM); activity score 3 representing ultrarapid metabolizers (UM) with a duplication/multiduplication of a functional allele. Because some authors , also suggested a contribution of CYP3A to plasma disposition of metabolites and analgesic efficacy the CYP3A53 variant was investigated exploratively. Individuals were assigned to the group of low expressors (CYP3A53/3) or high expressors carrying at least one CYP3A51 allele .\nPlasma Concentrations of Oxycodone and Its Metabolites\nOxycodone, the metabolites oxymorphone, noroxycodone, and noroxymorphone as well as the deuterated standards oxycodone-d3, noroxycodone-d3, oxymorphone-d3 and hydromorphone-d3 were purchased from Cerilliant Corporation (Round Rock, TX, USA). Methanol, water, formic acid (all of HPLC grade), acetonitrile (hypergrade for LC/MS), borate buffer (pH 11), and ammonium formiate were purchased from Merck (Darmstadt, Germany); n-chlorbutane (for HPLC) was obtained from Sigma-Aldrich (Steinheim, Germany).\nHPLC mobile phase A consisted of water (HPLC grade) and acetonitrile (90∶10, v/v), mobile phase B consisted of water (HPLC grade) and acetonitrile (10∶90, v/v), both with 0.005 M ammonium formiate and pH was adjusted to 3.5 by addition of formic acid.\nQuantification of oxycodone, oxymorphone, noroxycodone and noroxymorphone was performed by a liquid chromatographic-mass spectrometric method with electrospray ionization in positive mode. A previous procedure showed ion suppression effects for the hydrophilic metabolites and was modified: A mixture of 0.2 ml plasma, 20 µl methanolic internal standard solution (1 µg/ml of oxycodone-d3, noroxycodone-d3, oxymorphone-d3 and hydromorphone-d3) and 0.1 ml borate buffer were extracted with 1 ml n-chlorbutane. After centrifugation (4000×g, 8 min), the organic phase was transferred and evaporated to dryness under a stream of nitrogen at 60°C. The residue was dissolved in 0.1 ml of mobile phase B and a 10 µl-aliquot was used for chromatography. LC-MS/MS system consisted of a Shimadzu LC 20 series (Duisburg, Germany) high-performance liquid chromatography system (binary pump, degasser, controller and autosampler) coupled with an Applied Biosystems (Darmstadt, Germany) API 4000 QTrap triple quadrupole mass spectrometer. Chromatographic separation was achieved on a Phenomenex (Aschaffenburg, Germany) Hydro RP column (1502 mm; 4 µm) with a flow of 0.5 ml/min and with following gradients: 0–15 min from 10% to 100% mobile phase B, 15–20 min 100% mobile phase B, 20–21 min from 100% to 10% mobile phase B, 21–25 min equilibration with 10% mobile phase B. For mass spectrometric detection in multiple ion monitoring mode (MRM), following transitions from the molecular ions ([M+H+]+) were used: oxycodone (316.1→298.0, 241.0), oxycodon-d3 (319.1→301.1, 244.1), oxymorphone (302.1→284.0, 227.2), oxymorphone-d3 (305.1→287.1, 230.1), noroxycodone (302.2→284.0, 187.0), noroxycodone-d3 (305.1→287.0, 230.2), and noroxymorphone (288.1→270.0, 213.0). For quantification, peak area ratios of the analytes to the corresponding deuterated standards were calculated as a function of the concentration of the substances. Noroxymorphone was quantified by referring its peak area to the peak area of oxymorphon-d3 due to the lack of its deuterated analogue. The limits of quantification were between 0.08 and 0.11 ng/ml. Precisions and matrix effects were checked according to international guidelines and all criteria were fulfilled The data are summarized in Table 1.\nThe primary study endpoint was the influence of CYP2D6 genotypes on metabolism and plasma concentrations of oxycodone and its metabolites. As on demand administered drugs per se require an alternative approach for analyses of drug and metabolite concentrations due to varying amounts of oxycodone being administered according to individual needs, mean metabolite ratios of oxymorphone/oxycodone plasma concentrations were compared between genotype groups (ANOVA, consecutive post hoc analysis using the Tukey-test). These ratios reflect the CYP2D6 activity-related plasma concentrations of both ocycodone and oxymorphone at the time points for blood sampling . From previous data it was conservatively assumed that in PM this ratio was about one third of that in EM and UM with a standard deviation being as high as the means of PM , . For CYP2D6 7–10% of Caucasian individuals are PM. A total minimum number of at least 120 patients was calculated to provide sufficient pharmacokinetic data for the PM group. The x2-goodness of fit test was applied to all SNPs to ascertain whether they were in Hardy-Weinberg equilibrium.\nAs a secondary endpoint, a comparison of genotype-dependent cumulative analgesic consumption that measured titration doses in the recovery room as well as delivered PCA bolus doses was performed (repeated measures ANOVA). For analysis of equianalgesic doses, a comparison to a cohort receiving the standard treatment with piritramide, a synthetic opioid structurally related to meperidine, was used. Depending on their body weight, patients received piritramide 4–8 mg i.v. before the end of surgery. In the PACU, further doses of piritramide 2–3 mg were titrated if pain scores were >40 at rest. The setting used on the PCA device was identical to the oxycodone group, however, the 1 ml bolus dose consisted of piritramide 2 mg. This ratio was chosen due to a lower relative analgesic potency of piritramide compared to morphine , .\nEquianalgesic ratios piritramide : oxycodone were calculated from piritramide doses versus oxycodone doses titrated in the recovery room and from the delivered amount of the respective opioid via PCA. For the opioid consumption via PCA the first eight hours were represented in hourly intervals. Thereafter, opioid consumption up to the 12th, 18th, 24th, 30th, 36th, 42nd and 48th hour (15 observation time points) was extracted from electronic PCA protocols. Patients were allocated to genotype dependent CYP2D6 activity groups with no (PM), one (HZ/IM) or at least two active CYP2D6 alleles (EM+UM). Mean overall equianalgesic ratios piritramide : oxycodone with standard deviations (SD) and 95%-confidence intervals (95%-CI) were calculated and compared by ANOVA followed by post-hoc analysis.\nFor all analyses level of significance was defined as p<0.05 with subsequent correction for multiple testing. Analyses were performed by using the statistical software STATISTICA 10 (Stat Soft, Inc. Tulsa, OK, USA).\nDemographic Data and Genotypes\nIn this trial, a total of 131 patients were enrolled. Complete data for 121 patients on oxycodone could be analyzed (major urologic surgery: 80 patients, major abdominal: 29, liver/pancreatic surgery: 5, thoracotomy 4, major gynecological laparotomy: 3 patients). Ten patients had to be excluded due to violation of the study protocol, need for prolonged postoperative mechanical ventilation or surgical complications. Demographic and surgery-related as well as frequency of genotype groups are displayed in Table 2.\nCYP2D6 and CYP3A Genotypes\nOf the participants enrolled, 104 were of German descent, the remainder from other European countries (13), Arabia or Africa (4). Genotyping was successful in all blood samples. The observed CYP2D6 allele frequencies were 2.0% (95%-CI: 0.9/4.7) for 3, 17.4% (13.1/22.6) for 4, 2.9% (1.4/5.9) for 5, 0.6% (0.4/3.6) for 6, 4.5% (2.6/7.9) for 10, 7.9% (5.1/11.9) for 41 and 2.1% (0.9/4.7) for wtxN. The CYP2D67 allele was not detected. For CYP3A5, the allele frequency of 3 was 94.1% (91.7/95.9). Allele frequencies did not differ when considering subjects of European descent only. There was no deviation of allele frequencies from Hardy-Weinberg equilibrium (p-values >0.05) and results were in agreement with data reported previously , . Considering genotype dependent metabolic activity 6.6% and 4.1% of the patients carried a CYP2D6 dependent activity score of 0 or 3 (Table 2). For CYP3A, 10.7% high expressors with at least one wt-allele were detected (Table 2).\nGenotype-Dependent Plasma Concentrations\nPlasma concentrations of oxycodone and oxymorphone were dependent on CYP2D6 activity groups. The resulting metabolite ratio oxymorphone : oxycodone was lowest in PM and highest in UM (p = 0.001; Figure 1). The time course of plasma concentrations showed lowest oxymorphone doses in PMs (comparison of genotype groups by repeated measures ANOVA, p = 0.004; Figure 2). There was no difference in plasma concentrations for noroxymorphone among CYP2D6 genotypes (concentrations at 30 minutes: PM 2.8±3.2, HZ/IM 2.2±1.7, EM 3.4±2.5, UM 2.9±2.5 ng/ml; p = 0.9). For CYP3A53/3 carriers neither plasma concentrations of oxycodone (p = 0.5), nor the concentrations of noroxycodone (p = 0.4) or noroxymorphone (p = 0.8) differed compared to those subjects carrying at least one wt-allele.\nBoxes represent 1st and 3rd quartile; whiskers the 5th and 95th percentiles. ANOVA p = 0.001; Tukey-test: PM vs. UM: p = 0.009, HZ/IM vs. UM: p = 0.005).\nAnalgesic Consumption and Efficacy\nSixty patients (PM: 3, HZ/IM: 24, EM: 32, UM: 1) needed an additional oxycodone dose (3.3±4.3 mg) in the recovery room (no difference between CYP2D6 genotypes). The cumulative oxycodone consumption up to the twelfth hour varied between the CYP2D6 activity groups (Figure 3, repeated measures ANOVA, p = 0.005; post-hoc analysis PM versus EM: p<0.001; PM versus carriers of at leat one active allele: p = 0.002). For CYP3A activity groups, no difference in analgesic consumption could be detected (CYP3A high ecxpressors 20.7±9.6 mg oxycodone up to the twelfth hour, CYP3A low expressors: 20.0±10.5 mg). Pain scores at rest and movement did not differ between CYP2D6 genoytpye groups (Table 3) and none of the patients had to be switched to analgesic rescue medication. The postoperative questionnaire revealed a high-degree of patient satisfaction. Only two individuals on oxycodone (PM:1, EM:1) judged pain management as insufficient. Twelve patients (PM: 2, HZ/IM:4, EM:6, UM:0) answered “no” to the question whether delivered opioid doses were high enough.\nPatients were allocated to CYP2D6 genotype groups. Data are presented as mean with -SD. Repeated measures ANOVA, p = 0.005 for consumption up to the 12th hour. Thereafter, there was no significant difference after correction for multiple testing.\nFor comparison of equianalgesic doses, an additional cohort of 125 patients on piritramide were analyzed. Demographic and sugery-related data as well as genotypes and pain scores were comparable to the oxycodone group (Tables 2–4). Equianalgesic doses of piritramide versus oxycodone differed between CYP2D6 genotypes (Table 5). For the combined group of EM and UM this ratio was higher compared to PM and HZ/IM (p<0.001).\nIn patients receiving oxycodone for postoperative analgesia after major surgery, the CYP2D6 genotype influenced the ratio of plasma concentrations of oxymorphone/oxycodone as well as analgesic consumption via PCA during the first 12 postoperative hours. This confirms our hypothesis and demonstrates that sufficiently high pain scores resulting in relevant analgesic needs are necessary to detect genotype dependent differences.\nInfluences of CYP2D6 Genotypes on Plasma Concentrations\nThe CYP2D6-dependent metabolite oxymorphone has a 40 to 45-fold higher μ-opioid receptor binding affinity than oxycodone – and has proved to be a more potent μ-opioid receptor agonist. However, its impact on analgesia is controversial since formation of oxymorphone is not considered the major metabolic pathway , .\nIn a previous trial, plasma concentrations were measured 25 minutes after i.v. injection of oxycodone 5 mg (PM: 0.04 ng/ml; EM: 0.12 ng/ml) . Similar to the present findings oxymorphone concentrations and the metabolite ratio oxymorphone ∶ oxycodone varied depending on CYP2D6 genotypes, but overall substance concentrations measured in plasma were lower than in the present study, which might be due to different laboratory techniques . Furthermore, another panel of SNPs was investigated resulting in a different classification of CYP2D6 activity status .\nA decrease of oxymorphone concentrations and a shift to the N-demethylation pathway was reported in subjects with blocked CYP2D6 activity (by comedication with quinidine), which resembles the PM status . In 20 chronic-pain patients, co-administration of paroxetine decreased plasma AUC of oxymorphone by 67% and increased AUC of noroxycodone by 100%, but had no effect on oxycodone analgesia or the use of rescue medication . In contrast, the effect of paroxetine on plasma concentrations of one single i.v. dose of oxycodone was negligible in an experimental setting . In these previous investigations, either no genotyping was performed or no sufficient number of subjects was enrolled to perform a genetic association study.