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Dr. Maged Ghattas is an anesthesiologist in Freehold, who manages patient pain levels before, during, and after surgical procedures.\nWe invite you to write a review about your experience with Dr. Ghattas.\n901 W Main Street, Suite 203, Freehold, NJ 07728-2537\n\|Doctor’s Specialties\|\|Anesthesiology & Palliative Care\|\nNOTE: Please contact the doctor’s office to confirm your coverage before making an appointment.\nMD • 1992\nPlease Note: The information displayed below is sourced from the 2014 Medicare Physician and Other Supplier National Provider Identifier (NPI) Aggregate Report. It's important to remember that the statistics below are not inclusive of all patients treated by Dr. Ghattas, but only those who participate in Medicare.
Maryland Oral Surgery Associates\nWrite a Review\n9 months ago\nProfessional, friendly and on-time\nHave gone to Maryland Oral Surgery Associates for past procedures and am in the process for another procedure -I'm a happy repeat customer/patient !! Highly recommend Dr. Cohen. Great staff at this location.\n9 months ago\nTerrible experience for dental surgey\nThe surgeon's name is NKEMAKONAM R.EGOLUM. I only have my lower right wisdom tooth removed. There were three huge stitches in my gum after teeth extraction with a 3-cm long stitch thread outside. With local anesthesia, I experienced the worst teeth extraction procedure ever. The whole process was very rude, without any infection precautions and medication, resulting in massive infection afterwards. The extraction was done without any antibiotics prescription. I told them I have been experience severe swelling and pain first day after extraction, but was informed that it was normal. The third day, I feel the swelling caused the pressure on my central airway and had a hard time breathing and speaking. I coughed a lot, with mucus out with blood clot. I called the doctor, and he still said it was normal and I did not need to go back for checkup. My husband insisted to let me go back for a check. We were told that there was lots of infection. We are sent to get a CT scan, showing lots of abscess formed in the place of teeth extraction. We went back to the office, and the doctor told me that I need to get another surgery and also cut open the neck to drain the abscess. We asked the doctor why this happened and why not give us the antibiotics, he just said it was totally normal. We went to the ER in Washington Hospital Center. The CT showed there was lot of abscess in the root of the teeth, meaning the infection already in the process of the surgery. I had to take another surgery both intra-oral and extra-oral to drain the abscess with neck cut open, to prevent the pressure on my central airway for life-saving. We want to know, what the odds of this kind of massive infection happened? During all the process of interacting with NKEMAKONAM R.EGOLUM, his attitude was very rude. We are so unsatisfied and hold the right to ask for a lawyer for the malpractice of negligence, and the doctor just responded that it is waste of time and money with arrogance.\n11 months ago\nDr. Cohen is AWESOME! You cannot find a more professional and caring doctor. Dr. Cohen has always explained procedures to me in simple terms. She is definitely at the TOP of her PROFESSION. The staff is friendly and always considerate. I enjoying going to this office and receiving excellent customer service.\n12 months ago\nFor the probably the only time anyone ever said, "Going to the dentist was a pleasant experience"! It was pain-free. And I had dental surgery at that. If you want the best, this is the place to go and Dr. Cohen is a five star rating on a four star scale. There was even a follow-up at home. It was clearly the best!\n1 year ago\nProfessional and friendly people\nMy son was well treated and tells me the whole tooth extraction procedure was a lot less painful than he expected. Thank you!\n1 year ago\nThus far, very satisfied...\nI don't usually take the time to write reviews, however I have been impressed with the office staff and Dr. Cohen I just had to. At my first visit I was not at all happy about being there (consult for tooth extraction and implant) but Dr. Cohen's warm smile, understanding, wealth of knowledge, and professionalism, all put me at ease. On the day of my extraction, she was the same. Dr. Cohen has a great rapport with her assistant and they work very well together, providing me with a detailed outline of the treatment plan, what insurance would cover and what my out-of-pocket expense would be. Whenever I called with questions throughout the process (several months), they always took the time to fully answer my questions about treatment as well as finances/insurance. I am still disappointed about needing the extraction and implant, but I have been very happy with Dr. Cohen and her staff. Highly recommend!\n2 years ago\nNeeds to improve customer service\nIt was okay but not the best experience. Dental assistant wasn't friendly, doesn't smile and barely talks. Seems like a bad day for her. Did not even introduce her name, i just assume she's the assistant. My mind was set to do general anesthesia for wisdom tooth extraction, was expecting Dr. Cohen to offer alternatives/options to general anesthesia, but did not. I was told by my Dentist that Dr. Cohen is the best,the sweetest and will explain every detail, so (maybe) i over expected, but I didn't see it that day. As soon as i woke up from general anesthesia, same assistant just handed me a pack with i assumed intstructions in it saying 'it's done', and again didn't say anything else. I also expected Dr. Cohen to check on me after i woke up before checking out, but haven't seen her.\n2 years ago\nFirst rate experience\nEveryone was very professional warm and welcoming from those at the front to the doctor and her assistant and even the person who explains the financial aspect. Dr. Cohen was very thorough in explaining the process up front and as she worked through it. Her preparation and keeping me informed throughout the procedure managed my expectations. I am generally uneasy about any kind of professional dental appointments. Not saying I love them now, but certainly this experience helped ease my fears considerably. I highly recommend this service and Dr. Cohen in particular\n2 years ago\nneeded more info\nWas not told of extra charges until right before appointment. I was told someone would contact me today with the financials on the implant, I have not heard from anyone\n2 years ago\nExcellent experience - Recommend highly!\nWas impressed from the moment I arrived at the office, from the check in process through to the actual procedure. Dr. Cohen explained the procedure, and also mentioned alternative options - in my case I was there for a tooth extraction and implant evaluation. I would recommend this practice very highly. Office staff and medical staff were extremely courteous!\nResponse from Maryland Oral Surgery Associates\nHi David, Thank you for your feedback! We are so glad you had such a smooth and comfortable experience with Dr. Cohen and the staff at our Silver Spring office! Best, Kathleen Professional Relations Coordinator @ MOSA Management
Laser-Assisted Tonsil Ablation for Sleep Apnea & Snoring\nWhat is laser tonsil ablation?\nLaser-assisted tonsil ablation is a minimally invasive procedure that reduces the size of the tonsils using laser technology instead of surgery. The treatment opens up the airway and provides relief from symptoms of snoring and sleep apnea. A laser-assisted tonsil ablation is an in-office procedure that usually takes less than 30 minutes and performed using local anesthesia.\nWhy is laser tonsil ablation performed?\nLaser-assisted tonsil ablation is used to treat the following conditions:\n- Chronically infected tonsils\n- Tonsil stones\n- Enlarged tonsils\n- Sleep apnea caused by enlarged tonsils\nWhat does laser tonsil ablation involve?\nUsing laser technology, the tonsils are targeted to vaporize their outer surfaces. The treatment reduces the size of the tonsils and eliminates any infections that may be present. The precision and control afforded by the state-of-the-art laser technology minimize damage to surrounding tissue and result in faster recovery.\nWhat are the benefits of having laser tonsil ablation?\nSome benefits of undergoing laser tonsil ablation at eos sleep include\n- Minimally invasive procedure\n- Little or no discomfort during procedure (local anesthetic used)\n- Provides results without invasive tonsil removal surgery (tonsillectomy)\n- Fast and easy recovery\n- Most patients can resume normal diet within one day\n- Reduces snoring intensity\n- Controls sleep apnea\n- Scar tissue causes the tonsils to shrink\n- Noticeably increases airway size\nIf you are suffering from snoring or sleep apnea and believe you may benefit from laser tonsil ablation, the first step is to consult with an ear, nose, and throat expert. Specialists at eos sleep have extensive experience in laser tonsil ablation. Call 1-800-EOS-SLEEP today or fill out the form on this page to schedule an appointment or to learn more about eos sleep treatment options.
Malignant Hyperthermia (MH) is a genetic inherited disease which causes a rise in body temp and severe muscle contractions when the person receives certain forms of general anesthesia. Most instances occur in children and has been estimated to be present in about one case per 15000 surgeries. It is less frequent in adults.\nMH is a dominant trait. This means that only one parent has to have the disease to pass it on to their child. It may also be associated with other musculoskeletal diseases. There is usually a history of an MH episode or an unexplained death as a result of anesthesia in a patient’s family history. In case of a non specific history or a history of high body temperature after general anesthesia a muscle biopsy may be obtained to confirm the diagnosis.\nThe signs of Malignant Hyperthermia attacks are generally rapid onset in nature and occur within the first hour of anesthesia. There is a rapid rise in body temperature up to 113 degrees. There is also a rise in heart rate, respiratory rate and blood pressure. There is onset of muscle contraction or rigidity. There is also the possibility of dark brown urine formation.\nTreating MH is geared toward reducing body temperature and ceasing the cascade. All triggering agents are immediately stopped and respiratory rate is increased with the administration of oxygen to remove excess CO2 from the system. Packing the patient in ice as well as irrigating the stomach and bladder with cold solution are important. Maintaining intravenous fluids is also crucial to avoid kidney damage. The key drug to administer is dantrolene which has significantly improved the outcome of MH. This drug relaxes the muscles and stops the contractions.\nMalignant Hyperthermia can lead to respiratory or cardiac arrest, brain damage, or organ failure. When the disease was first diagnosed nearly 50 years ago it was associated with a survival of only 20%. Today, due to earlier diagnosis and dantrolene treatment there is a survival of greater than 90%.\nAnesthesiologists can prevent the onset of MH by avoiding its triggers. These triggers include a paralytic (paralyzing) agent called succinylcholine and inhalational agents (gases) during general anesthesia. General anesthesia can be performed safely in the MH individual if precautions are taken.\nMH, as well as all disease processes, are taken very seriously at my surgical center. In patients who have had uneventful general anesthesia in the past we are able to perform traditional anesthesia. In those patients who have not had anesthesia in the past we perform an intravenous anesthesia only. This also holds true for anyone with a questionable history. In these situations intravenous anesthesia only is administered.\nFor more information about Malignant Hyperthermia there is a hotline: 1-(800)-644-9737\nOr you can visit MH Muscle Biopsy Centers
Thursday, December 11, 2008\nThe surgery went very well and the Dr said he is very pleased with how Jack's lip was put together. He is doing well now but it was awful seeing him come out of the anesthesia and the morphine. The hardest part is that we have to feed him through a syringe for two weeks so that he doesn't stress the incision. He seems to be handling it a bit better now. Poor thing is on hydocodone (vicodin) now which is actually good because it helps him sleep. We were only in the hospital one night but I can tell he is getting a lot more rest now that we're home. Thank you all sooooo much for your prayers, good wishes and support!!! I felt so much more uplifted after reading your comments. The good news is that the hardest part is behind us and I think things will start to dramatically improve over the next two weeks.
Pitangui Medical & Beauty is the oldest plastic/cosmetic surgery clinic in Gangnam, Seoul, South Korea. We provide translation services in English, Chinese, Indonesian, Mongolian, Russian, Portuguese and Japanese.\nGangnam has been recognized as a plastic surgery hub not only in Korea but also abroad by numerous patients all around the world.\nPitangui Medical & Beauty, a leading plastic/cosmetic surgery clinic in Gangnam has been visited by the highest numbers of foreign patients from 65 countries from all over the world.\nPitangui Medical & Beauty also provides a one-stop care system for its foreign patients. Pitangui assists its foreign patients with online consultation, visa application, trip itinerary (flight tickets, accommodation, sight-seeing), surgery, post-surgery treatments etc.\nPitangui Medical & Beauty consists of plastic/cosmetic surgery, dentistry, dermatology, aesthetics and cosmetic genital surgeries.\nFor plastic/cosmetic surgery, all kinds of plastic surgery can be performed such as eyes, nose, facial contouring, body contouring (breasts, liposuction, tummy tuck, buttocks enlargements), non-invasive procedures and fillers.\nFor dentistry, orthodontics, whitening, laminate, crown, veneer, gum aesthetic surgery, cavity filling etc. can be performed.\nFor dermatology, acne, large pores, pigmentation, scars, wrinkles, hair removal can be treated with various range of laser machines.\nFor aesthetics, permanent make-up, manicure, pedicure, non-invasive slimming etc. can be treated.\nFor cosmetic genital surgeries, labia plasty, vagina tightening, G-spot enhancement can be performed.\nPitangui Medical & Beauty has board certified plastic surgeons, dentists, dermatologists, aestheticians, and anesthesiologists.\nThe medical director, Dr. Jea Sung Yoo, is a board certified plastic and general surgeon both in Brazil and Korea with experience of more than 30 years in plastic surgery field. As he is a general surgeon, he can also ensure high patient safety during surgery in any case of emergencies. Due to the rich experiences in plastic surgeries, he can perform all kinds of plastic surgeries.\nDentists at Pitangui Medical & Beauty are also board certified dentists in Brazil, United States and Korea. Dr. Samuel Khoo obtained his Ph.D. at Harvard University. Dr. Daniel Khoo obtained his Ph.D. at New York University.\nPitangui Medical & Beauty is full equipped with latest medical equipment and technology to ensure high patient safety such as uninterrupted power supply, high-tech monitoring, air shower anesthesia systems.\nPitangui Medical & Beauty always tries its best to maintain the highest patient satisfaction and safety for more than 25 years.\nPlease contact us for free online consultation!
How Much Do Breast Implants Cost?\nThe cost of breast augmentation of breast implants surgery can vary, but the national average is around $6,000. The cost of implants can vary depending on the type of implant used. Some plastic surgeons will offer breast implant specials and other promotions from time to time, and many provide on-site financing as well. Remember that the cost of your surgery may or may not include fees for anesthesia, prescriptions, post-surgery support garments, facility costs, and similar items.\nWhat Results Can You Expect?\nFollowing your surgery, the results of your breast augmentation will be immediate. However, you may encounter some swelling, and the incision lines from your surgery will be visible as they heal. With proper follow-up care, your breast implant scars should dissipate over time. You should also be aware that breast implants aren’t designed to last forever, so don’t rule out the need for a future breast lift or implant exchange—particularly if your weight fluctuates or you go through a pregnancy.\nWhat Types of Implants Are Available?\nThere are several different types of breast implant options available, including tear drop breast implants, textured implants, and gummy bear implants. Implants can also differ in the material with which they’re filled. For instance, saline breast implants contain sterile salt water, whereas silicone implants are filled with a gel. Both are FDA-approved, but you’ll want to make an appointment with Dr. Ferguson to find out which is best for you.\nAre There Any Potential Risks?\nAny surgery or medical procedure comes with inherent risks. Be sure you understand them before you choose to have the procedure done and sign any consent forms. Some potential risks of breast augmentation surgery include:\n- Pain and bleeding\n- Scarring of the skin\n- Changes in breast/nipple sensation\n- Implant rupture or leakage accumulation of fluid\nWhat Happens During the Procedure?\nWhen you decide to get breast implants, it’s important that you know what to expect. First, you’ll undergo anesthesia; then the implant is inserted either under the pectoral muscle or behind the breast tissue itself. The incisions are then closed with sutures, surgical tape, or skin adhesive and the results are immediately visible.\nWho Performs the Surgery?\nDr. Earl Ferguson III performs this surgery and has years of experience in breast implants in San Antonio, Texas. He is board-certified by the American Board of Plastic Surgery and works to ensure that all his patients are well informed and comfortable regarding their breast augmentation procedures.\nThe best way to decide if a Breast Implants is right for you is to call Dermatology Associates of San Antonio at\nClick Here to Schedule your next appointment.\nor click the link below and schedule an appointment with our board-certified plastic surgeon to discuss all your options.
The world of dentistry continues to advance at a rapid pace. If you have visited your Derry dentist lately, you have probably noticed some things that make your visit more comfortable, such as the ability to watch TV or listen to music while receiving treatment. Many Manchester dentistry patients welcome oral conscious sedation to reduce or eliminate pain.\nWhat may not be as obvious are the advances in techniques, tools, and materials. Top Derry dentists now use digital computer imaging which is safer than traditional x-rays. Dental technicians can store, retrieve and transmit digital images much easier than was possible with traditional x-ray film.\nThe use of lasers has also changed the face of dentistry. Laser surgery requires less anesthesia, minimizes swelling, and protects surrounding tissue. Manchester family dentists use lasers for detecting and treating cavities and dental technicians use them for the curing of restorative materials.\nAnother exciting development in cosmetic dentistry is the CAD-CAM technology that allows Chester cosmetic dentists to perform restorations in a single visit. The types of procedures that can be completed in one visit include crowns, fillings, inlays, onlays and veneers.\nIf you need a thorough exam, expert dental cleaning, or want to improve your smile with cosmetic dentistry, call Vanguard Dental Group at 603-435-1482 to schedule a consultation. During your consultation, you can see before and after photos of some of our smile makeover patients. We would love to help you achieve the smile you deserve, and we have the tools, experience and technology to make that happen.\n– Craig A. Rothenberg DMD and Michael H. Moskowitz DMD
Come to St. Louis Cosmetic Surgery for a specialized facelift procedure. Our surgeons evaluate your skin quality, skin thickness, and skin elasticity to determine what facelift procedure is right for you.\nNEXT DAY LIFT\nThe Next Day Lift or Mini facelift, is the perfect procedure to address issues with the lower face. This procedure is meant for patients that have some skin laxity in the lower face and need more subtle-looking results.\nA forehead/brow lift is a perfect procedure for patients who have developed a constant angry/tired look due to age and sagging eyebrows.\nEyelid surgery or blepharoplasty is one of the most common procedures that patients desire. This surgery addresses the upper eyelids, lower eyelids, or both, and can be performed under general anesthesia or local anesthesia in our office depending on your specific case.\nChin Enhancement is a great procedure for patients who have a weak jawline and need some profile balancing. Chin augmentation with a silicone implant will balance your profile, improve the jawline length, contour your jawline and diminish the appearance of a double chin.\nA lip lift can be a beneficial procedure for any age. The procedure uses a small incision that is placed under the nose to improve lip proportions and rejuvenate the lip area.\nBUCCAL FAT PAD REMOVAL\nSlim your lower face and enjoy more sculpted and slimmed cheeks with buccal fat pad removal. This is a quick and easy procedure that is performed in our office under local anesthesia to reduce the appearance of chubby chipmunk cheeks.\nMICRO FAT TRANSPLANT\nA micro fat transplant is a great procedure to restore volume that has been lost due to aging or other factors. This procedure involves the harvesting of fat via minimal liposuction and then the fat is transferred into another area of the body.\nOUR BREAST COSMETIC PROCEDURES\nIncrease your breast size, correct asymmetries, and give your breasts shape with an augmentation.\nOur team of board-certified plastic surgeons work to restore and correct your desired breast appearance with a breast lift.\nWith any surgery, complications can arise. Our surgeons are at your side to help correct these issues. Breast revision surgery addresses nipple malposition, pocket adjustment, lift correction, and scar revision.\nHeavy, large hanging breasts often cause severe back, neck and/or shoulder pain. A breast reduction can help alleviate pain and lift breasts for a better-proportioned body.\nMALE BREAST REDUCTION\nGynecomastia is a condition in which males have an overdevelopment or enlargement of breast tissue. We offer a male breast reduction that removes the excess tissue and restores the male chest back to normal.\nOUR BODY COSMETIC PROCEDURES\nThe tummy tuck procedure is great for eliminating loose skin, flattening the abdominal appearance, and addressing abdominal muscle weakness.\nThis is a fully customizable procedure. After having children, women’s bodies go through many changes, our board-certified surgeons want to help address those changes with a combination of procedures.\nLiposuction is the perfect procedure for patients who have reached their ideal goal weight and are looking to address stubborn fat pockets that cannot be eliminated with diet or exercise.\nbrazilian butt lift\nSome women prefer a larger behind, but it is not always possible to achieve through exercise. A Brazilian Butt Lift gives your buttocks the shape it was always meant to have.\nThe Labiaplasty procedure addresses aesthetic issues on the women’s vaginal appearance. This simple procedure is a great way to improve women’s intimate confidence that is performed under local anesthesia in our office.\nThigh & Buttock lift is a procedure designed to tighten loose skin that may have been caused by weight gain or aging. This procedure is for candidates who have some sagging skin or excess fat in the thigh, buttock, or hip area.\nExcess fat and loose skin often leave a “flabby” appearance on the upper arms. This area can be difficult to target with diet and exercise and sometimes impossibly due to skin laxity. Arm Lift surgery or a Brachioplasty is performed to eliminate the stubborn fat and get rid of the batwing appearance.\nOur body lift procedure is perfect for patients who have lost a significant amount of weight or slimmed down via bariatric surgery and are left with loose excess skin. The body lift procedure can involve multiple procedures to correct multiple areas.\nOur TEAM IS READY TO GIVE YOU THE body you deserve\nAt St. Louis Cosmetic Surgery, we believe that the way you feel about yourself is key for maintaining a positive self-image. With over 75 years of experience in cosmetic procedures, we are committed to natural-looking enhancements, that doesn’t change your inherent beauty, only enhances it.
Do you have a question about your pet’s health, our recommendations, or our animal hospital policies at Edmond East Animal Hospital? We invite you to browse through a list of our most frequently asked questions to see if your concerns are addressed. If you still have questions, our veterinary team asks you to contact us so we may help you.\nPet Care Questions\nPets age at different rates according to the size and breed of your pet. Visit our Life Stage Wellness page for more information about senior pets. What does this mean for them? They may have special needs that require extra attention and possibly more frequent veterinary visits. Mostly they need extra TLC for their "golden years."\nAny changes in appetite, water intake, bathroom habits, or weight changes are issues that should be discussed and examined further. These are only a few and we invite you to contact us if you have any questions about your pet’s health.\nRead no further and call us right away! If you are experiencing concerns after hours, contact BluePearl OKC Emergency.\nOur animal hospital is open Monday through Friday from 8:00 am to 5:30 pm. The hospital is closed Saturday, Sunday and major holidays.\nAppointments are our preferred method of scheduling. Walk-ins are welcome and will be seen as soon as possible. All patients will be seen in this order: Emergencies, appointments, walk-ins.\nPayment is expected at time of services. We accept cash, credit, debit and some third party payment plans. In order to focus on each patient’s needs, customer service, and minimizing costs, we do not bill.\nSpaying or neutering can be done at approximately 5-6 months of age. Your pet is given a physical exam prior to surgery to help determine whether they are healthy enough to undergo the surgical procedure. Current vaccinations are required at the time of surgery. Also a pre-anesthetic blood screen is required prior to undergoing anesthesia and surgery.\nThis is a blood test that is run in the clinic or sent to a local veterinary laboratory prior to surgery. It tests the organ functions, blood counts, and clotting function of your pet. The pre-anesthetic blood screening is done to ensure safety during surgery and the ability to heal following surgery.\nNo, there is no advantage to letting your pet have one litter. However there are plenty of advantages to having your pet spayed or neutered. For females, the advantages include decreasing the chances of breast tumors, cystic ovaries, and uterine infections. For males, neutering decreases the desire to roam the neighborhood and the incidence of prostate cancer, and it helps prevent spraying and marking. Spaying and neutering also help control the surplus of unwanted puppies and kittens.\nNo, we do not offer boarding. We believe that our hospitalized patients are better cared for if the staff is not distracted by boarding animals. Contact us and we can make recommendations for boarding in our area.\nNo, we do not offer grooming. Again, our philosophy is to give the best care to our hospitalized patients. Contact us and we can make recommendations for grooming in our area.\nYou could not get better Veterinarians! Known these 2 for years and we are blessed to have them back in Oklahoma! Welcome Home!\nHands down the best place ever..Our Babies love them too!!\nI highly recommend this animal hospital. I felt very comfortable and they did such a wonderful job checking the lump on my Guinea Pig. They were very careful and sweet when handling him. Really awesome place! Will be returning there for sure!\nThe best vet in Edmond! Seriously the cleanest and cutest office! Dr Johnson and his staff were so incredibly helpful, and fit Sadie in and she is on the mend!\nEdmond East does a wonderful job with Bon. Like every dog, Bon hates going to the vet but he is relaxed and calm when going here. Plus he gets top-notch vet care. I highly recommend Edmond East.\nThanks for taking such good care of Fancy's leg. She's such a sweet dog we love her to pieces, and she will live out her life as a princess!!!\nI simply love each and every person there!!! Never had a vet that loved my pets as much as me and were so friendly and caring!!! Thank you for making our move better!\nThey treat you and your loved ones like family! They have been so generous and kind to our babies(we are forever grateful). We will never have the need to look for another Vet. This practice, this family rocks!!\nThis place is the best from the veterinarians to the staff. We are so happy we found this place. My 9 dogs, 3 cats and bird are happy patients and say thank you.\nWe absolutely love Dr. Johnson and his staff. They take great care of our Watson and make us feel like family as soon as we walk through the door.\nI love everything about Edmond East! They have amazing doctors, outstanding staff and a fabulous facility!\nAlways reasonably priced, caring, and excellent customer service!!\nDr. Johnson and his staff didn't give up when it came to figuring out what was wrong with our Duke. They are so caring and so very understanding when it comes to your concerns and it does not feel that it is all about the money but rather about the well being of your pet. They have definitely earned my business!\nDr. Rex and the whole Staff are great. Very helpful and caring group.
Background: Oral premedication is widely used in pediatric anesthesia to reduce preoperative anxiety and ensure smooth induction. Midazolam is currently the most commonly used premedicant, but good results have also been reported with clonidine. The aim of the present study was to compare clinical effects of oral midazolam and oral clonidine. Methods: We performed a prospective open study in 64 children who were randomly assigned to receive either oral midazolam 0.5 mg.kg (-1) (group M) or oral clonidine 4 mu g.kg (-1) (group C) prior to mask induction. Drug acceptance, preoperative sedation and anxiolysis, quality of mask acceptance, recovery profile and parental satisfaction were evaluated. Results: The taste of oral clonidine was judged as significantly better; 14% of children rejected oral midazolam. Onset of sedation was significantly faster after premedication with midazolam (30 +/- 13.1 min) than with clonidine (38.5 +/- 14.6 min), but level of sedation was significantly better after premedication with clonidine. Quality of mask induction was equally successful in both groups. A steal-induction was performed in 66% of patients of group C, but none in group M. We observed a trend towards an increased incidence of emergence agitation after premedication with midazolam. Parental satisfaction was significantly higher in group C. Conclusions: In this study, premedication with oral clonidine appeared to be superior to oral midazolam. Quality of mask acceptance was comparable between groups, but oral clonidine was better accepted by the child, produced more effective preoperative sedation, showed a trend towards better recovery from anesthesia and had a higher degree of parental satisfaction.\nPremedication in children: a comparison of oral midazolam and oral clonidine / Nicole, Almenrader; Maurizio, Passariello; Bruno, Coccetti; Roberta, Haiberger; Pietropaoli, Paolo. - In: PAEDIATRIC ANAESTHESIA. - ISSN 1155-5645. - 17:12(2007), pp. 1143-1149. [10.1111/j.1460-9592.2007.02332.x]\nScheda prodotto non validato\nAttenzione! I dati visualizzati non sono stati sottoposti a validazione da parte dell'ateneo\n\|Titolo:\|\|Premedication in children: a comparison of oral midazolam and oral clonidine\|\n\|Data di pubblicazione:\|\|2007\|\n\|Citazione:\|\|Premedication in children: a comparison of oral midazolam and oral clonidine / Nicole, Almenrader; Maurizio, Passariello; Bruno, Coccetti; Roberta, Haiberger; Pietropaoli, Paolo. - In: PAEDIATRIC ANAESTHESIA. - ISSN 1155-5645. - 17:12(2007), pp. 1143-1149. [10.1111/j.1460-9592.2007.02332.x]\|\n\|Appartiene alla tipologia:\|\|01a Articolo in rivista\|
Having undesirable fat in numerous locations of your body can have a significant influence on your health and self-confidence. While standard weight-loss through workout and diet plan is a terrific method to slim down overall, even the very best workouts cannot target issue locations like the stomach, inner thighs, arms, and butts. Liposuction is a time tested treatment that is used to get rid of excess fat from particular areas of the body, enabling a specific to form and contour their body to their taste. Is liposuction right for you? Learn now.\nPros of Liposuction\nThere are numerous benefits to this cosmetic treatment, including:\n• Right away visible changes. Unlike standard weight reduction, liposuction creates modifications that are right away visible in the body. Some distinction is noticeable right away, and the wanted results are typically achieved in simply a few days.\n• Proven and safe. This cosmetic treatment has been performed by knowledgeable surgeons all over the world for several years and the technique has actually been improved over and once again to be safe and reliable.\n• Healing time is normally quick. The downtime required after having this kind of procedure is normally much less than exactly what is needed for other types of cosmetic treatments, including abdominoplasty, breast reduction, and more. Individuals who have had the procedure can typically return to work far more rapidly than they anticipated and can return to living a healthy, active lifestyle.\n• Weight loss can be permanent. With the best upkeep methods, the fat that was gotten rid of during the liposuction procedure will not return.\n• Complete control over your physique. With liposuction, an individual can have complete control over how they want to look, beyond what traditional diet and workout can offer. Giving individuals this power over their bodies increases self-esteem and help people feel their very best.\nWhile there many advantages to liposuction, there are of course a few caveats that must be thought about before making the decision to progress with the treatment.\nCons of Liposuction\nPrior to having liposuction done, it is essential to analyze the possible drawbacks of the procedure and identify if the advantages surpass the threats in your specific case. Your cosmetic surgeon can assist you learn more about the threats connected with the treatment and can assist you choose if progressing is the best thing for you.\n• Problems with basic anesthesia. Because liposuction is performed under general anesthesia, the treatment brings the very same threats as other kind of surgery where basic anesthesia is used. Underlying medical conditions may enhance these risks.\n• Adverse reactions. Bruising, bleeding, and pain are all to be expected, nevertheless, in uncommon cases can cause more significant complications.\n• The possible to get the weight back. After having actually liposuction done, it is important to keep a healthy diet plan and exercise correctly as suggested by your physician. Failure to do so might cause getting back the weight that was lost or perhaps even more.\nAlthough there are threats connected with liposuction, for lots of people, the benefits far exceed them. Educate yourself about the treatment by having in-depth conversations with your cosmetic surgeon and consider how liposuction has the possible to affect you as a special person. Just you and your cosmetic surgeon can figure out if liposuction will offer you with the outcomes you are looking for within your expectations.\nLaser Liposuction procedure is a new non invasive procedure to loose unwanted bodyfat in Saronville NE\nLaser liposuction is a more recent, minimally intrusive procedure that includes heating the fat cells to melting point and removing the melted fat through a little cannula. The treatment is typically done right in your physician's office and is an excellent choice for people who have less than 500 ml of fat to remove from any one area. Laser liposuction can be a safe, complementary treatment to weight loss in order to shape the body you have actually always desired.\nContact a Surgeon in your Saronville NE today.\nIf you're considering liposuction as a weight-loss option, it is very important that you discuss your desires with a qualified plastic surgeon in your location. Your specialist will perform a total exam and health history survey to figure out if liposuction can benefit you and help you reach your physical and emotional goals. Call today for an assessment and learn more about how liposuction can help you achieve the body of your dreams.
Dental Services in Bonn\nFor the Dentist in Bonn the comfort of patients and their families is of the utmost importance to provide the highest level of dental care possible using the very latest techniques and equipment.\nHealth insurance reimburses (in full or in part) those with insurance in Germany for the costs associated with the treatment of disease, motherhood, and also often following accidents. There are two ways of being insured, namely with statutory or private health insurance. Health insurance is an obligatory insurance in Germany and may be filed with different health carriers. Private health insurance is available for people with a higher income (€4.800 per month as of 2017), for civil servants or self-employed individuals.\nSocial care insurance (PV) in Germany is another obligatory form of insurance. In order to safeguard against the risk of needing long-term care, the role of social care insurance is to provide help to those in need of care who are dependent on support and assistance due to the gravity of their need.\nMore information about health and care insurance, as well as any other health-related questions, is available in the healthcare guide for migrants (Gesundheitswegweiser für Migranten) or under www.1a.net.\nYour dental practice in Siegburg with a feel – good ambience and modern technology. In addition to the wide range of dentistry, the Siegauenpraxis offers you complementary services. We would like to have our patients feel well with us.\nOur dental practice in Bad Honnef near Bonn has specialized for years in dental treatment and tooth restoration under anesthesia or general anesthesia. In cooperation with our very experienced specialist for anesthesiology, Dr. Sybille Plankermann, we offer patients with a fear of the dentist or dental phobia dental treatment under anesthesia under professional conditions.\nThe Dental Practice Dr. Andreas Scharnbeck is an old-established dentist's practice in Bonn, which combines the principles of fair treatment with modern dentistry and personal practice. Reliability, service, personal and dedicated contact persons.
Second of a 2-part article.\nWelcome to OR Manager, your source of information and insight into the clinical and business management of the surgical suite.\nThis article is only available to OR Manager subscribers. To read this article, and gain access to all OR Manager resources, please log in below:\nExplore Subscription Options\nPlease contact our Customer Service Team if you are unable to log in at [email protected]\nTakeaways • This buddy program works for all levels of…\nFind out more\nTakeaways Leading practice is innovative, people-centered, and evidence-informed and can…\nTakeaways Perianesthesia and sterile processing leaders are feeling the pain…
\|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 transumbilical breast augmentation for San Jose, Palo Alto, Mountain View, Los Altos, Los Gatos, and San Francisco residents.\nDr. Zachariah is one of the most experienced surgeons in the U.S. performing the Transumbilical method of Breast Augmentation.\nBreast Augmentation Using the TUBA Method\nWhen considering breast enlargement in San Jose, almost every woman wants the most natural-looking result possible. While breast implant size and type is important, another crucial consideration is the method used to place the implant underneath your breast tissue. Most methods, such as inframammary and periareolar, require incisions on or around the breast itself, increasing your chances for unattractive scarring that will detract from your larger, more shapely breasts.\nBut a proven method that has been around for over 15 years offers patients a great way to improve their breast appearance and gain a more attractive figure with less visible scarring. Transumbilical breast augmentation, or TUBA, is a surgical method Dr. Zachariah can use to insert saline breast implants through the navel ("belly button"), carefully positioning the implants under the breast tissue (subglandular) or under the pectoral muscle (submuscular) for a more naturally-curved appearance. Be sure to discuss your positioning options in detail with Dr. Zachariah during your consultation.\nSan Jose cosmetic surgeon Dr. Zachariah specializes in the TUBA procedure and is one of the most experienced surgeons in the U.S. for this procedure. To see before and after photos of patients who have chosen this procedure, visit our TUBA method breast augmentation photo gallery.\nHow TUBA Is Performed\nOnce you have received general anesthesia or local anesthesia with minimal sedation, Dr. Zachariah begins the procedure by making a half-circle incision inside the belly button. After placing this incision, the doctor inserts a tube (endoscope) to create two narrow pathways between the belly button and each breast. After the pockets for the implants have been created, Dr. Zachariah next inserts the empty breast implants through the tunnels created under your skin, and once in place, fills each implant with sterile saline (salt water) based on your desired breast size.\nRecovering from Breast Enlargement in San Jose\nIf you choose TUBA breast augmentation in San Jose with Dr. Zachariah, you are likely to see smooth recovery. Most patients begin to enjoy their fuller, natural shape and return to light activities in about three to five days, with full recovery in approximately four to eight weeks. Patients need to take care of the incision site to avoid infection and to minimize scarring. Additionally, they will need to wear a support bra until any swelling around the breasts has subsided. Because every patient is different, Dr. Zachariah will customize the instructions for each individual based on their specific situation.\nTUBA isn't right for every woman, so Dr. Zachariah also offers other breast enlargement methods in San Jose, including axillary (insertion through the armpit), areolar (insertion through the edge of the areola), or inframammary (insertion underneath the breast in the inframammary fold) incisions. You can learn more about each of these methods during your consultation.\nRegardless of the implant method you choose, count on San Jose cosmetic surgeon Dr. Zachariah to provide a beautiful breast augmentation outcome that will have you looking and feeling your best.
On NYC's Central Park's Fifth Avenue and 103rd Street, there is a statue of Dr. Marion Sims, the "Father of Gynecology."\nWhile Sims was responsible for curing a common ailment among women in the 19th century, he did so by operating on Black female slaves without anesthesia or consent.\nPlease sign this petition to ask New York City to remove Sims' statue from public and move it to a museum.\nFrom 1845 to 1849, Dr. Sims experimented on slave women in order to develop a cure for Vesico-vaginalfistula (VVF), a tear from the bladder to the vagina that can occur during labor. Women with the condition are unable to control their bladder and constantly leak urine. Many poor immigrant women in the U.S. suffered from it in the 19th century. Women who suffered this condition were often socially outcast and often committed suicide. Sims conducted surgery on 7 slave women who were brought to him by their masters and totally unable to give consent due to the lack of bodily autonomy and personal decisionmaking afforded to slaves at the time.\nAnesthesia had been developed in 1846, and was beginning to gain wider use. Sims may have been unaware\nof this area of medical advancement, and he did not use it.\nSims performed his first operation on a slave woman named Lucy, and he invited 12 local doctors to watch. Can you imagine the humiliation she must have endured, not to mention the pain?\nThe operation was unsuccessful, and Lucy nearly died. It took her almost 3 months to recover.\nFour years later, Sims successfully repaired VVF in Anarcha, a slave woman who had endured 13 operations without anesthesia.\nApparently the surgeries were so painful, many of the white women who came to Sims for VVF treatment after the successful operation on Anarcha were able to endure a single operation due to the pain.\nSims may have treated a common ailment, but he did so at the expense of Black female bodies and Black women's autonomy.\nHe failed to recognize them as autonomous beings, and yet he has enjoyed widespread fame and has many statues and hospitals named for him.\nAnd it wasn't just "the way things were": even at the time of the experiments, Sims' reputation in his community was suffering because people did not approve of his use of human beings are experiment subjects.\nSims used the horrible institution of slavery to achieve his fame and did so at the expense of real people. Please sign this petition to ask New York City to remove Sims' statue from public and move it to a museum.
What Are the Benefits of Avéli™\nAfter a one-year clinical study for Avéli™, clinical data shows that this treatment can dramatically reduce cellulite in the thighs and buttocks in adult women.\nAvéli™ offers significant, long-lasting cellulite reduction and has been officially FDA-cleared for the long-term reduction of cellulite.\nAvéli™ is a minimally invasive procedure performed using local anesthesia that provides highly effective cellulite treatment in about an hour.\nAm I a Candidate for Avéli™ Cellulite Treatment?\nIf you are concerned with cellulite on your buttocks or thighs and want a convenient but effective treatment to reduce this deeply-rooted skin condition, you may be a good candidate for Avéli™.\nTo determine if Avéli™ is right for you, consider the following:\n- You should be in good health.\n- You should have reasonable expectations for the procedure.\nYou might not be a good candidate for Avéli™ cellulite treatment if any of the following are true for you:\n- You have an infection\n- You have very loose skin\n- You have received liposuction in the treatment area\nA consultation with Dr. Agullo, or one of his team members, is the best way to find out if you are a good candidate for Avéli™ or one of his other cellulite treatments including Cellfina® and QWO®.\nAre you interested in trying treatment with AviClear™? Call Dr. Agullo and his team at (915) 590-7900 to set up a consultation.\nWhat Is Discussed During My Avéli™ Consultation?\nDr. Agullo, or one of his team member, will listen to your cellulite concerns and goals, obtain a medical history, and examine the areas you wish to be treated.\nWe will also thoroughly explain the process and results you can expect and provide you with an accurate and inclusive cost estimate.\nAt Agullo Plastic Surgery, tailored care begins with a full consultation to discuss the goals and options available.\nHow Is the Avéli™ Procedure Performed?\nCellulite is created when fat forms under the skin, and collagen fibers (septa bands) that connect the skin to underlying tissue separate this fat into multiple small pockets, creating dimples. Cellulite becomes more noticeable with age as skin loses elasticity and gets thinner.\nAvéli™ targets the connective bands responsible for cellulite and precisely cuts them, freeing the fat trapped within.\nA local anesthetic is administered to the treatment area(s) to ensure you remain comfortable throughout the procedure. When the site is completely numbed, Dr. Agullo inserts the Avéli™ device through small incisions in the skin and guides it to the tissue bands, releasing them one by one.\nTreatment time for Avéli™ may vary but is usually completed in about an hour.\nWhat Are Your Concerns?\nWhat Is Recovery Like After Avéli™ Treatment?\nYou can return to work or your regular routine immediately after treatment. However, you should avoid lower body workouts, including jogging and running, for up to two weeks, as instructed by Dr. Agullo.\nYou may experience mild discomfort and tenderness for the first 24 hours following treatment, along with swelling and bruising that typically disappears within 30 days. Firm-feeling spots under the skin sometimes develop but are not usually painful or visible and should resolve within a month or two.\nDon’t be alarmed if the tiny incisions made during the procedure leak clear or pink fluid, as this sometimes occurs. When this happens, it should only last for 24 to 48 hours.\nHow Long Will It Take to See My Results?\nAfter the swelling subsides, you should see gradual improvement and clear results visible within 30 days, with final results appearing in three months.\nIs Avéli™ Cellulite Treatment Painful?\nBecause a local anesthetic is administered, you should not feel any discomfort during your Avéli™ treatment, though the treated area may be sore when the numbing effects wear off.\nHow Much Does Avéli™ Cost?\nAvéli™ can be used to treat a small section of the skin or multiple larger areas. Your cost will depend on the extent of cellulite you want to address.\nDr. Agullo is committed to making treatments affordable and will provide you with an inclusive cost quote during your consultation. He also offers financing to make the cost of receiving treatment with Avéli™ manageable.\nFrequently Asked Questions About Avéli™\nAvéli™ is a safe procedure to treat cellulite when performed by a qualified professional.\nAvéli™ is FDA-cleared for long-lasting cellulite treatment.\nAvéli™ is a new procedure to treat cellulite that provides long-lasting results. Patients involved in clinical trials find their results have lasted at least one year when last assessed.\nHow can I find Avéli™ cellulite treatment in El Paso, TX?\nContact Dr. Agullo’s office and MedSpa today at (915) 590-7900 with any questions you have about cellulite treatment or to schedule your El Paso Avéli™ consultation.\nDr. Agullo serves all of West Texas, New Mexico, and Northern Mexico.
Open Access Subscription Access\nComparative Study of 0.5% Bupivacaine and 0.5% Bupivacaine with Clonidine (50μg) for Spinal Anaesthesia\nIn present day, bupivacaine is the most commonly used drug for spinal anaesthesia. To improve upon the quality of analgesia and prolong the duration of its action, many adjuvants have been tried. Intrathecal clonidine an α2 adrenoceptor agonist has potent central antinociceptive properties with analgesic effect at spinal level mediated by post-synaptically situated adrenoreceptor in dorsal horn of spinal cord. Low doses of clonidine have shown effectiveness in intensifying spinal anaesthesia. This study was done to evaluate the efficacy of spinal anaesthesia with clonidine added to hyperbaric bupivacaine in lower abdominal surgeries.\nSpinal Anesthesia, Clonidine, Bupivacaine, Complete and Effective Analgesia.\n- Eisenach JC, et al. a2-adrenergic agonists for regional anaesthesia: a clinical review of clonidine (1984-1995). Anaesthesiology; 1996:85, 655-674.\n- Niemi L. Effects of intrathecal clonidine on duration of bupivacaine spinal anaesthesia, haemodynamic, and postoperative analgesia in patients undergoing knee arthroscopy. Acta Anaestesiological Scandinavica 1994, 38: 724–728.\nAbstract Views: 436
Liposuction in Akron, OH\nAfter losing that last bit of weight, certain areas of the body may still be disproportionate to others. Some people also have more than the usual amount of fat on their thighs, buttocks, or abdomen and find it difficult to eliminate through diet and exercise. Liposuction is a permanent way of eliminating fat in problem areas and can be performed safely by Dr. Steven Carp for patients in Akron, Cleveland, Canton, Beachwood and Green, OH.\nWhat is Liposuction?\nLiposuction is a cosmetic surgery procedure designed to provide shape and contour to the body by getting rid of excess fat from specific locations, such as the buttocks, thighs, belly, knees, hips, chin, neck, cheeks, and upper arms. Throughout the past 10 years, liposuction procedures, which are also known by Canton and Akron patients as “suction lipectomy” or “lipoplasty,” have undergone a number of improvements. A variety of new techniques, such as power-assisted liposuction, ultrasound-assisted lipoplasty (UAL), and the super-wet and tumescent techniques, enable Dr. Carp to give his patients better results with less downtime.\nWhile liposuction is not meant to replace regular exercise and a healthy diet, it is helpful for removing unwanted body fat that won’t respond to healthy lifestyle practices. If you’re thinking about having liposuction, please read the rest of this page and speak with Dr. Carp so he can address any questions you may have and provide a professional recommendation that suits your particular needs.\nThe Best Candidates for Liposuction\nA good liposuction candidate should have realistic expectations for the procedure’s outcome. While it can enhance your appearance and bolster your self-confidence, it won’t make you become a different person. It’s important to think about your expectations carefully and discuss them with Dr. Carp, who serves the residents of the Akron and Canton areas, so you can come to a mutual understanding of your goals.\nLiposuction is best suited to individuals of a healthy weight who have isolated areas of excessive body fat. Age isn’t a major consideration, but some older individuals can have a loss of skin elasticity and may not see the same results as younger people with tighter skin. If you’re diabetic or struggle with lung, cardiovascular, or circulation problems, Dr. Carp may advise against surgery. He will go over your medical history thoroughly to make sure you are a good candidate for liposuction.\nPlanning for Liposuction\nDuring your initial consultation, Dr. Carp will assess your health, determine where pockets of excess fat are located, and evaluate your skin condition. He will also describe the body-contouring methods that may suit you best. For instance, many people come to the office for their consultation thinking they need liposuction on their abdomen when they really need a tummy tuck, also known as abdominoplasty, which removes excess skin and tightens the abdominal muscles. In other cases, a combination of liposuction methods may provide ideal results.\nIt’s important to be straightforward when telling Dr. Carp about your expectations. He will be honest and frank about the details of your procedure.\nMen and women in the Akron and Canton areas who are thinking about liposuction often feel overwhelmed by the variety of techniques and options available. By using the surgical judgment he has honed through years of experience and training, Dr. Carp can decide the treatment method that works best for you.\nFor quality advice and information regarding liposuction, you can count on the guidance of Dr. Carp, who is certified by the American Board of Plastic Surgery (ABPS). By choosing a surgeon certified by the ABPS, you can rest assured knowing your doctor has graduated from an accredited medical school and undergone at least five additional years of residency. This typically consists of three years of general surgery and two more of plastic surgery. To achieve ABPS certification, a doctor must also practice surgery for two years as well as pass extensive oral and written tests.\nPreparing for Your Liposuction\nDuring your consultation, you will be provided with specific preparation instructions, including advice on drinking, eating, and avoiding certain medications and supplements. If you smoke, it’s necessary to quit prior to surgery to lower your risk of complications and ensure optimal results. Make sure to let Dr. Carp know if you develop any kind of infection or illness, as this may require your treatment to be postponed.\nWhile preparing for your surgery, ask a friend or loved one to drive you home following your procedure. This person will also need to stay with you for at least the first day to monitor you and help around the house.\nAnesthesia for Liposuction\nDifferent kinds of anesthesia can be used for liposuction. You and Dr. Carp will work together to choose the anesthesia that offers the greatest safety, effectiveness, and comfort for your particular surgery.\nFor small quantities of fat in a limited number of body parts, Dr. Carp typically recommends local anesthesia. In many cases, this is provided along with IV sedation so patients can feel relaxed and comfortable during their surgery. If large quantities of fat are being removed, or if the patient would rather sleep through the procedure, general anesthesia is a good option. In this case, an anesthesiologist or nurse anesthetist will be there to monitor you.\nThe Liposuction Surgical Procedure\nDuring your liposuction surgery, isolated fat deposits are removed to recontour lumpy or bulging areas such as saddlebags, love handles, and other areas of unwanted fat on the back, thighs, belly, hips, and buttocks. Dr. Carp also performs liposuction for facial contouring by minimizing fat in the neck and cheeks.\nDr. Carp inserts a narrow tube known as a cannula through a tiny incision and then vacuums the layer of fat underneath the skin. This tube is moved back and forth to break up the fat cells, making them easier to remove. If several areas are being treated, Dr. Carp will go from one area to the next, making sure the number of incisions is kept at a minimum and that they’re as inconspicuous as possible.\nLiposuction Technique Variations\nDr. Carp offers a variety of liposuction methods for his cosmetic surgery patients in the Akron and Canton areas.\nDr. Carp uses this method frequently, which involves injecting a medicated solution, called tumescent fluid, into fat deposits prior to removal. This fluid is a mix of IV saline solution, lidocaine (local anesthetic), and epinephrine (for blood vessel contraction). It facilitates easier removal of fat tissue, minimizes bruising and blood loss, and offers greater comfort.\nTumescent liposuction, which is usually done for patients requiring only a local anesthetic, can take up to five hours when removing large quantities of fat. “Tumescent” refers to the firm, swollen state of the fat tissue when it’s injected with the fluid. Dr. Carp also performs a variant of this called the super-wet technique, which uses less fluid and generally takes less time.\nUltrasound-Assisted Lipoplasty (UAL)\nThis liposuction method uses a specialized cannula that emits ultrasonic waves. As it is moved through the fat tissue, these waves destroy the walls of fat cells, effectively liquefying them. This fat can then be removed easily using a traditional liposuction technique.\nUAL has been found to enhance the effectiveness and simplicity of liposuction in fibrous parts of the body, like the upper neck or enlarged male breast tissue. It is frequently used in secondary procedures when fine-tuning is required. Generally, this method takes longer than the traditional method.\nAfter Your Liposuction\nFollowing your surgery, you should expect some fluid drainage from the incisions. In some cases, a small, temporary tube may be placed under the skin to prevent the fluid from accumulating. To minimize swelling and help your skin adhere to your new contours, you may need to wear a special elastic garment over the treated area for a few weeks. Dr. Carp may also prescribe a preventative course of antibiotics.\nYou shouldn’t expect to feel completely normal immediately after your procedure. Although newer liposuction methods can minimize post-surgical discomfort, you may still experience some burning, pain, swelling, temporary numbness and bleeding. These can be controlled by using a prescription or over-the-counter pain reliever.\nIt’s normal to feel somewhat depressed or anxious in the days and weeks after your surgery. Fortunately, this will go away as you begin to feel better and your appearance improves.\nHow Much Does Liposuction Cost?\nLiposuction is considered to be elective, so most insurance providers won’t cover the costs. To help make liposuction affordable and accessible for everyone, Carp Cosmetic Surgery Center offers financing options. We also accept cash, personal checks, and major credit cards. Contact us today if you have any questions about the cost of liposuction.\n\|Uniontown, OH Liposuction\|\|Portage Lakes, OH Liposuction\|\n\|North Canton, OH Liposuction\|\|Massillon, OH Liposuction\|\n\|Cuyahoga Falls Liposuction\|\|Canton, OH Liposuction\|\n\|Wadsworth, OH Liposuction\|\|Hudson, OH Liposuction\|\nAdvances in the way liposuction is performed make this procedure more appealing than ever since less downtime is required than in years past. Find out about the benefits of liposuction by contacting Dr. Steven Carp, M.D., F.A.C.S., at his Green or Beachwood, OH clinics, which also serves patients in and around Akron and Canton.
- Subscribe NowLimited Time Offer\nRachel M. Brown, CRNA, DNP \| People on the Move\n- Rachel M. Brown, CRNA, DNP\n- Date added:October 5, 2012\n- Submission Type:New Hire\n- Current employer:Middle Tennessee School of Anesthesia\n- Current title/position:Assistant Program Administrator\n- Position department:General Management\n- Previous Employer:Anesthesia Services Associates\n- Previous title/position:Certified Registered Nurse Anesthetist (CRNA)\n- Duties/responsibilities:As an integral part of the faculty and leadership team, Dr. Brown's responsibilities at MTSA will include curriculum planning, program development, implementation, and evaluation of the nurse anesthesia program. She will also help the MTSA’s program administrator with the day-to-day operations at the school.\n- Company headquarters:Nashville\nSubscribers Only: Download People on the Move contact information.\nSend this story to a friend\nMore People on the Move\nReno & Cavanaugh, PLLC\nBradley Arant Boult Cummings LLP\nRoscoe Brown, Inc.\nRegions Insurance Group\nCrowell & Crowell, PLLC\nBaker, Donelson, Bearman, Caldwell & Berkowitz, PC\nSubmit People on the Move\nKnow of a Professional Recognition, New Hire, Promotion or Board of Directors change that Nashville Business Journal should publish?\nDownload Contact Names & Addresses\nSend well wishes. Introduce yourself. Connect. Contacting People on the Move is an excellent way to grow your network and your business.\nExecutive Director The Bluegrass Sports Commission \| Lexington, KY\nWork For: Capital Financial Group Capital Financial Group \| Brentwood, TN\nRAC Auditor / Saint Thomas - Metro Center / FT Days Saint Thomas Health \| Nashville, TN\nTechnical Business Analyst Vaco Technology \| Nashville, TN\nAssociate Program Professional * - PROFESSIONAL: RECRUITING Parallon Workforce Solutions \| Nashville, TN
BUENA VISTA ANESTHESIA MEDICAL GROUP\nSpecializing in patient safety and the highest quality outcomes.\nBVAMG was formed in 1993 and is structured as a partnership of physicians. There are approximately 45 board-certified/eligible physician anesthesiologists, including four cardiac fellowship trained specialists associated with BVAMG. We currently have a 30-year relationship with Providence Health Systems as the exclusive provider of anesthesia services at Providence Saint Joseph Medical Center (PSJMC) in Burbank, Providence Holy Cross Medical Center (PHCMC), San Fernando Valley Surgery Center in Mission Hills, and Summit Surgery Center in Valencia.\nWe work collaboratively with administration, nursing, and our surgeons to provide seamless care at all facilities 24/7. We are well known within the Providence family, and we believe our track record precedes us. Our physician members have vast experience and expertise in the delivery of a full range of anesthesia services, including but not limited to cardiothoracic, neurosurgical, bariatric, orthopedic, vascular, robotic surgery, obstetrics, trauma, pediatric anesthesia, and the management of critically ill patients. We also offer expertise in multimodal acute pain management. Having recruited many anesthesiologists from excellent training programs, BVAMG has multiple board-certified anesthesiologists trained in the latest nerve block techniques for postoperative pain relief.
Payment & Shipping Terms:\n\|Name:\|\|Disposable Medical Infusion Pump\|\|Material:\|\|AS+PC+ABS+PVC+Silicone Rubber\|\n\|Type:\|\|CBI (Fixed Flow Rate - Continous)\|\|Instrument Classification:\|\|Class III\|\n\|Flow Rate:\|\|2ml/h, 8ml/h, 10ml/h\|\|Certificate:\|\|CE ISO 13485\|\n\|Application:\|\|Control Aches After Surgical, Cancer Pains Control\|\nThe infusion pump adopts imported silica gel tube and advanced flow control technology. Consisting of press pump, flow rate controller, and connective catheters. It is flowing rate stable, flexible, resistive to any electromagnetic interference etc. The patients can press the PCA administration set add medication to meet their different needs.\nThis model has two-way valve, it is used for infusion, and you can draw the remaining part back.\n1. General anesthesia intravenous anesthesia maintenance medication\nIt is especially suitable for continuous intravenous infusion of intravenous anesthetics such as propofol, fentanyl, remifentanil and etomidate.\n2. Continuous epidural anesthesia continuous injection\nThe main advantages are stable anesthesia block, stable blood concentration, little effect on the circulatory system and respiratory system, and effectively reduce postoperative complications.\n3. Painless childbirth\nCan effectively alleviate the pain of the mother during natural childbirth\nThis model STT19-CBI-100-2 and STT19-CBI-100-4 is for control aches after surgical operations and cancer pains control, it is flow fixed pump for continous injection, PCA (patient control Analgesia) type is available.\n\|Model\|\|Maximum Capacity\|\|Flow rate\|\|Working time\|\|Eject air time\|\n\|STT19-CBI-100-2\|\|100ml\|\|2ml/h\|\|About 48 hr.\|\|About 4 minutes\|\n\|STT19-CBI-100-4\|\|100ml\|\|4ml/h\|\|About 24 hr.\|\|About 3 minutes\|\n\|STT19-CBI-200-2\|\|200ml\|\|2ml/h\|\|About 96 hr.\|\|About 4 minutes\|\n\|STT19-CBI-200-4\|\|200ml\|\|4ml/h\|\|About 48 hr.\|\|About 2.5 minutes\|\n\|STT19-CBI+PCA-100-2\|\|100ml\|\|2ml/h\|\|About 25-50 hr.\|\|About 6 minutes\|\n\|STT19-CBI+PCA -100-4\|\|100ml\|\|4ml/h\|\|About 12.5-25 hr.\|\|About 4 minutes\|\n\|STT19-CBI+PCA -200-2\|\|200ml\|\|2ml/h\|\|About 50-100 hr.\|\|About 6 minutes\|\n\|STT19-CBI+PCA -200-4\|\|200ml\|\|4ml/h\|\|About 25-50 hr.\|\|About 4 minutes\|\n※ The speed is surveyed in the temperature of 30℃ and inject liquid is physiological saline\n※ The flow rate may vary along of medicine type, liquid viscosity and temperature condition.\n* The pump is sterilized and one-off application, not be sterilized used again.\n* It should be destroyed immediately after used.\nThe speed is surveyed in the temperature of 30℃ and inject liquid is physiological saline The flow rate may vary along of medicine type, liquid viscosity and temperature condition.\nThe pump should be place within ±20cm at the injected part of patient. Otherwise, the flow rate will be increased.\n* When the last medication in the pump is less than 10ml, the flow rate will be reduced obviously.\n* Do not inject the medication over the pump’s Maximum Capacity\n* The injector and the epidural crunode must match the nation standard\n* After injected medication, perhaps there are air bubbles in the reservoir, it will disappear themselves within 3 hours.\n* Do not forget to cover the injected port with the dust-proof cap after injected medication\n* Do not use if find the next cases\na. The packaging has been opened or damaged\nb. Parts lack\nc. Parts damaged\n* Storage condition: dry, ventilated and room temperature within 5~40°C\n* The pump is valid for two years and the production date is indicated on the packing port\n100pcs/carton, can be deliver by air, courier and sea.\nQ1. What is your package\nA: Strong Brown box\nQ2. What is your terms of payment?\n1.L/C at sight;\n3.Alibaba Trade Assurance(mastercard,visa,e-checking)\nQ3. What is your terms of delivery?\nA: EXW, FOB, CIF\nQ4. How about your delivery time?\nA: Generally, it will take 3-5 days working days after receiving your advance payment. The specific delivery time depends\non the items and the quantity of your order.\nQ6. Do you test all your goods before delivery?\nA: Yes, we have 100% test before delivery\nQ7: How do you make our business long-term and good relationship?\nA:1. We keep good quality and the most competitive price to ensure our customers benefit ;\nA:2. We respect every customer as our friend and we sincerely do business and make friends with them,\nno matter where they come from.
NEJM Study on Pain Medication and C-Section\nSummary, Analysis, Concerns\nChildbirth Connection visitors are hearing about a new study about the timing of labor pain medication. Many media reports are providing misleading coverage. Childbirth Connection has prepared the following information to help visitors interpret this study, which Cynthia Wong and colleagues published in the New England Journal of Medicine on February 17, 2005.\nPlease see Childbirth Connection's clear, simple advice for women about labor pain relief.\nWhat did the February 2005 study do?The focus of the new study was on how to use the intervention, rather than whether to use it. The researchers looked at two approaches to regional analgesia, which refers to giving pain medications within the spinal column. Their objective was to understand whether waiting until later in labor could offer benefits, including reduced likelihood of cesarean section.\nOnly healthy women participated in the study. Each woman who agreed to participate was assigned by chance to one of two study groups:\nThe early regional group had two types of regional analgesia. Early in labor, women in this group had spinal analgesia, which is injected into the fluid that surrounds the spinal cord and given just once. When they asked for more pain relief, they had epidural analgesia. An epidural is when pain medication is delivered through a small tube (catheter) into the epidural space just inside the tough outer membrane covering the spinal cord. This multi-stage technique, which is not widely available in U.S. maternity settings, is sometimes called combined spinal-epidural analgesia.\nThe late regional group received a narcotic, hydromorphone, through an injection into the muscle and through an intravenous drip early in labor, followed later in labor with epidural analgesia, regional medication through a tube into the epidural space.\nDid the study do a good job measuring differences between earlier and later regional analgesia?Unfortunately, it is difficult to answer the main question, whether delaying regional analgesia reduced the likelihood of cesarean section, for two reasons.\nFirst, other things could have influenced the results:\nSecond, the combined spinal-epidural technique is not widely used in the United States and differs in fundamental respects from epidural analgesia. We do not know if results of the combined technique apply to the more common use of epidural alone.\nHave other studies found that delaying regional analgesia lowers risk for cesarean section?Lieberman and O'Donoghue (2002) carried out a rigorous systematic review of the best available research to understand whether delaying use of epidural until later in labor reduced the likelihood of cesarean birth. They concluded that such a delay may lead to fewer cesareans, but that existing research could not give a clear answer.\nDoes the study show that epidurals are safe?No. Women in both groups had epidural analgesia later in labor. The study did not compare groups that did and did not have this type of pain relief. Therefore, this study sheds no light on the safety or effectiveness of epidurals. It is wrong to conclude from this study that epidurals are "safe".\nWhat is the best evidence about the safety of epidural analgesia?There is ample rigorous research showing that epidurals have many adverse consequences, including systematic reviews from Childbirth Connection's "The Nature and Management of Labor Pain" project (published in American Journal of Obstetrics and Gynecology, May 2002). It is important that all pregnant women understand pros and cons of epidurals and other methods of labor pain relief.\nIn a systematic review of adverse effects of epidural analgesia, Lieberman and O'Donoghue (2002) found that epidurals increase:\nThis review also found that mothers with epidural were less likely to have a spontaneous birth (with neither cesarean nor use of vacuum extraction or forceps), and that their babies scored worse on Brazelton Neonatal Behavioral Assessment Scale.\nA systematic review by Mayberry and colleagues (2002) looked at the impact of epidurals on the labor experience, and found that epidurals increase likelihood of:\nMayberry and colleagues found that use of epidural analgesia was associated with use of many other interventions to monitor, prevent or treat epidural side effects. This regional analgesia technique involved routine use of electronic fetal monitoring, intravenous drip, and frequent blood pressure monitoring, and increased the likelihood that mothers would have other labor interventions, such as synthetic oxytocin, bladder catheters, and drugs for low blood pressure (2002).\nDoes the February 2005 study show that epidurals do not increase risk for cesarean section?No. Because women in both groups had epidurals, this study sheds no light on whether an epidural increases risk for cesarean section. Lieberman and O'Donogue's systematic review of randomized controlled trials and observational research looked at the best available studies for answering this question and concluded that available studies did not permit a clear answer (2002). For now, the best we can say is that having an epidural may increase risk for cesarean section.\nWhat are some concerns about the quality of care provided in this study?Childbirth Connection has concerns about the quality of care that participants in this study received. Due to these concerns, to difficulty understanding the impact of hydromorphone and synthetic oxytocin on study results, and to limited use of combined spinal-epidural technique, this study should not serve as a model for the care of healthy birthing women.\nNearly all of the healthy study participants (early group: 92%, late group: 95%) received synthetic oxytocin. For most, use of this drug began early in labor. Due to adverse effects associated with synthetic oxytocin (click "Full Prescribing Information"), its routine use in healthy women is not appropriate.\nDespite this near-universal "stimulation" of labor and inclusion of only healthy women, over one-third in both groups experienced either surgical delivery cesarean section or use of vacuum extraction or forceps when giving birth.\nThe "late" group received hydromorphone (trade name Dilaudidï¿½), a narcotic that is stronger, quicker-acting, and more sedating than morphine. The Food and Drug Administration "label" or guidelines for hydromorphone in the Physician's Desk Reference (PDR), states that it is contraindicated (not to be used) for labor and birth.\nDrug-free help with pain relief (for example, continuous supportive care in labor and use of tubs, showers and "birth balls") was not offered to the "late" group, yet these options have good safety profiles and many who use them give high ratings for pain relief. Providing continuous labor support would reflect a serious commitment to limiting use of cesarean section in healthy women, as a systematic review on effects of continuous labor support has found that, across many higher-quality studies, the presence of a companion with an exclusive focus on labor support reduced risk of cesarean by 26%.\nWhat are additional concerns about this study?The report opens by describing current policy of the American College of Obstetricians and Gynecologists (ACOG) on timing of epidurals. ACOG recommends not providing epidurals until a woman's cervix has dilated to 4 or 5 centimeters, as earlier use of epidurals may increase risk of cesarean section. The authors discuss their concern that this policy may prevent women from access to effective pain relief in early labor, and hypothesize that initiating combined spinal-epidural in early labor would not increase risk of cesarean. Because the policy addresses epidural analgesia, the new study does not evaluate the wisdom of this policy.\nThe study was not seriously set up to measure differences between the groups. The bar for detecting differences was set so high as to ensure that the conclusion would be: no difference in cesarean rates between the 2 groups. The researchers enrolled just enough women in the study to be able to detect an improbable difference between groups of 50 percent or more in the rate of cesarean delivery. Such dramatic results are not achieved with a single intervention, especially one in which both groups received such similar treatment (e.g., epidurals, synthetic oxytocin). The study was not set up to detect differences in cesarean rates that might be less than 50%, which the authors trivialize as "small".\nA casual glance at Tables 1 and 2 could lead people to assume that this study compared having regional analgesia to not having it. In these tables the study groups are labeled as regional versus injection/intravenous groups rather than early versus later regional analgesia. The article does not provide specific numbers that clarify that virtually all women in both groups had epidurals. Similarly, the authors note that although epidural has been associated with increased use of synthetic oxytocin, this study found no differences in groups; in fact, the study cannot shed light on whether epidural involved increased used of labor stimulation as both groups received epidurals.\nMedia coverage of the study has been confusing and could lead many to conclude erroneously that the study could in fact shed light on the safety of epidural and whether it is associated with cesareans. Some headlines erroneously state that the study shows that epidural is not associated with increased risk of cesarean and is a safe option for laboring women, without qualification.\nThe study was not endorsed and funded by an external group, such as the National Institutes of Health, but was supported by the department of anesthesiology with which most authors were affiliated.\nThe sweeping conclusion at the end of the discussion section goes far beyond what can be determined from the present study:\n"In summary, the results of this randomized trial suggest that nulliparous women in spontaneous labor or with spontaneous rupture of membranes who request pain relief early in labor can receive neuraxial [regional] analgesia at this time without adverse consequences." (p. 665). This is misleading in three major respects:\nAdditional labor pain resources on Childbirth Connection's website:\nReferencesLieberman E, O'Donoghue C. Unintended effects of epidural analgesia during labor: a systematic review. Am J Obstet Gynecol 2002;186:S31-68.\nMayberry LJ, Clemmens D, De A. Epidural analgesia side effects, co-interventions, and care of women during childbirth: a systematic review. Am J Obstet Gynecol 2002;186:S81-93.\nWong CA, Scavone BM, Peaceman AM, McCarthy RJ, Sullivan JT, Diaz NT et al. The risk of cesarean delivery with neuraxial analgesia given early versus late in labor. N Engl J Med 2005;352:655-65.\nMost recent page update: 6/30/2008\n© 2014 National Partnership for Women & Families. All rights reserved.\nFounded in 1918, Childbirth Connection has joined forces with and become a core program of the National Partnership for Women & Families. Together, these two women's health powerhouses are transforming maternity care in the United States.\nNews and Features\nChildbirth Connection has joined forces with and become a core program of the National Partnership for Women & Families.\nThis interactive timeline highlights our trailblazing work since 1918.\nWe want all women and babies receive the best possible maternity care.\nCheck out our resource, "What Every Pregnant Woman Needs to Know about Cesarean Section."