\nThe CYP3A4 pathway is described as quantitatively more important with the N-demethylated metabolite noroxycodone showing poor antinociceptive effects , , . CYP3A is the most abundant CYP protein in the human liver, and the influence of genetic variants on metabolism has been demonstrated in immunosuppressive drugs with a narrow therapeutic index and frequent side effects –. In contrast, data on other widely used drugs metabolized by CYP3A are sparse. For healthy volunteers, Samer and co-workers stated that oxycodone's pharmacokinetics is also modulated by CYP3A activity . A higher noroxycodone/oxycodone ratio and a higher daily oxycodone escalation rate was described in cancer patients carrying the CYP3A53/3 genotype , however, an association of plasma concentrations and analgesic consumption to CYP3A5 genotype could not be confirmed in the present trial. It is well described that comedication with voriconazole, itraconazole, telithromycin, rifampin or ketoconazol produces considerable changes in oxycodone's pharmacokinetic , , – and even foods like grapefruit juice can inhibit CYP3A activity with respective interactions . Several authors have pointed out that dose adjustment of oxycodone might be necessary, when used concomitantly with CYP inducers or inhibitors to either maintain adequate analgesia or prevent overdosing , . However, data from large-scale clinical studies are lacking thus far.\nGenotype and Opioid Consumption\nThe central nervous system effects of oxycodone were described as governed by the parent drug, with a negligible contribution from its oxidative and reductive metabolites , . This hypothesis was mainly based on the low contribution of CYP2D6 to the overall metabolism of this opioid , , however, this hypothesis was not confirmed in all human trials. Specifically in some volunteer studies, oxymorphone did play a role for analgesic efficacy in parallel to the clear-cut pharmacokinetic effects described in nearly all publications in which this issue has been addressed , , .\nIn experimental pain models enrolling a limited number of volunteers, oxycodone analgesia was reduced in PM compared to EM, whereas increased pharmacodynamic effects were described in two UM , . Some case reports – as well as the present results are in line with these findings. In contrast, no genotype dependent difference in analgesic consumption was detected in a previous PCA study , but, no differentiation of UM and HZ/IM was performed, surgical procedures were less invasive and the 24 h oxycodone consumption was considerably lower with about 40% of the patients not using the PCA device at all . The overall low analgesic needs might have masked possible differences between genotypes. Stubhaug and co-workers stated that a sufficiently strong base-line pain is necessary to discriminate between drugs or as in this case between different genotypes. As hypothesized in the present trial, enrolling patients undergoing major surgery PM needed more oxycodone. A substantial change in the analgesic regimen for postoperative PCA seems not to be necessary as PM could compensate higher analgesic needs by demanding additional PCA bolus doses and titrating themselves to comfortable low pain intensities. This is also reflected by comparable pain scores in the different CYP2D6 activity groups.\nThe definition of equianalgesic doses of oxycodone to morphine has been described as difficult due to pharmacokinetic differences of the drugs . For morphine∶oxycodone a ratio of about 1.5 has been suggested –. In a further trial reporting a ratio of 1.0 in patients undergoing non-abdominal surgeries, high PCA bolus doses (oxymorphone 30 µg/kg) might have contributed to an increased overall opioid consumption . Thus, possible differences in opioid potency may have been concealed.\nEquianalgesic doses of piritramide∶oxycodone have not been reported up to now. They are useful for clinicians in the case of opioid switching. Piritramide is the preferred opioid in a postoperative setting in several European countries due to rapid onset, absence of active metabolites, and unproblematic use, also in the case of impaired renal function , . Due to higher oxycodone consumption in PM, the present trial revealed a respective change in equianalgesic dose ratios piritramide∶oxycodone compared to subjects carrying at least two wild-type alleles.\nThere are some limitations in the current study. First, the overall number of patients included in this trial is limited. Nevertheless, the results show a significant association between CYP2D6 genotypes and oxycodone metabolism and consumption at a statistical power of 80%. Second, for analysis of equianalgesic doses piritramide∶oxycodone a double-blinded study design might have been suitable as well. However, as the patients' genotypes were unknown during the clinical part of the trial and the drugs were administered via PCA by the patients themselves, the influence of physicians and nurses on analgesic consumption should be negligible. For more detailed evaluation of genotype-associated oxycodone effects and side effects a larger patient cohort needs to be investigated in a future trial. Additionally, the influence of concomitant medication interfering with CYP activity has to be addressed in a postoperative setting.\nIn this patient cohort recovering from major surgery and requiring clinically relevant opioid doses, a CYP2D6 genotype-dependent effect on plasma concentrations of oxycodone and oxymorphone was detected. The higher oxycodone consumption in PM resulted in genotype specific equianalgesic doses of piritramide∶oxycodone. PCA technology overcomes differences in doses needed by various genotype groups, so that the PM also experienced sufficient pain relief from oxycodone in this postoperative setting.\nRevising the manuscript critically: LZ MB LL. Final approval of the version to be published: US MB LL LZ FS FM. Conceived and designed the experiments: US MB LL FS FM. Performed the experiments: US MB LZ FM. Analyzed the data: US MB LL FM FS. Contributed reagents/materials/analysis tools: US FS FM. Wrote the paper: US FS FM.\n- 1. Zwisler ST, Enggaard TP, Mikkelsen S, Brosen K, Sindrup SH (2010) Impact of the CYP2D6 genotype on post-operative intravenous oxycodone analgesia. Acta Anaesthesiol Scand 54: 232–240.\n- 2. Samer CF, Daali Y, Wagner M, Hopfgartner G, Eap CB, et al. (2010) Genetic polymorphisms and drug interactions modulating CYP2D6 and CYP3A activities have a major effect on oxycodone analgesic efficacy and safety. Br J Pharmacol 160: 919–930.\n- 3. Gronlund J, Saari TI, Hagelberg NM, Neuvonen PJ, Laine K, et al. (2011) Effect of inhibition of cytochrome P450 enzymes 2D6 and 3A4 on the pharmacokinetics of intravenous oxycodone: a randomized, three-phase, crossover, placebo-controlled study. Clin Drug Investig 31: 143–153.\n- 4. Stamer UM, Lee EH, Rauers NI, Zhang L, Kleine-Brueggeney M, et al. 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Gronlund J, Saari T, Hagelberg N, Martikainen IK, Neuvonen PJ, et al. (2010) Effect of telithromycin on the pharmacokinetics and pharmacodynamics of oral oxycodone. J Clin Pharmacol 50: 101–108.\n- 34. Kharasch ED, Vangveravong S, Buck N, London A, Kim T, et al. (2011) Concurrent assessment of hepatic and intestinal cytochrome P450 3A activities using deuterated alfentanil. Clin Pharmacol Ther 89: 562–570.\n- 35. De Leon J, Dinsmore L, Wedlund P (2003) Adverse drug reactions to oxycodone and hydrocodone in CYP2D6 ultrarapid metabolizers. J Clin Psychopharmacol 23: 420–421.\n- 36. Foster A, Mobley E, Wang Z (2007) Complicated pain management in a CYP450 2D6 poor metabolizer. Pain Pract 7: 352–356.\n- 37. Maddocks I, Somogyi A, Abbott F, Hayball P, Parker D (1996) Attenuation of morphine-induced delirium in palliative care by substitution with infusion of oxycodone. J Pain Symptom Manage 12: 182–189.\n- 38. Susce MT, Murray-Carmichael E, de LJ (2006) Response to hydrocodone, codeine and oxycodone in a CYP2D6 poor metabolizer. Prog Neuropsychopharmacol Biol Psychiatry 30: 1356–1358.\n- 39. Stubhaug A, Grimstad J, Breivik H (1995) Lack of analgesic effect of 50 and 100 mg oral tramadol after orthopaedic surgery: a randomized, double-blind, placebo and standard active drug comparison. Pain 62: 111–118.\n- 40. Lemberg KK, Heiskanen TE, Kontinen VK, Kalso EA (2009) Pharmacology of oxycodone: does it explain why oxycodone has become a bestselling strong opioid? Scandinavian Journal of Pain 1: S18–S23.\n- 41. Lenz H, Sandvik L, Qvigstad E, Bjerkelund CE, Raeder J (2009) A comparison of intravenous oxycodone and intravenous morphine in patient-controlled postoperative analgesia after laparoscopic hysterectomy. Anesth Analg 109: 1279–1283.\n- 42. Kalso E (2007) How different is oxycodone from morphine? Pain 132: 227–228.\n- 43. Kalso E, Poyhia R, Onnela P, Linko K, Tigerstedt I, et al. 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Private Expert. Dr. Engin Ocal Clinic\n- 0 (0 reviews)\n- 1,352 m from center\nPlastic surgery with innovative techniques Private Expert. Dr. Engin Ocal Clinic was established in 2018. After graduating from Istanbul Medical School, he started his plastic and plastic surgery specialty at Hacettepe University. For many years, he gained experience by conducting academic studies, conducting national and international congresses, courses and observances. Procedures such as total facial rejuvenation, nose, breast and abdominal aesthetics, and repair of post-obesity deformations are the doctor's areas of expertise.\nFace and Neck Rejuvenation\nIt is an aesthetic operation that includes eyelid, forehead and brow lifting, Middle face lifting, cheek and neck lifting.\nIt is an operation to remove sagging in the abdomen after pregnancy or excessive weight loss and make the waist fold more aesthetic.\nWith the 3D Vectra system, a 3D simulation of how you will look after surgery is prepared and thus rhinoplasty is performed with the most innovative techniques.\nIn this operation, the main goal is to reshape the lubrication around the eye instead of emptying it, and to gain the lost volume by fat injections.\nFat injections in large areas can be applied in an operating room and under general anesthesia, as well as in a local anesthesia and sterile practice for small areas.\nThese are short-term applications that do not require anesthesia. About 10-20 cc of blood is taken into a special tube and brought to the desired form with the help of a centrifuge. It is given under the skin with the help of an injector or dermapen.\nA special serum is injected into the desired area under general anesthesia. Then, with 1 cm thin incisions, the oils are broken down under the skin with the help of a vaser or laser, and the oils are drawn with a vacuum with the help of cannulas that do not cause trauma.\nCorrection surgery may differ in which breast to resemble which, or in order to normalize both. For this purpose, surgical procedures such as reducing or enlarging the other breast with a silicone prosthesis are made according to the person.\nIt is a surgical operation that can be easily applied under local anesthesia. In cases where the nipple is collapsed, that is, in cases of inverted nipple, the structures that pull the nipple to the bottom are saved with the help of a small incision and returned to its original form.\nIt is an operation for women who are not satisfied with their breast size and gives excellent results.\nThe desired breast size is achieved by planning before surgery. But after surgery, weight changes affect the size of the breast.\nIt is the process of thinning the wide contour of the cheek by removing cheek fats from the mouth with a small incision.\nSurgical and non-surgical procedures can offer solutions according to the problem. Surgical applications are especially suitable for congenital problems or longer-term techniques for aesthetic purposes.\nIt is to change the short, long and width of the jaw tip to gain an aesthetic appearance. The most common interventions are surgery supported by medpor, silicone and bone graft.\nIt is the only surgical procedure applied for patients who are dissatisfied with The Shape of the nose and have breathing problems.\nIt is the second correction surgery applied to patients who are not satisfied with the nose surgery performed.\nIt is an operation in which the breast tissue is of sufficient size and is performed to eliminate its sagging.\nCards accepted at this hospital:\nPrivate Expert. Dr. Engin Ocal Clinic's Doctors