IV Sedation for YOUR Dental Office\nHow Does It work?\nDr. Salatino will come to your office with all required emergency and sedation equipment as required by the California Dental Board to provide IV conscious sedation to a patient(s) that you feel may need sedation assistance to provide the necessary dental care. Please contact Dr. Salatino as soon as possible to decide a day and time for the procedure and sedation.\nA patient’s need for sedation may range from dental anxiety, fear, extreme phobia and may even be desired for longer cases that would help the patient be more comfortable. Dr. Salatino has worked with general practice offices as well as specialists such as endodontists to help provide care and assistance to doctors and patients in need.\nWhat Dental procedures are good for IV Sedation?\nMost dental procedures can be accompanied with IV conscious sedation including but not limited to; restorative treatment, crowns, bridge, implants, extractions, scaling and root planning, full mouth rehabilitation.\nWhat Patients are good for IV Sedation?\n- At least 12 years of age\n- Able to tolerate placement of an intravenous line (IV)\n- ASA I, ASA II, and some ASA III patients\nWhat Dr. Salatino needs from your office:\n- Patient medication list\n- Documented Blood pressure, pulse, and oxygen saturation (if possible to obtain)\n- Patient’s Height, Weight, & Date of Birth\n- Consents for Sedation signed by the patient (to be provided to you)\n- Copy of the patient’s health history\nWhat is Dental Sedation?\nDental Sedation is another term for “Conscious Sedation” which is some patients refer to as “being asleep” sedation. This is a type or form of sedation in which our patients are “conscious” and able to communicate to us throughout their dental procedures even though many people assume they will be “knocked out” or “asleep” throughout the procedure. The goal for the sedation appointment is to relieve our patient’s anxiety, fear, and discomfort while performing the standard dental care. Consciousness is extremely important to a sedation appointment and even though patients are not “asleep”, there are many patients who remember little to almost nothing of their dental appointment.\nWhen Do Patients Need Sedation Dentistry?\nOver 60% of Americans avoid necessary dental treatment because they are afraid of basic dental treatments such as cleanings, fillings, or crowns. Not surprisingly, surgical procedures such as extractions are extremely frightening to many patients and many people will put off treatment until teeth become so infected that hospital care is necessary. Sedation Dentistry allows patients to relax during ANY dental procedure whether it is a dental cleaning or removal of wisdom teeth.\nIs Sedation Dentistry Safe?\nDental Sedation is extremely safe because all of our patients are “conscious”. Patients are able to breathe and communicate on their own while Dr. Salatino and her well trained staff monitor our patient’s heart rate, blood pressure, oxygen intake, and heart rhythms.\nHow Do Patient’s Get Sedated?\nWhile there are many methods for delivering sedation medications the safest and most predictable method for delivering medications is via an intravenous line; also known as an IV. Medications can be given rapidly and as necessary via an IV while other forms of sedation such as Oral Sedation are less predictable, less effective, and extremely time consuming. Dr. Salatino has spent years of training in all forms of sedation and has found that the most effective, predictable, and safest form of Dental Sedation is through an IV.\nDoes Insurance Pay for Sedation Dentistry?\nIn some cases, Yes. There are many insurance carriers that participate in paying for IV Sedation Dentistry. Although there are some types of procedures that some insurance carriers may not participate in; Rockstar Family Dental is consistently trying to help our patients with their dental needs while working with insurance companies.\nHow Do I Know If I Am a Candidate for Sedation Dentistry?\nThe best way to determine if you are a candidate for Sedation Dentistry is to call our office and make an appointment for a FREE Sedation Dentistry Consultation. Although most people are candidates for Sedation Dentistry there are specific health and medical factors that need to be reviewed by Dr. Salatino prior to sedation in order to insure the safety of all of our patients.\n1. Will I be asleep?\nMost people assume that because they do not remember the dental treatment that they were “asleep” throughout the appointment. In reality, very few people “sleep” through the entire appointment but rather,they are so relaxed that they sleep through portions of the appointment but because the medication is designed to create memory loss, people assume they were asleep. Patients however, are considered conscious because they will respond if we call them by name, or ask them specific questions throughout the procedure like, “are you cold? Can we get you a blanket?”\n2. Is Sedation Safe?\nYes. IV Conscious sedation is very safe because the patient is conscious and able to protect themselves with their normal protective reflexes such as the cough reflex. General Anesthesia is a form of deeper sedation which is primarily performed in hospitals and is associated with a greater risk of complications because the patient is not conscious.\n3. I was asleep for my wisdom teeth removal, isn’t that the same thing?\nMost people remember very little to nothing about their wisdom teeth being removed from an oral surgeon. The easy answer to this question is YES, both forms of sedation are very similar and yield the same results.\n4. Can I drive myself home from my appointment?\nNo. The medications create memory loss and it is not safe to drive or go to work immediately after the appointment. Patients are encouraged to wait at least 24hrs before driving.\n5. Will my insurance pay for sedation?\nSome dental insurance will participate in paying for IV Conscious Sedation however;these payouts are usually associated with dentistry that involves surgery.\nDiscover the confidence that comes from a better smile!\nFind out if Invisalign is right for you.
Oral Cancer (cont.)\nIn this Article\nWhat are the symptoms of oral cancer?\nYour regular checkup is a good time for your dentist or doctor to check your entire mouth for signs of cancer. Regular checkups can detect the early stages of oral cancer or conditions that may lead to oral cancer. Ask your doctor or dentist about checking the tissues in your mouth as part of your routine exam.\nCommon symptoms of oral cancer include:\nAnyone with these symptoms should see a doctor or dentist so that any problem can be diagnosed and treated as early as possible. Most often, these symptoms do not mean cancer. An infection or another problem can cause the same symptoms.\nHow is oral cancer diagnosed?\nIf you have symptoms that suggest oral cancer, the doctor or dentist checks your mouth and throat for red or white patches, lumps, swelling, or other problems. This exam includes looking carefully at the roof of the mouth, back of the throat, and insides of the cheeks and lips. The doctor or dentist also gently pulls out your tongue so it can be checked on the sides and underneath. The floor of your mouth and lymph nodes in your neck also are checked.\nIf an exam shows an abnormal area, a small sample of tissue may be removed. Removing tissue to look for cancer cells is called a biopsy. Usually, a biopsy is done with local anesthesia. Sometimes, it is done under general anesthesia. A pathologist then looks at the tissue under a microscope to check for cancer cells. A biopsy is the only sure way to know if the abnormal area is cancerous.\nIf you need a biopsy, you may want to ask the doctor or dentist some of the following questions:\nMedically Reviewed by a Doctor on 3/28/2014\nViewers share their comments\nOral Cancer - Symptoms Question: What are the symptoms of your oral cancer?\nOral Cancer - Side Effects Question: Oral cancer treatment can make chewing and talking difficult. What side effects have been challenging for you?\nOral Cancer - Treatment Question: What types of treatment or surgery have you had to treat your oral cancer?\n- Allergic Skin Disorders\n- Bacterial Skin Diseases\n- Bites and Infestations\n- Diseases of Pigment\n- Fungal Skin Diseases\n- Medical Anatomy and Illustrations\n- Noncancerous, Precancerous & Cancerous Tumors\n- Oral Health Conditions\n- Papules, Scales, Plaques and Eruptions\n- Scalp, Hair and Nails\n- Sexually Transmitted Diseases (STDs)\n- Vascular, Lymphatic and Systemic Conditions\n- Viral Skin Diseases\n- Additional Skin Conditions
Even the most responsible owners can get separated from their pets: a door or gate or window left open for just a moment can lead to hours, days, or weeks of worry. As many as one in three pets get separated from their owners at some point in their lives which is why we provide microchipping in Indianapolis.\nUnlike a tag or collar that can be broken or lost, a microchip carrying your contact information and placed just below your pet’s skin is safe, permanent, and can’t be tampered with.\nIn dogs and cats, the chip is usually placed between the shoulder blades. The chip is coated in a substance that will cause the animal’s body to bind with it, so it won’t move no matter how active your pet may be. If you expect your pet will struggle during the implantation, you may want to consider anesthesia, but they will only feel a small pinch.\nWhen Can My Pet Get a Microchip?\nDepending upon the size of the animal, they can be microchipped as young as six to eight weeks old; consult with the Paw Patch team on timing. Adults can be done at any time.\nIf your pet is unchipped and due for other surgery, like a spay/neuter, you can have the microchip implanted during that surgery, while your animal is still under anesthesia, to save you an extra trip to the office and therefore time and money.\nRegistering Your Pet’s Chip\nOnce the chip is implanted, you can register it online with your contact information, so that if your pet is found by a shelter or vet with a chip reader, you’ll be called and quickly reunited with your pet. Registration takes only a few minutes and can be easily updated if you move.\nMany rescues and shelters, as well as professional breeders, routinely chip the animals before they adopt them out. If you are not sure if your new pet is chipped, your vet can scan for a chip.\nIf they have one, you can transfer the registration from the rescue or breeder to yourself.\nAre There Risks?\nYes, there are some risks, but the chances of microchipping in Indianapolis causing a problem are very, very small.\n- Infection. The veterinarian will insert a properly sterilized needle into the site. That means changes of infection are extremely slim.\n- Migration. There have been reports of chips migrating to other parts of the body. That won’t hurt your animal, but the scanner may not find the chip unless they scan the whole body.\n- Cancer. In extremely rare cases (one in one million, according to one study), develop cancer at the implant site.\n- Allergic Reactions. Rare complications include allergic reactions to the coating on the chip.\n- Migration. There have been reports of chips migrating to other parts of the body. That won’t hurt your animal, but the scanner may not find the chip unless they scan the whole body. This is something that is well-known in the veterinary and shelter/rescue communities so we generally scan the entire body to make sure we aren’t missing a potential chip.\nAccording To The American Veterinary Medical Association (AVMA), studies have shown that the benefits of microchipping far outweigh the risks. One study found:\n- Less than 2% of lost cats that were not chipped, found their way home. Likewise, cats that were chipped were reunited with their owners 38.5% of the time.\n- For dogs, 21.9% of non-chipped dogs got home compared to 52.2% of chipped pooches.\nLosing a pet is a heartbreaking experience, one no veterinarian wants to see their clients go through. If you’d like to discuss microchipping in Indianapolis with a vet, give us a call.
Lack of Analgesia by Oral Standardized Cannabis Extract on Acute Inflammatory Pain and Hyperalgesia in Volunteers\nKraft, Birgit M.D.; Frickey, Nathalie A. M.D.†; Kaufmann, Rainer M. M.D.‡; Reif, Marcus Ph.D.§; Frey, Richard M.D.∥; Gustorff, Burkhard M.D.#; Kress, Hans G. M.D., Ph.D.*\nBackground: Cannabinoid-induced analgesia was shown in animal studies of acute inflammatory and neuropathic pain. In humans, controlled clinical trials with Δ9-tetrahydrocannabinol or other cannabinoids demonstrated analgesic efficacy in chronic pain syndromes, whereas the data in acute pain were less conclusive. Therefore, the aim of this study was to investigate the effects of oral cannabis extract in two different human models of acute inflammatory pain and hyperalgesia.\nMethods: The authors conducted a double-blind, crossover study in 18 healthy female volunteers. Capsules containing Δ9-tetrahydrocannabinol–standardized cannabis extract or active placebo were orally administered. A circular sunburn spot was induced at one upper leg. Heat and electrical pain thresholds were determined at the erythema, the area of secondary hyperalgesia, and the contralateral leg. Intradermal capsaicin-evoked pain and areas of flare and secondary hyperalgesia were measured. Primary outcome parameters were heat pain thresholds in the sunburn erythema and the capsaicin-evoked area of secondary hyperalgesia. Secondary measures were electrical pain thresholds, sunburn-induced secondary hyperalgesia, and capsaicin-induced pain.\nResults: Cannabis extract did not affect heat pain thresholds in the sunburn model. Electrical thresholds (250 Hz) were significantly lower compared with baseline and placebo. In the capsaicin model, the area of secondary hyperalgesia, flare, and spontaneous pain were not altered.\nConclusion: To conclude, no analgesic or antihyperalgesic activity of cannabis extract was found in the experiments. Moreover, the results even point to the development of a hyperalgesic state under cannabinoids. Together with previous data, the current results suggest that cannabinoids are not effective analgesics for the treatment of acute nociceptive pain in humans.\nTHE detection of two specific cannabinoid receptors (CB1\n) and their endogenous ligands prepared the ground for numerous animal studies with different cannabinoids, confirming analgesic, antihyperalgesic, and antiinflammatory activities of exogenous and endogenous ligands1–5\nin these models. However, inconsistent data exist from the few controlled clinical studies on the potential analgesic effect of oral cannabinoids such as Δ9\nNo analgesic effect was found after a postoperative oral dose of 5 mg THC, whereas significant dose-related reductions of analgesic rescue medication by a single dose of 10 or 15 mg THC were demonstrated in a recent study with oral THC-standardized cannabis extract.9,10\nUsing purely nociceptive stimuli in an experimental setting, a recent trial did not show any analgesic effect of 20 mg oral THC.11\nHowever, the stimuli used in those experiments may be considered inappropriate to find any antineuropathic or antihyperalgesic drug effects. In contrast, the prevention of capsaicin-induced pain was reported using a model of topical administration of the synthetic cannabinoid HU-210 onto human skin.12\nBesides studies with smoked cannabis,13,14\nno controlled experimental clinical trials on the analgesic efficacy of oral cannabis extract or THC on acute inflammatory pain and hyperalgesia in humans have been published to date. Therefore, the current study was designed to detect a potential analgesic activity of oral THC-standardized cannabis extract by two different and well-established human models of acute inflammatory pain and hyperalgesia, i.e.\n, the sunburn model and the intradermal injection of capsaicin.\nMaterials and Methods\nStudy Population and Design\nAfter institutional review board (Ethics Committee of the Medical University of Vienna, Vienna, Austria) approval and written informed consent, 18 healthy female volunteers without a history of cannabis use participated in this randomized, double-blind, active placebo–controlled, crossover study. Only female volunteers were included, because animal studies suggested a more pronounced effect of cannabinoids in females compared with males.15,16\nAfter completion of a confidential medical questionnaire and a physical examination (including electrocardiography, blood pressure, body temperature, and standard chemical blood test), the Mini-International Neuropsychiatric Interview (M.I.N.I. German Version 5.0.0) and a structured face-to-face psychiatric interview were used to exclude any psychiatric disorder.\nGeneral exclusion criteria were a history of or any existing drug abuse (urine multidrug screening test; Coachrom Diagnostics, Vienna, Austria); psychiatric disorder; smoking (> 5 cigarettes/day); drug treatment except contraceptives in the past 14 days; pregnancy (urine test before each treatment); infections; liver, renal, cardiac, or skin diseases; and current acute or chronic pain conditions.\nThe volunteers agreed to abstain from alcohol, nicotine, and caffeinated drinks for 24 h before and during the study sessions, and also from oral food intake for 12 h before the session.\nExperimental Conditions and Monitoring\nThe study sessions were always performed in the same quiet and air-conditioned room at 22°C environmental temperature, starting at 8:00 am. The same two trained investigators performed all tests, which started with a short physical examination, urine pregnancy test, and drug screening. A venous cannula was placed into a cubital vein, and the monitoring of blood pressure, electrocardiography, body temperature, and pulse oximetry was established before the individual baseline pain thresholds were determined. The expected typical side effects of drowsiness, euphoria, sedation, nausea, dry mouth, and vertigo were evaluated every hour by the subject herself and by the blinded investigator, using a visual analog scale (VAS). To detect acute psychotic symptoms, the psychiatric status was assessed with the validated Brief Psychiatric Rating Scale, consisting of 18 items rated on seven-point severity scales before and 3 and 6 h after the intake of cannabis extract or placebo.17\nPain measurements were performed after defined time intervals in a uniform sequence: reaction time, pinprick, heat pain perception and tolerance, and electrical pain perception and tolerance. All sessions started 20 ± 0.5 h after ultraviolet-B irradiation, and the test battery was repeated exactly 2 h after oral intake of study medication (fig. 1\n). Each subject remained hospitalized in our pain center for 8 h after drug administration. The washout period between the two respective crossover test sessions was at least 4 weeks.\nAfter baseline measurements, each proband received four indistinguishable brown and one white capsule containing either standardized cannabis extract calibrated on a THC content of 20 mg in total (Institute for Clinical Research, Berlin, Germany) or active placebo (5 mg diazepam; Nycomed, Linz, Austria), in a double dummy design together with a standardized breakfast (herbal tea or decaffeinated coffee, small breads with hazelnut cream [Nutella®; Ferrero Inc., Innsbruck, Austria]). The cannabis extract was a product of pharmaceutical quality containing a mixture of cannabinoid plant extracts in a gelatin base, provided by the Institute for Clinical Research that had been used already in previous studies.10,18\nTHC and cannabidiol (CBD) predominated and were in the ratio of 2:1; other plant cannabinoids were less than 5% per capsule.\nThe blinding of the study medication was performed by our hospital pharmacy according to a computerized randomization list. To verify a sufficient gastrointestinal absorption and bioavailability, plasma levels of THC, CBD, and the two THC-metabolites 11-hydroxy-THC (THC-OH) and 11-nor-9-carboxy-THC (THC-COOH) were determined before and 2, 4, and 8 h after administration of the study medication. The heparinized blood samples were instantly centrifuged, and the plasma was frozen and stored at −20°C until analysis. Cannabinoids were analyzed by gas chromatography–mass spectrometry at the Department of Legal Medicine, University Hospital Charité, Berlin, Germany.19\nExperimentally Induced Pain and Hyperalgesia\nUltraviolet B–induced inflammation of the skin is an established model of hyperalgesia in humans. In this model, primary and secondary hyperalgesia are considered to reflect peripheral and central mechanisms of pain, respectively.20\nAs previously described,21\n20 h before each treatment session, a circular spot (diameter 50 mm) was irradiated with the threefold individually determined minimal erythema dose at one upper leg using a calibrated ultraviolet-B source (Sellasol; Sellas Medizinische Geraete GmbH, Gevelsberg-Vogelsang, Germany; wavelength 290–320 nm). According to the crossover design, one leg was irradiated for each session, and the side of first irradiation was randomized. The irradiation procedure induced a state of local hyperalgesia that remained constant between 20 and 30 h thereafter.20\nBefore the measurements of baseline pain thresholds, the area of secondary hyperalgesia surrounding the erythema was determined by pricking with a von Frey filament (150 g) and by brush stimulation, while the probands kept their eyes closed. Stimulation was started 100 mm distant from the central erythema and was repeated along a pattern of eight radial spokes. While moving along each spoke in 5-mm intervals, the subject was asked to report when the sensation of the pricking changed definitely. The borders were marked with a pen, and the respective distance to the erythema was measured. Subsequently, marks were erased to avoid any bias during the following measurements. The area of pinprick hyperalgesia was calculated as an octagon based on the eight obtained radial distances.\nIntradermal Capsaicin Model.\nIntracutaneous administration of capsaicin is an established model to induce spontaneous pain, followed by secondary mechanical hyperalgesia and neurogenic flare reaction.22–24\nBecause of the release of neuropeptides by nociceptors, capsaicin leads to a rapid onset neurogenic inflammation. The immediate strong pain after capsaicin injection is followed by a secondary (mechanical) hyperalgesia that involves central sensitization rather than sensitization of peripheral nociceptors and is therefore considered a model of secondary hyperalgesia.\nDuring every session, exactly 2.5 h after medication, 20 μl capsaicin, 0.1% (vol/vol), was injected intradermally into a defined test area on one forearm contralaterally to the sunburn site. Pain intensity was rated by VAS at 15-s intervals for the first 2 min, followed by measurements at 2.5, 9, and 15 min after the injection. The flare area was assessed by tracing the edge of the visible erythema on a transparent acetate sheet 10 min after injection. The area was calculated using the software Osiris 4.19 for Microsoft Windows (University of Geneva, Geneva, Switzerland). The hyperalgesic area was determined by pinprick and brush stimulation along six radial spokes (see Sunburn Model section).\nTo make all of the subjects equally familiar with the test procedures, a preceding training session was always performed when the subjects presented for the ultraviolet-B irradiation 1 day before the actual drug treatment session.\nHeat Pain Thresholds.\nHeat pain perception (HPPT) and tolerance (HPTT) thresholds were assessed by a thermal sensory testing device (TSA-2001; Medoc, Ramat Yishai, Israel) and always performed in a uniform sequence at three different sites: contralateral leg, area of secondary hyperalgesia, and sunburn erythema. A Peltier thermode, size 18 × 18 mm, was attached to the skin at the sites of measurement using an elastic bandage. The bandage was wrapped tightly around the upper leg, stretched by 2 cm, and the ends were fixed. Much care was taken to consider upper leg curvatures in placing the probe to achieve optimal skin contact. Skin adaptation temperature was 32°C, and the rate of temperature change was 0.8°C/s (heat ramp) with a return rate of 4°C/s. The stimulator temperature span ranged from 32° to 54°C. HPPT and HPTT were measured with the method of limits as previously described.25\nThe trained subject was instructed to stop the increase in heat immediately when the stimulus became painful. The measurements of the HPPT were repeated three times and averaged. To determine the HPTT, the subject was advised to stop the increase of heat as soon as the painful stimulus became intolerable. This test was repeated twice and averaged. A 60-s interstimulus resting period separated the heat pain threshold determinations.\nElectrical Pain Thresholds.\nElectrical pain perception (EPPT) and tolerance (EPTT) thresholds were determined using an automated electric current sensory testing device (Neurometer® CPT/C; Neurotron Inc., Baltimore, MD). A pair of 10-mm-diameter gold electrodes separated by a 17-mm Mylar spreader was coated with a thin layer of chloride-free electroconductive gel and taped onto the skin of the three consecutive testing sites. The pain thresholds for two different frequencies (5 Hz, 250 Hz) of a constant current sine wave stimulus were tested. EPTT determinations were performed using a standardized automated double-blinded methodology. The stimulus was presented in an ascending staircase fashion from zero to a maximum of 9.99 mA. The duration of each step was a function of the stimulus frequency: 2.52 s at 5 Hz (29 steps) and 2.16 s at 250 Hz (20 steps).The electrical pain thresholds were determined by the subject pressing and holding the “Test Cycle” button. The subjects were instructed to discontinue the increase in stimulus intensity when the stimulus became painful (EPPT). The tests were repeated three times and averaged. To determine the EPTT, the subjects were asked to stop the increase of the stimulus intensity immediately when the stimulus became intolerable. This test was repeated twice and averaged. There was a 60-s interstimulus resting period between each threshold measurement. For safety reasons, the stimulation automatically stopped at the maximum output intensity (9.99 mA).\nAt baseline and 2 h after medication, the individual’s reaction time was assessed by pressing the button of a stopwatch initialized together with an acoustic signal. Subjects were asked to stop the watch as fast as possible when the signal appeared in intervals of 5–15 s in random order. Measurements were repeated three times and averaged.\nThe biometrical analysis was performed at the Institute for Clinical Research, Berlin, with the exception of the Brief Psychiatric Rating Scale scores, which were analyzed at the Department of Biologic Psychiatry with SPSS for Windows, version 11.0 (SPSS Inc., Munich, Germany).\nIn previous studies,21,25\nan SD of the threshold difference between 2 study days of 0.42°C and 2,107 mm2\nfor HPTT and area of secondary hyperalgesia were observed, respectively. To detect a 0.5°C reduction of HPTT in the sunburn with 80% power in the crossover design, a sample size of 2 × 4 (4 patients in each sequence) suffices, assuming a two-sided significance level of 5%. A 30% reduction of secondary hyperalgesia area can be detected with 2 × 6 probands.\nStatistics were calculated with the software SAS® version 8.2 (SAS Inc., Cary, NC). The intention-to-treat analysis set used for efficacy analysis was defined as all subjects who finished at least one study period and provided at least one measurement on outcome for the second period. Thereby, missing observations were replaced using the last observation carried forward principle. Safety data were analyzed from all subjects enrolled.\nAll efficacy parameters were regarded as interval scaled and were analyzed using mixed linear models,26,27\nincluding the parameters “treatment” and “period” as fixed factors, the parameter “general reactivity” as continuous covariate, and each individual study subject as random factor. Dependent variables were chosen as changes from baseline, except for the flare area where no baseline measurements were taken. Carryover effects were not included because they were considered to be negligible due to the 4-week washout phase between the treatment periods. The model estimates for the fixed effects and for the continuous covariate were tested for significance by t\ntests on a two-sided α error level of 5%.\nIn total, for the primary analysis of efficacy five separate measurements were combined to two efficacy indices. The parameters “heat pain threshold at erythema site” (averaged from three consecutive measurements) and “heat pain tolerance at erythema site” (averaged from two consecutive measurements) were joined to a global index “primary hyperalgesia” by summing up the respective standardized changes from baseline.\nFor the second primary efficacy parameter, another global index, called “secondary hyperalgesia,” was calculated by summing up the standardized changes from baseline with regard to the parameters “area of secondary hyperalgesia” (averaged from two assays using pinprick and brush) and “heat pain perception threshold” (averaged from two consecutive measurements).\nThe primary analysis of efficacy was performed in the a priori fixed order “primary hyperalgesia–secondary hyperalgesia,” thus keeping the global α error.\nRegarding the secondary analysis of efficacy as well as the analysis of safety, the same statistical model was used. For adverse events, incidence rates were calculated and compared between treatment groups by χ2 test. All tests comparing those parameters between active drug and placebo are reported with their local P values (i.e., without adjusting for multiple testing), serving as flags for differences that would be statistically significant (P < 0.05) if chosen as primary efficacy criterion.\nAll randomized female subjects could be included in the intention-to-treat analysis set. Therefore, intention-to-treat and safety sets were identical (table 1\nCannabinoid Plasma Levels\nCannabinoid plasma levels were measured at 2, 4, and 8 h after drug intake. Despite the standardized conditions, a broad variability in peak plasma levels for all cannabinoids was observed, ranging between 1.05 and 7.92 ng/ml (mean ± SD, 4.23 ± 2.28 ng/ml) for THC and 0.46 and 3.57 ng/ml (1.71 ± 1.00 ng/ml) for CBD. Peak plasma levels were found between 2 and 4 h, coinciding with the time when pain measurements were performed. At 2 h, mean metabolite levels for THC-11-OH were 6.28 ± 3.20 and 37.95 ± 21.48 ng/ml for THC-COOH. There was no correlation between individual plasma levels of THC, CBD, metabolites, and pain thresholds.\nThe applied dose of cannabis extract did not significantly affect systolic and diastolic blood pressure, oxygen saturation, or body temperature. Only the mean heart rate was significantly elevated compared with baseline or placebo, but returned to normal until the end of the study session. The heart rates reached their maximum approximately 3 h after administration of the study medication, correlating also with the painful injection of capsaicin.\nPsychotropic and other side effects were stronger and more frequent after cannabis extract than after placebo (table 2\n). The intensity of each side effect was independently rated by a VAS before (baseline) and at every hour after the study medication by both the subject and the blinded investigator. Ratings reached their maximum between 2.2 and 3.2 h after drug administration and returned to baseline within 8 h. No correlation between the intensity of side effects and changes of heart rate and blood pressure was found.\nTo detect acute drug-induced psychotic symptoms, the psychiatric status was assessed by the means of the Brief Psychiatric Rating Scale scores at baseline and 3 and 6 h after the intake of the study medication. Despite the obligatory psychiatric prescreening, one subject experienced acute psychotic symptoms (total score, 84) after cannabis extract, such as unpleasant depersonalization, suspicion, derealization, and anxiety for approximately 4 h. During this period, pain measurements according to the study protocol could not be performed, and she was not included into the statistical analysis. The symptoms attenuated in the course of time and completely disappeared within the observation period of 8 h.\nSunburn Pain Model\nContralateral Pain Measurements.\nHeat pain thresholds (HPPT, HPTT), electrical pain thresholds (EPPT, EPTT), and pinprick pain (VAS) were measured first at the contralateral leg, in normal nonsensitized skin. For all parameters, no significant analgesic effect of cannabis extract or placebo could be found. Electrical pain thresholds were even diminished, showing an unexpected tendency toward hyperalgesia, without reaching statistical significance, however (table 3\nThe sunburn erythema was surrounded by the area of secondary hyperalgesia, which was assessed before and 2 h after the study medication. The extent of the area of secondary hyperalgesia was not altered by cannabis extract or placebo (data not shown) for both pinprick and brush stimuli. There was no difference in HPPT and HPTT between baseline, cannabis extract, and placebo (fig. 2\nEPPT and EPTT (5 and 250 Hz) were also determined in the area of secondary hyperalgesia. Compared with healthy skin, all pain thresholds were decreased. However, similar to the results obtained for normal skin, EPPT and EPTT were lower after cannabis compared with baseline and placebo, but again without reaching statistical significance (table 4\nPrimary Hyperalgesia (Sunburn Erythema).\nWithin the erythema site, neither cannabis extract nor placebo had any significant effect on HPPT or HPTT (fig. 3\n). Also, cannabis extract did not alter pinprick pain in the inflamed skin area. Surprisingly, the electrical pain thresholds EPPT and EPTT for 250 Hz were significantly decreased after cannabis extract (fig. 4\nThe intradermal injection of capsaicin induced a nearly maximum pain sensation in both groups with a peak value immediately after injection, followed by a consecutive decrease within 15 min to a moderate spontaneous pain level averaging VAS 1.3 (fig. 5\n). There was no difference in pain intensity between the two groups, but interestingly, pain showed a tendency to decrease more rapidly after cannabis compared with placebo (data not shown). The difference between the two groups was not statistically significant (P\nThe site of the flare area (fig. 6A\n) was traced onto a transparent plastic sheet 10 min after capsaicin injection, followed by the determination of the area of secondary hyperalgesia by pinprick (fig. 6B\n). Again, no significant differences between cannabis and placebo were found in the two areas.\nThe cannabis extract used in the current study predominantly contained THC and CBD (2:1) at defined concentrations, together with a mixture of various other cannabinoid compounds that constituted less than 5% of the total cannabinoid content. In the past, the major constituent THC has been extensively shown to produce analgesic, antihyperalgesic, and antiinflammatory effects in animal experiments.\nIn our study, however, orally administered cannabis extract did not produce any significant analgesic or antihyperalgesic effects in two well-established acute human pain models, i.e., sunburn and intradermal capsaicin. Within the sunburn erythema, but also in the surrounding area of secondary hyperalgesia and in the healthy skin of the contralateral leg, the heat and electrical pain thresholds were unaltered or even reduced after cannabis extract. In the area of primary hyperalgesia within the sunburn erythema, EPPT and EPTT at 250 Hz were significantly lower, indicating the induction of an unexpected hyperalgesic state in the cannabis group.\nAlthough in our experiments the respective pain thresholds were determined in pathologically sensitized skin, our results are remarkably consistent with the observations of a previous study by Naef et al.\nwho found unaltered or decreased pain thresholds in normal skin of cannabis-experienced subjects after 20 mg oral THC. Using pressure, an ice-cold immersion test, and also heat and electrical stimulation in normal skin, their experiments substantially differed from our experimental setting but nevertheless produced similar results. Also, clinical trials with different oral cannabinoid preparations for postoperative acute pain management did not unequivocally support cannabinoid efficacy. In one study, nabilone (Cesamet®; Valeant Pharmaceuticals International, Aliso Viejo, CA), a synthetic THC analog, increased postoperative morphine consumption and pain, most likely reflecting a cannabinoid-induced hyperalgesic state.28\nInterestingly, increased pain was found in those patients receiving the highest dose of nabilone, indicating that higher doses may have a pronociceptive activity. In another study, no analgesic effect on postoperative pain after abdominal hysterectomy could be seen with a low oral dose of 5 mg THC. Because in that study no cannabinoid-specific side effects were observed and no plasma levels were determined, an insufficient gastrointestinal absorption of THC could not be ruled out.9\nFinally, although Holdcroft et al.10\ndescribed some dose-dependent analgesic effects in postoperative pain using the same THC-standardized cannabis extract as in our study, only moderate analgesia could be achieved by oral administration of 10 mg THC plus 5 mg CBD. The higher doses of 15 mg THC plus 7.5 mg CBD were more effective but produced severe side effects and were therefore considered inappropriate. From these previous clinical data, the lack of an analgesic action in our experiments with 20 mg THC plus 10 mg CBD cannot be considered the result of inadequate analgesic dosage or insufficient gastrointestinal absorption. Moreover, the high levels of THC and its metabolites detected in the plasma of our probands and the occurrence of psychotropic side effects, although moderate and completely reversible by the end of the 8-h observation period, also argue for a sufficient bioavailability.\nIn our study, however, besides frequently observed side effects, such as sedation, nausea, and vertigo, only one subject of the 18 cannabis-naive volunteers (6%) experienced a transient psychotic episode. This low rate of psychotic symptoms was most likely due to the thoroughly performed psychiatric prescreening. Other authors reported severe psychotic episodes after 20 mg oral THC in up to 25% of cannabis-experienced subjects, but—in contrast to our study—no previous psychiatric screening was performed to exclude individuals at risk.29\nAlthough the occurrence of acute transient psychosis can never be completely ruled out, the different incidences in the former and in our study strongly suggest a mandatory psychiatric preevaluation for future trials with single high-dose administration of THC or cannabis extract.\nIn contrast to oral cannabinoids, smoked whole plant cannabis exerted analgesic effects not only in clinical studies on chronic pain,14\nbut also on acute pain.13,14,30\nOne possible explanation for this apparent discrepancy could be the well-known pharmacokinetic differences of smoked versus\noral cannabis, because inhaled cannabinoids do not undergo initial first-pass metabolism in the liver and quickly reach high concentrations at their target sites in the nervous system. In a recent study by Wallace et al.\nan analgesic effect of smoked cannabis on capsaicin-evoked spontaneous pain was reported, demonstrating a complex and not-well-understood dose dependence. In this study, analgesia was delayed, occurring 55 min but not 5 min after inhalation of a medium THC dose, but surprisingly, the highest THC dose caused hyperalgesia, which was somehow similar to our results. With respect to bioavailability, the hyperalgesia-producing high dose of smoked cannabis induced some threefold-higher and the analgesia-inducing medium dose induced twofold-higher mean plasma levels of THC compared with the mean peak levels reached after oral administration in our study. The lack of analgesic action in our experiments could be due to the lower THC peak levels and the slow increase in plasma and tissue concentration resulting from gastrointestinal absorption and first-pass effect, as clearly demonstrated by the individual as well as the mean plasma levels of THC, CBD, and the two major metabolites found in our study at the time of pain measurements. However, the mean levels of the first active metabolite, THC-11-OH, which is three times more potent than THC,31,32\nwere three to four times lower after smoking compared with the concentrations measured in our trial. Hence, the high levels of THC-11-OH might have been responsible for the lack of analgesia and some hyperalgesic effects in our subjects by the same way as it has been suggested for the high THC levels measured in the inhalational study by Wallace et al.13\nHowever, in contrast to the report with smoked cannabis, we could not see any correlation between analgesic or hyperalgesic effects and THC, CBD, or metabolite levels at the time when pain measurements were performed. This argues against a simple pharmacokinetic explanation for the discrepant results of the two studies.\nComparing the two study designs, an effective blinding in a crossover study must be questioned, when cannabis or placebo cigarettes were smoked by cannabis-experienced individuals, who must have fulfilled the inclusion criterion of cannabis consumption within the past 6 months and were again intentionally exposed to high-dose cannabis just before the study experiments. Given the known fast psychotropic effects of cannabis smoking, any attempt at blinding experienced cannabis users in a crossover trial and exposing them to placebo versus\nlow-, medium-, or high-dose THC-containing cigarettes seems impossible, in particular when testing was performed 5 or even 55 min after smoking. Therefore, a major impact on the results from Wallace et al.13\nby possibly biased expectations of the probands cannot be ruled out, because the analgesic effects seen in such studies might have been influenced by the unintended but inevitable unblinding of the subjects, in particular when every proband underwent high-dose cannabis exposure before the series of experiments.\nWith respect to the typical THC-mediated psychotropic actions caused by cannabis and cannabis extracts, 5 mg diazepam was used in our study as an “active placebo” to prevent the potential unblinding of the probands in a crossover design. Diazepam has no clinically relevant analgesic effect33\nbut may give a cannabis-naive individual the impression of an active psychotropic drug. Therefore, the use of diazepam as an active placebo is unlikely to have negatively influenced the results of our study. As revealed by self assessment of our cannabis-naive probands, blinding was effective in our experimental setting.\nThe analgesic effects of smoked cannabis reported by Abrams et al. 14\nfor heat- and capsaicin-evoked dermal hyperalgesia cannot be compared directly with our experimental results, because all individuals tested in that study already had chronic human immunodeficiency virus–associated neuropathy. Therefore, although similar acute noxious stimuli have been used, the cannabis effects are not at all comparable with data obtained in healthy subjects of our study or the studies of Naef et al.11\nand Wallace et al.13\nOnly clinical trials in chronic pain patients have been published to date with the sublingual application of a THC/CBD-containing spray (Sativex®; GW Pharmaceuticals, Salisbury, United Kingdom), which produces pharmacokinetic and metabolic profiles more similar to those of smoking. As mentioned previously, these results from patients with multiple sclerosis,18,34,35\nchronic inflammatory pain,36\nand neuropathic pain37\ncannot be directly compared with our data obtained from an experimental human model of acute pain or with clinical acute pain conditions such as postoperative pain.\nBased on our data and those from other studies on acute pain, the analgesic efficacy of oral THC-standardized cannabinoids seems to be considerably lower in humans than in animals. This discrepancy could be, at least partially, due to species differences, because endocannabinoid levels in rodents were reported to be four times lower than in humans, suggesting a lower sensitivity to endogenous and exogenous cannabinoid compounds in the latter. Moreover, because data from animal pain models are mostly based on observations of behavioral changes,38,39\nand because cannabinoid doses sufficient to produce relevant antinociception in rodents are similar to those inducing other behavioral effects, such as hypomotility and catatonia,40,41\nit may be difficult to clearly separate these effects from each other. Although there is no doubt that animal experiments are important and helpful tools for studying mechanisms of acute and chronic pain, their predictive value for human conditions of pain and hyperalgesia remains limited.42\nIn conclusion, a surprising result of our study is the absence of any kind of analgesic activity of THC-standardized cannabis extract on experimentally induced pain and hyperalgesia using two different, well-established human models of acute pain caused by peripheral and central nociceptive mechanisms. In striking accordance with previous data from other experimental settings,11,13,28\nour results also seem to support the impression that high doses of cannabinoids may even cause hyperalgesia in certain acute pain conditions.\nBut even if cannabinoids might have some analgesic effects at certain dosage and under special circumstances,10,13\ntheir general use for acute pain management is limited by the apparent and not-well-understood existence of a small therapeutic window, and by the dose-dependent occurrence of mainly psychotropic side effects. With respect to the broad variety of available effective and evidence-based medicine–proven analgesics such as nonsteroidal antiinflammatory drugs or opioids, our results do not suggest the use of cannabinoids as appropriate analgesics for the treatment of acute nociceptive pain in humans. From our data, however, no final conclusion can be drawn about their potential therapeutic efficacy in certain chronic pain conditions. The respective mechanisms underlying the whole variety of chronic pain syndromes may considerably differ from acute nociception. The chronicity of pain has been shown not only to lead to multiple changes in peripheral and central neuronal processing,43,44\nbut also to be associated with complex psychosocial phenomena, physical disorders, and functional disabilities. Recent clinical trials have indicated that oral and sublingual cannabinoids can be effective coanalgesics in chronic pain patients, improving not only pain intensity, but also coping behavior and quality of life.18,34–37,45,46\nTherefore, future clinical studies in chronic pain patients are required to define the actual role of cannabinoids in chronic pain management, whereas our results further argue against a relevant antinociceptive and/or antihyperalgesic effect of clinical doses of oral THC or standardized cannabis extract in acute nociceptive inflammatory pain or hyperalgesia.\n1. 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Nelder JA, Weddenburn RW: Generalized linear models. J R Statist Soc A 1972; 135:370–84\n27. Wolfinger R, Chang M: Comparing the SAS GLM and MIXED Procedures for Repeated Measures. Cary, North Carolina, SAS Institute, 1996\n28. Beaulieu P: Effects of Nabilone, a synthetic cannabinoid on postoperative pain. Can J Anaesth 2006; 53:769–75\n29. Favrat B, Menetrey A, Augsburger M, Rothuizen LF, Appenzeller M, Buclin T, Pin M, Mangin P, Giroud C: Two cases of “cannabis acute psychosis” following the administration of oral cannabis. BMC Psychiatry 2005; 5:17\n30. Greenwald MK, Stitzer ML: Antinociceptive, subjective and behavioural effects of smoked marijuana in humans. Drug Alcohol Depend 2000; 59:261–75\n31. Razdan RK: Structure-activity relationship in cannabinoids. Pharmacol Rev 1986; 38:75–149\n32. Grotenhermen F: Pharmacology of cannabinoids. Neuro Endocrinol Lett 2004; 25:14–23\n33. Chapman CR, Feather BW: Effects of diazepam on human pain tolerance and pain sensitivity. Psychosom Med 1973; 35:330–40\n34. Rog D, Young CA: Randomised controlled trial of cannabis-based medicinal extracts in the treatment of neuropathic pain due to multiple sclerosis. Neurology 2005; 65:812–9\n35. Wade DT, Makela PM, House H, Bateman C, Robson P: Long-term use of a cannabis-based medicine in the treatment of spasticity and other symptoms in multiple sclerosis. Mult Scler 2006; 12:639–45\n36. Blake DR, Robson P, Ho M, Jubb RW, McCabe CS: Preliminary assessment of the efficacy, tolerability and safety of a cannabis-based medicine (Sativex) in the treatment of pain caused by rheumatoid arthritis. Rheumatology 2006; 45:50–2\n37. Berman JS, Symonds C, Birch R: Efficacy of two cannabis based medicinal extracts for relief of central neuropathic pain from brachial plexus avulsion: Results of a randomised controlled trial. Pain 1998; 112:299–306\n38. Hogan Q, Sapunar D, Modric-Jednacak K, Mc Callum JP: Detection of neuropathic pain in a rat model of peripheral nerve injury. Anesthesiology 2004; 101:476–87\n39. Eaton M: Common animal models for spasticity and pain. J Rehab Res Dev 2003; 40:41–54\n40. Scott DA, Wright CE, Angus JA: Evidence that CB-1 and CB-2 cannabinoid receptors mediate antinociception in neuropathic pain in the rat. Pain 2004; 109:124–31\n41. Herzberg U, Eliav E, Bennett GJ, Kopin IJ: The analgesic effects of R(+)-WIN 55,212-2 mesylate, a high affinity cannabinoid agonist, in a rat model of neuropathic pain. Neurosci Lett 1997; 221:157–60\n42. Seltzer Z: The relevance of animal neuropathy models for chronic pain in humans. Semin Neurosci 1995; 7:211–9\n43. Flor H: Cortical reorganisation and chronic pain: Implications for rehabilitation. J Rehabil Med 2003; 41:66–72\n44. Flor H: The functional organization of the brain in chronic pain. Prog Brain Res 2000; 129:313–22\n45. Svendsen KB, Jensen TS, Bach FW: Does the cannabinoid dronabinol reduce central pain in multiple sclerosis? BMJ 2004; 329:257–8\n46. Karst M, Salim K, Burstein S, Konrad I, Hoy L, Schneider U: Analgesic effect of the synthetic cannabinoid CT-3 on chronic neuropathic pain: A randomized controlled trial. JAMA 2003; 290:1757–62\nThis article has been cited 13 time(s).\nNeuropsychopharmacologyComparison of the Analgesic Effects of Dronabinol and Smoked Marijuana in Daily Marijuana SmokersNeuropsychopharmacology\nClinical and Experimental Pharmacology and PhysiologyEvaluation of the analgesic efficacy and psychoactive effects of AZD1940, a novel peripherally acting cannabinoid agonist, in human capsaicin-induced pain and hyperalgesiaClinical and Experimental Pharmacology and Physiology\nExpert Opinion on Investigational DrugsCannabinoids against pain. Efficacy and strategies to reduce psychoactivity: a clinical perspectiveExpert Opinion on Investigational Drugs\nScience SignalingEndocannabinoids Can Open the Pain GateScience Signaling\nExpert Opinion on Drug DiscoveryNew frontiers in assessing pain and analgesia in laboratory animalsExpert Opinion on Drug Discovery\nPainGenuine antihyperalgesia by systemic diazepam revealed by experiments in GABA(A) receptor point-mutated micePain\nExpert Opinion on PharmacotherapyExamining the roles of cannabinoids in pain and other therapeutic indications: a reviewExpert Opinion on Pharmacotherapy\nBritish Journal of PharmacologyEmerging strategies for exploiting cannabinoid receptor agonists as medicinesBritish Journal of Pharmacology\nPharmacopsychiatryAcute Psychotropic Effects of Oral Cannabis Extract with a Defined Content of Delta(9)-Tetrahydrocannabinol (THC) in Healthy VolunteersPharmacopsychiatry\nBritish Journal of PharmacologyClinical pharmacology of analgesics assessed with human experimental pain models: bridging basic and clinical researchBritish Journal of Pharmacology\nPlos OneEvaluation of Anti-Hyperalgesic and Analgesic Effects of Two Benzodiazepines in Human Experimental Pain: A Randomized Placebo-Controlled StudyPlos One\nPainAmygdala activity contributes to the dissociative effect of cannabis on pain perceptionPain\nBrain Behavior and ImmunityLow-dose endotoxin potentiates capsaicin-induced pain in man: Evidence for a pain neuroimmune connectionBrain Behavior and Immunity\n© 2008 American Society of Anesthesiologists, Inc.\nPublication of an advertisement in Anesthesiology Online does not constitute endorsement by the American Society of Anesthesiologists, Inc. or Lippincott Williams & Wilkins, Inc. of the product or service being advertised.
Having unnecessary fat in various areas of your body can have a considerable impact on your health and self-esteem. While conventional weight reduction through workout and diet is a terrific method to drop weight overall, even the best exercises cannot target issue areas like the stomach, inner thighs, arms, and buttocks. Liposuction is a time tested treatment that is used to eliminate excess fat from specific locations of the body, permitting a specific to form and contour their body to their liking. Is liposuction right for you? Learn now.\nPros of Liposuction\nThere are many benefits to this cosmetic treatment, including:\n• Immediately obvious changes. Unlike conventional weight-loss, liposuction produces modifications that are instantly visible in the body. Some distinction is visible right away, and the wanted results are generally accomplished in simply a few days.\n• Proven and safe. This cosmetic treatment has been performed by experienced cosmetic surgeons all over the world for many years and the method has been refined over and again to be safe and reliable.\n• Healing time is generally quickly. The downtime needed after having this kind of procedure is normally much less than exactly what is needed for other types of cosmetic treatments, consisting of abdominoplasty, breast reduction, and more. People who have had the procedure can often go back to work far more quickly than they expected and can get back to living a healthy, active lifestyle.\n• Weight loss can be long-term. With the best maintenance techniques, the fat that was eliminated throughout the liposuction procedure will not return.\n• Complete control over your physique. With liposuction, a person can have complete control over how they want to look, beyond exactly what conventional diet plan and workout can provide. Offering people this power over their bodies enhances self-esteem and aid people feel their best.\nWhile there countless advantages to liposuction, there are of course a couple of caveats that need to be taken into consideration prior to making the final decision to move forward with the treatment.\nCons of Liposuction\nPrior to having liposuction done, it is essential to analyze the prospective downsides of the treatment and figure out if the advantages surpass the threats in your specific case. Your surgeon can assist you learn more about the dangers connected with the procedure and can assist you choose if moving on is the ideal 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 dangers as other type of surgery where basic anesthesia is used. Hidden medical conditions may increase these threats.\n• Unfavorable responses. Bruising, bleeding, and discomfort are all to be expected, nevertheless, in rare cases can cause more substantial problems.\n• The prospective to acquire the weight back. After having actually liposuction done, it is important to maintain a healthy diet plan and workout correctly as suggested by your doctor. Failure to do so might lead to acquiring back the weight that was lost or potentially a lot more.\nAlthough there are dangers connected with liposuction, for lots of people, the benefits far outweigh them. Educate yourself about the procedure by having extensive conversations with your specialist and consider how liposuction has the possible to impact you as an unique person. Just you and your cosmetic surgeon can determine if liposuction will offer 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 Danevang Texas\nLaser liposuction is a more recent, minimally invasive procedure that involves heating the fat cells to melting point and removing the melted fat through a little cannula. The procedure is usually done right in your doctor's office and is an outstanding choice for individuals who have less than 500 ml of fat to eliminate from any one area. Laser liposuction can be a safe, complementary treatment to weight loss in order to shape the body you have actually constantly desired.Contact a Specialist in your Danevang Texas today.\nIf you're thinking about liposuction as a weight loss option, it is necessary that you discuss your desires with a certified plastic surgeon in your location. Your surgeon will perform a total exam and health history questionnaire to determine if liposuction can benefit you and help you reach your physical and emotional objectives. Call today for an examination and learn more about how liposuction can help you accomplish the body of your dreams.
Science Editor Wang XL and Guo SY Language Editor Elsevier HK\nPublished online Jul 7, 2005. doi: 10.3748/wjg.v11.i25.3920\nRevised: November 20, 2004\nAccepted: November 24, 2004\nPublished online: July 7, 2005\nAIM: To investigate the protective effect of isoflurane on energy balance in isolated hepatocytes during in vitro anoxia/reoxygenation, and to compare isoflurane with halothane.\nMETHODS: Hepatocytes freshly isolated from fed rats were suspended in Krebs-Henseleit buffer, and incubated in sealed flasks under O2/CO2 or N2/CO2 (95%/5%, V/V) for 30 or 60 min, followed by 5 or 10 min of reoxygenation, with an added volatile anesthetic or not. ATP, ADP, and adenosine monophosphate in hepatocytes were determined by high performance liquid chromatography, and energy charge was calculated.\nRESULTS: During 30 min of anoxia, the energy charge and total adenine nucleotide steadily increased with the isoflurane dose from 0 to 2 minimum alveolar anesthetic concentration (MAC), then decreased from 2 to 3 MAC. In short incubations (30-35 min) at 1 MAC isoflurane, energy charge modestly decreased during anoxia, which was partially prevented by isoflurane and completely reversed by reoxygenation, and total adenine nucleotide did not decrease. In long incubations (60-70 min), both energy charge and total adenine nucleotide greatly decreased during anoxia, with partial and no reversal by reoxygenation, respectively. Isoflurane partly prevented decreases in both energy charge and total adenine nucleotide during anoxia and reoxygenation. In addition, 1 MAC isoflurane obviously increased ATP/ADP, which could not be changed by 1 MAC halothane.\nCONCLUSION: Isoflurane partially protects isolated hepatocytes against decreases in both energy charge and total adenine nucleotide during short (reversible) or long (irreversible) anoxia.\nCitation: Li Q, Yu WF, Zhou MT, Lu X, Yang LQ, Zhu M, Song JG, Lu JH. Isoflurane preserves energy balance in isolated hepatocytes during\nin vitroanoxia/reoxygenation. World J Gastroenterol 2005; 11(25): 3920-3924\n- URL: https://www.wjgnet.com/1007-9327/full/v11/i25/3920.htm\n- DOI: https://dx.doi.org/10.3748/wjg.v11.i25.3920\nHepatic anoxia, alone or as a component of ischemia, is an ever-present concern during abdominal surgery, because associated inhibition of energy supply threatens liver cell function and viability[1,2]. Evidence is mounting that the inability of the liver to maintain or regain energy balance during and after surgery is one of the strongest predictors of liver damage and adverse outcome[3,4]. Also, release from injured tissue of metabolites, such as adenosine, with cardiovascular effects may further compromise the anesthetic management of seriously ill or injured patients. Thus, surgeons and anesthesiologists need to be aware of, and to use, whatever measures are available to preserve energy balance in tissues.\nThe sum of ATP splitting by many concurrent energy-requiring reactions is called “ATP demand.” ATP supply occurs mainly via mitochondrial oxidative phosphorylation, which is absolutely dependent on O2. Under normal conditions, ATP supply easily keeps pace with ATP demand, and adenine nucleotide (high-energy phosphate) exists mainly in the form of ATP, along with relatively small amounts of ADP and adenosine monophosphate (AMP). However, when ATP supply is inhibited by lack of oxygen, ATP demand predo-minates, ADP and AMP then accumulate at the expense of ATP, and eventually adenosine and other non-nucleotide metabolites appear. Thus, shifts in the balance between ATP supply and demand can be assessed by measuring changes in the absolute and relative levels of ATP and its metabolites. A more complete and accurate expression is energy charge. Energy charge = (ATP+1/2ADP)/(ATP+ADP+AMP).\nHepatocytes were isolated from adult male Sprague-Dawley rats (250-300 g) having free access to food and water. Livers were perfused in situ by using Ca2+-free Krebs-Henseleit buffer (pH 7.4) supplemented with 20 mmol/L 4-(2-hydroxyethyl)-1-piperazineethanesulfonic acid, maintained at 37°C and equilibrated with O2/CO2 (95/5). Perfusion was continued for 10 min with buffer alone, then for another 12-14 min with added collagenase (Type I, Sigma Chemical Co., St. Louis, MO). The softened liver was transferred to a plastic weighing dish containing 25 mL Krebs+2% dissolved bovine serum albumin, teased apart with a spatula and chopped finely with sharp scissors. After further dilution to 100 mL with Krebs+2% dissolved bovine serum albumin, the cell slurry was washed into a 500-mL Erlenmeyer flask, gently swirled under a flowing O2/CO2 (95%/5% V/V) atmosphere at 37°C for 15 min, then filtered through nylon mesh. Each 12 mL of crude cell suspension was mixed with 28 mL Percoll (Pharmacia, Sweden, obtained from Sigma) and centrifuged at 10 000 g for 10 min. The layer of intact, purified hepatocytes at the bottom of the gradient was rinsed free of Percoll by suspension in Krebs and centrifugation for 2 min at 50 r/min. The final pellet contained a total of 2-4 × 108 cells that were 90-95% viable by dye exclusion. Cells were stored for 2 h on ice before use without loss of viability.\nIn 25-mL round-bottomed flasks, 12.5 million cells were suspended in a total volume of 2.5 mL Krebs+2% dissolved bovine serum albumin (pH 7.4). Flasks were sealed with rubber caps through which 14-gauge needles were inserted for in- and out-flow of gas mixture. After 10 min preincubation under O2/CO2, regassing and experimental incubations were carried out as follows: O2/CO2 for 35 or 70 min (= oxygenated), N2/CO2 for 30 or 60 min (= anoxic), or N2/CO2 for 30 or 60 min followed by O2/CO2 for 5 or 10 min, respectively (= reoxygenated). All incubations were performed by swirling the flasks in a water bath at 37°C. When needed, anesthetics were added at the desired concentrations to the gas mixture used for gassing the flasks by means of a copper kettle vaporizer. Gas chromatography measurements established that anesthetic concentrations in liquid phase reached a constant value within 5-10 min. (The absolute concentrations in the liquid phase varied with anesthetic dose and cell concentration.) Incubations were terminated by injecting 0.5 mL 2 mol/L perchloric acid forcefully into the suspension to arrest enzyme-catalyzed reactions. After removal of preci-pitated membranes and protein by centrifugation, the clear supernatant containing extracted adenine nucleotides and other metabolites was neutralized with 2 mol/L potassium hydroxide and cooled on ice to precipitate excess potassium perchlorate. The supernatant was decanted and stored at-20°C before metabolite measurements.\nATP, ADP, and AMP were analyzed by high performance liquid chromatography (LDC Analytical, Riviera Beach, FL, USA) using a CM4000 pump interfaced with a SM5000 detector. The separation was accomplished on a C18 reversed phase column. Elution with a binary gradient was carried out at a flow rate of 1.0 mL/min. Mobile phase A consisted of 30 mmol/L potassium phosphate as buffer (pH 6.0) and 8 mmol/L tetrabutylammonium hydrogen sulfate as ion-pairing reagent. Mobile phase B was identical except that it contained 500 mL/L methanol. Recovery of ATP, ADP, and AMP routinely exceeded 90-95%, as estimated from the concentration of caffeine added as an internal standard.\nData were presented as mean±SD. One- or two-way analysis of variance with replications and Scheffe’s or paired t-tests were used for statistical analysis. P < 0.05 was considered statistically significant.\nFigure 1A shows the effect of isoflurane dose on adenine nucleotide levels in isolated hepatocytes after exposure to anoxia for 30 min. ATP levels increased and AMP levels decreased from their respective control values as isoflurane increased from 0 to 2 minimum alveolar anesthetic concentration (MAC, 0-3% concentration), with a slight reversal from 2 to 3 MAC (3-5% concentration). Total adenine nucleotide increased to a lesser degree with isoflurane dose and was significantly higher than baseline only at 2 MAC. Values of ADP did not change significantly from baseline at any dose of isoflurane. Values of energy charge (not shown) paralleled to those of ATP.\nFigure 1B shows data obtained from incubations performed for 30-35 min. In cells incubated under O2 for 35 min, amounts of ATP were maximal and balanced by relatively small amounts of ADP and AMP. Isoflurane slightly decreased ATP while increasing ADP and AMP. Although changes in individual nucleotide concentrations were not statistically significant, they combined to produce a significant decrease in energy charge.\nIn cells anoxic for 30 min (under N2 rather than O2), ATP substantially decreased and ADP and AMP increased compared to oxygenated cells. The associated decrease in energy charge confirmed that anoxia shifted energy balance toward a much lower degree of phosphorylation in the adenine nucleotide pool. When isoflurane was present during anoxia, ATP remained significantly higher and AMP lower than in anoxic cells without isoflurane. These two effects of isoflurane combined to maintain a proportionately higher value of energy charge.\nCells exposed to 30 min of anoxia followed by 5 min of reoxygenation showed values of all three adenine nucleotides and energy charge that were not significantly different from those of cells exposed to O2 continuously for 30 min. Furthermore, no difference in any of these variables was seen for +isoflurane compared to -isoflurane.\nFigure 1C shows results obtained from a second set of cell preparations subjected to incubations for 60-70 min. In cells incubated under O2 alone for 70 min, absolute and relative amounts of ATP, ADP, and AMP were not significantly different from those incubated for 30 min. The changes produced by inclusion of isoflurane along with O2 decreased ATP, increased ADP and AMP, and a statis-tically significant decrease in energy charge were only slightly (and not significantly) larger than in cells incubated for 35 min.\nIn cells that were anoxic (exposed to N2) for 60 min, values of ATP, ADP, AMP, total adenine nucleotide, and energy charge were all significantly lower than in cells exposed anoxia for 30 min. The effects of including isoflurane during anoxia were also generally more pronounced in cells exposed to anoxia for 60 min: compared to values in the absence of isoflurane, ATP was more than double and energy charge almost double, ADP and total adenine nucleotide were significantly higher while AMP was not significantly lower.\nReoxygenated cells incubated for longer periods (N2 for 60 min, O2 for 10 min) differed greatly from cells subjected to shorter incubations (N2 30 min, O2 5 min), whereas values of ADP and AMP were not much different from those of oxygenated cells. Energy charge, ATP and total adenine nucleotide were drastically decreased. Another difference between longer and shorter incubations of reoxygenated cells was that in the longer ones, isoflurane-related differences in energy status persisted into the reoxygenation period; increases in ATP, ADP, and total adenine nucleotide during anoxia were maintained during reoxygenation.\nTable 1 shows the data from a separate experiment carried out solely to compare isoflurane and halothane at approximately 1 MAC for their ability to alter energy status in isolated hepatocytes during 30-min exposure to anoxia. ATP/ADP was again higher with 1 MAC isoflurane present than in paired control incubation (isoflurane absent) using cells from the same preparation. With 1 MAC halothane, no difference at all in ATP/ADP during anoxia was seen, each incubated in the presence and absence of that agent.\n\|Non- anesthetics Group\|\|5.3 ± 0.6\|\|0.7 ± 0.1\|\|7.4 ± 1.1\|\|1.1 ± 0.3\|\n\|Anesthetics Group\|\|4.8 ± 0.5\|\|1.2 ± 0.1a\|\|7.3 ± 1.5\|\|1.2 ± 0.2\|\nIntact isolated hepatocytes embody a physiologic balance of the reactions involved in ATP supply and demand in a form that permits uniform control and ready measurement of biochemical variables. We have studied these cells extensively under simulated intra-operative conditions to predict energetic responses at the tissue and organ level.\nThe data in Figure 1B show that the energy-protective effect of isoflurane in anoxic hepatocytes varied in a systematic way with isoflurane dose. There was a graded dose-response relationship from 0 to 2 MAC, with a slight reversal of protection at 3 MAC. It seems that, at least in isolated cells, the energy-protective effect of isoflurane is optimal in the dose range used for clinical anesthesia. The basis for the response “ceiling” at 2 MAC awaits an understanding of the biochemical basis of the protective effect. An important question still to be addressed in this line of investigation is the extent to which the protective effect is associated with the anesthetic state. Is this effect limited to isoflurane or to other halogenated or volatile agents? Does ED50 for the protective effect correlate with MAC?\nIn the shorter incubation (30-35 min) that examined varying oxygenation status, 1 MAC isoflurane tended to decrease ATP and increase ADP and AMP in cells exposed to oxygen, presumably because isoflurane inhibits mitochondrial recycling of ADP to ATP via oxidative phosphorylation[6,7]. An opposite and larger effect of isoflurane on energy status was found in anoxic cells: superimposed on the great decrease in ATP and energy charge produced by anoxia, the effect of isoflurane was to enhance energy balance rather than to further impair it. In reoxygenated cells, there were neither protective nor detrimental effects of isoflurane on energy balance; and isoflurane produced no effect at all on any of the measured variables of energy status. The similarity between reoxygenated and continuously oxygenated cells indicates that exposure to 30-min anoxia with or without isoflurane has no irreversible effect on the energy status of hepatocytes.\nThe longer incubation (60-70 min) produced physiologically significant and/or irreversible effects of anoxia on cellular energy status. As in the 35-min incubation, data from cells oxygenated for 70 min showed that non-anoxic injury might have occurred during that period of incubation. The similarities in ATP, ADP, AMP, and total adenine nucleotide values suggest that the longer period of incubation is well tolerated, because damaged cells rapidly lose adenine nucleotides. The effects of anoxia on adenine nucleotide content and energy balance were considerably greater after 60-min exposure to anoxia than after 30-min exposure to anoxia. In anoxic cells after 60-min exposure to anoxia, there was a great decrease in total adenine nucleotide compared to oxygenated cells (vs none at 30 min), the decrease in energy charge was also greater after 60-min exposure to anoxia than after 30-min exposure to anoxia. In reoxygenated cells, none of the effects of 60-min exposure to anoxia were reversed, in contrast to all of the effects of 30-min exposure to anoxia. The importance of total adenine nucleotide in limiting the levels of ATP, ADP, and AMP during brief recovery from anoxia was shown clearly by the almost identically lowered values of total adenine nucleotide in corresponding anoxic and reoxygenated cells after 70-min exposure to anoxia. Also, in contrast to the shorter incubation, in the longer incubation the protective effect of isoflurane was observed during anoxia-increased energy charge and total adenine nucleotide was persistent through the reoxygenation period.\nAs mentioned earlier, the measured values of ATP, ADP, and AMP concentrations and the calculated values of total adenine nucleotide and energy charge in isolated hepatocytes are sensitive indicators of changes in the dynamic balance of ATP supply and demand. The anesthetic effects reported here may well be due to the direct action of the drug on one or more of the intracellular reactions involved in producing or consuming ATP[8-10]. The results of other studies suggested that the protective effect of isoflurane may be due to “decreased metabolism” and, more precisely, due to inhibition of ATP demand[11-13]. The conclusion holds also for the findings of the present study. Previous studies showed that isoflurane causes a dose-related decrease in O2 consumption in isolated hepatocytes. However, it would be erroneous to conclude that this decrease in O2 consumption reflects primary inhibition of ATP demand (with secondary inhibition of mitochondrial oxidative phosphorylation via respiratory control), because volatile anesthetics are also able to inhibit oxidative phosphorylation directly[15,16]. In fact, inhibition of ATP demand in intact cells can be ascertained only by direct measurement of ATP consumption.\nTwo possible mechanisms may be mentioned by which decreased AMP formation can maintain ATP levels. An anoxia-induced increase in AMP promotes its degradation to adenosine and other non-nucleotide metabolites. The latter step seems to be a physiologic “point of no return”, because ATP is not easily resynthesized from its non-nucleotide metabolites when oxygen and ATP supply are restored. Thus, a decrease in AMP formation would decrease the rate of ensuing AMP degradation and loss of total adenine nucleotide. Also, a decrease in AMP formation from ADP via inhibition of adenylate kinase can preserve the availability of ADP for conversion back to ATP via glycolysis.