The Vbeam 595nm pulsed dye laser is the gold standard in the treatment of vascular lesions, as well as in the treatment of acne, psoriasis and wrinkles. The Vbeam treats all skin types quickly, comfortably and effectively and features DCDTM, Candela’s patented cryogen cooling system.\nPurpura-free Treatment – Innovative ultra-long pulse duration – the longest offered in a dye laser – delivers laser energy to targeted blood vessels over longer periods of time, resulting in a more gentle heating effect and uniform coagulation. By heating targeted vessels more gently, Vbeam eliminates postoperative purpura or bruising.\nVersatility – Vbeam’s user-selectable pulse durations and spot sizes are the keys to its versatility. The 5mm spot and short .45msec pulse duration were both added to enable treatment of a greater range of conditions without downtime.\nPatented Epidermal Cooling – Candela’s Dynamic Cooling Device represents an adjustable epidermal protection technology to maximize patient safety and comfort.\nThe Candela Vbeam produces an intense but gentle burst of light that selectively destroys the blood vessels of your rosacea, without damaging the surrounding tissue. After laser treatment the surrounding tissue is left intact.\nDr. Levit utilizes this laser to treat: Blood vessels, Rosacea, Scars, Keloids, PWS (port wine stain), cherry angiomas, Hemangiomas, warts: The gold standard for treating these conditions is a laser in the 585nm wavlength (Pulse Dye Laser).\nTreatment with the Vbeam may consist of multiple treatments. For facial veins, one treatment may be sufficient for clearance but a second visit is recommended for the best results. These treatments occur on an average of every six to twelve weeks. Each individual situation may vary and it is best to discuss yours with the our physicians. The type of vascular lesion to be treated will determine the number of treatments needed. The red veins respond better than blue veins and the smaller, matting vessels will respond sooner than the vessels up to 1.5mm in size. Port wine stain lesions have more vessels to be treated and require multiple treatments but the number of treatments is unknown in advance.\nThe DCD (Dynamic Cooling Device) which is built into the laser system, delivers a short burst or spray of cryogen just prior to the laser pulse being delivered. The feeling of a laser pulse has been described as being snapped by a rubber band or a slight stinging sensation. Following laser treatment, the area may continue to sting slightly or feel warm like a sunburn. If a large area is to be treated, anesthesia may be used. A small test area can be performed before the entire area is treated to evaluate your pain tolerance. Most patients tolerate this procedure without any need for anesthesia.\nThe duration of your rosacea laser treatment depends on the size of the area you wish to have treated or the time allotted by the physician or nurse performing your treatment. You will need to discuss this with the physician or nurse performing the treatment.\nRemoval of Hemangioma ( Before)\nRemoval of Hemangioma (After)
When you need a surgical treatment or testing, get top-quality care from Owensboro Health Medical Group Surgical Specialists, formerly Ohio Valley Surgical Specialists. You’ll find services for a broad range of medical needs because we’re the largest practice of our kind in western Kentucky. Trust us to help you enjoy better health.\nYou benefit from the expertise of board-certified, award-winning Owensboro Health surgeons who are leaders in their fields, teach surgical procedures to other doctors and speak at national conferences. And because Surgical Specialists includes providers in a wide range of disciplines, your physician can easily consult with a variety of medical experts to make sure you get well-rounded care.\nThrough Surgical Specialists, you gain access to a broad spectrum of treatments and diagnostic procedures, including:\n- Bile duct surgery\n- Breast disease\n- Chest (thoracic) surgery\n- Colorectal surgery\n- Endoscopies, including colonoscopy and EGD (upper endoscopy)\n- Gallbladder surgery or removal (cholecystectomy)\n- Head and neck surgery\n- Hernia repair\n- In-office non-surgical treatment of hemorrhoids\n- Liver surgery or tumor removal (liver resection)\n- Lumpectomy with 3D BioZorb tissue marker (to directly target radiation after surgery)\n- Micro-invasive laser\n- Surgical oncology / Oncoplastic surgery\n- Breast cancer (restores the breast’s appearance right after removing the tumor)\n- Head and neck\n- Pancreatic surgery (available from only a few providers in Kentucky, including Owensboro Health)\n- Skin grafts and other surgical treatment of wounds & burns\n- Skin lesions and cancer\n- Vein treatment\n- Varicose & spider vein treatment\n- Vascular screenings\n- Vascular surgery\n- Minimally invasive\nMinimally Invasive Approach\nWhenever possible, your surgeon will perform your procedure using a minimally invasive technique. This approach requires only tiny incisions and thus decreases pain, scarring and recovery time.\nIf you need treatment for your pancreas, bile duct, gallbladder or liver, a doctor may perform your procedure using a minimally invasive technique called interventional endoscopy. In this approach, the physician inserts an endoscope—a small tube with a video lens—through your mouth and into your digestive tract while you’re under sedation. He or she then slides tiny surgical tools through the tube to perform your treatment. You’ll recover faster after this type of procedure than after traditional surgery.\nYou won’t find this treatment option at many other locations in Kentucky. Owensboro Health is home to one of only a handful of doctors in the state who perform interventional endoscopies.\nAnesthesia For Surgical Procedures\nThe anesthesia department staffs highly trained certified registered nurse anesthetists (CRNA) and a physician trained in anesthesia. The department offers a variety of services, including:\n- Axillary blocks\n- Bier blocks\n- General anesthesia (put to sleep)\n- Additional types of anesthesia for all age groups
It isn’t uncommon for children to be afraid of going to the dentist to have a cavity filled or to undergo another type of dental treatment. At Colorado Kids Pediatric Dentistry, we understand these concerns and strive to do all we can to help our young patients through the process of visiting a children’s dentist. As a trusted pediatric dentistry practice with offices in Highlands Ranch & Castle Pines, one of the ways we accomplish this is by offering sedation dentistry to help alleviate fear and anxiety.\nAbout Sedation Dentistry at our Highlands Ranch & Castle Pines Offices\nOur team of dentists offer sedation dentistry to our patients who are afraid of the dentist to help them relax. There are many types of dental procedures which can require sedation such as fillings, root canals, crowns, extractions, periodontal treatments and some cosmetic procedures.\nWhen Sedation Dentistry May Be Used\nFor children who are very fearful and anxious about visiting the dentist\nFor children who are unable to sit still during a dental visit\nFor children in need of extensive dental work\nFor children requiring oral surgery or other dental treatments that would be difficult for them to tolerate when awake\nFor children with disabilities that limits their ability to understand directions\nTypes of Sedation Offered at Colorado Kids Pediatric Dentistry\nConscious Sedation Through the Use of Nitrous Oxide\nNitrous oxide or laughing gas as it’s also called, is commonly used as a conscious sedative during a dental visit. The gas is mixed with oxygen and administered through a small mask that fits over the nose. Nitrous oxide has a calming effect that helps frightened or anxious patients relax so they can get the dental treatment they need. The effects of nitrous oxide wear off very rapidly, allowing children to get back to their daily activities quickly following their dental visit.\nOur practice works directly with Care Point Anesthesia, a group of anesthesiologists that specialize in providing advanced anesthesia services, all in the comfort of our offices and at a fraction of the cost. General anesthesia puts a child into an unconscious state (deep sleep) so he/she cannot feel pain or move around. This is the same type of anesthesia used when removing tonsils.\nHave Questions About Castle Pines or Highlands Ranch Sedation Dentistry?\nWe never want fear or anxiety to prevent your child from receiving the dental care he or she needs! If you have any questions about the pediatric sedation dentistry options we provide, please feel free to contact us in Highlands Ranch or Lone Tree dental offices as we’re always here to help!
What is Implant?\nThe implant is artificial tooth roots made of titanium, which are placed in the jawbone instead of the teeth lost anywhere. In implant application, the aim is to repeat the aesthetic and function of the lost teeth. Implant application is performed under local anesthesia in the surgery environment. Implant application can be performed with the conscious conscious sedation application which is the fear of dentist and needle. Conscious sedation is a deep sleep state by connecting the patient to the drugs given by the vein. Sedation application by performing the consciousness is clear, you can hear the dentist saying, you can do by applying.\nImplant Application How?\nImplant application is planned to be performed clinically and radiologically. Local anesthesia is applied to the implant site. The appropriate size and diameter of the implant is placed in the jaw bone. The implant is implanted in the implanted area and the implant is covered. After 1 week of implantation, sutures are taken, after implantation, the implant is expected to be 2-4 months in the lower jaw and 4-6 in the upper jaw to fuse to the jawbone. After the time required for the implant to boil with the bone, the superstructure stage is started. Under local anesthesia, the gum on the implant is opened and the healing head is attached to the implant. Waiting for one week to measure the size of the porcelain teeth on the implant is taken.\nWhat are the advantages of implant?\n- The jawbone following tooth extraction starts to melt. Implant application prevents bone loss. In this way, the aesthetics of the prosthesis will be improved. Ingestion of the gum in the missing tooth area is prevented.\n- In traditional bridge applications, cutting of teeth adjacent to the missing tooth area is prevented.\n- With multiple implant applications, patients are prevented from using removable prosthesis. Thus, the patient’s bone loss is prevented and an aesthetic appearance is provided. The patient is provided with natural bite and chewing\n. • Implants on the implant with prosthesis removes the patient ‘s prosthetics. Thus, patients can easily chew hard food like apples.\nFrequently Asked Questions\nQuestion: Will the body reject the implant?\nAnswer: implants are made of titanium alloy that is compatible with the body. The most common causes of implant loss are systemic systemic disorders (such as diabetes and so on) that patients do not pay attention to their oral care.\nQuestion: Can anyone be implanted?\nAnswer: All patients with good general health may be implanted. In order to complete bone development in young people, it is appropriate to wait for boys between the ages of 17 and 18 in girls aged 16-17.\nQuestion: Will I experience pain during and after implantation?\nAnswer: Implant application is performed under local anesthesia in the practice. The patient does not feel any pain when implanting. If the patient applies the dentist’s advice after the implant, the patient will be comfortable after the operation. After the operation, the patient is given ice compressors and drugs to prevent swelling and pain. After the operation, all tobacco products should not be consumed for 2 days.\nQuestion: How long does the implant last?\nAnswer: The success rate of implant application is above 98%. In order for the implant life to be long, patients should make regular oral care and should not disrupt their controls.\nQuestion: Are the implants difficult to maintain?\nAnswer: Implant care is no different from our own teeth. It is necessary to brush and floss regularly every day.
Anal Skin Tag Removal in Cincinnati, Ohio\nNo More Discomfort.\nWhat are Anal Skin Tags?\nAnal skin tags, also called rectal skin tags, are growths of excess tissue on the outside of the rectum. They are extremely common and often mistaken as hemorrhoids. Anal skin tags completely harmless; however, they can cause discomfort, embarrassment or decreased confidence during sexual intimacy and hygiene issues.\nWhat Causes Anal Skin Tags?\nThe most common cause is having a history of hemorrhoids or an anal fissure (tear in the skin of the anus). Although the hemorrhoid or fissure resolves in time, in its place a skin tag forms. Both of these conditions are very common during or after pregnancy or in patients with chronic constipation. Another cause of anal skin tags is obesity.\nWhat it Treats\n30 – 60 minutes\nThe first week following surgery, Dr. Brenner will advise to avoid heavy lifting and exercise. Most patients can return to normal activity in two weeks.\nIn the first days after the procedure, Dr. Brenner may recommend you take a laxative or try a liquid diet to make using the restroom easier and reduce the possibility of constipation. Medication will be prescribed to control pain and prevent infection.\nAnal Skin Tag Removal\nAnal Skin Tag Removal in Cincinnati is typically performed with local anesthesia and oral sedation. IV sedation is also available, if preferred, in our AAAASF accredited office surgical suite. Benefits of local anesthesia include decrease risk of complications from general anesthesia, quicker recovery, and cost savings.\nDr. Brenner utilizes the Ellman Surgitron, a unique instrument that has a cool tip, so thermal damage to the underlying tissue is able to be minimized or even eliminated. During this procedure, anal skin tags are excised, resulting in a smooth and natural looking perianal area.\nThe Surgitron is unparalleled in its finesse and no-touch technique. The Surgitron provides superior precision and cutting (compared to a scalpel), less thermal injury, thereby promoting faster and less painful healing.\nAll sutures used in Anal Skin Tag removal are self-dissolvable and disappear within six weeks.\nAnal Skin Tag Removal Explained\nOur Cosmetic GYN Procedure Suite\nTypes of Cosmetic GYN Procedures\nDo You Need This Procedure?\nHow Long is Anal Skin Tag Removal Procedure\nRecovery After Anal Skin Tag Removal
Members of the American Academy of Facial Plastic and Reconstructive Surgery estimate they performed more than 40,200 rhinoplasties, 34,800 facelifts, and 34,700 eyelid lifts in 2012. You may find yourself considering one or more of these facial plastic surgeries. Before you commit, however, one thing you should think about is the timing.\nUnlike emergency surgeries where you are rushed into the surgery as soon as there is an opening, plastic surgery is timed around your schedule. There are five things you must consider when planning any of these facial cosmetic surgeries.\nBe Ready to Give Up Certain Medications and Nutritional Supplements\nThere are certain prescription and over-the-counter medications that thin your blood. Blood thinners, aspirin, and products containing ibuprofen should be eliminated from your use a couple of weeks before and after the surgery. During the consultation, it’s also important to mention all nutritional or herbal supplements you use. Large amounts of vitamin E inhibit the healing process. There are also certain herbal remedies that interact with anesthesia and must be avoided.\nCan You Really Afford Facial Plastic Surgery?\nIn very rare circumstances, health insurance will cover the cost of a cosmetic surgery. These situations are usually tied to birth defects, health issues, or problems with sagging skin decreasing the line of vision. You should plan to pay for your cosmetic surgery on your own.\nStart saving in advance for your facial plastic surgery. Just looking at the average surgeon fees in 2012 for AAFPRS members, facelifts average $7,400; rhinoplasties are $5,541; brow lifts are $3,817; and eyelid lifts are $3,804. Total costs will be more to reflect additional feels like the anesthesiologist or facility fees. Further, as these are averages, you need to consult with a facial cosmetic surgeon to find out what your actual cost is.\nIf you plan to charge your surgery to a credit card, make sure you can really afford the monthly payments. Credit card interest adds up quickly, so you need to be aware of what that interest will add to the cost of the surgery.\nRegardless of how you decide to pay, make sure you leave yourself enough time to come up with the necessary financing. You don’t want to reach the day of your surgery and suddenly discover your credit card is going to be declined or a personal loan wasn’t approved.\nHoliday Season Brings Lots of Social Events\nPeople want to look their best around the holidays. You need to make sure that you plan your surgery far enough in advance that you’re past the recovery period before the myriad of social events arrive. Here’s a look at the healing time frames for common surgeries.\n- Eyelid Lift – After an eyelid lift, swelling and bruising are common. They will diminish in two to four weeks. It takes about five days before you’re ready to return to work, and another two weeks before you can engage in strenuous activities.\n- Facelift – Swelling and some bruising may occur after a facelift. In general, you have the stitches removed after a week. You need a second week to rest before returning to work and social activities. It takes three weeks before you can resume more strenuous activities.\n- Rhinoplasty – Postpone strenuous activities for four weeks. It can take months or even a year for swelling to completely subside.\nShape Up Before Facial Plastic Surgery\nThe best candidates for facial plastic surgery are in good health. Prior to the surgery, switch to a healthy diet that is low in sugars and alcohol. A diet rich in antioxidants benefits the skin tissue and helps with wound healing. See your family physician for a physical to make sure you are in good physical health for the surgery and the anesthesia. Finally, smoking slows the flow of blood to the tissues and impacts healing times, so you need to quit smoking a few weeks before your surgery.\nYour Expectations Must Be Realistic When Having Facial Plastic Surgery\nNever rush into a facial plastic surgery because the media says it’s the new trend, or someone mentions they had it done so you should have it done. Prior to any consultation with Dr. Michael Schwartz, a West Palm Beach facial plastic surgeon, research the surgery you want. Start your search at the American Academy of Facial Plastic and Reconstructive Surgery.\nOnce you’re ready to discuss the surgery in more depth, schedule a consultation with Dr. Schwartz in his Palm Beach facial plastic surgery office. He is board certified in otolaryngology and facial plastic surgery and has more than two decades of experience. Reach Dr. Schwartz’s office by calling 561-655-5562.
A Prospective Study of 40 Patients\nAttygalle D. & Rodrigo N.\nAnaesthesia 2002 Aug;57(8):778-817\nA prospective observational study was conducted to examine the efficacy and safety of magnesium sulphate for control of spasms and autonomic dysfunction in 40 patients with tetanus. Magnesium was infused intravenously, aiming to control spasms despite suppression of patellar reflex or respiratory insufficiency. Spasms were controlled in 38 of the 40 patients within a serum Mg2+ range of 2-4 mmol.l-1 with only two patients needing additional neuromuscular blocking drugs. Seventeen of 24 patients (< 60 years) and six of 16 patients (>/= 60 years) did not require ventilatory support. Thirty-six patients were conscious and co-operative throughout their management. Sympathetic over-activity was controlled without supplementary sedation. Overall mortality was 12%; all five deaths were in patients >/= 60 years and no deaths were due to autonomic dysfunction. We recommend magnesium as possible first line therapy in the routine management of tetanus.
Having unwanted fat in numerous areas of your body can have a considerable effect on your health and self-confidence. While traditional weight reduction through exercise and diet plan is a great way to reduce weight in general, even the best exercises can't target issue areas like the belly, inner thighs, arms, and butts. Liposuction is a time tested treatment that is used to remove excess fat from specific locations of the body, allowing an individual to shape and contour their body to their taste. Is liposuction right for you? Discover now.\nPros of Liposuction\nThere are lots of advantages to this cosmetic procedure, including:\n• Right away obvious changes. Unlike traditional weight loss, liposuction produces modifications that are instantly noticeable in the body. Some distinction is noticeable right away, and the wanted results are typically attained in just a few days.\n• Proven and safe. This cosmetic procedure has actually been carried out by skilled specialists all over the world for many years and the technique has been improved over and once again to be safe and reliable.\n• Healing time is usually fast. The downtime required after having this kind of treatment is normally much less than what is needed for other kinds of cosmetic treatments, consisting of abdominoplasty, breast reduction, and more. Individuals who have had the procedure can frequently return to work far more quickly than they anticipated and can return to living a healthy, active lifestyle.\n• Weight reduction can be irreversible. With the right maintenance methods, the fat that was removed throughout the liposuction treatment will not return.\n• Complete control over your physique. With liposuction, a person can have complete control over how they wish to look, beyond what conventional diet and workout can supply. Offering individuals this power over their bodies enhances self-esteem and assistance individuals feel their best.\nWhile there countless advantages to liposuction, there are naturally a few caveats that need to be considered prior to making the final decision to progress with the procedure.\nCons of Liposuction\nPrior to having actually liposuction done, it is essential to examine the potential drawbacks of the treatment and determine if the benefits surpass the dangers in your certain case. Your cosmetic surgeon can help you learn more about the risks related to the treatment and can help you choose if moving forward is the ideal thing for you.\n• Problems with basic anesthesia. Because liposuction is performed under general anesthesia, the treatment brings the exact same risks as other type of surgical treatment where general anesthesia is used. Hidden medical conditions may increase these threats.\n• Negative responses. Bruising, bleeding, and discomfort are all to be anticipated, however, in uncommon cases can trigger more substantial problems.\n• The prospective to gain the weight back. After having liposuction done, it is critical to maintain a healthy diet plan and exercise correctly as suggested by your doctor. Failure to do so might result in gaining back the weight that was lost or possibly a lot more.\nThere are risks associated with liposuction, for numerous people, the advantages far exceed them. Educate yourself about the treatment by having extensive conversations with your surgeon and think about how liposuction has the potential to affect you as a special person. Just you and your specialist can identify if liposuction will provide you with the results you are trying to find within your expectations.\nLaser Liposuction procedure is a new non invasive procedure to loose unwanted bodyfat in Mill Creek California\nLaser liposuction is a newer, minimally intrusive procedure that includes heating the fat cells to melting point and eliminating the melted fat through a small cannula. The treatment is usually done right in your doctor's office and is an outstanding alternative for people who have less than 500 ml of fat to eliminate from any one area. Laser liposuction can be a safe, complementary treatment to weight reduction in order to shape the body you have actually constantly wanted.\nContact a Surgeon in your Mill Creek California today.If you're considering liposuction as a weight loss option, it is necessary that you discuss your desires with a certified cosmetic surgeon in your location. Your surgeon will perform a total test and health history survey to figure out if liposuction can benefit you and assist you reach your physical and emotional objectives. Call today for a consultation and learn more about how liposuction can help you accomplish the body of your dreams.