\nThe present study demonstrates that 1 MAC isoflurane actually helps to preserve liver cell energy balance during anoxia (whereas 1 MAC halothane has no such effect). The demonstration of this protective effect might be crucially dependent on the specific experimental conditions used in this study. Relatively short periods of anoxic exposure may prevent enzymes that catalyze ATP-consuming reactions from being degraded to the extent that inhibition of their activity by isoflurane could not be detected. Also, the use of anoxia (0% O2) rather than hypoxia may eliminate vestiges of mitochondrial ATP formation, anesthetic inhibition of which may decrease ATP/ADP and thus opposing or even canceling ATP/ADP increases resulting from anesthetic inhibition of ATP consumption[18,19].\nFor optimal anesthetic and surgical care, we need to know as much as possible about the effects and actions of the drugs we use, especially with regard to a process as essential as energy balance. The work described here has documented certain effects of isoflurane on ATP supply and demand at the cellular level and laid the groundwork for explaining them in terms of actions on specific biochemical reactions that produce and consume ATP. In addition to further elucidate such basic mechanisms, we also need to examine the consequence of these cellular effects in physiologic and clinical terms, by using more intact systems and measures of outcome.\n\|1.\|\|Vagts DA, Iber T, Puccini M, Szabo B, Haberstroh J, Villinger F, Geiger K, Nöldge-Schomburg GF. The effects of thoracic epidural anesthesia on hepatic perfusion and oxygenation in healthy pigs during general anesthesia and surgical stress. Anesth Analg. 2003;97:1824-1832. [PubMed] [DOI]\|\n\|2.\|\|Ishida H, Kadota Y, Sameshima T, Nishiyama A, Oda T, Kanmura Y. Comparison between sevoflurane and isoflurane anesthesia in pig hepatic ischemia-reperfusion injury. J Anesth. 2002;16:44-50. [PubMed] [DOI]\|\n\|3.\|\|Net M, Valero R, Almenara R, Deulofeu R, López-Boado MA, Capdevila L, Barros P, Bombí JA, Agustí M, Adalia R. Hepatic preconditioning after prolonged warm ischemia by means of S-adenosyl-L-methionine administration in pig liver transplantation from non-heart-beating donors. Transplantation. 2003;75:1970-1977. [PubMed] [DOI]\|\n\|4.\|\|Diskin MG, Mackey DR, Roche JF, Sreenan JM. Effects of nutrition and metabolic status on circulating hormones and ovarian follicle development in cattle. Anim Reprod Sci. 2003;78:345-370. [PubMed] [DOI]\|\n\|5.\|\|Liu XL, Li LJ, Chen Z. Isolation and primary culture of rat hepatocytes. Hepatobiliary Pancreat Dis Int. 2002;1:77-79. [PubMed]\|\n\|6.\|\|da-Silva WS, Gómez-Puyou A, de Gómez-Puyou MT, Moreno-Sanchez R, De Felice FG, de Meis L, Oliveira MF, Galina A. Mitochondrial bound hexokinase activity as a preventive antioxidant defense: steady-state ADP formation as a regulatory mechanism of membrane potential and reactive oxygen species generation in mitochondria. J Biol Chem. 2004;279:39846-39855. [PubMed] [DOI]\|\n\|7.\|\|Ason B, Handayani R, Williams CR, Bertram JG, Hingorani MM, O'Donnell M, Goodman MF, Bloom LB. Mechanism of loading the Escherichia coli DNA polymerase III beta sliding clamp on DNA. Bona fide primer/templates preferentially trigger the gamma complex to hydrolyze ATP and load the clamp. J Biol Chem. 2003;278:10033-10040. [PubMed] [DOI]\|\n\|8.\|\|Leal NA, Olteanu H, Banerjee R, Bobik TA. Human ATP: Cob(I)alamin adenosyltransferase and its interaction with methionine synthase reductase. J Biol Chem. 2004;279:47536-47542. [PubMed]\|\n\|9.\|\|Halestrap AP. Mitochondrial permeability: dual role for the ADP/ATP translocator? Nature. 2004;430:1 p following 983. [PubMed] [DOI]\|\n\|10.\|\|Kokoszka JE, Waymire KG, Levy SE, Sligh JE, Cai J, Jones DP, MacGregor GR, Wallace DC. The ADP/ATP translocator is not essential for the mitochondrial permeability transition pore. Nature. 2004;427:461-465. [PubMed] [DOI]\|\n\|11.\|\|Korzeniewski B. Influence of substrate activation (hydrolysis of ATP by first steps of glycolysis and beta-oxidation) on the effect of enzyme deficiencies, inhibitors, substrate shortage and energy demand on oxidative phosphorylation. Biophys Chem. 2003;104:107-119. [PubMed] [DOI]\|\n\|12.\|\|Koebmann BJ, Westerhoff HV, Snoep JL, Solem C, Pedersen MB, Nilsson D, Michelsen O, Jensen PR. The extent to which ATP demand controls the glycolytic flux depends strongly on the organism and conditions for growth. Mol Biol Rep. 2002;29:41-45. [PubMed] [DOI]\|\n\|13.\|\|Korzeniewski B. Parallel activation in the ATP supply-demand system lessens the impact of inborn enzyme deficiencies, inhibitors, poisons or substrate shortage on oxidative phosphorylation in vivo. Biophys Chem. 2002;96:21-31. [PubMed] [DOI]\|\n\|14.\|\|Pathak BL, Becker GL, Reilly PJ, Hanson KA, Landers DF. Isoflurane partially preserves energy balance in isolated hepatocytes during in vitro anoxia. Anesth Analg. 1991;72:571-577. [PubMed] [DOI]\|\n\|15.\|\|Kayser EB, Morgan PG, Sedensky MM. Mitochondrial complex I function affects halothane sensitivity in Caenorhabditis elegans. Anesthesiology. 2004;101:365-372. [PubMed] [DOI]\|\n\|16.\|\|Liu ZH, He Y, Jin WQ, Chen XJ, Shen QX, Chi ZQ. Effect of chronic treatment of ohmefentanyl stereoisomers on cyclic AMP formation in Sf9 insect cells expressing human mu-opioid receptors. Life Sci. 2004;74:3001-3008. [PubMed] [DOI]\|\n\|17.\|\|Vincent MF, Van den Berghe G, Hers HG. The pathway of adenine nucleotide catabolism and its control in isolated rat hepatocytes subjected to anoxia. Biochem J. 1982;202:117-123. [PubMed]\|\n\|18.\|\|Becker GL, Hensel P, Holland AD, Miletich DJ, Albrecht RF. Energy deficits in hepatocytes isolated from phenobarbital-treated or fasted rats and briefly exposed to halothane and hypoxia in vitro. Anesthesiology. 1986;65:379-384. [PubMed] [DOI]\|
Group Health Plan 550 Maryville Centre Dr, Saint Louis, MO63141 This is an administrative office for the Group Health Plan Insurance Company, a subsidiary of Coventry Health. It…More process claims out of this office.\nHealth First Physician Services 14309 Manchester Rd, Ballwin, MO63011 This is both a primary-care doctor's office and an urgent-care facility. The doctor who runs the office is an internist…More associated with SSM St. Clair Health Center. The office is located at the corner of 141 and Manchester.\nMedical Office Online 2821 N Ballas Rd, Saint Louis, MO63131 Medical Office Online provides physicians, health care providers and medical professionals that have secure, web-based…More access to medical records, scanned insurance and identification cards, calendars, billing information and much more. Medical Office Online is a frequently updated system that has been tested by programmers, security personnel and medical professionals. Contact the office directly with further inquiries.\nLaw Office of David M. Stolze 11805 Manchester Rd, Saint Louis, MO63131 The Law Office of David M. Stolze is a firm offering a variety of legal services. As a general practice firm,…More the Law Office of David M. Stolze is staffed by a competent team of legal professionals.\nPearline & Roach Dental Offices 777 S New Ballas Rd, Saint Louis, MO63141 Pearline & Roach Dental Offices is an endontic dentistry office, offering services for cracked teeth, root canals,…More surgery options and more. The practice is headed up by Dr. Rodrick Evan Pearline, D.D.S., and Dr. Robert Roach, D.M.D.\nPatent Law Office, LC 763 S New Ballas Rd, Saint Louis, MO63141 The Patent Law Office is a firm offering extensive legal services relating to intellectual property laws. Patents…More are handled here, along with copyrights, trademarks, software licensing and more. For more information, please contact the Patent Law Office.\nSt. Louis Dermatology 12855 N Forty Dr, Saint Louis, MO63141 This dermatology office has three doctors who specialize in skin care problems. This office treats general skin problems…More like acne and rashes. They also treat more serious problems like skin cancer. The doctors also perform reconstruction and cosmetic surgery.\nLee S. Portnoff, M.D. 3009 N Ballas Rd, Saint Louis, MO63131 Dr. Lee S. Portnoff is a physican with offices within the Missouri Baptist Medical Center. As a dermatologic…More surgeon, Dr. Portnoff specializes in cancer treatment. Please contact his offices for more information regarding the details of his services.\nUnited States Post Office 14373 Manchester Rd, Manchester, MO63011 Along with stamps and shipping materials, The Ballwin Post Office offers the USPS' flat-rate, trackable shipping --…More if your item fits in the box, it ships for one low rate, no matter the weight. The facility is open every day except Sunday.\nProfessional Imaging 777 S New Ballas Rd, Saint Louis, MO63141 Professional Imaging is located in the Ballas Medical Office Center, near both Missouri Baptist Medical Center and St.…More John's Hospital. When you walk in to the building, the office is right there on the first floor, so it's easy to find. It provides MRIs, CTs and X-rays in an alternative setting to hospitals.\nGateway Capital Mortgage 13610 Barrett Office Dr, Ballwin, MO63021 Gateway Capital Mortgage has a corporate office located in Manchester. It is a retail captive lending division of…More Gateway Bank of St. Louis. Gateway has no hidden fees. All branch accounting is done online, where it is viewable at any time. Gateway uses quality control technology and will even process your loans for you.\nRailcar Tracking 13422 Clayton Rd, Saint Louis, MO63131 This is an administrative office for Railcar Tracking, which designs software that allows rail companies to manage their…More delivery systems efficiently. Its programs are user-friendly and up-to date. For more information, call the office during regular business hours or visit the website.\nDBC Napoli Food Service 13623 Barrett Office Dr, Manchester, MO63021 DBC Napoli Food Service is a broker for a variety of food and beverage items. It sells its products to distributors,…More restaurants, hotels and other businesses. The company is headquartered in Nebraska and maintains a regional office at this location.\nFedEx Office Print & Ship Center 1012 Town and Country Crossing Dr, Chesterfield, MO63017 FedEx Office Print and Shipping Center in Chesterfield is modest yet hefty in practical methods to quickly serve your…More printing and shipping needs. It is clean and organized which makes finding your wishes and wants easy. Get questions answered by inviting salespeople and quickly find results.\nPremier Dental Anesthesia 339 Consort Dr, Ballwin, MO63011 Premier Dental Anesthesia is a company offering the services of on-site, board-certified anesthesiologists. Traveling to…More its clients' offices, its team of board-certified anesthesiologists, nurses and anesthesiologist assistants administer anesthesia in the offices of dental professionals, caring for more than 70,000 patients per year.\nRawlings Sporting Goods 510 Maryville Centre Dr, Saint Louis, MO63141 This is an administrative office for the famous Rawlings Sporting Goods chain. In this office, it makes sure the stores…More are well stocked with all the current merchandise. It also does a variety of other behind-the-scene activities to make sure the stores run smoothly.\nUnited States Postal Service 1015 Grupp Rd, Saint Louis, MO63131 This post office branch is tucked away behind the Colonnade Center off Manchester. It serves the residents and…More businesses in the 63131 ZIP code. It is a regular United States Post Office with all the corresponding services.\nTown and Country Events 13422 Clayton Rd, Saint Louis, MO63131 Town and Country Events is an event planning and design company. A planner creates and plan a variety of events…More including business meetings, weddings and parties. The office is located in the Mason Woods Village office building next to Straub's.\nLaw Office of Carl D. Kraft 12901 N 40 Dr, Saint Louis, MO63141 Carl D. Kraft is an attorney offering a variety of legal services to his clients. Specializing in automobile law,…More Mr. Kraft is adept at handling traffic law, DUIs, insurance specifics, personal injury and more. Contact his office directly for more information.
become an editor\nthe entire directory\nonly in Health/Dentistry\nBrian H. Kvitko, DDS\n- Offering services in general, restorative and cosmetic dentistry.\n- Specializing in orthodontics for children, teens, and adults. Features credentials, staff photos, new patient forms, financial services, office hours, FAQs, a map and directions.\nCrown Point Dental Care\n- Specializing in cosmetic and laser dentistry. Staff profiles, virtual tour, and dental care tips.\nDr. Jeffrey A. Tilson DDS.\n- Offers cosmetic procedures and family dentistry, hours and contact information.\nEdward A. Belkin, DDS\n- Biography of the doctor, list of services, and testimonials.\nErik W. Hrabowy, DDS, MS\n- Orthodontics for children and adults. Staff profiles, online tour, and descriptions of their services.\nHealthy Smile Dentistry\n- List of services and dental care tips.\nJames Metz DDS.\n- Provides correction for dental problems.\nMark Fixari, DDS\n- Offers cosmetic and family dentistry.\nMichael Firouzian DDS\n- Offering general and cosmetic dentistry. Descriptions of their services, staff overview and testimonials.\nOhio Dental Group\n- Biographies of the dentists, list of services, and office hours.\nOral & Facial Surgery for Adults and Children\n- Provides details of services, credentials, patient information and directions to office locations.\nRichard W. Bowen DDS Inc.\n- Provides dental care with an emphasis on implant, cosmetic and sedation dentistry.\nRobert Brewer, DDS\n- Family dental services. Staff profiles and office hours.\nRoy Gottlieb, DDS\n- Offers cosmetic dentistry, implants, repairs, dentures and sedation services.\nRummel and Schumacher DDS\n- Provides family dental care, cosmetic dentistry, and restorative services.\nTimothy H. Moore, DDS & Associates\n- Biography of the doctor, list of services, and before and after pictures.\nTooth Family Dental\n- Staff biographies, their philosophy, list of services, and customer comments.\nVincent J. Lombardo\n- List of services and driving directions.\n" search on:\nto edit this category.\nCopyright © 1998-2016 AOL Inc.\nVisit our sister sites\nLast update: December 22, 2015 at 15:52:51 UTC -
Eye surgery: treatments and prognosis\nAlthough varying degrees of vision loss are very common and caused by a variety of factors, surgery can now be used to correct many of these problems. But at the same time, you need to be careful any time you deal with your eyes and vision, so be sure to consult an eye doctor before making a decision.\nLASIK, short for laser-assisted keratomileusis in situ, is the most common type of refractive eye surgery to treat a range of vision problems, including:\nHowever, the procedure cannot reverse age-related near vision (presbyopia). But, if a person with presbyopia wishes to undergo LASIK, they can go for a modified version of surgery called “monovision,” in which one eye is corrected for distance and the other to see things nearby.??\nStandard LASIK is an outpatient surgical procedure that uses an ultraviolet laser to remove a thin layer of the cornea, reshaping it in the process, allowing light rays to focus more clearly on the retina.\nThe procedure is performed using anesthetic eye drops while the patient is awake and takes about 10 to 15 minutes for each eye.Although not all patients have 20/20 vision after LASIK, 95% of people report being satisfied with the result.??\nPersonalized LASIK, also known as “wavefront guided LASIK,” uses a more advanced type of laser to obtain a three-dimensional image of the patient’s eye. The goal is then to use this image to ensure that the corrections made to the patient’s cornea are as precise as possible.??\nLasers are used in more than refractive surgery\nLaser surgery and refractive surgery are often used interchangeably, but they are not the same thing.\n- Refractive surgery is the general term for surgical procedures aimed at correcting myopia, hyperopia and astigmatism.\n- LASIK is a type of refractive surgery that uses lasers, but lasers are also used for many other types of surgeries. Likewise, there are methods of refractive surgery that do not involve a laser.\nRefractive photokeratectomy (PRK) is another type of laser surgery used to correct mild myopia, farsightedness, and astigmatism.\nLike LASIK, the procedure involves using ultraviolet light to reshape the cornea. The difference is that in PRK the laser reshapes the surface of the cornea while LASIK reshapes the cornea under a flap.\nAbout 90% of people who have had PRK reported having 20/40 or better vision without glasses or contact lenses.??\nWhen the lens of a person’s eye becomes cloudy, it is most likely caused by cataracts. Surgery is often necessary to treat cataracts.\nCataract surgery involves removing the cloudy lens of the eye (located in the front of the eye) and replacing it with an artificial, transparent lens.??\nAbout 90% of people say they have seen improvement in their vision after cataract surgery, although this does not mean that a person’s vision will be fully restored. Many people still need to wear glasses or contact lenses after the procedure.??\nUse of anesthesia in eye surgery\nBecause there are several types of eye surgery, with varying degrees of invasiveness, different types of anesthesia are used.\nAny eye surgery performed on children typically uses general anesthesia (when the whole body is put into a medically induced “sleep”).\nFor adults, it really depends on what is involved in the procedure. For example, while some cataract surgeries can be performed under local or topical anesthesia, others require the patient to receive general anesthesia.??\nIf someone has had glaucoma and drugs or laser treatments aren’t helping, their doctor may recommend surgery. While glaucoma surgery does not cure glaucoma or reverse any vision loss, it can at least prevent a person’s glaucoma from getting worse and help reduce the pressure in their eyes. If a patient requires glaucoma surgery in both eyes, the doctor will perform each procedure separately.\nThere are three main types of glaucoma surgery:\nThis surgery, typically used to treat open-angle glaucoma, involves the surgeon making a small opening in the top of the eye (below the eyelid, so it’s pretty well hidden). The incision allows additional fluid to flow into the patient’s eye, thereby reducing the pressure in the eye.\nAlthough performed in a hospital, the outpatient procedure typically takes less than an hour.\nGlaucoma implant surgery\nUsed to treat:\n- Congenital glaucoma\n- Neovascular glaucoma\n- Glaucoma caused by injury\nThis outpatient procedure takes one to two hours and involves the surgeon implanting a small tube in the white part of the eye to allow extra fluid to drain out of the eye, lowering eye pressure.\nMinimally invasive glaucoma surgery (MIGS)\nThere are several different types of MIGS, although they all use microscopic-sized equipment and tiny incisions. While this could mean that a patient heals faster after surgery, it can also mean that the surgery is not as effective as that using traditional methods.??\nOverall, glaucoma surgery is generally 70-90% effective in older patients.??\nMacular degeneration surgery\nThere are two types of macular degeneration: dry and wet. About 80% of people with macular degeneration have the dry variety, which unfortunately has no effective treatment at present. But the 20% of those with wet macular degeneration, which is the most severe type, treatment options include injectable medication or laser surgery.\nDuring laser surgery, the doctor shines a beam of laser light on the abnormal blood vessels in the patient’s eye, thereby reducing the number of vessels and slowing their leakage.\nAlthough the specific success rate for this procedure is not available, a 2015 study demonstrated that in some cases laser surgery limits the progression of macular degeneration.\nWhile some corneal issues can be resolved with LASIK or other procedures, in some cases a person’s anterior and inner corneal layers are damaged, which means they need a transplant. cornea. This is called penetrating keratoplasty (PK), or full thickness corneal transplant.\nThis involves removing a diseased or damaged cornea from a patient, and then the seam of a transparent donor cornea is sewn in place.??\nConsidering such factors as the potential rejection of the donor cornea, the success rate of PK varies widely, so it is best for a patient to discuss their specific situation with their doctor.??\nDiabetic retinopathy surgery\nPeople with diabetes can be diagnosed with an eye disease called diabetic retinopathy. This condition, which can lead to vision loss, occurs when high blood sugar levels damage the blood vessels in the retina. While there are some non-surgical options for diabetic retinopathy (like medication), two types of surgery are used to treat the condition:\n- Laser surgery: Used to help narrow or seal leaky blood vessels, which can reduce swelling in the retina. In some cases, several treatments are necessary.\n- Vitrectomy: A surgery that removes glassy gel and blood from leaky vessels at the back of the eye, allowing light rays to focus properly on the retina again. It can also include the removal of scar tissue from the retina.\nWhile the results of surgical procedures vary depending on the extent of the patient’s eye damage, between 75 and 98% of patients report significant improvements in their visual activity after recovering from the procedures.??\nIn addition to treating diabetic retinopathy, vitreoretinal surgery can also be used for the following conditions:\n- Floats and flashes\n- Macular degeneration\n- Macular holes\n- Retinal detachments or tears\n- Retinitis pigmentosa\n- Retinal venous occlusion\n- Retinopathy of prematurity\nThere are a few different procedures that are considered vitreoretinal surgery, although they usually involve a surgeon making three small incisions in the patient’s eye and using them to make necessary adjustments in the eye.??\nAgain, since there are different procedures considered to be vitreoretinal surgeries, success rates are procedure dependent, although they typically range from around 90-98%.??\nEye muscle surgery\nEye muscle surgery is used to correct eye muscle problems that cause strabismus (also called crossed eyes). Although it is most often performed on children, eye muscle surgery can also be performed on adults.\nThe procedure involves the surgeon making a small incision in the clear tissue covering the white of the eye called the conjunctiva.\nFrom there, the surgeon will identify the eye muscles that require surgery and then strengthen or weaken the muscle, depending on the specific needs of the patient. The earlier the eye muscle surgery is performed, the more effective it is.??\nAbout 10-20% of adult patients return for follow-up surgery to resolve remaining eye alignment issues.??\nA word from Verywell\nIt is quite normal to be nervous before any type of surgery, especially surgery involving your eyes. If the risks of a procedure outweighed its benefits, the doctor wouldn’t even have brought it up as an option in the first place.\nOn the day of your surgery, make yourself as comfortable as possible. This may include wearing loose or loose clothing (you will probably be putting on a gown, but you might as well travel comfortably to and from the hospital) or bringing a trusted friend with you (you will also need these to get you back to the hospital). the House).
Mile High Dental and Implant Centers, locally owned and operated since 1979, we’re the original all-in-one dental and implant center serving Colorado. Each Mile High Dental & Implant Center has onsite dental labs, 3-D CT scanners, and a team of dental and implant specialists. We’ll get to know you and help you reclaim your dental health and confident smile! We are growing and looking to add to our team of Surgical Assistants with a full-time Oral Surgery Assistant. This is an immediate opportunity to work in our locations in the Denver Metro area including Lakewood, and Englewood.\nUnder general supervision, our Oral Surgery Assistant will be responsible for the following responsibilities:\n- Assist surgeon with general anesthesia and IV sedation procedures.\n- Inform patients on pre-op and post-op instructions.\n- Provide diagnostic information through x-rays, dental impressions, and casts.\n- Maintain patient's vital statistics and intravenous fluids during surgery. Document treatment by charting in patient's records. . Passing surgical tools, surgical dressing preparation, and suture/debris removal.\n- Ensure the patient does not breathe in fluids during the procedure through constant monitoring.\n- Protect the patient’s lips, cheeks, and tongue from unnecessary injury.\n- Sterilization of equipment and materials.\n- Obtain proper consent forms regarding surgery and updating patient health history.\n- Setting up of surgical suite by the type of procedure being planned.\n- Preparing patients by obtaining and recording the patient’s vital signs.\n- Attach relevant monitoring equipment in preparation for surgery.\n- Re-sterilization of equipment and returning them to their proper places.\n- Continued monitoring of vital signs and instruction on post-operation care with patient and or chaperone.\n- Help recover patients from sedation and anesthesia.\n- Record treatment charts.\nWe offer a complete benefits package including medical, dental, vision, 401K (matching) PTO, holiday pay, bonus opportunities, continuing education, professional development, and more.
Tramadol is a morphine-like painkiller forming part of the class of drugs known as opioid analgesics. It is a moderate to strong painkiller that acts in the central nervous system within the spinal cord and brain. Tramadol is prescribed to treat severe sudden or long-term pain, e.g. pain resulting from serious injury, surgery or cancer, as well as to treat neuralgia and joint pain caused by arthrosis. It can also help to treat premature ejaculation.\nTramadol and the benefit of DNA analysis\nThe rate at which tramadol is processed within your body varies from one individual to another. This means that the efficacy and side effects of tramadol can be predicted to some extent on the basis of your genes.\nPreventive DNA analysis can therefore be an important tool in optimising your medication.\nTramadol and the enzyme CYP2D6\nTramadol is processed to a large extent by the enzyme CYP2D6. The activity of this enzyme can vary considerably depending on your genetic predisposition, which means the efficacy of tramadol can also differ from person to person.\nInformation about your genetic predisposition may therefore provide grounds for extra vigilance in relation to a treatment with tramadol.\nRead more about CYP2D6 enzyme »\nAlso known as\nTramal, Tramagetic, Zaldiar,Tramadol/Paracetamol, Rybix, ConZip, Durela, Ralivia, Ryzolt, Tridural, Ultram
Doctor insights on:\nIs Botox Working For Migraines\nYes: Yes, Botox is an fda approved medication for treatment of migraine headaches. Like every medication, some people may not respond to Botox treatments and may need another form of treatment. In addition, Botox works to prevent headaches but has little effect on an acute onset. ...Read moreSee 2 more doctor answers\nBotulinum Toxin (Botox) Injection (Definition)\nBotox is a medicine that causes muscles to relax. It is commonly used to improve the appearance of deep facial lines or wrinkles between the eyebrows. It is also used to relieve migraine, and in certain conditions that involve muscle spasm. ...Read more\nWhat pain meds can b used to treat chronic migraine that dont cause rebound? Did Botox already still in pain.\nNerve blocks: It depends if you got some relief. I would ask your neurologist or medical headache doctor about nerve blocks. A response to either botox or nerve blocks would mean that you are a candidate for surgical headache treatment. Talk to your neurologist about these options, and seek out an experienced surgeon to talk about the procedures with you. ...Read moreSee 2 more doctor answers\nHow long do u have to wait till botox works have 38 niddles every 12 weeks as had migraine for 5 years now had botox for nearly 2 years ?\nI took botox for migraine 2 times in 6 months but the second dose i lost half of my hair all of sudden\nIs it because the botox should i stop it ?\nMany: Botox has a long track record of improving frequent migraines in many patients. At first, was anecdotal but has become common use. Effects against migraines does not last as long as the muscle block, so migrainers must return for supplement at first recurrence. Typically lasts 2-3 months, many times eliminating migraine symptom or treatment requirements with other meds. ...Read moreSee 2 more doctor answers\nBotox for headache: It is unlikely that a single treatment of Botox will cure migraines as it will wear off in several months and the headaches will probably recur then. However, many patients have had significant if not near total relief of their migraines after Botox treatments. Only you and your doctor can decide if this is a good choice for you. ...Read moreSee 2 more doctor answers\nWhat's the best way to treat status migraine when the ER migraine cocktail doesn't work? Had Botox wed. Migraine began Thursday.\nNot rocket science: Have no problem with BOTOX, but effect may take several days to weeks, and is a good approach in many. Severe repetitive migraines may be aborted by several days of steroids, even intravenous Solumedrol (methylprednisolone). A long-term solution should focus on prevention, and I prefer to use OTC approaches such as riboflavin, butterbur, Co-Q10, and maybe magnesium. Suggest you stay out of the ER, see neurologist. ...Read more\nPlease i need dermatologist\nI took botox for migraine 3 times in 6 months\nafter last dose I lost half of my hair all of sudden\nShould i stop taking it?\n- Talk to a doctor live online for free\n- Migraine botox treatments\n- Botox injections for migraine headaches\n- Can botox treat migraines?\n- Ask a doctor a question free online\n- Where do you inject botox for migraines\n- Has anyone had total cure with botox for migraine headaches\n- Migraine for 4 days meds not working what do i do on topamax\n- Talk to a dermatologist online
Symptoms of Frozen Shoulder\nFrozen shoulder occurs when there is constraint of motion in the shoulder joint. Physicians aren’t sure why this occurs and it often happens for no particular reason. The shoulder joint becomes extremely stiff and individuals have a hard time moving their arm because it becomes painful. Other symptoms include: shoulder pain, limited movement in the shoulder, difficulty lifting arms above the head, and shoulder pain while sleeping. Some common risk factors of frozen shoulder include age and gender, endocrine disorders, and trauma or surgery. This condition affects patients between 40 to 60 years old and is more common in women than men. Individuals with diabetes or thyroid problems have a higher chance of developing this condition. Although it is unlikely, patients who undergo surgery or sustain an injury can also encounter frozen shoulder.\nPain Relief, Physical Therapy\nExercising and stretching helps to increase mobilization and reduce the chance of losing muscle in the affected area. Patients will need to work with a physical therapist to come up with a routine. It is important that the patient knows they must complete these exercises several times a day to see results, even if they don’t attend a physical therapy class that day. The therapist will develop a program and that will include ice, heat and other key things to help in reducing symptoms of frozen shoulder.\nApplying moist heat on the shoulder will help reduce stiffness and pain. Moist heat can be applied to the shoulder, and then the stretching exercises can take place. Soak a washcloth in hot water and place on the shoulder for 10 minutes before exercising. Patients will need to do this three times every day.\nCortisone injections are used to decrease inflamed areas around the shoulder joint. Physicians aren’t sure how successful cortisone injections are, but it does help to temporally relieve pain, and in turn increases time for additional physical therapy. Cortisone is effective when combined with a physical therapy routine.\nIn some cases, the treatments listed above do not always help relieve frozen shoulder. In these rare circumstances, the patient will need to consider manipulation under anesthesia as an option. The physician would use manipulation techniques while the patient is asleep under anesthesia. During the procedure, the physician will rotate the arm to break apart joints and muscles that are sticking together. This is not surgery because there are no incisions made while treatment is performed.\nWill the shoulder return to normal?\nMost people who experience frozen shoulder will have some limitations in motion even years after treatment. The limitation in motion is minimal and only recognized during physical examinations. Majority of individuals who have frozen shoulder will fully recover with stretching and physical therapy.
Comparative Anatomy & Physiology\nThis course will cover anatomy and physiology of laboratory animals including study of body systems such as skeletal, muscular, circulatory, digestive, nervous, respiratory, reproductive and special sense organs and principles of diseases.\nApplied Biostatistics & Research Design\nThis course will cover the fundamentals of research design, including the use of literature search, the formulation of testable hypotheses, selection of the appropriate methodology and statistics to evaluate these hypotheses and the generation and interpretation of experimental outcomes. Students will learn to critique published studies, as well as to create and evaluate their own studies and protocols.\nLaboratory Animal Husbandry, Care & Ethics\nThis course will discuss husbandry practices, proper nutrition and enrichment requirements for different species; environmental parameters, such as proper housing, temperatures, humidity and lighting. Humane handling, restraint and overall well-being of laboratory animals will also be covered.\nThis course will review the selected publications in related fields such as animal models in research, new technologies, etc.\nDiseases of Laboratory Animals I & II\n(3 & 3 Credits)\nThese courses will cover the biology, husbandry, diseases, pathology, treatments and main research uses of main laboratory animal species.\nAnesthesia & Surgery\nThis course will review techniques and procedures used in surgery and anesthesia, including instruments and equipment preparation and identification, handling of instruments and supplies during surgery, anesthesia induction and monitoring, post-surgical care, clean up and surgical record keeping.\nDuring this course, students will have hands-on experience on various aspects and techniques and on multiple laboratory animal species. This course is for one week (40 hours) on the EVMS campus in Norfolk, VA.\nThis course provides both technical and Non-technical skills necessary for the successful laboratory animal facility managers such as; understanding of facility equipment, personnel management and scheduling, supply procurement, space allocation, animal production management, communication with researchers and senior management, conflict resolution, hiring and firing, critical thinking, problem solving, negotiation, finance/budgeting and vendor management skills.\nBiotechnology & Diagnostic Techniques\nThis course will cover various topics such as molecular analysis and detection systems including ELISA, PCR and real time PCR, basics of cell culture, laboratory blood, urine processing and basics of imaging techniques such as ultrasound, etc.\nDuring this course students will be assigned to one topic of interest which will be presented to the whole group. Students will review the recent publications in their assigned topic and with recommendation and suggestions of their selected expert mentors, will prepare and present their presentation.\nLaboratory Animal Behavior and Behavioral Management\nThis course will provide students with behavioral biology of species commonly used in laboratories. The course will also cover behavioral management, including enrichment and positive reinforcement training and will introduce students to some behavioral tests utilized to model human behavior.\nCell freezing is now a well-established laboratory activity in both clinical and research facilities. This course is designed to teach technically complex process of cryopreservation by explaining the procedure of cryopreservation (freezing) of cells.\nThis website reflects current program information, including admissions criteria and curricula. Information is subject to change.