Dental Implants Westminster MA\nDental implants are designed to provide a foundation for replacement teeth that look, feel and function like natural teeth. The person who has lost teeth regains the ability to eat virtually anything and can smile with confidence, knowing that teeth appear natural and that facial contours will be preserved. The implants are tiny titanium posts which are placed into the jaw bone where teeth are missing. The bone bonds with the titanium, creating a strong foundation for artificial teeth. In addition, dental implants can help preserve facial structure, preventing the bone deterioration which occurs when teeth are missing.\nDental implants are changing the way people live! With them, people are rediscovering the comfort and confidence to eat, speak, laugh and enjoy life.\nEvaluation for Dental Implants\nIf, like many others, you feel implant dentistry is the choice for you, we ask that you undergo a dental/radiographic examination and health history. During these consultation visits, your specific needs and considerations will be addressed by either Dr. Palermo or Dr. Manzella or by an Oral and Maxillofacial Surgeon referred by our practice. Your questions and concerns are important to us and our team will work with you very closely to help make your procedure a success.\nInterested in Restoring Your Smile?\nDon’t suffer from missing teeth any longer! Dental implants are natural-looking replacement teeth that can preserve your facial structure and improve your smile.\nDental Implant Procedure\nDental implants are metal anchors, which act as tooth root substitutes. They are surgically placed into the jaw bone. Small posts are then attached to the implant, which protrude through the gums. These posts provide stable anchors for artificial replacement teeth.\nFor most patients, the placement of dental implants involves one surgical procedure. First, implants are placed within your jaw bone. For the first three to six months following surgery, the implants are beneath the surface of the gums, gradually bonding with the jaw bone. This is known as Osteointegration. You should be able to wear temporary dentures, a flipper, or a temporary crown. You must eat a soft diet during this time. At the same time, the dental laboratory designs the final bridgework or denture, which will ultimately improve both function and aesthetics. You will be given antibiotics and anti-microbial rinses to prevent infection. All instructions will be covered during your surgical visit. The surgical appointment generally takes about an hour. You will receive local anesthesia during the procedure and be very comfortable. Mild discomfort may be experienced for a few days. Over the Counter tylenol or Motrin is usually all that is required to manage the temporary discomfort. However with that said, most patients feel virtually no discomfort after the anesthetic wears off.\nAfter the implant has bonded to the jaw bone, and Osteointegration has occurred, the second phase now begins. Dr. Palermo will remove the healing collar, inspect the implant, and take all necessary impressions. The Dental Laboratory will fabricate your final crown, bridge, or denture. Once the final restoration is ready Dr. Palermo will insert them into place. This generally involves a custom post with screw that “screws” directly into the interior of the implant itself. Then a full crown that will be cemented onto the custom post. If this is a full denture then multiple attachments are needed and these hold the denture in place.\nThe entire procedure usually takes six to eight months. Most patients do not experience any disruption in their daily life.\nPatient Reviews for Dental Implants\nWachusett Family Dental\nI was so nervous coming in, Dr. Palermo and his staff made me feel so welcome and relaxed, I just want to say "Thank You"!\n- Heather B
Estimated read time: 5-6 minutes\nHave extreme makeovers - combo face-lifts, tummy tucks, liposuction and more - left Hollywood and gone Main Street?\nApparently thanks to numerous prime-time television shows devoted to the world of personal cosmetic upgrades, plastic surgeons from across the country are reporting an increase in the number of requests for multiple operations, the type seen on popular programs like ABC's Extreme Makeover.\n"I have seen an increase in the number of patients requesting multiple procedures over the last year," says Dr. Michael Olding, chief of plastic surgery at George Washington University Medical Center. Several other surgeons contacted by ABCNEWS.com confirm the trend.\nNot only are patients requesting more operations, they are increasingly particular about the exact procedures they want performed.\n"Patients used to come to the office with a specific complaint, for example, 'I look tired,'" says Olding. "Now they request particular procedures, for example, 'I need a blepharoplasty [eyelid surgery], face-lift, and chin implant, and I was thinking about thigh liposuction.'"\nBut even as more patients request more than one cosmetic procedure at a time, doctors are wary of the risks of performing several simultaneous surgeries.\n"Many of my patients will ask for multiple procedures to be done at the same time. The key determinant about whether that should be done or not is safety," says Dr. John Anastasatos, professor of plastic surgery at the University of Alabama at Birmingham.\n"As these are outpatient procedures and often done under general anesthesia, I don't like to exceed six hours of operating time," explains Anastasatos. "The risk of postoperative complications increases if one does so."\nThat's because general anesthesia has a strong effect on the cardiovascular system.\nAmong the dangers involved in multiple surgeries and long periods of general anesthesia are pulmonary thrombosis, which occurs when a blot clot forms in the artery carrying blood to the lungs.\n"Furthermore, the longer the anesthesia time, the longer the recovery time is," Anastasatos adds. "Surgery and anesthesia both represent trauma to the body and its immune defenses."\nBut not all multiple procedures are problematic, and there are good reasons for performing some operations at the same time.\n"If a surgeon can perform multiple operations on a patient at the same time there is some merit to that" acknowledges Anastasatos. "The patient will have to undergo general anesthesia once and recuperate from all at the same time."\nBefore and After Pictures\nOne reason for the increase in patient requests for specific, multiple procedures appears to be the TV programs' ubiquitous "after" pictures of smiling patients. Yet plastic surgeons view such images with skepticism.\n"The media, including TV and magazines, often allow for misleading representations of what is efficacious and safe when it comes to plastic surgery," says Anastasatos. "Often there is misinformation."\nViewers' expectations run high when they see the quick results shown on television. "On Extreme Makeover, it is striking how limited the swelling and bruising is depicted," says Dr. Peter Rubin, eye plastic surgeon and professor of ophthalmology at Harvard Medical School in Cambridge, Mass.\n"I suspect that some of the dressings are changed just prior to filming," Rubin adds. "Though this may make things more palatable for the viewer at home, it creates unusually high expectations from potential patients."\nHe adds: "Even in the best hands some of the more dramatic surgery that I perform may take two weeks or more before the planned 'overcorrection' settles into the desirable postoperative appearance."\nOne Step at a Time\nIn the face of that surge of interest, plastic surgeons are increasingly advising their patients of safer ways of performing cosmetic procedures, even when it means modifying their requests.\n"We have an obligation to keep our patients' safety at the forefront," says Dr. Susan Obagi, dermatologist at the University of Pittsburgh Medical Center. "We, not the patients, should formulate a treatment plan that will give them the results they seek but in the safest manner possible."\nThough performing multiple procedures may be good for business, Rubin says: "I do not think it necessarily serves the patients well in the long run. I feel that some of our patients are best served by doing several smaller procedures. Each procedure's outcome allows us to customize the next step, and achieve the best long-term outcome."\nTips for Patients\nPatients considering cosmetic surgery needs to think twice about whether they really need the surgery, said Dr. Robert M. Wachter, professor and associate chairman of the department of medicine at the University of California, San Francisco. For smaller surgeries, such as chin tightening, the death rate is estimated at about 1 out of 100,000 surgeries, he said.\n"[There's] nothing wrong with looking better, but you need to go in with your eyes open," Wachter said. "Even a 1 in 100,000 chance means that someone will be that one." To minimize your chances of becoming a statistic, do the following, he said: 1. Choose a board-certified surgeon and anesthesiologist. 2. Check on the number of procedures the surgeon and the hospital have done. 3. If you are having outpatient surgery, check to be sure the facility has a cardiac defibrillator, and ask about its procedures for handling a "crashing" patient. 4. Check to be sure the hospital follows appropriate guidelines to protect patients from blood clots, heart attacks and infections. This is mostly relevant to patients having bigger procedures than minor plastic surgery. 5. Check on the hospital's and surgeon's outcomes (mortality rates, post-op infection rates, return-to-OR rates) and compare to any published "benchmarks." 6. Get in shape prior to the surgery 7. If you smoke, stop for at least a few weeks prior to the surgery. 8. Show your doctors all your medicines, including over-the-counter products and herbal supplements. 9. If you choose to go ahead, realize that surgery is generally safe. Try to relax.\nTo see more on this story, go to http://www.ABCNews.go.com\nCopyright 2004 ABCNEWS.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
The web site features a multiple endeavor to write subscribers illuminated, knowledgeable, and interested.\nHi! My Own names Leif. I also go-by PoF, the medic unstoppable. Im an old anesthesiologist, kids dude, and a supposed outdoors enthusiast whom invests too much energy indoors.\nYou will find a charming girlfriend and a couple lively young sons. I love creating, I like picture taking, modest physical exercise, spectator sporting, vocals, create beer and homebrewing (likewise moderately, clearly).\nWe reached economic health (the F.I.) at the age of 39, this means We possibly could manage to retire easily after a 9-year career. I persisted to your job for a variety of motives, but generally relished my own job, but used to do want to move early on (the R.E.) from treatments during the chronilogical age of 43.\nTo learn more about this is achievable, you should understand to the Story or My way to FI.\nPhysicianOnFIRE.com are an internet record a.k.a. blog site dedicated to the dialogue of problem for particular loans, beginning retirement, drug, and miscellany. I’ll publish brand new media once a week so long as We have one thing to declare, and visitors read through.\nThe vegetables the blogs happened to be grown during mind in 2014, I made a specific arrange in 2015, and created the page using my fundamental post on January 9, 2016. We usually distribute a few blog articles each week, most notably well-liked Sunday better gather article every weekend break.\nI online, function, and write out North, but Ive survived and functioned both north and west from the Mason Dixon range, and east and to the west of the Mighty Mississippi. A good many authorship is completed in a corner company on a great walnut table which was once used in a surgeons front company.\nIve existed most of living in Minnesota, and also now we today phone northern Michigan household. I had been as soon as a Gator Sedator as an anesthesiology citizen with the school of Fl, but completed simple internship at Gundersen Lutheran in La Crosse, WI, an urban area recognized for obtaining most taverns per capita during the entire nation.\nMy favorite a lot of locum tenens stints (previously, in-between, and often within my permanent opportunities) took me to healthcare facilities in southwest Fl, crucial Wisconsin, northern Minnesota, Pittsburgh, PA, numerous components of Michigan from at the Indiana surround within the U.P. I also worked regular anesthesia employment in northern Michigan, east southern area Dakota, and north Minnesota.\nmy own various other workplace\nI produced this blog to enlighten, educate, and captivate fellow medical professionals along with other men and women that own equivalent conditions (high-income, late begin, educational loans, etc). Our aim should help individuals who would you like to assist by themselves and discuss some distinctive ideas through the attitude of a practicing doctor. Hopefully to go out of your notified and prompted to consider being only a little in different ways than you may posses before.\nMedical professionals, on the average, is very negative with dollars. We’re singled out through the uniform across the street as being the most terrible accumulators of money among highest getting workers. At the same time, the requirements your jobs are increasing, bureaucratic requirement tend to be stifling our personal capability to training autonomously, and burnout is rising.\nI would like to assist the associate doctors among others to comprehend what it really means to feel financially independent, how to achieve that target, and just why it will eventually help you. Some, like me, will ponder a young pension. Other people will use the company’s FI status to practice in a fashion that fits all of them. It would be part-time or in an approach which significantly less centered on wages, but even more rewarding.\nIndividual financial would be plainly included with my writing in this particular ideas. Are your physician, I most certainly will additionally discuss some physician-specific problem on occasion. You are able to expect to find some tales and position which happen to be individual, or because particular as you’re able collect from an anonymous compywriter.\nYou will observe advertising on the webpage. Almost certainly my own dreams is create a big giver guided fund, and 1 / 2 datingmentor.org/escort/st-louis of all your income from this webpages is redirected to altruistic forces.\nThanks so much for ones focus, your service, and for aiding me see the sites charitable objective. If you like the things you find out, start thinking about becoming a member of the email message set to obtain notification of the latest blogs and quarterly improvement notes from myself.\nIn reverse chronological order. Begin your very own excessive reviewing at the end and manage the right path doing todays right here.\nShare this post:\n53 applying for grants About Me\nI do think this is often an excellent web site. Congrats on your own fulfillment, realizing FI after 9 decades ways which you were planned but through the most recent blog post it appears just like you remain taking pleasure in a good quality of daily life.\nThank-you, Dr. Mo! Im grateful you have located your site to e helpful. Perhaps i have already been deliberate during my cost savings through the years, nevertheless amnt until fairly just recently that We knew the reasons why. Ive lost from frugal without an underlying cause to the full fledged follower of FIRE.\nIn the event that you truly enjoy the web site, make sure you subscribe to email changes, or follow on Feedly.com, and dont disregard to inform your friends!\nPoF, good products here! Our relation normally an anesthesiologist and producing a reasonably coin these days. However, Having been astonished after satisfying the his or her various other companion anesthesiologist neighbors that all are making measures youd think towards an earlier pension. Some in reality were still cycling in substantial debt. Cash flow is the vital thing. It just goes to show you that all of the kinds anyone have to have higher assistance. Therefore, kudos for you personally for to be able to inform the guy physicians! Congrats on your ability to FIRE by 39.\nComments for one’s piece, of retiereing the docteur of anaestesiologist.My every day life is the same, however i.m working with 71 activ like rheumatologist and interior treatment. Thanks A Lot ! I recomended for almost any Collegeus!\nThanks for the remark, Dr. Szkonyi. I am just pleased a person receive the webpages!\nHi, Im expecting examining blog articles and learning more about your own non-profit objective. Im positive your very own educational substance floods a void into the physicians area. Congrats individual FI!\nOur I question a comical matter? Exactly how easy or hard do you find it for someone to never rise after obtaining anesthesia for surgical procedures? Like, may I shoot the affected person with X ML of material from inside the IV then depend upon the lady to wake-up in 3 many hours after I insert the woman with something?
Are you torn between lipocavitation and lipolysis for your fat reduction journey? Don't fret; we've got you covered. This post will delve into the nitty-gritty of both treatments, but spoiler alert: we're rooting for lipocavitation. Here's why.\nHow it Works\nLipocavitation employs ultrasound technology to target and break down fat cells, which are then naturally eliminated by the body. It's non-invasive, meaning no needles, no incisions, and no downtime.\n- Quick and painless\n- No anesthesia required\n- Targeted fat reduction\nHow it Works\nLipolysis, often referred to as laser lipolysis, uses laser energy to liquefy fat before it's removed through a thin tube. This method is minimally invasive, requiring small incisions.\n- Minimally invasive\n- Can be more precise\n- Local anesthesia is used\nComparing the Two\nBoth treatments are effective for fat reduction, but lipocavitation allows for a more comfortable experience with similar results.\nLipocavitation is generally safer, as it doesn't require incisions or anesthesia, reducing the risk of infection or complications.\nLipocavitation is often more budget-friendly, especially when considering the absence of surgical fees or anesthesia costs.\nWhy Lipocavitation Wins\nPros Over Lipolysis\n- Non-Invasive: No needles, no problem.\n- No Downtime: Get back to your life immediately.\n- Cost-Effective: Save those dollars for something fabulous.\n- Comfort: Most people find the procedure to be pain-free.\n"I chose lipocavitation over lipolysis and couldn't be happier. The results are amazing!" - Sarah, 38\n"I was back to my routine right after the treatment. Highly recommend lipocavitation!" - Emily, 29\nIs lipocavitation suitable for all skin types?\n- Generally, yes. However, a consultation is recommended.\nHow many sessions will I need?\n- This varies but usually fewer than you would with lipolysis.\nIs it permanent?\n- Results can be long-lasting if you maintain a healthy lifestyle.\nWhere can I get it done?\n- Many aesthetic clinics offer this treatment, and there are also at-home devices.\nRecommended At Home Body Sculpting Device:
Adult dogs generally sleep 12 – 14 hours/day, whereas puppies and older dogs require more, ranging from 15 – 18 hours/day. Unlike humans who generally receive eight hours of consecutive sleep, dogs sleep on and off throughout the day.\nIs it normal for my senior dog to sleep all day?\nJust like senior citizens need more sleep, an older dog sleeps a lot when compared to their younger counterparts. On the higher end of the scale, a senior dog can sleep up to 18-20 hours a day, says Dr. Rossman. She estimates that the lower end is probably around 14-15 hours per day.\nHow many hours a day does a 10 year old dog sleep?\nPuppies usually sleep 15-18 hours per day, while adult dogs generally reach 12-14 hours of sleep. Dogs that have active work duties, such as seeing-eye dogs or farming dogs may sleep less during the day.\nWhat are signs of a dog dying of old age?\nHow Do I Know When My Dog is Dying?\n- Loss of coordination.\n- Loss of appetite.\n- No longer drinking water.\n- Lack of desire to move or a lack of enjoyment in things they once enjoyed.\n- Extreme fatigue.\n- Vomiting or incontinence.\n- Muscle twitching.\nWhy does my dog suddenly want to sleep alone?\nDogs that suddenly hide or want to be left alone behave that way because something is bothering them. If it’s not physical, it’s likely emotional. … Often, issues that seem emotional really stem from physical, medical causes. The first thing to do if you notice a behavior change is to have your pup checked by your vet.\nAt what age is a senior dog?\nSmall dogs are considered senior citizens of the canine community when they reach 11 years of age. Their medium sized friends become seniors at 10 years of age. Their larger sized colleagues are seniors at 8 years of age. And, finally, their giant-breed counterparts are seniors at 7 years old.\nWhat are the symptoms of a dog dying from liver failure?\nSigns that a dog has liver disease can vary and include loss of appetite, vomiting, stomach ulceration, diarrhea, seizures or other neurologic problems, fever, blood clotting problems, jaundice (a yellow tinge noticeable in the skin, mucous membranes, and eyes), fluid collection in the abdomen, excessive urination and …\nHow old is a 15 year old dog in human years?\nDog Years to Human Years Chart\n\|Age of Dog (dog’s age according to the calendar)\|\|Dog’s Age in Human Years (dog’s age in equivalent human years, based on stage of breed size)\|\nShould a 14 year old dog have surgery?\nThere are 14-year-old dogs who are healthier than 8-year-olds. When properly done, the risk of anesthesia is not significantly greater in seniors. … In any of these situations, the reason we recommend anesthesia and surgery is to improve the dog’s quality of life.\nDo dogs know when humans are sleeping?\nIncreases Sense of Security\nThink about it — your dog’s instinct is to protect. They will let you know immediately if anything is amiss while you are asleep.\nWhat time do dogs go to bed?\nTheir average sleeping hours lie between 10 – 14 hours a day. Large breeds need more hours of sleep, hence they doze off for 14 – 18 hours a day. Sometimes people also call them ‘mat dogs’ as they tend to sleep a lot. But the sleeping habit also depends on their daily routine, diet and of course their health.\nHow far should you walk a 10 year old dog?\nOlder dogs can be surprisingly active when it comes to walks. Susan Rosenau’s dogs, a 10-year-old Boston terrier and a 10-year-old French bulldog, get four walks daily, two for 20 minutes and two that are shorter. Jenn Stollery’s cavalier King Charles spaniels walk 1 to 4 miles daily.
The price of removing wisdom teeth varies from city to city and state to state. Also, keep in mind certain factors may affect the price such as; Do you have dental insurance or not? I, on the other hand, currently do not have dental insurance. I need all 4 of my wisdom teeth pulled. I got my first one pulled about 3 hours ago and paid in full cash of $130. ---- Here's a very "ball park" estimate of the price that you might pay to have a wisdom tooth extracted that is classified as a soft tissue impaction. Wisdom teeth that are bony impactions can cost up to twice as much to have removed. $100.00 - $350.00. Please keep in mind this is just an estimate and varies depending where you live.\nI think the cost is nearly $950 to get your wisdom teeth removed\n125 per tooth\nI just had my two remaining wisdom teeth extracted at a cost of $220 per tooth and a $65 consultation fee. That seemed excessive but I needed it done.\n$1400-$1500 depending on if you have good insurance\nDelta dental is a dental insurance company. Delta dental will pay 50%-80% of the cost for the extraction of wisdom teeth.\n$800 - $2000, depending if they are impacted ($2000) or simple ($800)\nThe cost of removing wisdom teeth can vary greatly, depending on a number of factors:1. How many teeth are being removed? Sometimes not all wisdom teeth require removal.2. How impacted are the wisdom teeth? Full boney impactions are usually the most costly because they are often the most complicated procedures. This can usually be determined by the dentist or oral surgeon by viewing the teeth on an x-ray.3. Are there any conditions, such as underlying medical conditions that will complicate the procedure and contribute to the cost?4. The type of anesthesia used can also affect the cost. Will it be local anesthesia only? IV sedation? Or full general anesthesia? Discuss your options with the surgeon beforehand.5. Is the surgeon a contracted provider on your insurance plan? If so, he may be obliged to take a lower fee than he might otherwise.A simple surgical extraction of a single wisdom tooth with local anesthesia can cost just a couple of hundred dollars, while multiple full boney impacted extractions with general anesthesia can cost a few thousand dollars. In any case, you are entitled to know what the upper end of your cost will be before the procedure is done. Talk to your surgeon and get firm answers before you agree to the surgery.One last piece of advice: Beware of bargains in parachutes and oral surgery.\nI am having all 4 of my Wisdom teeth removed today... I live in Ontario, Canada. the most it will cost me with a local anestetic will be $1086... $271/tooth. the cheapest it will be is about $500... I have coverage through Empire Life and they cover around $116/tooth depending on the procedure taken...If you are unsure about the cost you can always ask your dentist office for an estimate... they are very helpful in that aspect.ANSWER: It just cost me $500. cash/per MOLAR, in NEW YORK, to have extracted under local anesthia.\nI got four wisdom teeth taken out in MA and the total (with good insurance) came to 220 dollars! hope that helps\nAround $1500 regular price. Depending on services. If you go to an oral surgeon without insurance to get your wisdom teeth removed, you will pay anything from $1200-$1500. You usually need to pay half the amount up front and then you can make payments. I suggest you do what I did and go to the local college or university. I had mine extracted at UCLA school of dentistry and I paid only $130 total for all four wisdom teeth. They were professional and I actually had fun! The cost should be the same, with or without dental insurance. In Canada, a wisdom tooth extraction, for a single tooth, can cost up to $350.\nYES, calnculator is a real word Einstein\nTwo weeks ago, we paid $1,204.00 for four wisdom teeth to be extracted. This was done by an oral surgeon who was also a medical doctor which may account for the high cost. We used this person because my son has bad allergies so we wanted the medical doctor expertise as well.
Job title: Pajunk USA is looking for a Product Manager\nCompany: German American Chambers of Commerce\nJob description: outcomes. PAJUNK USA provides regional anesthesia and pain management solutions for hospitals and surgery centers…\nJob date: Tue, 05 Oct 2021 22:12:08 GMT\nApply for the job now!
Rush University Medical Center is currently recruiting for several Certified Registered Nurse Anesthetists (CRNA) to join their team. The CRNA will function under the medical direction of the anesthesiologist with regard to pre anesthetic, anesthetic and post anesthetic patient management.\nPosition Qualifications Include:\nRush University Medical Center is an Equal Opportunity/Affirmative action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability or Protected Veteran status.\njob, healthcare, licensure, medical, clinical, wellness, career, employment, opening, staff, benefits, health care, clinic, Chicago\nRush University Medical Center is an elite medical community recognized for excellence in patient care, medical discovery and clinical expertise. Our continued pursuits have earned Rush University Medical Center the distinction of being on U.S. News & World Report’s Best Hospitals Honor Roll for 2020-2021. This places the Medical Center amongst the top 20 of the 3,000 hospitals evaluated. U.S. News & World Report has also recognized 11 Rush programs amongst the nation’s best, including top five national rankings for orthopedics, neurology and neurosurgery.\nThese accolades, along with many others that include a decade of Magnet® designation, are a reflection of the collective efforts and commitment to excellence demonstrated by our physicians, advanced practitioners, nurses and medical staff.\nRush is united by diversity, inclusion and a commitment to health equity. Rush is also a perennial “Leader in LGBT Healthcare Equality.”\nQuality of life\nChicago offers an excellent selection of homes in downtown, suburban and rural locations, as well as public and private schools and colleges. Local museums, entertainment, culture and the arts are world-class. Celebrated restaurants, craft breweries and local distilleries abound.\nResearch at Rush\nRush is currently involved in more than 1,600 research studies, many NIH-funded. Rush’s long tradition of discovery dates back to determining the causes of scarlet fever, heart attacks and sickle cell anemia. Today we’re also leaders in neurosciences, cancer, immunology, infection, regenerative medicine and more. Join us in spearheading life-changing research at the national level.
Postoperative Care of the Chronic Opioid-Consuming Patient\n- Swenson Jeffrey D, Davis Jennifer J, Johnson Ken B\n- Anesthesiology clinics of North America SCOPUS\n- 37p ~ 48p ISSN 0889-8537\n- Cited Count\nRecently, there has been a significant increase in the use of opioid analgesics for chronic pain in the outpatient setting. As a result, anesthesiologists are commonly presented with the dilemma of treating acute postoperative pain in patients who do not receive adequate analgesia with conventional doses of opioid. This article presents a practical approach to treating postoperative pain in the chronic opioid-consuming patient. Specifically, a technique based on pharmacokinetic modeling is described that predicts safe and therapeutic opioid dosing in these patients.\n1.Chronic opioid therapy for non-cancer pain. Br J Anaesth. Vol. 87. 133143(2001)\n2.Opioid analgesic prescribing: use of an audit of analgesic prescribing by general practioners and the multidisciplinary pain center at Royal Brisbane Hospital. Br J Clin Pharmacol. Vol. 52. 693698(2001)\n3.IMS H. IMS National sales perspective.(2004)\n4.Preoperative fentanyl infusion with pharmacokinetic simulation for anesthetic and perioperative management of an opioid tolerant patient. Anesth Analg. Vol. 97. 16611662(2003)\n5.Opioid therapy for chronic pain. N Engl J Med. Vol. 349. 19431953(2003)\n6.Regulation of opioid receptor trafficking and morphine tolerance by receptor oligomerization. Cell. Vol. 108. 271282(2002)\n7.Opioid tolerance-in search of the holy grail. Cell. Vol. 108. 587590(2002)\n8.The development of morphine tolerance and dependence is associated with translocation of protein kinase C(1994) Mayer David J. et al. PainNeuroscience cited 101 times\n9.A locus and mechanism of action for associative morphine tolerance. Nat Neurosci. Vol. 3. 4752(2000)\n10.Drug addiction and drug abuse. Goodman and Gilman's the pharmacologic basis of therapeutics. 621642(2001) Hardman J.G. et al.