LifeLinc Anesthesia is currently seeking a skilled Certified Registered Nurse Anesthetist (CRNA) for an exciting opportunity providing high quality, cost-effective anesthesia care in an autonomous, but collaborative clinical environment. Come practice at the top of your license and join a team committed to leadership in anesthesia care.\nAbout the Facility: Offering a wide array of new technical advancements, the surgery center strives to provide patients with the best outpatient experience possible in a safe, caring environment.\nSchedule: Monday – Friday 7a-3p (No nights, no weekends, no call)\nCase Mix: General, Ophthalmologic, GI, ENT and Orthopedics\n• CME Reimbursement\n• Health Insurance\nProfessional Liability will be covered by LifeLinc.\nLifeLinc Anesthesia has emerged as one of the top, comprehensive anesthesia management providers in the country. Since 2003, LifeLinc has centered its mission on "Changing the Status Quo" of healthcare through innovative solutions and excellent clinical quality. We recognize that an exceptional anesthesia team enhances patient safety and experience. This is why we enable our providers to serve as leaders in the perioperative setting, maximizing their potential and fostering long-term employment relationships. LifeLinc’s educational arm, LifeLinc Academy, enables our providers to optimize the skills necessary to practice autonomously and attain CME credits in the process. LEAP, Leadership Empowered Anesthesia Providers, is LifeLinc’s clinical leadership training program designed to produce clinical leaders who excel in the business of anesthesia. Come join a team committed to provider growth and continuing innovation in anesthesia!\nThe CRNA scope of practice includes, but is not limited to, the following:\nTo perform this job successfully, an individual should have general computer literacy skills and knowledge of Microsoft Office applications.\nThe physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.\nEducation and experience equivalent to:\nThe Nurse Anesthetist shall be a Graduate of an approved school of nursing and a graduate of a nurse anesthesia educational program accredited by the AANA Council on Accreditation of Nurse Anesthesia Educational Programs or its predecessor. The CRNA will have successfully completed the American Association of Nurse Anesthetists (AANA) Council on Certification or its predecessor's.
Following the amputation\nof an extremity, nearly all patient\ns experience an illusion\nthat the missing limb is still present. Although this sensation usually diminishes over time, it persists in some degree throughout the amputee's life and can often be reactivated by injury\nto the stump or other perturb\nations. Such phantom sensations are not limited to amputated limbs; phantom breast\ns following mastectomy\n, phantom genitalia following castration\n, and phantoms of the entire lower body following spinal cord\ntransection have all been reported. Phantoms are also common after local nerve block for surgery\n. During recovery from brachial plexus anesthesia\n, for example, it is common for the patient to experience a phantom arm, percieved as whole and intact, but displaced from the real arm. When the real arm is viewed, the phantom appears to jump into the arm and may emerge and reenter intermittently while the anesthesia wears off\n. These sensory phantoms demonstrate that the central machinery for processing somatic\nsensory information is not idle in the absence of peripheral stimuli; apparently, central sensory maps and processing systems continue to operate independently of the periphery.\nPhantoms might simply be a curiosity -- or a provocative clue about higher-order somatic sensory processing -- were it not for the fact that a substantial number of amputees also develop phantom pain. This common problem is usually described as a tingling or burning sensation in the missing part. Sometimes, however, the sensation becomes a much more serious pain that patiences find increasingly debilitating. Phantom pain is, in fact, one of the more common causes chronic pain syndromes, a condition that is extraordinarily difficult to treat. Because of the relative independence of the central processing of pain, ablation of the spinothalamic tract, portions of the thalamus, or even primary sensory cortex does not generally relieve the discomfort felt by these patients.\nI wonder... is this a "thing" or an "idea"?\nNeuroscience, Sinaur Associates (QP355.2.N487 1997)
Like most of you, I have been busy with life and haven't posted in forever. Long story short, my mother passed away and now I have 0 contacts left in the veterinary world and very few in the rescue world. Now I have a house full of animals (3 dogs and 4 cats, 5 of them over 10 yrs old) that I somehow assumed I would have a free pass on cheap veterinary care for the foreseeable future. And the many home improvement projects that stemmed from having to replace my floors are maxing out any extra money I had. Taking out any more credit is not a realistic option to fund vet care.\nSo enough about my past 3 years . Parker is still kicking. She is estimated at least 13 years old and her latest health problem is a saliocele, probably related to the very painful mouth she had 8-10wks ago that resolved after a long course of antibiotics. I know salioceles are effectively treated surgically and Parker's bloodwork has been consistently not too bad for an ancient dog so she could theoretically handle anesthesia, but I just wanted to vent and see if anyone has experience with salioceles/mucoceles. Hopefully non-surgical treatment even if just to buy time to raise money for surgery.\nTalk about diets, exercise, and disease.\n2 posts • Page 1 of 1\n- Super Bully\n- Posts: 642\n- Joined: Tue Dec 26, 2006 2:38 pm\n- Location: Northern California\nWell, whatever it is it's not a sialocele. All the swelling in her face & chest is edema which points more toward renal failure. Blood work will tell more.\nWho is online\nUsers browsing this forum: Bing [Bot] and 15 guests
Diskectomy is a surgical procedure to remove the damaged portion of a herniated disk in your spine. A herniated disk can irritate or compress nearby nerves and cause pain, numbness or weakness. These symptoms can affect your neck or back or may radiate down your arms or legs.\nDiskectomy works best on radiating symptoms. It's less helpful for actual back pain or neck pain. Most people who have back pain or neck pain find relief with more-conservative treatments, such as pain medications or physical therapy.\nYour doctor may suggest diskectomy if conservative, nonsurgical treatments haven't worked or if your symptoms worsen. There are several ways to perform a diskectomy. Many surgeons now prefer minimally invasive diskectomy, which uses small incisions and a tiny video camera for viewing.\nWhy it's done\nHow you prepare\nWhat you can expect\nA diskectomy is performed to relieve the pressure a herniated disk (also called slipped, ruptured or bulging disk or disk prolapse) places on a spinal nerve. A herniated disk occurs when some of the softer material inside the disk pushes out through a crack in the tougher exterior.\nYour doctor may recommend diskectomy if:\nYou have trouble standing or walking because of nerve weakness\nConservative treatment, such as medication or physical therapy, fails to improve your symptoms after six weeks\nA disk fragment lodges in your spinal canal, pressing on a nerve\nPain radiating into your buttocks, legs, arms or chest becomes too much to manage\nDiskectomy is considered a safe procedure. But as with any surgery, diskectomy carries a risk of complications. Potential complications include:\nLeaking spinal fluid\nInjury to blood vessels or nerves in and around the spine\nInjury to the protective layer surrounding the spine\nYou may need to avoid eating and drinking for a certain amount of time before surgery. Your doctor will give you specific instructions.\nSurgeons usually perform diskectomy using general anesthesia, so you're unconscious during the procedure. You'll receive the anesthetic medication as a gas — to breathe through a mask — or by an injection into a vein. Small amounts of spinal bone and ligament may be removed to gain access to the herniated disk.\nIdeally, just the fragment of disk that is pinching the nerve is removed, relieving the pressure but leaving most of the disk intact.\nIf the entire disk must be taken out, your surgeon may need to fill the space with a piece of bone — taken from a cadaver or from your own pelvis — or a synthetic bone substitute. The adjoining vertebrae are then fused together with metal hardware.\nAfter surgery, you're moved to a recovery room where the health care team watches for complications from the surgery and anesthesia. You may be healthy enough to go home the same day you have surgery, although a short hospital stay may be necessary if you have any serious pre-existing medical conditions.\nDepending on the amount of lifting, walking and sitting your job involves, you may be able to return to work in two to six weeks. If you have a job that includes heavy lifting or operating heavy machinery, your doctor may advise you to wait six to eight weeks before returning to work. Limit activities involving lifting, bending and stooping for four weeks after diskectomy. You may also need to limit the amount of time you spend sitting for four weeks following the surgery.\nA physical therapist can teach you exercises to improve the strength and flexibility of the muscles around your spine.\nDiskectomy reduces herniated disk symptoms in most people who have clear signs of nerve compression, such as radiating pain. However, diskectomy may not be a permanent cure, because it doesn't do anything to reverse the process that allowed the disk to become herniated in the first place. To avoid re-injuring your spine, your doctor may recommend weight loss, a low-impact exercise program, and ask that you limit some activities that involve extensive or repetitive bending, twisting or lifting.
If i was your doctor i will recommend u to relax and take appropriate rest. The feeling of light headedness is pretty normal after surgeries. it can be due to the general anesthesia\ngiven to u before sinus surgery\n. it takes time to wean off. Also it can be because of loss of blood and low blood pressure. If your CAT scan report is normal then you dont have to worry.
Mon–Fri: 8 AM – 6 PM\nSaturday: 9 AM – 3 PM\nPoor dental health is one of the most common problems facing dogs and cats. It is estimated that as many as 85% of dogs and cats have some form of periodontal disease by four years of age. The problems associated with dental disease can range from relatively minor problems such as bad breath, to loss of teeth and bone, and even to life-threatening conditions such as kidney failure and heart disease.\nWe understand that good dental care is essential to maintaining your pet’s overall health. This can only be accomplished through a regimen of regular preventive care, such as brushing, dental chews, or a dental diet, along with regular cleanings. Just as we humans need annual dental cleaning, it is important that our pets’ mouths be regularly examined for hidden problems. Remember, they can’t tell us when something hurts!\nAll pets are different, and they all have their own level of tolerance for home dental care. This is why we carry a broad range of dental care products including treats and chews, water additives, tooth brushes and toothpaste (in yummy flavors like salmon and beef), and dental diets. We’ll help you choose the approach that is best for you and your pet. You can also check out our online pharmacy for products that ship right to your door!\nWhat is periodontal disease?\nPeriodontal disease is a term used to describe inflammation or infection of the tissues surrounding the tooth. Accumulation of tartar and calculus on the teeth causes gum recession around the base of the tooth. Infection and bad breath soon follow and the gums recede further, exposing sensitive unprotected tooth root surfaces and the bony tooth sockets. Left untreated, the infection spreads deep into the tooth socket, destroying the bone. Ultimately, the tooth loosens and falls out. Advanced periodontal disease can lead to other serious health problems, including infections of the throat, heart, kidneys, and liver. And as you can imagine, it is quite painful.\nWhat is involved in a routine dental cleaning?\nA routine dental cleaning involves a thorough dental examination, along with a dental scaling and polishing to remove the tartar and invisible plaque from all of the tooth surfaces. We will perform pre-anesthetic blood tests to ensure that kidney and liver function are satisfactory for anesthesia. Sometimes antibiotic treatment is started before the periodontal therapy is performed. Your pet’s doctor will discuss the specific pre-dental recommendations for your pet.\nOnce your pet is anesthetized, tooth scaling will be performed using both traditional hand scalers and ultrasonic cleaning equipment to remove all traces of tartar, both above and below the gum line. The tartar below the gum line causes the most significant gum recession and it is extremely important that it is removed thoroughly. After scaling, full mouth x-rays are taken, which will help the doctor in determining the extent of any problems below the gum line. Next, the doctor will thoroughly examine the mouth for abnormalities such as periodontal pockets, fractures, or resorptive lesions. The teeth are then polished to remove microscopic scratches in order to help prevent subsequent plaque build-up. Special applications such as fluoride, antibiotic preparations and cleaning compounds may be indicated to decrease tooth sensitivity, strengthen enamel, treat bacterial infection and reduce future plaque accumulation.\nThe procedures that your pet may require will be discussed with you before scheduling the dental cleaning. Since it can be difficult to predict the extent of dental disease in advance of the procedure, it is imperative that we be able to reach you during the procedure to discuss any additional treatment that may be necessary.\nWhat if extractions are necessary?\nIf the doctor determines that one or more teeth need to be extracted, we will perform this after the cleaning. Additional pain medications will be given to your pet prior to the extractions, and the resulting pockets will be filled and sutured. Extractions are not something anyone looks forward to, but when indicated they can greatly improve your pet’s quality of life.\nWhat about anesthetic safety and pain?\nPain management and patient safety are top priorities with us. Our dental procedures are performed under the same anesthetic and pain management protocols that we use for surgery. These are designed and proven to increase safety, improve recovery time, and minimize pain during and after the procedure.\nCan we do the dental procedure without the use of anesthesia?\nThe practice of veterinary dentistry without the use of anesthetics is not endorsed by the vast majority of veterinary practitioners, for a number of reasons. Most important, it is not possible to fully examine your pet’s teeth without sedation, since 70% of the tooth is below the gum line. This is where most problems occur. It is also impossible to fully clean the teeth with the patient conscious, since they will not tolerate the use of instruments on the gums. Finally, non-anesthetic dentistry can be dangerous for your pet and our staff, since the patient has to be physically restrained during the procedure.
This medication is a muscle relaxant, prescribed as an adjunct to general anesthesia for induction of skeletal muscle relaxation. It is also used for facilitation of management of patients undergoing mechanical ventilation (breathing management); facilitation of tracheal intubation.\nAdult: IV- Endotracheal intubation Initial: 50-100 mcg/kg. Maintenance: 10-20 mcg/kg.\nFacilitate mechanical ventilation in intensive care: 60 mcg/kg every 60-90 minutes.\nIt comes as a solution for injection, to be administered by a healthcare provider into the vein.\n• Caution should be exercised in patients with history of myasthenia gravis, electrolyte disturbances, heart disease, liver or kidney impairment, elderly, during pregnancy and breastfeeding.\n• Avoid use of this medication in prolonged surgery (neurosurgery).\n• Avoid rapid administration; otherwise it may cause high blood pressure and fast heart rate.\nHigh blood pressure and fast heart rate.\n• Skin: Rash and itching.\n• Gastrointestinal: Increased saliva.\n• Respiratory: Respiratory insufficiency, shortness of breath and wheezing.\n• Miscellaneous: Skeletal muscle weakness, asthma, flushing, redness and increased eye pressure.\nPatient should be given proper airway and respiratory support during the treatment.\nStore it in refrigerator and in an airtight container. Do not freeze it.\nSubscribe to our Free Newsletters!
Jump to section\nA partial caudectomy in dogs is the amputation of part of the tail for medical reasons. Reasons that may result in the requirement to remove part of your dog’s tail include trauma resulting in damage to blood vessels, tailbone, or soft tissues that can not be repaired, congenital defects of the tail such as corkscrew tail, or tumors present in the tail. If possible, partial caudectomy is performed with only a portion of the tail being removed. If disease or trauma necessitates it, amputation of the entire tail may be necessary. The advantage of partial caudectomy is that the procedure is less invasive and some portion of the tail remains, allowing the dog to wag their tail to express emotion. Disadvantages may include remaining tissue becoming infected or cancerous or susceptible to injury. This procedure should be performed by a veterinarian in conjunction with sedation and local anesthetic, epidural local anesthetic, or intravenous general anesthetic. The form of anesthetic used will depend on the age of your dog, the extent of repair and partial caudectomy required, and other factors such as disease or medical conditions present in your dog.\nThe type of anaesthetic required for this procedure varies depending on the degree of repair and caudectomy required, the age of the animal, and medical conditions present dictating the type of anesthetic required. Anesthetic may include sedation and liberal use of local anesthetic at the surgical site, epidural anesthetic or general anaesthetic, usually intravenously administered as the procedure is not of long duration. If general anesthetic is required you will need to fast your dog prior to surgery. After appropriate anesthetic is administered, the tail area is shaved and cleaned and a tourniquet applied to the tail. An incision is made around the skin and subcutaneous tissue in a “U” or “V” shape, distal to the amputation site. Muscles are dissected. Blood vessels are cauterized or ligated. The tail is then amputated either by disarticulation of the joint space or through the vertebra with bone cutting forceps. Muscle and subcutaneous tissue are then sutured back together. Usually skin on the dorsal side is left longer than on the ventral side to create a flap to close over the end of the remaining tail.\nIf tumors are present, the tumor is removed along with the tail and healthy margins of tissue. Tumor tissue will be sent for examination by a veterinary pathologist to identify cells present and ensure healthy margins were removed with the tumor to prevent spread of abnormal growth.\nPartial caudectomy for dogs with congenital defects of the tail such as ingrown tails can be a more complicated procedure than for other conditions and is associated with a higher incidence of complications. However the benefit of the procedure to prevent the development of infections exceeds the risk of complications. Partial caudectomy is also efficient for removal of neoplasia and to address traumas that can not be repaired in the tail. Dogs adapt quickly to partial caudectomy of the tail and do not show signs of distress associated with the loss of a part of their tail, especially if disease present prior to removal caused discomfort.\nPost surgery, a bandage may be applied to the tail to protect it. It may be difficult to maintain a bandage on this part of the body and this will require maintenance to keep it in place. Your dog may also require an e-collar to prevent them from biting or chewing at the wound. Pain medication and antibiotics will be prescribed and should be administered as directed. Removal of non-absorbable sutures will be performed one to two weeks post-surgery by your veterinarian. The wound should be monitored for signs of infection or dehiscence, which should be addressed with your veterinarian if they occur.\nThe cost of partial caudectomy depends on the invasiveness of the procedure required. For congenital defect, the procedure may be more complicated and incur more expense. Also, the method of anesthesia utilized will affect the price of the procedure. Partial caudectomy ranges in cost from $100 to $500 and is also affected by the cost of living in your area.\nComplications such as fecal incontinence, nerve pain, and infection have been reported with partial caudectomy, but theses are rare and the benefits of the procedure usually outweigh the risks of complications. Partial caudectomy is performed to address medical conditions not cosmetic conditions.\nPreventing injury to the tail in your dog can prevent the requirement for partial amputation of the tail. Be careful in your home, especially with closing doors, to ensure your dog's tail does not get caught. When outside, dogs should be contained or on a leash at all times to prevent motor vehicle accidents or incidents with other animals that would result in tail injuries. If your dog develops infection or dermatitis or is biting or chewing at their tail aggressively, seek veterinary advice to address before the condition compromises tail tissues, resulting in an irreversible condition.\n*Wag! may collect a share of sales or other compensation from the links on this page. Items are sold by the retailer, not Wag!.\n1 found helpful\nWhen doing a partial Caudectomy is it better to remove the tail from the joint just above the "kink" (vertebrae fusion ) or go just a little further and cut the last good vertebrae in half? I have a Golden Retriever with a fused bone and my vet feels as if there are less nerve endings involved if the bone is cut in half when we do the surgery - that healing will be easier and less painful. Yes? No?\nFeb. 23, 2018\nDr. Michele K. DVM\nThank you for your email. There is so much information that I don't know with this situation, it would be irresponsible for me to offer ann opinion over an email. The surgery necessary completely depends on the dog, the situation, nerve function, and the reason for the surgery. If you are not sure of the opinion of your veterinarian, it would be best to have a second opinion with someone that can examine Kudos. I will say when amputating a tail, there are nerves that control bladder and bowel function, and the higher up one takes off the tail, the more risk there is to those nerves... I'm sorry that I can't offer more insight - that is a question for your veterinarian. I hope that all goes well for Kudos!\nFeb. 23, 2018\nWas this experience helpful?\n0 found helpful\nWe have a six and a half year old English Bull Mastiff, Bella, and last year she started to develop a growth about midway on her tail. At first it was the size of a garden pea, now it is the size of a walnut. It keeps oozing and when she knocks it it bleeds, a lot. Our usual vets have hummed and ha'ad about her tail, but because it is bothering her, and causing her some degree of discomfort, we decided to seek a second opinion from another vet. They looked at it and they were in total agreement with my husband and myself, that Bella would benefit from a partial Caudectomy. This is booked to take place on 9th October 2019. The tail will be removed one joint above the growth, so she will be left with around a third of her tail. Our usual vets quoted around £600, but the practice that is going to carry out the procedure, it is costing £200. We questioned the difference in price, and were told that some vets charge what they like, knowing that owners will pay it because they love their pets! We are worried and apprehensive, but will do what ever is needed to make sure Bella lives a pain free and as happy a life as possible. All we can do until her surgery is keep the tail as clean as possible, and Bella as comfortable as we can\n© 2020 Wag Labs, Inc. All rights reserved.\nDownload the Wag! app\nDownload the Wag! app
David McD Taylor, MD, MPH, DRCOG, FACEM, Director of Emergency and General Medicine Research, Principal Fellow; Anthony Bell, FACEM, Director of Emergency Medicine; Anna Holdgate, MMed, FACEM, Director of Emergency Medicine Research; Catherine MacBean, BA, DipEd, Research Assistant (formerly); Truc Huynh, FACEM, Staff Specialist; Ogilvie Thom, FACEM, Staff Specialist; Michael Augello, FACEM, Staff Specialist, Honorary Fellow; Robert Millar, FACEM, Staff Specialist; Robert Day, FACEM, Staff Specialist; Aled Williams, FACEM, Staff Specialist; Peter Ritchie, FACEM, Director of Emergency Medicine; John Pasco, FACEM, Director of Emergency Medicine.\nRisk factors for sedation-related events during procedural sedation in the emergency department\nArticle first published online: 17 MAY 2011\n© 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine\nEmergency Medicine Australasia\nVolume 23, Issue 4, pages 466–473, August 2011\nHow to Cite\nTaylor, D. M., Bell, A., Holdgate, A., MacBean, C., Huynh, T., Thom, O., Augello, M., Millar, R., Day, R., Williams, A., Ritchie, P. and Pasco, J. (2011), Risk factors for sedation-related events during procedural sedation in the emergency department. Emergency Medicine Australasia, 23: 466–473. doi: 10.1111/j.1742-6723.2011.01419.x\n- Issue published online: 8 AUG 2011\n- Article first published online: 17 MAY 2011\n- Accepted 17 March 2011\n- adverse event;\n- emergency department;\n- procedural sedation\nObjective: To determine the nature, incidence and risk factors for sedation-related events during ED procedural sedation, with particular focus on the drugs administered.\nMethods: Eleven Australian EDs enrolled consecutive adult and paediatric patients between January 2006 and December 2008. Patients were included if a sedative drug was administered for an ED procedure. Data collection was prospective and employed a specifically designed form. Multivariate logistic regression was employed to determine risk factors for sedation-related events.\nResults: Two thousand, six hundred and twenty-three patients were enrolled (60.3% male, mean age 39.2 years). Reductions of fracture/dislocations of shoulders, wrists and ankles were most common. Four hundred and sixty-one (17.6%) cases experienced at least one airway event that required intervention. Airway obstruction, hypoventilation and desaturation occurred in 12.7%, 6.4% and 3.7% of all patients, respectively. Two thousand, one hundred and forty-six cases had complete datasets for further analyses. Increasing age and level of sedation, pre-medication with fentanyl, and sedation with propofol, midazolam or fentanyl were risk factors for an airway event (P < 0.05). Ketamine was a protective factor. Hypotension (systolic pressure <80 mmHg) occurred in 34 (1.6%) cases with midazolam being a significant risk factor (P < 0.001). Vomiting also occurred in 34 (1.6%) cases, 12 of whom required an intervention. One patient aspirated. Vomiting occurred after administration of all drugs but was not associated with fasting status. Other events were rare.\nConclusions: Sedation-related events, especially airway events, are common but very rarely have an adverse outcome. Elderly patients, deeply sedated with short-acting agents, are at particular risk. The results will help tailor sedation to individual patients.\nProcedural sedation in the ED is commonly undertaken and a variety of sedative agents and techniques are employed. However, sedation-related events are commonly reported especially respiratory depression and obstruction, and to a lesser extent hypotension and vomiting.1,2 Although there are numerous reports of the efficacy of a range of sedative agents, the large majority are underpowered to effectively examine and compare the incidence of related events. Furthermore, reports are often limited to specific drugs or populations (e.g. propofol, paediatrics) and have utilized heterogeneous methodology, often without account for important confounding variables.3,4 Consequently, the comparative safety of these agents (as a reflection of unexpected events) is poorly understood.\nThe present study aimed to examine the nature and incidence of sedation-related events with the agents commonly used for ED sedation (midazolam, propofol, morphine, fentanyl, ketamine and nitrous oxide) and to determine which independent variables, among a comprehensive range, are significant risk factors for these events. The findings will identify sedative agents or patients at high risk of related events. This will inform the development of evidence-based, best-practice guidelines aiming to maximize efficacy and safety of procedural sedation in the ED.\nThe present study was undertaken as part of a multi-centre, prospective, observational project, the complete details of which are reported elsewhere.5 It was a prospective, analytical, observational project undertaken at 11 Australian EDs between January 2006 and December 2008. A consecutive sample of adult and paediatric patients who received parenteral sedation for a procedure in the ED was enrolled. Most data (weight, fasting status, details of defined sedation-related events, level of sedation, designation of the person in charge of the sedation and procedure outcome) were recorded prospectively, immediately after the procedure. Other data (demographics, nature of the procedure, time and dose of all drugs administered and disposition) were extracted, by the site investigator, after explicit review of the medical record.\nThe sedation-related events examined included respiratory events that required an intervention, vomiting, aspiration of stomach contents, hypotension (systolic BP <80 mmHg) or hypertension (systolic BP >180 mmHg), bradycardia (HR <60 /min) or tachycardia (HR >120 /min), and ‘other’ events. A respiratory event was defined as hypoventilation (<10 breaths/min) and/or oxygen desaturation (<90% mmHg) and/or an obstructed airway (partial/complete). Interventions for respiratory events included painful stimuli, chin lift or jaw thrust, insertion of an oro/nasopharyngeal airway, bag and mask ventilation, endotracheal intubation and the administration of flumazenil or naloxone.\nThe sample size calculation is reported elsewhere.5 Only cases with complete datasets were included in the analyses. The dependent variables examined were the unexpected events, as defined above. The independent variables included sex, age, weight, nature of the procedure, deepest level of sedation, designation of the sedator, pre-medication and sedation drugs administered, and fasting status (time since last food/fluid ingested). Each independent variable was separated into either nominal or ordinal subgroups prior to analysis.\nThe Observer's Assessment of Alertness/Sedation Scale6 was used to assess each patient's level of sedation. This 6-point ordinal scale comprised variables ranging from ‘responded readily to name spoken in normal tone’ (level 1) to ‘did not respond to noxious painful stimulus’ (level 6). It was easy to use and has proven validity and reliability.6\nUnivariate analyses were undertaken for the common sedation-related events (respiratory, vomiting, hypotension). The proportions of independent variables (or subgroups) among the cases that did/did not experience an event were compared using the χ2-test. Multivariate logistic regression analysis was subsequently undertaken including all variables except sex, which had no association with any event. Stata 1999 statistical software 1999 (Stata, College Station, TX, USA) was used for data analysis. The level of significance was 0.05.\nA total of 2623 patients were enrolled. Of these, 1581 (60.3%, 95% CI 58.4–62.2) were male and the median (interquartile range, IQR) age was 34 (20–60) years. Reductions of fractured/dislocated shoulders, wrists and ankles were the most common procedures.5 Airway events were most commonly seen. Overall, 461 (17.6%, 95% CI 16.2–19.1) patients experienced at least one airway event that required intervention. Airway obstruction, hypoventilation and desaturation occurred in 333 (12.7%, 95% CI 11.5–14.0), 166 (6.3%, 95% CI 5.4–7.4) and 97 (3.7%, 95% CI 3.0–4.5) cases, respectively. Chin lift, bag ventilation, painful stimuli and a pharyngeal airway were required in 403 (15.4%), 84 (3.2%), 66 (2.5%) and 45 (1.7%) cases, respectively. Naloxone and flumazenil were required in 9 (0.3%) and 6 (0.2%) cases, respectively.\nOverall, 2146 cases had a complete dataset and were included in further analyses. Of these, 1306 (60.9%, 95% CI 58.8–62.9) were male and the median (IQR) age was 34 (19–60) years. The median (IQR) levels of sedation provided by the registrar and consultant were 4 (2–5) and 4 (2–6), respectively (Mann–Whitney U-test, P < 0.001). Sex, age and level of sedation were very similar for the cases not included (P > 0.05).\nWithin this group, respiratory events that required intervention were experienced by 447 (20.8%, 95% CI 19.1–22.6) cases (Table 1). On univariate analysis, a large number of variables were significantly associated with respiratory events. Multivariate analysis (Table 2) indicated that age ≥40 years, pre-medication with fentanyl, sedation with either propofol, midazolam or fentanyl, and a deep level of sedation were all risk factors for a respiratory event. Weight, procedure and fasting status were not associated with respiratory events. Having a trainee in charge and sedation with ketamine were protective factors. Notably, the administration of morphine for pre-medication or sedation was not associated with a respiratory event and ketamine has a protective effect. No patient who had morphine pre-medication or who received ketamine required intubation for a respiratory event.