Before: Female bothered by her turkey neck which she noticed after significant weight loss. She was also bothered by volume loss in her cheeks and lips and sun damage and wrinkles. Cost, recovery, and general anesthesia were concerns.\nAfter: Two years after a neck lift, utilizing the “Direct Neck Lift” approach where excess skin was removed from the front of the neck and the platysma (bands) tightened. The incision in the front of the neck is camouflaged by hiding it in the natural neck lines and by treating the scar with three Fraxel treatments starting 6 weeks after surgery. This type of neck lift can be done under local anesthesia with oral sedation. Recovery is only one week and the cost is about half of conventional neck and face lift surgery. Results are often superior to conventional neck lift surgeries, especially where there is severe loss of skin tone from weight loss as the problem, excess skin, is tackled at the of site of the problem rather than trying to pull that skin behind the ears. In order to further enhance her results, she had volume restoration to her cheeks, lower eye lids, and jaw line and with Sculptra injections. Juvederm was injected to soften her naso labial and marionette lines and lips. Note rejuvenated skin from a series of 4 Fraxel Dual laser treatments. Using this balanced approach provided her the most natural results.\n- Ran Rubinstein, MD\n- View profile page
Acupuncture to facilitate the birth\nParents magazine estimates that half of gynecology departments practice acupuncture to ease births. For 20 years, the pain-relieving effect of acupuncture has been known and scientifically researched in Europe as well [2;6;11]. As early as the mid-1970s, the first attempts to introduce acupuncture for analgesia in obstetrics were successful [3;4;5;10].\nIn Germany, acupuncture has only been used for obstetrics in the last 10 years. The great interest of gynecologists and midwives in this method is reflected in the lively participation in continuing education courses .\nThe analgesic effects of acupuncture have now been widely elucidated through intensive research [2;6]. Increasing awareness among patients, particularly in the field of obstetrics, is directing the interest of doctors and midwives increasingly toward treatment procedures that are as free of side effects and low-risk as possible.\nEase of birth – Reduction of pain\nWith the help of the analgesic effect Acupuncture can significantly reduce the pain during childbirth. There is also a significant reduction in delivery time [4;12]. In case of weakness in labor, it stimulates the labor activity. The episiostomy and the later perineal suture can also be performed painlessly under acupuncture analgesia.\nBesides the analgesic effect, the psychologically relaxing and harmonizing effect acupuncture is particularly useful, as it improves the mother’s cooperation.\nBirth facilitation technique\nFirst, in the early phase of birth, the Psychically sedating and harmonizing points Du 20 Baihui, Ex. 6 Sishencong and He. 7 Shenmen are set. With these points, the patient can move freely or take a bath.\nWith the analgesic acupuncture to facilitate labor, it is started at a cervical opening of 4 to 5 cm or. with the onset of pain first with the important analgesic points Di. 4 Hegu and Ma. 44 Neiting.\nThen Near points in the area of the lower abdomen or the back combined with important Distant points, which have a specific effect on the organs in the small pelvis [7;8;9]. The distant points of the spleen-pancreas, kidney and liver meridians on the inner side of the leg have a strong effect on the genitourinary organs.\nHere one chooses MP.;6;Sanyinjiao – meeting point of the three yin meridians MP., Ni., Le. – and the analgesia point Neima on the inner side of the leg. Neima is an important extra point for acupuncture anesthesia, whose location corresponds to the point Le. 6 Zhongdu (7 Cun above the medial malleolus) corresponds to a large extent. Initially, these points are needled on both sides, but in order not to hinder the obstetrician, the two points on one leg are removed in the late stage of labor.\nThe two important remote points MP.6 and Neima are initially also electrostimulated on both sides with a frequency of 4-12 Hz and relatively high intensity. The intensity of the stimulation current is slowly increased until the patient experiences a strong throbbing sensation.\nIn addition to these two important distant points on the leg, near points in the area of the lower abdomen such as Ma. 29 Guilai, Ren 4 Guanyuan, Ren 2 Qugu or on the back Du 2 Yaoshu, Du 6 Jizhong or the bladder points of the sacral segments Bl.27 – Bl.30 selected. In case of severe pain in the lower back, electrostimulation is also applied to these points.\nIntense electrostimulation is indispensable for effective pain relief [7;8]. Without electrostimulation, only a fraction of the possible analgesia is achieved. Therefore, birth facilitation without electrostimulation must be considered inadequate.\nAs a rule, one chooses as a basic combination two near points (z.B. Ma. 29 or Du 2 and Du;6) and two far points, Di. 4 on the arms and two remote points on the legs MP.;6 and Neima from. In case of severe pain, the stimulation intensity can be increased and a few more needles can be added.\nFor a good analgesic effect, the strong electrical – a pair of near points on the abdomen or back and a pair of far points – additionally manual stimulation (Di.;4;Hegu) of essential importance.\nIn daily practice, the good effectiveness of acupuncture in childbirth is demonstrated by its application in many clinics. To date, there are few controlled clinical studies that would scientifically prove this to be true.\nRemote points on the leg\nMP. 6 Sanyinjiao Le. 3 Taichong Ma. 36 Zusanli Bl. 67 Zhiyin\nSuture points on the lower abdomen and back\nMa. 29 Guilai Ren 4 Guanyuan Du 2 Yaoshu Gb. 21 Jianjing Du 6 Jizhong\nPsychically effective points\n- You 20 Baihui\n- Ex. 6 Sishencong\n- He. 7 Shenmen\n- Pe. 6 NeiguanMa. 44 Neiting\nAnalgesically acting points\n- Di. 4 Hegu\n- German Acupuncture Society Düsseldorf (ed.) (1988): Newsletter\n- Han JS, Terenius L (1982) Neurochemical basis of acupuncture analgesia. Ann Rev Pharmacol Toxicol 22:193-220\n- Lederberg CP (1976) Electroacupuncture in obstetrics. Acupuncture & Electro-Therapist 2:105-118\n- Perera WSE (1977) The results of a pilot trial to investigate the relief of pain during childbirth using acupuncture analgesia as an adjuvant to active management of labor. Fifth World Congress of Acupuncture, Tokyo\n- Pontinen PJ, Kalinowski J, Ronkainen H (1986) Transcutaneous electrical nerve stimulation for birth pain. Lecture pain therapy colloquium, Hamburg\n- Pomeranz B (1987) Scientific basis of acupuncture. In: Stux G, Pomeranz B (eds) Acupuncture – Textbook and Atlas. Springer-Verlag, Berlin Heidelberg New York\n- Stux G, Stiller N, Pomeranz B (1993) Acupuncture – Textbook and Atlas. 4. Edition Springer, Berlin Heidelberg New York\n- Stux G (1987) Acupuncture to facilitate childbirth and in gynecology. Course script. German Acupuncture Society Düsseldorf\n- Stux G (1994) Introduction to acupuncture. 4. Edition. Springer-Verlag, Berlin Heidelberg New York\n- Tsuei JJ, Yin-Fun S, Sharma D (1977) The influence of acupuncture stimulation during pregnancy. Induction and inhibition of labor. Ob Gyn 50:479-488\n- Vincent CA, Richardson PH (1986) The evaluation of therapeutic acupuncture: concepts and methods. Pain: 24:1-13\n- Wiesenthal B (1987) Acupuncture in preparation for childbirth. Acupuncture Physician, Auriculotherapist 1-2:10-17\nAuthor: Dr. med. Gabriel Stux\nAcupuncture Center Düsseldorf\nIsland Street 34\nTel.: 00 49 (0)211 369099
BOSTON (CBS) - Donna Durell, 59, from New Hampshire was told she had a small lung nodule, found incidentally on a CT scan.\n"They weren't sure exactly what it was," Durell explains. Donna was a former smoker and the concern was that the nodule might be cancerous.\nUsually the options for tiny nodules are to watch them over time or undergo lung surgery with the hope that the surgeon can actually feel the tiny tumor and take it out successfully.\nDurell opted to the AMIGO suite at Brigham and Women's Hospital where she had her tumor removed with unbelievable precision.\nDr. Raphael Bueno, the Chief of Thoracic Surgery at Brigham and Women's Hospital, was Durell's surgeon.\n"What we have developed here at the Brigham is a method to use a CAT scan in the middle of the operating room to view the spot, view the nodule, and mark it with a small device that looks like a fishing hook," he explained.\nThen they remove the nodule, leaving healthy lung tissue behind.\n"They have a shorter operation, shorter anesthesia, shorter recovery, less complications," Dr. Bueno says. "And they go home faster."\nSo far, Dr. Bueno has performed this procedure on 21 patients in a clinical trial with great success, and Durell was one of them. Her tumor did end up being cancerous, but Dr. Bueno is confident they got it all.\n"She is perfectly healthy now," he says. "And for all intents and purposes, she's cured."\nDurell says she's optimistic about her future.\nDr. Bueno says curing patients of lung cancer is gratifying.\n"Telling them yes, lung cancer is a big deal and yes it is dangerous, But you're going to be fine," he explains. "Doesn't get any better than that."\nBrigham and Women's is the only hospital in the world with an AMIGO suite and the only hospital in the world performing this type of lung nodule surgery. If you're interested in finding out more about the clinical trial, click here or call Brigham and Women's Hospital at 617-732-5922.\nMORE LOCAL NEWS FROM CBS BOSTON
Ask The Doctor\nBrian Rupert, MD,\nMedical Director of Anesthesiology, Chief of Staff at CentraCare Health - Monticello\nQuestion: I am scheduled to have knee replacement surgery. What are my anesthetic options?\nAnswer: There are a few anesthesia choices available for knee replacement surgery. Deciding which option is best for you depends on your choice combined with a thorough evaluation of your medical condition by the anesthesiologist. The two primary anesthetics for this type of procedure are either general anesthesia or a spinal anesthetic.\nA general anesthesia is one where the patient goes completely to sleep with medicine administered through an IV. A small airway device is then used to help with breathing and safety during the procedure.\nAnother option is spinal anesthesia combined with sedation. The sedation medications are given through an IV along and an injection in the lower part of the back. This numbs the area from the waist down. With spinal anesthesia the patient is breathing on their own as opposed to general anesthesia where an airway device is used. Patients on blood thinners or who have had back surgery may not be candidates for spinal anesthesia.\nBoth methods are very effective ways of providing anesthesia for a knee replacement. Which is best for you will be determined when you meet your anesthesiologist and discuss your overall health history in detail. Regardless of the anesthetic choice, an anesthesia team member will be present with you throughout the procedure.\nA nerve block is a procedure which uses a local anesthetic injection to provide prolonged pain relief for 12 to 24 hours to specific part of the body. This procedure is often performed for surgeries involving shoulders or knees. For a knee replacement surgery it would be recommended in addition to a general or spinal anesthetic for postoperative pain control.\nCentraCare Health – Monticello offers various anesthetic options for other procedures as well including:\nPeripheral Nerve Block - Numbs the upper or lower extremities.\nIV Sedation - Medicine is given to help patients relax and the surgeon uses a local anesthetic to numb the surgical site.\nEpidural Anesthetics for laboring moms - This involves a small tube placed in the lower back to provide a continuous flow of local anesthetics to relieve pain.\nIntrathecal Opioid Injection - Laboring moms may choose this injection to relieve pain during labor.\nAt CentraCare Health – Monticello, our goal is to provide a safe and comfortable experience for all of our patients and that is why we offer a variety of anesthetic and sedation options, administered and monitored by experienced Anesthesiologists working with Certified Registered Nurse Anesthetists, to ensure the highest quality of care.\nFor more information about CentraCare Health – Monticello’s Surgical Services visit us at www.centracare.com/services/surgery/monticello/.\nFor questions specific to anesthetic care, please contact our Same Day Surgery Center at 763-271-2290 and ask to speak with one of the anesthesiologists. The anesthesiologists welcome the opportunity to discuss any questions or concerns you may have about your anesthetic options for any upcoming surgery or procedure.