\n\|Variable\|\|n\|\|Cases of airway event\|\|Cases of vomiting\|\|Cases of hypotension\|\n\|n (%)\|\|P\|\|n (%)\|\|P\|\|n (%)\|\|P\|\n\|Male\|\|1306\|\|259 (19.8)\|\|0.16\|\|22 (1.7)\|\|0.73\|\|17 (1.3)\|\|0.22\|\n\|Female\|\|840\|\|188 (22.4)\|\|12 (1.4)\|\|17 (2.0)\|\n\|<20\|\|566\|\|46 (8.1)\|\|<0.001\|\|28 (5.0)\|\|<0.001\|\|0 (0.0)\|\|<0.001\|\n\|20–29\|\|407\|\|76 (18.7)\|\|2 (0.5)\|\|4 (1.0)\|\n\|30–39\|\|251\|\|52 (20.7)\|\|1 (0.4)\|\|1 (0.4)\|\n\|40–49\|\|172\|\|39 (22.7)\|\|1 (0.6)\|\|5 (2.9)\|\n\|≥50\|\|750\|\|234 (31.2)\|\|2 (0.3)\|\|24 (3.2)\|\n\|≤50\|\|399\|\|27 (6.8)\|\|<0.001\|\|28 (7.0)\|\|<0.001\|\|2 (0.5)\|\|0.06\|\n\|51–75\|\|886\|\|200 (22.6)\|\|3 (0.3)\|\|20 (2.3)\|\n\|76–100\|\|744\|\|189 (25.4)\|\|3 (0.4)\|\|12 (1.6)\|\n\|>100\|\|117\|\|31 (26.5)\|\|0 (0.0)\|\|0 (0.0)\|\n\|Dislocated shoulder\|\|556\|\|126 (22.7)\|\|<0.001\|\|1 (0.2)\|\|<0.001\|\|7 (1.3)\|\|<0.01\|\n\|Fractured wrist\|\|280\|\|51 (18.2)\|\|1 (0.4)\|\|0 (0.0)\|\n\|Fractured ankle\|\|229\|\|64 (28.0)\|\|0 (0.0)\|\|4 (1.8)\|\n\|Laceration repair\|\|228\|\|11 (4.8)\|\|16 (7.0)\|\|1 (0.4)\|\n\|All other\|\|853\|\|195 (22.9)\|\|16 (1.2)\|\|22 (2.6)\|\n\|Level of sedation\|\n\|1\|\|274\|\|6 (2.2)\|\|<0.001\|\|6 (2.2)\|\|0.79\|\|0 (0.0)\|\|0.01\|\n\|2\|\|340\|\|23 (6.8)\|\|6 (1.8)\|\|3 (0.9)\|\n\|3\|\|237\|\|43 (18.1)\|\|3 (1.3)\|\|2 (0.8)\|\n\|4\|\|331\|\|70 (21.2)\|\|7 (2.1)\|\|9 (2.7)\|\n\|5\|\|454\|\|133 (29.3)\|\|5 (1.1)\|\|6 (1.3)\|\n\|6\|\|510\|\|172 (33.7)\|\|7 (1.4)\|\|14 (2.8)\|\n\|Person in charge\|\n\|Consultant\|\|1259\|\|290 (23.0)\|\|0.01\|\|20 (1.6)\|\|0.54\|\|16 (1.3)\|\|0.21\|\n\|Registrar\|\|852\|\|153 (18.0)\|\|12 (1.4)\|\|17 (2.0)\|\n\|Resident\|\|20\|\|3 (15.0)\|\|0 (0.0)\|\|1 (5.0)\|\n\|Other\|\|15\|\|1 (6.7)\|\|2 (13.3)\|\|0 (0.0)\|\n\|Pre-medication drug given†\|\n\|Morphine\|\|711\|\|179 (25.2)\|\|<0.001\|\|4 (0.6)\|\|<0.01\|\|8 (1.1)\|\|0.27\|\n\|Fentanyl\|\|304\|\|84 (27.6)\|\|<0.01\|\|2 (0.7)\|\|0.22\|\|6 (2.0)\|\|0.62\|\n\|Anti-emetic\|\|83\|\|23 (27.7)\|\|0.12\|\|0 (0.0)\|\|0.64\|\|1 (1.2)\|\|1.00\|\n\|Sedation drug given†\|\n\|Propofol\|\|1350\|\|374 (27.7)\|\|<0.001\|\|4 (0.3)\|\|<0.001\|\|23 (1.7)\|\|0.72\|\n\|Midazolam\|\|523\|\|109 (20.8)\|\|0.99\|\|6 (1.2)\|\|0.43\|\|19 (3.6)\|\|<0.001\|\n\|Fentanyl\|\|642\|\|174 (27.1)\|\|<0.001\|\|4 (0.6)\|\|0.02\|\|14 (2.2)\|\|0.19\|\n\|Morphine\|\|170\|\|35 (20.6)\|\|0.93\|\|2 (1.2)\|\|1.00\|\|1 (0.6)\|\|0.52\|\n\|Nitrous oxide\|\|184\|\|8 (4.4)\|\|<0.001\|\|15 (8.2)\|\|<0.001\|\|0 (0.0)\|\|0.11\|\n\|Ketamine\|\|354\|\|30 (8.5)\|\|<0.001\|\|15 (4.2)\|\|<0.001\|\|3 (0.9)\|\|0.35\|\n\|Time last ate/drank (hours)\|\n\|00.00–01.59\|\|224\|\|41 (18.3)\|\|0.11\|\|6 (2.7)\|\|0.62\|\|6 (2.7)\|\|0.28\|\n\|02.00–03.59\|\|563\|\|108 (19.2)\|\|7 (1.2)\|\|7 (1.2)\|\n\|04.00–05.59\|\|605\|\|137 (22.6)\|\|11 (1.8)\|\|6 (1.0)\|\n\|06.00–07.59\|\|334\|\|74 (22.2)\|\|6 (1.8)\|\|5 (1.5)\|\n\|08.00–09.59\|\|171\|\|26 (15.2)\|\|1 (0.6)\|\|5 (2.9)\|\n\|≥10.00\|\|249\|\|61 (24.5)\|\|3 (1.2)\|\|5 (2.0)\|\n\|Totals\|\|2146\|\|447 (20.8)\|\|34 (1.6)\|\|34 (1.6)\|\n\|Level of sedation\|\n\|Person in charge\|\nVomiting was experienced by 34 (1.6%, 95% CI 1.1–2.2) cases (Table 1). Univariate analysis revealed that young age, low weight, and sedation with nitrous oxide or ketamine were significant risk factors. Cases having a laceration repair also had a higher risk of vomiting. However, the large majority of these cases were children who had been administered ketamine. Pre-medication with morphine and sedation with propofol or fentanyl were protective factors. Although anti-emetic drug administration was not significantly associated with vomiting, none of the 83 cases who received an anti-emetic vomited. Although, fasting status was not significantly associated with vomiting, cases who had the shortest fasting period (<2 h) had a slightly increased risk. Multivariate analysis was not undertaken as the small number of cases who vomited precluded meaningful results.\nA single (0.05%) case aspirated. This was an 83-year-old woman who was sedated for the relocation of a dislocated hip prosthesis. She had a past history of hiatus hernia repair and had fasted for 24 h before the procedure. She received pre-medication with morphine (2.5 mg) and was deeply sedated (level 6) with fentanyl (50 µg) and propofol (50 mg). Chin lift and bagging was provided for an obstructed airway and hypoventilation. Although no vomiting was observed, her oxygen saturation slowly dropped after the procedure. She required intubation and an intensive care admission for radiologically confirmed pulmonary aspiration.\nHypotension was experienced by 34 (1.6%, 95% CI 1.1–2.2) cases (Table 1), 27 (79.4%) of whom were administered a bolus of i.v. fluids. Univariate analysis revealed that age ≥40 years, sedation with midazolam and deep sedation were significant risk factors for hypotension. Patients who had an ‘other’ procedure also had a higher risk. Multivariate analysis was not undertaken as the small number of cases with hypotension precluded meaningful results.\nOther sedation-related events among the original dataset of 2623 cases were uncommon. There were 42 (1.6%) cases of hypertension of whom only three (7.1%) required treatment (additional sedation). There were 75 cases of bradycardia of whom only two required treatment (i.v. fluids for both and aramine for one). There were 63 cases of tachycardia of whom only three required treatment (i.v. fluids for two and additional sedation for another). There were 29 other events reported. These included agitation (11 cases), seizure following morphine and propofol (2), twitching/jerking (1 after propofol/morphine, 1 after ketamine), drug allergy (3), laryngospasm (2), painful extravasation of propofol (2), nausea/retching (2), prolonged sedation (1) and excessive drooling (1). The nature of the event was not recorded in three cases.\nOne important finding of the present study was that sedation-related events are common and are experienced by approximately one-fifth of cases. This highlights the need among those undertaking ED sedation for competency in event management.7 Notably, with the exception of the case of aspiration, no case experienced an adverse outcome. It should not be concluded from this that procedural sedation is low risk, rather that patients are managed by emergency physicians and/or trainees adequately skilled in the appropriate management of unexpected events.\nAlthough most procedural sedation does not result in loss of protective airway reflexes,8 our finding that respiratory events comprised the great majority of events is consistent with others.2,9 Our definition of a respiratory event included the need for it to require an intervention. It is highly likely that other events occurred that did not require intervention and were, therefore, not documented, for example, transient partial obstruction. In this sense, our results might be an underestimation of all respiratory events. However, Bell et al.9 reported that respiratory interventions are often not necessary given the transient nature of most events. Hence, the actual incidence of clinically significant respiratory events is difficult to determine.\nThe regression analysis revealed important, independent risk factors for respiratory events. It is not surprising that the elderly are at particular risk. They are more likely to have comorbidities and regular medication requirements, reduced physiological reserve and greater sensitivity to sedative agents. The drugs with significant respiratory event risk (fentanyl, propofol, midazolam) are potent agents and their respiratory depression effects have been reported previously.2 However, the fact that these effects are relatively short-lived might contribute to their good safety profile. Notably, morphine was not a risk factor and, although its effect on respiratory depression is important in other settings10 it is not in the ED sedation setting. The protective effect of ketamine is consistent with its effects of preserving airway reflexes.11\nIt is clear that an increased level of sedation is associated with an increased incidence of respiratory events. This is most evident as the sedation level 6 odds ratio was almost double that of level 4. This association was expected as profound suppression of the consciousness is often associated with depression of a range of respiratory, cardiovascular and other vital functions. In this regard, it is noteworthy that approximately one-quarter of cases were sedated to level 6, a level tantamount to general anaesthetic.\nThe apparent protective factor of having a registrar in charge of the sedation is of interest. This finding is likely related to the lower level of sedation provided by the registrars. Despite this lower level of sedation, it is notable that the registrars' procedural failure rate was similar to that of the consultants.12 Alternatively, this apparent registrar ‘protective factor’ might have resulted from an ‘alpha’ error, a statistically significant finding by chance.\nThe drugs used routinely for procedural sedation are less emetic than the inhaled anaesthetic gases used for general anaesthesia.13,14 Few cases (1.6%) in the present study vomited and this low incidence is consistent with the findings of others.2,9,15–18 Procedural sedation is frequently undertaken in the ED regardless of the patient's fasting status.15–17 It is likely that doctors do not delay a procedure when the patient is in considerable pain and that such pain might delay gastric emptying, in any case.19\nImportantly, fasting status was not associated with vomiting risk. Few ED studies have specifically examined vomiting during procedural sedation. Some report that fasting status has no impact upon the risk of vomiting1,4,9,18,20 whereas others report that prolonged fasting might actually predispose to vomiting.21 Interestingly, guidelines on procedural sedation22 recommend determining patient fasting status but make no recommendation for the application of this information. Although fasting status might have limited importance, it is worthy of consideration in the pre-sedation risk evaluation of individual patients and decisions made accordingly.3,4,8,23 For example, for a non-fasted patient who requires sedation without delay, drugs associated with nausea and vomiting might best be avoided.\nThe variables that were found, on univariate analyses, to be risks for vomiting were expected. Children have a propensity to vomit1 and nitrous oxide24 and ketamine17 are known to be more emetic than other drugs. However, as regression analyses could not be undertaken, we cannot conclude that these are independent factors. Indeed, it is very likely that there were clear interactions between these variables. For example, children have low weight and are more frequently administered nitrous oxide and ketamine for suturing and less common procedures. Interestingly, morphine was found to be a protective factor. Morphine can induce nausea and vomiting although the routine use of an anti-emetic with morphine is considered unnecessary in the trauma setting.25 Our findings are consistent with these recommendations. Propofol was also a protective factor and its anti-emetic properties have been reported previously.26\nThe low incidence of vomiting in the present study, and the finding that no patient who vomited actually aspirated, is consistent with the reports of others that the absolute risk of aspiration is very small.1,4 Only one case of aspiration has been reported previously.27 It is likely that a variety of patient-specific factors determine the depth of sedation at which they become unable to protect themselves from significant aspiration.28 Our case of aspiration is instructive, especially as she did not vomit and was not administered drugs at risk of causing vomiting. Silent aspiration has been observed during normal sleep.29,30 Although conjecture, it is possible that her old age and the manual ventilation she received, in the setting of previous hiatus hernia surgery, partially inflated her stomach and left her prone to silent aspiration during her deep sedation.31 There was no suggestion that she was clinically ill prior to the procedure and earlier aspiration or other respiratory disease was highly unlikely.\nHypotension was also an uncommon event and this is consistent with other reports.2 Most patients were treated with a fluid bolus and no adverse outcomes were observed. The level of hypotension in our definition (<80 mmHg systolic) was low and, although the data were not collected, it is very likely that considerable numbers of cases had BP falls to between 80 and 100 mmHg. Also, our observed incidence of hypotension is likely to be an underestimate as BP was not measured continuously. The elderly are particularly at risk because of their physiological characteristics described above. Midazolam is known to have hypotensive properties, especially if substantial doses are administered rapidly.32 The finding that the level of sedation was a risk factor was expected as deep sedation is known to have significant adverse effects on cardiovascular reflexes. Like vomiting, these univariate data cannot identify truly independent risk factors.\nPatient risk assessment is important prior to procedural sedation and should include a consideration of duration of the procedure, expected sedation depth required, drug selection tailored to the patient and fasting status.8 The findings of the present study might inform the appropriate selection of a sedation regimen for an individual patient. For example, an 85-year-old patient with cardiovascular disease and hypertension is at risk of respiratory events and hypotension. In order to minimize these risks, fentanyl, midazolam and deep sedation should be avoided. Judicious doses of morphine and propofol would offer a reasonable alternative.\nA number of the present study's limitations have been reported elsewhere.5 In this part, there were few cases of vomiting and hypotension. Consequently, multivariate analyses were inappropriate and truly independent risk factors could not be determined. A truly consecutive sample was not achieved. The number of missed cases could not be determined retrospectively as sedation cases are not specifically classified. However, the number of missed cases is likely to have been small.5 Some cases were excluded from analysis because of missing data. It is possible that missing cases and data contributed to selection bias. Significant measurement bias is unlikely as most data were specific and collected prospectively on purpose-designed documentation. However, we relied upon self-reporting of sedation-related events. This might have been affected by prevarication bias and underreporting. Data collected on explicit chart review were also specific and not open to interpretation. Some subjectivity was inherent in determination of the level of sedation. However, the Observer's Assessment of Alertness/Sedation Scale tool has clearly defined sedation levels and has been validated previously. External validity is likely to be good as the large sample size was enrolled at a number of EDs across Australia.\nDirections for future research\nWe recommend that large collaborative studies or a national sedation registry be considered. Data from these initiatives would be valuable in informing the development of detailed risk profiles for individual drugs, demographics and other patient variables. These profiles will allow the tailoring of sedation techniques to individual patients in order to minimize the risk of sedation-related events. Databanks would also provide sample sizes large enough for detailed analysis of less common events, inform quality assurance audits and allow further research into specific research questions.\nSedation-related events in the ED are common although adverse outcomes are very rare. Respiratory events are particularly common and are experienced by approximately one-fifth of cases. Increasing age and level of sedation, pre-medication with fentanyl, and sedation with propofol, midazolam or fentanyl are significant risk factors for an airway event. Very deep sedation should be avoided if possible. Vomiting and hypotension are uncommon events and independent risk factors are yet to be determined. Other events, including aspiration, are rare. A knowledge of the risks associated with sedative drugs, demographics and other patient variables will assist in the selection of appropriate sedation techniques for the individual patient.\nThe authors would like to thank Professor Peter Cameron for data collection at the Alfred Hospital and Mr Antony Ugoni for statistical advice.\nDMcDT and AH are Section Editors, Original Research for Emergency Medicine Australasia.\n- 5Procedural sedation practices in Australian Emergency Departments. Emerg. Med. Australas 2011; 23: 458–65., , et al. for the Emergency Department Sedation Study Investigators.\n- 6Validity and reliability of the observer's assessment of alertness sedation scale: study with intravenous midazolam. J. Clin. Psychopharmacol. 1994; 10: 244–51., , et al.\n- 7American College of Emergency Physicians Subcommittee (Writing Committee) on Procedural Sedation and Analgesia in the Emergency Department. Clinical policy: procedural sedation and analgesia in the emergency department. Ann. Emerg. Med. 2005; 45: 177–96., , et al.\n- 12Factors associated with failure to successfully complete a procedure during Emergency Department sedation. Emerg. Med. Australas. 2011; 23: 474–8., , et al. for the Emergency Department Sedation Study Investigators.\n- 22ANZCA. Guidelines on Sedation and/or Analgesia for Diagnostic and Interventional Medical, Dental or Surgical Procedures. Review PS9 (2010): ANZCA, 2010.
Systematic review on awake surgery for lung metastases\nIn recent years, some authors started an awake surgery program for lung metastasectomy. Very few information are available, and there have been no randomized trials. Taking a cue from a clinical scenario a review on PUBMED was conducted from January 2000 to July 2017. The Following search terms were used to retrieve potentials published articles: “awake surgery” or “awake lung surgery” or “awake surgery for lung metastasectomy” or “non-intubated lung metastasectomy” or “awake surgery for pulmonary metastasectomy” or “non-intubated pulmonary metastasectomy” or “awake surgery for lung metastases” or “non-intubated lung metastases” or “awake surgery for pulmonary metastases” or “non-intubated pulmonary metastases”. Literature search yielded 5,295 studies, of which only 3 fulfilled our inclusion criteria, but only 2 studies presented statistical analysis for the survival and they were from the same group. Awake surgery for LM is a possible choice for selected patients when the general anesthesia or the intubation is contraindicated. Although there is “some encouraging” evidence regarding awake LM, its quality is still very weak to confirm the effectiveness for this approach. The initial positive results can drive further research in this direction, but caution is necessary.
Wisdom Teeth Recovery: Extractions and Surgery\nWisdom teeth usually grow during the late teenage years or early adult years. There are times when these do not fit well into the mouth or do not grow in the right way. Sometimes they never break through the gums at all. The type of procedure you need to remove your wisdom teeth depends on how they grow in. Some wisdom tooth removals must be scheduled quickly because of severe pain or because they are causing problems with other teeth. It is important to follow your dentist’s instructions during the recovery period so you do not have further problems.\nWisdom Teeth Recovery: The First Few Days\nIt is important to take time off of work or school before you have your wisdom teeth removed. You may need up to two weeks for a full wisdom teeth recovery. Wisdom tooth extraction is more invasive than traditional extraction. The teeth are further back in the mouth and are often impacted.\nWhen you first get home from the procedure, you may still be groggy from the anesthesia or sedative. Pain medicine may be administered before you leave the doctor’s office, as well. Expect your face to be swollen and sore. There may also be some bruising to the face. Your jaw can be sore from staying open during the extraction, as well.\nPlan to rest for several days if the removal involves surgery. Talk to your dentist about pain-relieving medication. Depending on the severity of the situation, you may get a prescription pain reliever. If your extraction is not surgical, your dentist may recommend over-the-counter pain medication. Take good care of yourself for the quickest recovery.\n- Use ice packs on swollen areas\n- Follow the doctor’s instructions about medication\n- Stay home from work or school and rest\n- avoid hot drinks or rinsing the mouth for at least 24 hours (this can cause problems with the tooth socket wound)\n- Adjust your diet for a few days to help healing (smoothies, soft foods, and no hot beverages)\nReasons for Wisdom Teeth Removal\nWisdom teeth were a necessary part of life for our ancestors. Diets have changed as the world has become more modernized. Our meat is tender and grains are pounded until they are soft. Genetics seem to be slowly changing, as wisdom teeth often do not fit well into the mouth of many modern humans. There are some cases where people are born without them, as well.\nWisdom teeth can be left in place if they grow in properly or teeth are moved to make room. Unfortunately, some wisdom teeth do not cooperate. Emergency Dentist can help relieve your wisdom teeth pain. There are a few common reasons to remove wisdom teeth.\n- Growing in crooked or completely sideways\n- Pushing other teeth out of the way\n- Not enough room in the mouth\nWhat is the solution to wisdom teeth pain?\nWisdom teeth are usually removed when they begin to cause pain. Pan is an indicator there is a problem with the position of the wisdom teeth.\nWhat to Expect from Erupted Wisdom Teeth Removal\nWhen you dentist recommends wisdom teeth removal, you may have questions about the process. Dentists usually monitor wisdom teeth growing in. This way they can extract them before they cause big problems, if necessary. If your wisdom teeth are coming through the gums, they have erupted. You can have teeth fully erupted or partially erupted wisdom tooth. The extraction of an erupted wisdom tooth may not be as invasive.\nYour dentist may decide to remove the wisdom tooth before it is fully grown in if it is growing the wrong way, causing pain, or causing infection. The process for removal of a fully erupted wisdom tooth is very similar to a traditional extraction. If the tooth is broken or too large, surgery may be necessary to remove the entire tooth. You may be given a choice of local or general anesthesia. The socket may heal faster since the opening is smaller for an erupted tooth. A doctor in Houston, TX 77027 can help you prepare for wisdom tooth removal.\nWhen is wisdom teeth removal necessary?\nWisdom teeth removal is necessary when you have pain, infection, or an impacted tooth. It is common for wisdom teeth to grow in crooked or fail to erupt. Emergency Dentist can help you end wisdom teeth pain.\nDealing with Partially Impacted Wisdom Tooth Removal\nA wisdom tooth eruption is not always complete. If the tooth is growing in at an angle, it may remain partially impacted. You must have a surgical procedure for partially impacted tooth removal. General anesthesia is usually necessary, as a surgical cut must be made in the gums.\nPreparing for Impacted Tooth Extraction\nMeet with your dentist for a consultation before the day of your surgery. This gives you a chance to ask questions and learn about the details of the impacted wisdom teeth removal. There are a few things you can do to prepare for surgery and recovery.\n- Take a few days off of work or school\n- Ask a friend or family member to drive you to and from the appointment\n- Purchase soft foods and items to make smoothies with\n- Ask a friend or family member to stay with you at home for the first night\n- Purchase your pain medication or fill the prescription\n- Put several ice packs in the freezer to use for swelling\nHow to deal with pain due to growing wisdom teeth?\nA wisdom tooth extraction is usually one of the best way to end wisdom tooth pain. In some cases, you may have orthodontic work to make room for your wisdom teeth. Your dentist may recommend pain medication and ice packs until the day of your surgery.\nWhen you Only Need a Bottom Wisdom Tooth Extraction\nBefore you have your bottom wisdom teeth extracted, your dentist may x-ray all of your wisdom teeth. It is important to check the progress of all four of the wisdom teeth before you have a tooth removed. Perhaps the top ones are aligned properly or already erupting.\nThe recovery period is the same whether you have 2 or 4 wisdom teeth removed. You may simply be a little more comfortable since only 2 sockets need to heal. Expect to be careful with food and take time off of work, as well.\nTop Wisdom Teeth Removal\nAll wisdom teeth can cause similar problems. If you only need your top wisdom teeth removed, talk to your dentist about position of your bottom teeth. Sometimes, the dentist recommends removal of all four so you do not need to go under anesthesia again for a second surgery.\nIn some cases, however, the bottom wisdom teeth can grow in properly, while the top wisdom teeth cause problems. Ask your dentist what is good for your oral health. Each patient has a unique situation.\nEating the First Week After 2 Wisdom Teeth Removal\nAfter a couple of days of smoothies and beverages, you may be wondering when you can eat a big meal. The first 24 hours after surgery or an extraction is crucial because the blood needs to clot in the tooth socket. You need to grow new tissue and bone. Sometime during the first week you can start some soft foods, such as mashed potatoes. If you don’t have a blender, get one before the surgery.\nHow you May Feel 2 Days After Tooth Extraction\nThe way you feel after a tooth extraction depends on the severity of the procedure. A traditional extraction is easier to recover from than surgery. Swelling should start to go down in 2 or 3 days. You should notice a big difference after the first week. You may also feel like eating more after 2 days. Follow your doctor’s orders for pain relief so you are comfortable enough to rest, as well.\nWisdom teeth extractions are a common occurrence in young adults. Dentists can tell when wisdom teeth are coming in the wrong way. Dentists that care for teens and young adults check the wisdom teeth with x-rays during routine visits. Problems are usually noticed before they cause major pain. Visit Emergency Dentist for sudden tooth pain and wisdom teeth problems.\nWhen your dentist tells you that your wisdom teeth must come out, you may wonder about the recovery period. It can take up to two weeks to feel fully recovered from the removal of your wisdom teeth. If your wisdom teeth erupt completely, you may be able to avoid surgery. Many people, however, must have their wisdom teeth removed because they do not grow in properly. They may never come through the gums completely. Surgery is necessary, even if the tooth is only partially impacted. An incision must be made in the gums for the dentist to reach the impacted part of the tooth. You need someone to drive you to and from a wisdom tooth removal procedure. These surgeries often require local anesthesia. You cannot drive yourself home after this. You may also have pain medication that makes it unsafe to drive. Plan to rest for at least two days. You must limit your food choices, however, for a longer time. It is especially important to avoid hot beverages and rinsing your mouth for the first 24 hours. The blood needs to clot well and stay in place in the tooth socket. Over time, your tissue and bone fills in this space. Talk to your dentist in Houston about pain relief, eating, and follow-up visits. During recovery, call your dentist if you have increased pain, swelling, or bleeding. You should plan to refrain from heavy physical activity for at least two weeks. Your dentist can help prepare you for wisdom teeth recovery and removal. You may have a consultation with an dentist if you need surgery for impacted wisdom teeth. Wisdom teeth growing in the wrong direction can cause a lot of pain. Once the recovery is complete, you should feel more comfortable.
What sedation is used for wisdom teeth removal?\nNitrous Oxide Sedation with Local Anesthetic\nNitrous oxide can be used during simple oral surgery procedures, as well as more complex procedures like wisdom teeth removal and dental implant insertion. Before and during surgery, you breathe a mix of nitrous oxide (also known as laughing gas) and oxygen.\nWhat kind of sedation is used for oral surgery?\nMedications most commonly used are Fentanyl (opiate), Versed (benzodiazepine), Ketamine, and Diprivan. Supplemental oxygen is delivered through a nasal breathing apparatus and the patient’s vital signs are closely monitored. Usual Indications General anesthesia is available for all types of oral surgery.\nDo they put you to sleep for wisdom tooth removal?\nYou do not necessarily have to be put to sleep for your wisdom teeth extraction. Wisdom teeth extraction can be done while the patient is fully awake with the mouth Numbed with local anesthesia. Wisdom teeth are the molars (back teeth) that come through last, usually in your late teens or early 20s.\nIs IV sedation common for wisdom teeth removal?\nMany patients qualify for IV sedation in a dental setting, and those who benefit most are those with severe anxiety and also those who need multiple procedures done in one sitting. Intravenous anesthesia diminishes your body’s ability to sense pain, which is why this technique is so common for wisdom tooth removal.\nHow are you sedated for wisdom teeth?\nYour dentist or oral surgeon gives you sedation anesthesia through an intravenous (IV) line in your arm. Sedation anesthesia suppresses your consciousness during the procedure. You don’t feel any pain and will have limited memory of the procedure. You’ll also receive local anesthesia to numb your gums.\nWhat is twilight sedation wisdom teeth?\nIV Sedation (“Twilight Sedation”)\nWith “twilight sedation”, you are awake (or drifting in and out of sleep) for the procedure, but you are comfortable and calm, and may have no memory of the surgery when you “wake up”.\nWhat does IV sedation feel like wisdom teeth?\nIV sedation is often referred to as ‘sleep dentistry’ or ‘twilight sleep’. Once the sedation is administered you will feel a state of deep relaxation and won’t be bothered by what’s going on. You will remain conscious and able to understand and respond to requests from your dentist.\nWhat is in twilight sedation?\nThe drugs used in twilight anesthesia are similar to those used in general anesthesia, but the doses are lower. Specific drugs commonly used include: fentanyl, valium, ketamine, midazolam, or nitrous oxide (laughing gas).\nWhat is IV sedation?\nIntravenous (IV) sedation refers to the administering of an anti-anxiety drug through the blood during your dental treatment. An IV sedation dentistry is sometimes referred to as ‘twilight’ or ‘sleep’ dentistry. However, rather than putting you to sleep, the sedative helps you to relax and feel at peace.\nCan you request general anesthesia for wisdom teeth?\nGeneral anesthesia is not typically required for the removal of your wisdom teeth. Your dental professional may recommend this option in some cases, especially if the procedure is lengthy, complicated or if you experience high levels of stress.\nHow long are you high after wisdom teeth removal?\nIt can last up to 4-6 hours or longer after your procedure, and the benzodiazepine-based medication may interfere with your short-term memory, lead to problems with decision-making, and alter your emotional state, which is why you may see lots of videos of people acting strange or irrationally after sedation at the …
The Rosato Plastic Surgery Center\nTuesday, October 28, 2014\nGummy bear implants, what's the difference?\nBreast augmentation is one of the most common cosmetic procedures performed in the U.S. and worldwide. In 1992 silicone implants were placed on hold in this country and the majority of physicians used saline implants for breast augmentation. However, the remainder of the world still used silicone implants.\nAfter extensive research the FDA approved the unrestricted use of silicone implants in 2006. Today silicone implants are made with fourth generation cohesive gel. The gel is similar to the consistency of a gummy bear candy. The gel is very cohesive and when cut in half the new implants maintain their shape and the gel does not leak out. Older silicone implants had gel that would leak into the tissues if the implant was broken. The cohesive gel implants have been available in Europe for many years and I have been using them here in Vero Beach with great success.\nMany patients with saline implants will exhibit wrinkles in the upper part of the breast or have a shape that is too round for a natural breast shape. These patients are opting for implant replacement with silicone implants. Silicone implants come in a round shape like saline implants and are also available in teardrop shaped sizes.\nSaline implants can be placed through a small incision because the implants are placed into the breast empty. The saline is added after the implants are placed into the body. If a saline implant leaks the saline is absorbed into the body and the breast loses it fullness. When an implant leaks it requires replacement, which is a simple procedure as long as it is done relatively soon after deflation.\nAn MRI can be used to access the status of silicone implants if a leak is suspected. A special device developed in central Florida called the "Keller funnel" (www.kellerfunnel.com) helps place silicone implants into the breast and minimize potential infection.\nThe surgery usually last about an hour and most patients return to work within a week. Surgery should be done in a certified operating room for your safety. Anesthesia is required and usually a twilight technique is used. At the Rosato Plastic Surgery Center anesthesia is directed by a board certified anesthesiologists. The RPSC is a licensed ambulatory surgery center inspected by the state of Florida and the Agency for Health Care Administration.\nCall the Rosato Plastic Surgery Center for more information, 772-562-5859, or visit our web site, www.rosatoplasticsurgery.com, or like us on facebook. Special pricing is available to patients that reference this story.
Dental disease affects up to 90% of cats and can be a significant cause of pain and discomfort\nDental disease affects up to 90% of cats and can be a significant cause of pain and discomfort, reducing quality of life. Cats hide pain very well, so just the fact that they are continuing to eat does not mean they are not suffering with the dental disease that has been noted.\nWhat is the alternative to not eating? Its starving. In the long term, a cat’s drive to feed itself so that it does not starve will over-ride any reluctance to eat because of pain. They may eat differently, to avoid any painful areas in the mouth – such as gulping food down or chewing only on one side.\nAt Vet2Cat, we do dentistry well. Your cat will be the only patient booked in that day, so we are not rushing to finish to get somewhere else.\nIf you prefer, we can collect and transport your cat to the practice where the dental will be done, and of course bring them back afterwards!\nWe perform full mouth digital dental radiographs to assess every tooth, along with a thorough oral examination; descaling and probing around each tooth.\nWe use multimodal anaesthesia – meaning a combination of injectable pain killers, anaesthetic gas and dental nerve blocks. Some cats even need a constant infusion of additional drugs to ensure a smooth anaesthetic.\nExtractions as required are performed, generally this is a surgical technique involving cutting the gums away from the bone and drilling away parts of the bone to expose the roots. It is fiddly, precise work that is very skilled, and time consuming, and we charge accordingly.\nAny remaining teeth are polished, so they are clean and shiny!\nWe include a post-operative check-up visit in the costs as well as one oral care product for you to begin your cat’s oral care at home.\nDepending on the duration of the whole dental work, costs can vary from £550 to £2500.
Microneedling RF Treatment in Hyderabad :\nMicro Needling is a technique used for the treatment of atrophic scars and skin rejuvenation. It can be combined with other anti-aging and scar treatments. such as peels and fractional lasers and has been used to enhance drug penetration.\nMicro Needling RF system is ideal technology for skin rejuvenation by applying controlled RF energy in to certain depth of dermis with less pain and less down time.\nApplication of micro Needling RF:\n- Acne scar treatment\n- Skin Rejuvenation\n- Wrinkle reduction\n- Anti –aging treatment\n- Pore size reduction.\n- Stretch marks.\n- Reduction of excessive sweating (hyper hydrosis )\n- Scars on body (traumatic or surgical scars.\n- Reduction of fine lines\n- No of sitting requires depends on type of indication.\n- Office procedure performed under topical anesthesia.\n- Less down time.\n- It can also be combined with other treatment modalties such as peels, homoablative lasers, subcision , Botox and derma filers .\n- Depending on indication products such as hyaluronic acid , growth factors, vitamin c, tranexemic acid ,monoxidil etc.