Dr. Jenny Ruoho has had a lifelong interest in dentistry and began working in the dental field in 1991. She started her career as a dental assistant and later graduated with a Doctor of Dental Surgery degree from the University of Minnesota School of Dentistry in 2002. After graduation, Dr. Ruoho completed a general practice residency at the Veteran’s Hospital in Minneapolis.\nDuring the residency, she learned advanced endodontic (root canal) and oral surgery techniques as well as dental sleep. After completing the residency, Dr. Ruoho worked in various private practice settings before opening Relaxation Dentistry in 2007. She has completed advanced training in several specialty areas including cosmetic dentistry, sedation, implants, tongue tie, TMJD, functional occlusion, snoring and sleep apnea. She completed her dental implant training through the Misch International Implant Institute and was awarded Fellowship status in The International Congress of Oral Implantologists in 2014. She is passionate. about learning the latest technology and techniques in implant dentistry and completes over 100 hours of continuing education per year. She is an alumnus of the Misch Resnik Implant Institute (formerly Misch International Implant Institute), Pikos Institute, and the California Implant Institute.\nDr. Ruoho has been a certified Invisalign provider since 2016. She is an ambassador of The Breathe Institute in Los Angeles, CA and has received training at The Alabama Tongue Tie Center, The Dawson Academy, and Advanced PRF Education in Facial Esthetics becoming a CARE (Center for Advanced Rejuvenation & Esthetics®) provider in 2020. Dr. Ruoho is. passionate about providing a wide range of single tooth dental services (endodontics/root canals, oral surgery, implants, and. restorative dentistry) as well as full arch immediate. implant dentistry and complete dentistry. Complete dentistry involves an understanding of how the TMJ, the muscles of mastication, the teeth, the tongue, and the airway all work harmoniously together. Complete dentistry may include an assessment of the TMJ, a functional analysis of the forces on the teeth and TMJ, tongue tie restrictions, airway assessment, sleep study, interpretation of airway and TMJ imaging, understanding forces that cause thinning, chipping, cracking and broken teeth, TMJ and facial pain. She provides three levels of sedation including Nitrous oxide, Oral Conscious Sedation and IV sedation (by special arrangement with CRNA). Her focus is doing high-quality, long-lasting dentistry and making each appointment as comfortable as possible.\nDr. Ruoho lives in Chaska with her husband, John and their sons, Jack and Charlie. She enjoys reading, photography, skiing, mountain biking, cooking and spending time with family, friends and her West Highland White Terrier, Lemon.\nSchedule your new patient appointment today.
Tylenol NO. 1\nacetaminophen - codeine - caffeine\nIn this drug factsheet:DIN (Drug Identification Number)\n\|02181061 \|\|TYLENOL NO.1 CAPLETS\|\nHow does this medication work? What will it do for me?\nThis combination product contains three medications: acetaminophen, codeine, and caffeine.\nAcetaminophen belongs to the group of medications called analgesics (pain relievers) and antipyretics (fever reducers).\nCodeine belongs to the group of medications called narcotic analgesics.\nCaffeine belongs to the group of medications called stimulants.\nThis combination of medications is used to treat mild-to-moderate pain associated with conditions such as headache, dental pain, muscle pain, painful menstruation, pain following an accident, and pain following operations.\nThis medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.\nYour doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.\nDo not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.\nPeople who read this article also read about:\nHow should I use this medication?\nThe usual recommended dose for people older than 12 years of age is 1 tablet taken every 4 to 6 hours as required. If 1 tablet is not effective, take 2 tablets at the next dose time. The dose should be adjusted according to the amount of pain experienced. The maximum dose of this medication is 12 tablets in 24 hours. Taking more than 12 tablets in a 24 hour period may cause severe liver damage, and could be fatal.\nMany things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.\nAcetaminophen should not be taken to relieve pain for more than 5 days or to relieve a fever for more than 3 days, unless directed by a doctor.\nIt is important to take this medication exactly as prescribed by your doctor. If your doctor has told you to take this medication on a regular basis and you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.\nStore this medication at room temperature, protect it from light and moisture, and keep it out of reach of children.\nDo not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.\nWhat form(s) does this medication come in?\nEach hard, white, capsule-shaped tablet, imprinted with stylized "M" and "McNEIL" on one face and "No. 1" on the other, contains acetaminophen 300 mg, caffeine 15 mg, and codeine phosphate 8 mg. Nonmedicinal ingredients: cellulose, cornstarch, magnesium stearate, and sodium starch glycolate. This medication does not contain gluten, lactose, sodium metabisulfite, or tartrazine.\nWho should NOT take this medication?\nDo not take this medication if you:\n- are allergic to to acetaminophen, caffeine, codeine, or any ingredients of the medication\n- are overdosed on or intoxicated by alcohol, hypnotics, analgesics, or psychotropic medications\n- are 12 years of age or younger\n- are experiencing acute asthma or other obstructive airway disease\n- are experiencing acute respiratory depression\n- have a blockage of the gastrointestinal tract, particularly paralytic ileus\n- have a head injury, a brain tumour, or increased pressure inside the head or spinal cord\n- have a convulsive (seizure) disorder\n- have suspected abdominal conditions that may require surgery\n- are pregnant or breast-feeding, in labour, or delivering
Coarse face, microcephaly, mental retardation, and epilepsy.\nOnly two sibs of nonconsanguineous parents have been described.\nInheritance was suspected to be autosomal recessive.\nFirst described by the Italian physician A. Battaglia and colleagues in 1995.\nBased on the clinical findings.\nA brother and sister presented with microcephaly, moderate to severe mental retardation, absent expressive language skills, and generalized tonic-clonic seizures, which were refractory to medical treatment in the brother, but satisfactorily controlled in the sister with valproic acid monotherapy. In addition, both individuals had hirsutism, (kypho-) scoliosis, pectus excavatum, diffuse muscular hypotonia, lax ligaments, delayed bone age and bilateral genua valga and pedes plani. The facial appearance was described as “coarse” with prominent ears and eyebrows, broad nose with thickened septum and alae nasi, short philtrum, large open mouth with thick lower lip, and dental malocclusion.\nPrecautions before anesthesia\nIn the presence of severe kyphoscoliosis and pectus excavatum, an echocardiogram might be justified to exclude pulmonary hypertension. Developmental delay may cause agitation and stress in the perioperative period; thus, anxiolytic and sedative premedication and/or presence of a parent (or primary caregiver) for induction of anesthesia may be beneficial. Anticonvulsant therapy should be continued until the morning of surgery and resumed as soon as possible postoperatively and given intravenously if oral intake is not possible.\nThe antiepileptic therapy should be optimized and may require preoperative adjustment. Drug interactions are common with certain antiseizure medications. Severe (kypho-) scoliosis and pectus excavatum can result in difficult endotracheal intubation, restrictive lung disease, and cor pulmonale, which may require an adapted anesthesia approach.\nChronic antiseizure treatment may interfere with the metabolism and elimination of other drugs that share the same metabolic pathways. Valproic acid treatment may result in a complex coagulopathy, but it is controversial if the medication should be reduced/stopped/replaced before surgery, particularly if the patient’s seizures are well controlled with it. The decision should be based on the planned type of anesthesia (regional vs. general) and surgical procedure. Valproic acid may also result in hepatotoxicity, thus liver function should be assessed and other potentially liver toxic drugs avoided.\nOther condition to be considered\n☞Coffin-Lowry Syndrome (Coffin-Siris-Wegienka Syndrome [do not confuse with ☞Coffin Siris Syndrome, which is a different medical condition]; Soft Hands Syndrome): X-linked, semi-dominant inherited disorder with mental retardation, osteocartilaginous abnormalities, and peculiar facies.\net al: New autosomal recessive syndrome of mental retardation, coarse face, microcephaly and skeletal abnormalities. Clin Dysmorphol 5:41, 1996. ...
Having unnecessary fat in different locations of your body can have a significant influence on your health and self-esteem. While standard weight-loss through workout and diet plan is an excellent way to drop weight in general, even the very best workouts can't target issue areas like the belly, inner thighs, arms, and buttocks. Liposuction is a time tested treatment that is utilized to get rid of excess fat from specific locations of the body, permitting an individual to form and contour their body to their taste. Is liposuction right for you? Find out now.\nPros of Liposuction\nThere are lots of benefits to this cosmetic treatment, including:\n• Instantly obvious changes. Unlike standard weight-loss, liposuction develops modifications that are instantly visible in the body. Some distinction is obvious right away, and the desired results are typically accomplished in simply a few days.\n• Proven and safe. This cosmetic treatment has been performed by seasoned specialists all over the world for years and the strategy has actually been fine-tuned over and once again to be safe and efficient.\n• Healing time is generally fast. The downtime needed after having this type of procedure is normally much less than exactly what is needed for other kinds of cosmetic treatments, consisting of tummy tucks, breast reduction, and more. People who have had the procedure can often go back to work much more rapidly than they anticipated and can get back to living a healthy, active way of life.\n• Weight reduction can be long-term. With the best maintenance techniques, the fat that was removed 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 traditional diet plan and exercise can provide. Giving individuals this power over their bodies increases self-confidence and assistance individuals feel their best.\nWhile there many benefits to liposuction, there are naturally a few cautions that must be taken into consideration prior to making the final decision to move on with the procedure.\nCons of Liposuction\nPrior to having actually liposuction done, it is necessary to examine the prospective drawbacks of the treatment and figure out if the benefits outweigh the dangers in your certain case. Your surgeon can help you learn more about the threats connected with the treatment and can help you decide if moving on is the best thing for you.\n• Issues with basic anesthesia. Because liposuction is carried out under general anesthesia, the procedure brings the same dangers as any other kind of surgical treatment where basic anesthesia is utilized. Underlying medical conditions may increase these threats.\n• Unfavorable reactions. Bruising, bleeding, and discomfort are all to be expected, nevertheless, in rare cases can cause more substantial problems.\n• The potential to acquire the weight back. After having liposuction done, it is vital to preserve a healthy diet plan and workout properly as recommended by your doctor. Failure to do so could result in gaining back the weight that was lost or perhaps a lot more.\nThere are risks associated with liposuction, for lots of people, the advantages far surpass them. Educate yourself about the treatment by having extensive discussions with your surgeon and consider how liposuction has the possible to impact you as a special individual. Only you and your specialist can determine if liposuction will provide you with the results you are looking for within your expectations.\nLaser Liposuction procedure is a new non invasive procedure to loose unwanted bodyfat in Eagle River AK\nLaser liposuction is a more recent, minimally intrusive treatment that involves heating the fat cells to melting point and eliminating the melted fat through a little cannula. The procedure is typically done right in your physician's workplace and is an outstanding alternative for people 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've constantly wanted.\nContact a Surgeon in your Eagle River AK today.\nIf you're thinking about liposuction as a weight-loss option, it is very important that you discuss your desires with a qualified plastic surgeon in your area. Your specialist will perform a complete exam and health history survey to figure out if liposuction can benefit you and assist you reach your physical and psychological goals. Call today for an assessment and learn more about how liposuction can assist you attain the body of your dreams.

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