The Strong Numb™ anesthetic cream t is widely used in clinics for laser treamen, micro pigmentation, skin microneedling, hair removal, moles, mikroiglovoy therapy, acupuncture, removal of nevus of Ota, removing freckles, skin peeling, skin cleaning, removal of warts, permanent make-up., surgical operations, laser therapy, laser removal of acne and a variesty of other cosmetic treatments.\n- High concentration of lidocaine - 10.56%;\n- Fast and effective anesthesia of the skin;\n- Only takes around 10 to 20 minutes to get the numb effect, while other product take over 1 hour\n- Perfect for injections, microneedling, mesotherapy and other cosmetic treatments;\n- Low consumption (not more than 2 ml).\nLidocaine cram works by temporarily blocking the pathway of pain signals along nerves. Lidocaine cram does this by stopping the sodium entering the nerve ending at the site of the pain. This prevents an electrical signal building up and passing along the nerve fibers to the brain.\nLidocaine may be absorbed following topical administration to mucus membranes, its rate and extent of absorption depends upon the specific site of application, duration or exposure, concentration and the total dosage. You may experience reddening of the procedure area.\nMedical Contents per 1g\nLidocaine (KP) 105.6mg\nAdditives (preservatives) : Benzalkonium chloride 0.2mg\nEffective topical anesthetic during cosmetic procedure. It quickly sooths and numbs the area.\nApply 0.25~0.66g cream before cosmetic procedure. Use minimum effective amount, and dose time of application may be different among individuals. Do not exceed applying 1.74g of cream and 187mg of lidocaine within 24 hours.\n- Keep out of the reach of Childhood hand\n- Store at room temperature (1℃~30℃)\n- Protect from light\n- Do not freeze\n- Do not throw it in the fire after use\n- Wash the area receiving tattoo or laser treatment with soap and water. Dry area completely.\n- Apply a thick amount of numbing cream to the area and rub in thoroughly.\n- After rubbing into the skin, apply a 2nd heavy layer of cream (1/8" or 3-5 mm thick) over the area.\n- Cover the cream with plastic wrap (saran wrap) and keep warm. The heat under the plastic wrap helps activate the cream and keeps the cream from drying out.\n- Leave cream and wrap in place for 10 to 35 minutes before procedure. For long procedures lasting hours over large areas; apply numbing cream over the entire work area, then remove in sections as procedure progresses.\n- Skin typically remains numb for 1 - 4 hours once cream is removed from numbed skin depending on skin type and location on body.\n- Not to be used on children under 6 years old.\n- Allergy to lidocaine or other local anesthetics\n- DO NOT apply the cream to cuts, grazes, wounds, areas where there is a skin rash or eczema, in or near the eyes, ears, mouth, (inside) nose or anus (back side) or the genitals of children.\n- Adults and children 6 years of age and older: Apply to affected areas no more than 2 times a day. Children under years please consult a physician.\n- Tell your prescriber or health care professional about other skin products you are using. Do NOT use this topical cream at the same site as other skin preparations without medical advice.\n- If your side effects bother you, or if you experience any unusual effects, stop using and contact your medical provider immediately.\n- DO NOT use if Patients with trauma or inflammation of the application\n- DO NOT use If patients are pregnancies.\n- DO NOT use for Liver, kidney diseased patients\n- This medicine is for external use only, do not eat\n- It is recommended that you do not apply a row on the same site\nIts possible side effects are likely to include swelling or redness at the application site, unusual sensations on skin or pale skin. Severe to rare side effects may include allergic reactions like hives, rash, itchiness, facial swelling, and difficulty in breathing or tightness in the chest.\nThe numb cream is liquid product which is restricted by shipping regulations. If you order it together with other product, the numb cream will be shipped separately. Please kindly notice that.\nPlease be noted product value of single unit over 1,500USD is not acceptable for Paypal payment.COD payment is not accepted. Credit card is acceptable if you link your credit card with Paypal.\nWe do not add taxes, VAT or any other hidden charges. You pay us what you see on your invoice, for example: Goods Subtotal + Shipping Costs (does not include duties). Please find out as much as you can about import taxes in your own country before purchasing an item. In special cases, you may need to pay import duties on certain goods. For assistant on any of this, you can contact us for further assistance.\nIs there anyway we can avoid or reduce importation duty?\nFor most countries, the answer is Yes. Please contact us directly for further assistance.\nAsk a Question\nYou may also be interested in the following product(s)\nRegular Price: $1,190.00\nSpecial Price $799.00\nRegular Price: $419.00\nSpecial Price $349.00
European Journal of Pain 11 (2007) 463–468 www.EuropeanJournalPain.\nEﬀect of hypnotic suggestion on ﬁbromyalgic pain: Comparison between hypnosis and relaxation\n´ rez a, Jose ´ Sala b, Anna Padrol a, Maria Rull , Magdalena Pe\n´ i Prestacio ´ de Serveis de Salut, Pain Clinic and UFISS Palliative Care. Hospital Universitari de Tarragona Joan XXIII and Gestio ´ Guasch 4, 43007 Tarragona, Spain C/Doctor Mallafre b Pain Clinic, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain c ´ a, Universitat Rovira i Virgili, Tarragona, Spain Departament de Medicina i Cirurgı Received 25 November 2005; received in revised form 17 June 2006; accepted 24 June 2006 Available online 4 August 2006\nAbstract The main aims of this experimental study are: (1) to compare the relative eﬀects of analgesia suggestions and relaxation suggestions on clinical pain, and (2) to compare the relative eﬀect of relaxation suggestions when they are presented as ‘‘hypnosis’’ and as ‘‘relaxation training’’. Forty-ﬁve patients with ﬁbromyalgia were randomly assigned to one of the following experimental conditions: (a) hypnosis with relaxation suggestions; (b) hypnosis with analgesia suggestions; (c) relaxation. Before and after the experimental session, the pain intensity was measured using a visual analogue scale (VAS) and the sensory and aﬀective dimensions were measured with the McGill Pain Questionnaire. The results showed: (1) that hypnosis followed by analgesia suggestions has a greater eﬀect on the intensity of pain and on the sensory dimension of pain than hypnosis followed by relaxation suggestions; (2) that the eﬀect of hypnosis followed by relaxation suggestions is not greater than relaxation. We discuss the implications of the study on our understanding of the importance of suggestions used in hypnosis and of the diﬀerences and similarities between hypnotic relaxation and relaxation training. Ó 2006 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Ltd. All rights reserved.\nKeywords: Hypnosis; Relaxation; Fibromyalgia; Chronic pain; Psychology\n1. Introduction The eﬃciency of methods of hypnosis at reducing pain has been well established (Hilgard and Hilgard, 1975; Barber, 1996; Syrjala and Abrams, 1996; Montgomery et al., 2000; Barber, 2001; Patterson and Jensen, 2003). Hypnosis has also proved to be eﬀective in cognitive-behavioural interventions (Kirsch et al., 1995; Milling et al., 2003) but it has not been shown to be superior to relaxation or autogenic training in the treatment of\nCorresponding author. Tel.: +34 977295862; fax: +34 977295805. E-mail address: [email protected] (A. Castel).\nchronic pain (Patterson and Jensen, 2003). As far as relaxation is concerned, and despite the fact that it has proved to be eﬀective at treating chronic pain (Arena and Blanchard, 1996; Syrjala, 2001), some studies highlight its drawbacks (Carroll and Seers, 1998; Keel et al., 1998). Although pain is a multidimensional experience, it is usually expressed in terms of its two principal components: the sensory-discriminative component, which refers to the quality, intensity and spatio-temporal characteristics of the sensation, and the motivationalaﬀective component, which refers to its negative valence and aversion (Melzack and Wall, 1965; Melzack and Casey, 1968; Gracely et al., 1978). These\n1090-3801/$32 Ó 2006 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.ejpain.2006.06.006\n1993. in a study in which they measured cerebral blood ﬂow in a sample of patients with ﬁbromyalgia.. 2001. and (2) to compare the relative eﬀect of relaxation suggestions when they are presented as ‘‘hypnosis’’ and as ‘‘relaxation training’’. The results of the various investigations are not totally conclusive on this point and it seems to be accepted that hypnosis has greater inﬂuence on the aﬀect of pain than on the sensation of pain (Price et al.\n. Participants Forty-ﬁve patients attended at the Pain Clinic of the Joan XXIII University Hospital in Tarragona. The experimental condition and the assessment were carried out by two diﬀerent researchers. De Pascalis et al. hypnosis is understood to be ‘‘a social interaction in which one person.7 years old [range 25–68].7% separated. hypnotics and myorelaxants. 1999). Other authors.. found that the patients experienced less pain during hypnosis than when they were at rest. responds to suggestions oﬀered by another person. 2005).. Despite deﬁning the concepts of hypnosis and relaxation. the study only took into account the Pain Rating Index Sensory (PRI-S) and the Pain Rating Index Aﬀective (PRI-A). 2001. Pain intensity was assessed using a Visual Analogue Scale (VAS) which consists of a 10 cm line anchored by two extremes of pain: ‘‘no pain’’ and ‘‘worst possible pain’’.3... There are very few studies on the eﬀects of hypnosis on ﬁbromyalgia.. the participants indicated the characteristics of their pain with the VAS and the MPQ. even though ﬁbromyalgia is the most common cause of chronic muscular–skeletal pain. 1998.. 1994). 2. 1985).7% of the sample are women and the remaining 13. Busquets et al. Meier et al. fatigue. Haanen et al.2% are married. 2002). 1969. Gracely et al. (1999). 82. 1987. Of all the participants. antidepressants. Procedure The patients were asked to go to the surgery where they were invited to participate in the study. The participants were invited to lie down on a comfortable. 1996). 2003).464\nA... and has been proved to be useful for assessing the intensity of pain in patients with chronic pain (Jensen et al. The aims of our study are: (1) to compare the relative eﬀects of analgesia suggestions and relaxation suggestions on clinical pain. Of the 48 patients who were invited to take part.\n2. 1995.. 1986). They were then randomly assigned to one of the three conditions.9% unmarried. with an approximate prevalence of 2% in the general population (Russell. the participants got up from the chair and did the VAS and the MPQ once again. In our study. Castel et al. reclining chair with arm rests and the experimental condition was applied. 60% have completed their primary education. As far as education is concerned. 2. Although the whole adaptation by La of the test was applied. 2002). Barber. Subjects are asked to make a mark on the line which represents their level of pain intensity. however. There are also studies that indicate that analgesia suggestions are no more eﬀective than suggestions of wellbeing and comfort at reducing the sensation of pain (Kiernan et al. 1999) and that analgesia suggestions and relaxation suggestions have diﬀerent eﬀects on the reduction of pain (Sachs. The scale is scored by measuring the distance from the ‘‘no pain’’ side of the line to the subject’s mark. for experiences involving alterations in perception. Spanish ´ zaro et al. designated the hypnotist.5 months [range 6–360]. designated the subject. 1995).7% secondary education and 13.. A total of 86.3% men.. Once over. These beneﬁts were maintained after a follow up of 24 weeks. 1978). There is growing interest in understanding the eﬀect of hypnosis on the sensory and aﬀective components of pain (Patterson and Jensen. while relaxation is understood as ‘‘a systematic approach to teaching people to gain awareness of their physiological responses and achieve both a cognitive and psychological sense of tranquillity’’ (Arena and Blanchard.2. 1975. 1970. After their demographic and clinical data had been collected. The participants were required to have been suﬀering from pain for at least 6 months. (1991) showed that the muscular pain. 45 accepted. 1999). The mean age is 43. 2. but be highly similar in practice (Schultz. Wik et al. indicate that the speciﬁc dimension in which hypnotic suggestion acts depends on the content of the instruction (Rainville et al. The mean duration of pain is 106. diagnosed with ﬁbromyalgia by a rheumatologist following the criteria of the American College of Rheumatology (Wolfe et al. There are also very few studies on the use of relaxation in ﬁbromyalgia (Keel et al. Gay et al.2% widowers and 8. Method 2.. 1990). Dahlgren et al. Price.. Fors et al.3% higher education. All the patients were following conventional pharmacological treatment with analgesics. Measures The description of pain was assessed using the McGill Pain Questionnaire (MPQ) (Melzack. 26. This system is widely used in clinical and experimental contexts.1. we cannot forget that both techniques can diﬀer in terms of their names or of their theoretical context. 6. / European Journal of Pain 11 (2007) 463–468\ncomponents can be measured by verbal descriptors (Melzack. sleep disorders and overall assessment of patients treated with hypnotherapy improved to a greater extent than in patients treated with physical therapy. 1975. memory and voluntary action’’ (Kihlstrom.\nRelaxation suggestions led to a 29% decrease in the pain intensity (VAS). Neither were any signiﬁcant diﬀerences found between the pre-experimental condition values of VAS.9–13. eliminated the tension. the t-test for related samples indicates that the VAS.3 47. The technique lasted for about 20 min. No signiﬁcant diﬀerences were found in age. PRI-S and PRI-A in the three groups. they had been asked whether this would be a suitable image). To determine whether there was any diﬀerence between the three experimental conditions.47–8. although they do not all decrease in the same proportion. This experimental condition was presented as a hypnosis technique.32–6.\n3.9** (SD 2.20–2.9 103. After 10 min. tactile. the diﬀerence\nTable 1 Demographic data Group Age Sex Male General Experimental condition 1 Experimental condition 2 Experimental condition 3 43. p < 0. distribution by sex.1* (SD 7. joints.3–0.50)\np < 0.68) 26. The technique lasted for about 20 min.7 SD 8. 27% (PRI-S) and 53% (PRI-A). Participants were asked to stare at an external stimulus and at a particular moment close their eyes.04) 4. duration of pain.2 SD 58.8–3.5 46 SD 9. Experimental condition procedures Experimental condition 1:‘‘Hypnosis with relaxation suggestions’’. catalepsy of the vocal cords and the raising of an arm.9 Pain duration Formal education Low 27 (60%) 10 (67%) 10 (67%) 7 (47%) Mid 12 (27%) 2 (13%) 4 (26%) 6 (40%) High 6 (13%) 3 (20%) 1 (7%) 2 (13%) Marital status Married 38 (84%) 11 (74%) 13 (86%) 14 (93%) Separated 3 (7%) 2 (13%) 1 (7%) 0 (0%) Single 4 (9%) 2 (13%) 1 (7%) 1 (7%)\nTable 2 Comparison of pre-experimental condition and after-experimental condition mean pain index Mean pre-after VAS 1–VAS 2 PRI-S1–PRI-S 2 PRI-Al–PRI-A 2\nExperimental condition 1 5. The data were statistically analysed using the SPSS programme for Windows. Subsequently.3 (SD 9.9 93. PRI-S and PRI-A values decrease signiﬁcantly after the application of each of the techniques. Immediately afterwards. The same chaining procedure and deeper hypnosis as in the previous technique were used. It was suggested that the liquid soothed the pain in the most aﬀected areas. / European Journal of Pain 11 (2007) 463–468\n2. Castel et al. kinaesthetic.6 48. instead of being asked to imagine a relaxing image.8–1.49–1. the patients were shown how to relax various parts of the body. The technique lasted for 20 min. They were advised to think about all the stimuli associated with the image (visual.7 (SD 2.7 SD 76. and created feelings of well being.5–3. olfactory) and also about all the associated sensations of relaxation and well being.56–0. for 10 min.4.7 SD 9. they were asked to visualize a leaf swaying on the branch of a tree and then ﬂoating slowly to the ground.001.9 (SD 5. Then. relaxation led to reductions of 43% (VAS). feelings of well-being and general relaxation were suggested for 5 min.32–2.44) 22.27–1. Results The three groups of participants were homogeneous.2 (SD 0.\nExperimental condition 3:‘‘Relaxation’’. they were told to focus on their diaphragmatic breathing. participants were asked to focus their attention on imagining on a pleasant beach (beforehand. the percentages of reduction were 71% (VAS).8 SD 99. As can be seen in Table 2.3* (SD 2. 76% (PRI-S) and 81% (PRI-A).7 (SD 2.99) 4.1 SD 7. Finally. This experimental condition was presented as a hypnosis technique. the participants were asked to imagine a liquid or blue analgesic stream that ﬁltered through their skin and reached diﬀerent parts of their body (muscles.6 SD 795 122. bones. marital status or educational level (see Table 1). A chain of suggestions were made using palpebral catalepsy.68–2.12)\nExperimental condition 2 5.01\nExperimental condition 3 5.01. beginning with feet and ﬁnishing with the head.4–1.58) 20.2 6 (13%) 3 (20%) 1 (7%) 2 (13%) Female 39 (87%) 12 (80%) 14 (93%) 13 (87%) 106.7–15.A. This image was associated with the descent of the arm and deeper hypnosis. For 5 min. Experimental condition 2:‘‘Hypnosis with analgesia suggestions’’.8 (SD 2. This experimental condition was presented as a relaxation technique.7–2.24) 4. Finally. This procedure lasted for about 10 min.2–6.\n. With analgesia suggestions. auditory. internal organs).51–8. a 39% decrease in sensory aspects (PRI-S) and a 61% decrease in the aﬀective dimension (PRI-A).\n. The relaxing suggestion of visualizing a pleasant beach can be regarded as a dissociative imagery suggestion (Price.. (1999).0001). does not modify the sensory component. The second conclusion from our study indicates that there is no diﬀerence between the results obtained by hypnosis with suggestions of relaxation and the results obtained by relaxation. 2003). This result shows that the content of the suggestion is important and indicates that some suggestions are more eﬀective than others at controlling pain (Sachs. dissociative imagery. 1999). and between hypnosis with analgesia suggestions and relaxation (Tukey test. (1999). Gay et al. they found that focused analgesia was the technique that most reduced pain.002] and in the MPQ-PRI-Sensorial score [F(2. 1975. Rainville et al. p < 0. If we focus on pain intensity variable.01.\n4. deﬁning the diﬀerence between hypnosis and relaxation is a complex task because both procedures contain components of relaxation and the focusing of attention (Syrjala and Abrams. As far as the sensory and aﬀective dimensions of pain are concerned. both between hypnosis with analgesia suggestions and hypnosis with relaxation suggestions (Tukey test.019.969. In our study. but not in the MPQ-PRI-Aﬀective [F(2. as we do. The diﬀerence was even more signiﬁcant when the values of the sensorial component of pain (PRI-S) were compared.466\nA. focused analgesia and placebo. and between hypnosis with analgesia suggestions and relaxation (Tukey test. / European Journal of Pain 11 (2007) 463–468\nTable 3 Comparison of the eﬀect of the experimental conditions Experimental conditions Condition 1 vs Condition 2 Condition 1 vs Condition 3 Condition 2 vs Condition 3 VAS 2 * *** * PRI-S2 * PRI-A2 * * \n = p < 0. Castel et al. 1970.001. however. Our results are diﬀerent. Discussion The study has two essential ﬁndings: (1) that hypnosis followed by suggestions of analgesia has a greater eﬀect on the intensity of pain and the sensorial dimension of pain than hypnosis followed by suggestions of relaxation. On the other hand. 2002) and there seem to be no empirical diﬀerences between them (Syrjala et al.005). De Pascalis et al. who show that the suggestion of analgesia modiﬁes both the sensory and the aﬀective components of pain. 1995). (1995) conclude.. Dahlgren et al. Stacher et al. This result is congruent with the ﬁndings of Rainville et al.392] (see Table 3). Our results also coincide with those of Kiernan et al. 1995. hypnosis with suggestions of relaxation diﬀered from relaxation in that the procedure was given the label of hypnosis and in that participants were asked to visualize relaxing images. = p < 0. (1975) also indicate that hypnosis plus suggestions of analgesia decreases the intensity of pain to a greater extent than hypnosis plus suggestions of relaxation. because they indicate that suggestions of sensory analgesia are not more eﬀective than suggestions of well-being at modifying the sensory component of pain.. Under the condition of hypnosis we used two diﬀerent types of suggestion.958..009). 1999). 1999. As has already been pointed out in the introduction.0001]. (1995) because they show that suggestions of analgesia do not modify the aﬀective components of pain any diﬀerently to suggestions of comfort and well-being. our ﬁndings are congruent with those of De Pascalis et al. When\nthey compared the analgesic eﬀects produced by the experimental conditions of deep relaxation. p < 0.\nin the pre. Signiﬁcant changes were found between the three experimental conditions in the VAS score of pain intensity [F(2. p < 0.. The changes in pain intensity and in the sensorial components of pain were greatest with the suggestion of focused analgesia. (2) that the eﬀect of hypnosis followed by suggestions of relaxation is no greater than that of relaxation. that analgesic hypnosis reduces the intensity of pain to a greater extent than the aﬀective dimension.0001).and post-session scores was calculated and ANOVA was carried out. the patients only had to focus their attention on the bodily sensations of relaxation and on their own breathing. our results indicate that analgesic suggestion has a greater eﬀect on the sensation of pain than the suggestion of relaxation. 1996. We believe that the lack of diﬀerence between the results\n. Stacher et al. Dahlgren et al. The suggestion of a blue. p < 0. On the other hand. p < 0. suggestion that aims to modulate the aﬀective component. 1999). although they only measured the intensity of the pain to determine the eﬀect of the changes produced. This corroborates the data that are available on this issue in the literature (Patterson and Jensen. analgesic stream ﬁltering into the painful area can be regarded as an indirect suggestion of focused analgesia. However. 42) = 6. Modulation of the sensory dimension of pain seems to produce a parallel modulation in the aﬀective dimension (Price. Post-hoc multiple comparisons showed that there was a signiﬁcant diﬀerence in the VAS score for pain intensity between hypnosis with analgesia suggestions and hypnosis with relaxation suggestions (Tukey test. p < 0. 42) = 17. the suggestion of analgesia has not proved to be more eﬀective than the suggestion of relaxation on the aﬀective dimension of pain. 42) = 0. there was no diﬀerence between hypnosis with relaxation suggestions and relaxation in any of the measures compared. In the procedure described as relaxation. * = not signiﬁcant. whereas relaxing hypnosis reduces the aﬀective component to a greater extent than the intensity. p < 0.\nHypnotic analgesia reduces R-III nociceptive reﬂex: further evidence concerning the multifactorial nature of hypnotic analgesia. scale-assessed suggestibility is much less predictive of the response to intervention with hypnosis (Montgomery et al. The relatively small number of participants is a drawback that limits the power of the statistical analyses and the generalization of the results obtained. In: Loeser JD. Meier W. Blanchard EB. editors. these ﬁndings indicate that analgesic suggestion can decrease pain intensity and the sensation of pain in patients with ﬁbromyalgia. Milling LS. Patterson and Jensen. 1768–78. Hypnosis as an adjunct to cognitive-behavioral psychotherapy: a meta-analysis. Pain 1995. Luminet O. Mambourg PH.22(4):406–13. Strube MJ. The skin senses. J Psychiatr Res 2002. and low hypnotizable subjects: eﬀects of diﬀerential pain reduction strategies. CA: William Kaufmann. 2001. ´ tico de origen Busquets C. Springﬁeld. Levine MR. There may have been prosodic changes in language or other variations as a function of the participants’ responses. Pain 1997. editor. De Pascalis V. Validity and sensitivity of ratio scales of sensory and aﬀective verbal pain descriptors: a manipulation of aﬀect by diazepam. Fors EA. Bonica’s management of pain. Jensen MP. Hilgard ER.83:499–508. Melzack R. Barber J. Gay MC. (1999). Brasseur L.73:361–7.10(6):464–70. Pain 1978. Analgesia suggestion should be studied in the context of intervention programmes designed for this type of patients. Go ¨ testam KG. Eur J Psychol Assess 1994. Karoly P. J Rheumatol 1991. / European Journal of Pain 11 (2007) 463–468\nof both procedures is due to the fact that they both use suggestions that are exclusively of well-being and comfort. Castel et al. 2000. Although this is not exceptional in this sort of study (see Faymonville et al. The McGill pain questionnaire: major properties and scoring methods.18:72–5.. Keel PJ. Pain 1986. Hypnosis. Meunier SA. Faymonville ME. Magurano M. Fissette J. Gerhard U.. Annu Rev Psychol 1985. Pain 2001. Pain mechanisms: a new theory. ´ zaro C. it cannot completely conceal their importance. It should also be borne in mind that the same researcher (the ﬁrst author) applied all the experimental conditions.5:19–29. somatosensory event-related potentials and skin conductance responses to painful stimuli in high.6:1–16. J Adv Nurs 1998. randomised. Kihlstrom JF.150:971–9. Kurtz RM.1:277–99. Wall PD. Pain 1975. Turk DC. who concluded that hypnotic analgesia is neither the result of relaxation. Chauvin M. Finally. New York: Norton Company Inc. Torrubia R. Ban La ˜ os JE.27:476–87. Melzack R. Hypnosis in the relief of pain. 2002). Clin J Pain 1998.A.\nBenhaiem JM. Our results corroborate those of De Pascalis et al..10(2):145–51. Barber J. 2003) and it limits the strength of the results. Dolor musculoesquele ´ nico e inﬂamatorio. patients with low suggestibility have similar levels of response to hypnotic suggestions as patients with high suggestibility (Jensen and Barber. Hop WCJ. Hoenderdos HTW. Science 1965. 1997. EEUU: Lippincott & Wilkins. p. Hypnotic hypo and hyperalgesia: divergent eﬀects on pain ratings and pain-related cerebral potentials. Price DD. Vilaplana J. Hypnotic enhancement of cognitive-behavioral interventions for pain: an analogue treatment study. Dahlgren LA. p. Spain: SED. Bromm B. Jensen MP. Despite the study’s drawbacks. Mallee C. McGrath P. Phillips LH. Hypnosis. controlled trial. Montgomery G.14(3):232–8. Our study has several. Bodoky C. 2005. J Pain Symptom Manage 1995. thus focusing only on the aﬀective component of pain. Carroll D.89:167–73. La Corun quele ˜ a. Bellusci A.63(2):214–20. Seers K. 2000.\n. Albert A. Los Altos. Comparison of integrated group therapy and group relaxation training for ﬁbromyalgia. Benhaiem et al. New York. Gay et al. Another important drawback of the study is that hypnotic suggestibility was not measured. although the signiﬁcance of the diﬀerences between the experimental conditions suggests that they are important. Dane JR. Sapirsten G. Kiernan BD. Controlled trial of hypnotherapy in the treatment of refractory ﬁbromialgia. The eﬀect of hypnotic suggestions on spinal cord injury pain. Hilgard JR. 1968. (2) understanding the diﬀerences or similarities between hypnotic relaxation and relaxation training. 2003).. Attal N.\nArena JG. In: Rull M. J Back Musculoskeletal Rehabil 2000. Gracely RH. Biofeedback and relaxation therapy for chronic pain disorders. Patterson and Jensen. Inc. In clinical pain. Psychological approaches to pain management: a practitioner’s handbook. however. The development of a Spanish questionnaire for assessing pain: preliminary data concerning reliability and validity. mid. Pain perception. Philippot P. Sensory motivational and central determinants of pain: a new conceptual model. 1996.60:39–47. Vrijens B. Joris J. Hypnosis versus stress reducing strategies: a prospective randomised study. Haanen HCM. A clinical guide. et al. p. Relaxation for the relief of chronic pain: a systematic review. Local and remote eﬀects of hypnotic suggestions of analgesia. important drawbacks.36:385–418. Psychological approaches during conscious sedation. The measurement of clinical pain intensity: a comparison of six methods. nor a question of distracting attention. Sexton H. In: Gatchel RJ. Bouhassira D. Braver S. Pain 1999.36:179–87.. IL: Thomas. There is evidence to suggest that highly suggestionable subjects are more responsive to hypnotic suggestion in experimental pain. Dubner R.14:3–10. In clinical samples. van Romunde LKJ. Klucken M. Philadelphia.53:175–81. 2001. Malone MD. Diﬀerential eﬀects of hypnotic suggestions on multiple dimensions of pain. Dolor musculoesmeca ´ tico.27:117–26. J Consult Clin Psychol 1995. Terweil JP. 1996. Barber J. Barber. Mu ¨ ller W. The eﬀect of guided imagery and amitriptyline on daily ﬁbromyalgia pain: a prospective. Pain 1993. Bosch F. the ﬁndings of this study have implications for: (1) understanding the importance of the suggestions used in hypnosis. p. EEUU: The Guilford Press. 345–52. 1975. Diﬀerential eﬀectiveness of psychological interventions for reducing osteoarthritis pain: a comparison of Erikson hypnosis and Jacobson relaxation. In: Kenshalo D. Another drawback was the fact that the application of each experimental condition was not completely homogeneous.. 179–230. Casey KL. Arxer A. Melzack R. Hypnosis and suggestion in the treatment of pain. Soyka D. Kirsch I. editor. editor. Eur J Pain 2002. 2001. et al. Health Psychol 2003. 63–103.\n129(4):495–521. Kippes ME. 2001. Psychol Bull 2003. Bombardier C.48(2):138–53. 1996. editor. p. Sensory-aﬀective relationships among diﬀerent types of clinical and experimental pain. Philadelphia. Functional Wik G. Brage anatomy of hypnotic analgesia: a PET study of patients with ﬁbromyalgia. Seattle. Comparison of hypnotic analgesia and hypnotic relaxation during stimulation by a continous pain source.3:7–12. Wolfe F. Eur J Pain 1999.\nMontgomery GH. Redd WH. Yunus MB. Syrjala KL. Hofbauer RK. WA: IASP Press. EEUU: Lippincott & Wilkins. Philadelphia. Price DD. Castel et al. Rainville P. 1969. editors. 543–56. Syrjala KL.28:297–307. Fredrikson M. 231–58. A meta-analysis of hypnotically induced analgesia: how eﬀective is hypnosis? Int J Clin Exp Hypn 2000. Bushnell MC. Bonica’s management of pain. Carr JE. Donaldson GW. Russell IJ. Relaxation and imagery and cognitive-behavioral training reduce pain during cancer treatment: a controlled clinical trial. Baker C. Baver P. Fibromyalgia syndrome. J Psychosom Res 1975.19:259–65. Smythe HA.2:206–10. Duncan GH. Finer B. Pain 1999. / European Journal of Pain 11 (2007) 463–468 Stacher G. Goldenberg DL. The American College of Rheumatology. Psychological mechanisms of pain and analgesia. Davis MW. Turk DC. p. Pain 1987. EEUU: Lippincott & Wilkins. Hypnosis and imagery in the treatment of pain. Carrier B. Relaxation and imagery techniques.33:160–72. Bonica’s management of pain. ´ geno: autorrelajacio ´ n contemplaSchultz JH. 543–56. Bennett RM. Price DD. New York. 1999.63:189–98. Spain: Editorial Cientı\n. Sachs LB. In: Loeser JD. Abrams JR. Fischer H. Arthritis Rheum 1990. Jensen MP. p. J Abnorm Psychol 1970. Patterson DR. In: Loeser JD. Hypnosis and clinical pain. EEUU: The Guilford Press.468\nA. ´ e B. et al. editor. Syrjala KL. In: Gatchel RJ. Eﬀects of suggestion of relaxation or analgesia on pain threshold and pain tolerance in the waking and hypnotic state. DuHamel KN. Schuster P. Schulze D.82:159–71. Barcelona. Harkins SW. 2001. Pain 1995. El entrenamiento auto ´ﬁco-Me ´ dica. Psychological approaches to pain management: a practitioner’s handbook. tiva. Dissociation of sensory and aﬀective dimensions of pain using hypnotic modulation. Criteria for the Classiﬁcation of Fibromyalgia: Report of the Multicenter Criteria Committee.
The youthful male and female eyebrow positions begin at different levels on the forehead, but with aging, both genders exhibit various degrees of sagging that produces a tired, sad or even angry appearance. This is often further accentuated by deepening of furrows and ridges in the forehead. A brow lift gently raises the eyebrow to its former, more youthful position, and reduces the furrows and frown lines creating a more refreshed and pleasing appearance.\nBROW LIFT FOR MEN\nThe youthful male eyebrow is horizontally oriented and lies directly against the bony upper border of the eye socket, but progressively droops with aging. As the thick brow skin descends, it weighs heavily on the upper eyelid and together with herniation of fat in both eyelids causes a tired and sallow appearance. This haggard look is often further accentuated by deepening of furrows and ridges in the forehead.\nBrow lift surgery may be done through a variety of incisions and techniques depending on the patient’s anatomy and goals of surgery. Patients have a choice of general anesthesia or “twilight” anesthesia, and brow surgery may be done alone or in conjunction with other facial procedures. The most common and popular technique is the endoscopic brow lift. Using three to five small (one centimeter) incisions hidden in the hair, an endoscope (a small “video camera”) is used to release the attachments tethering the brow, and to treat the small muscles responsible for “frown lines”.\nBrow lift surgery is typically well tolerated by most patients and only requires minimal downtime. Pain is minimal, but bruising and swelling often occurs around the eyes. Most patients resume normal activities within a few days, return to work within a week, and may resume exercise in two weeks.\nTAKE THE FIRST STEP\nTo learn more about Brow Lift surgery, please contact Kyle Song M.D. to set up a consultation by calling (949) 701-4454 or by completing our convenient online request form. Dr. Song will work closely with you to develop a surgical plan designed to deliver the look and feel you want. Kyle Song M.D. serves the Irvine & Orange County, CA areas.
Nerve Block or Regional Anesthesia\nWhat is regional anesthesia?\nRegional anesthesia or “a nerve block” is a form of anesthesia in which only a part (or region) of the body is anesthetized or made numb. Regional anesthesia involves injecting numbing medicine around the peripheral nerves that innervate certain parts of your body. We perform these nerve blocks so you will have reduced pain after your procedure.\nIf you are having surgery on your upper extremity (shoulder, hand, etc) you may receive a nerve block above or below your clavicle (collar bone) that will anesthetize only the arm. Surgery on your lower extremity (e.g. hip, knee, foot) may also receive a nerve block.\nNerve blocks have 2 different varieties. We can do a one-time injection that can last ~36 hours with the latest long-lasting numbing medicines. We can also place a small micro catheter near the nerves to continuously drip numbing medicine for 3 days. Deciding between these 2 options will depends on your particular surgery and medical factors. Nerve blocks are usually performed while the patient is sedated and are well tolerated.\nDr Shiraz is a board certified anesthesiologist who specializes in innovative techniques designed to reduce pain without the use of narcotics. After completing his residency in anesthesiology at Emory University in Atlanta, GA in 2011, he completed a fellowship specialization in regional anesthesia (nerve blocks) and acute pain medicine at Columbia University in New York City. Dr Shiraz also serves on the Speakers Bureau for Halyard Health, as well as the Advisory Board for Pacira Pharmaceuticals. He is frequently an instructor at regional anesthesia workshops.\nWhat are the benefits of regional anesthesia?\nThe benefits are numerous. In addition to substantially reduced pain after surgery, patients who receive nerve blocks with surgery have less nausea, higher satisfaction scores, less blood loss, and recover more quickly after surgery. There is also a reduced risk of serious medical complications, such as heart attack or stroke.\nIs regional anesthesia safe?\nAnesthesia, whether general or regional, is extremely safe today due to advances in medical knowledge, the availability of new and safer medications and techniques, as well as technological advances in the monitoring of a patients during and after the surgery. While no technique is completely risk free, the complications and side effects associated with regional anesthesia tend to be of a minor nature such as tenderness and/or bruising at the injection site. Occasionally a nerve block may followed by numbness and tingling in the distribution of the blocked nerve(s) for a limited time following the nerve block. Significant complications associated with regional anesthesia are extremely rare.\nHow is the nerve block performed, and is it painful?\nAll blocks are normally performed before you enter the operating room. An intravenous line is inserted, monitors are attached, and your anesthesia team will explain the entire procedure to you and answer any questions you may have. You will then be comfortably sedated and most patients hardly remember the block being performed. Before the block is performed the skin is cleaned with a sterile solution followed by a small skin wheal of local anesthetic at the block needle insertion site. All that you will feel is a small pinch, and usually not much after that.\nWill I see, feel, or hear anything in the operating room?\nMost patients receive general anesthesia and will be completely asleep during the procedure. If you would prefer to not have general anesthesia for your procedure, this may be possible depending on can be discussed with your anesthesiologist.\nWill I be nauseated during or after the surgery?\nIt is less likely you will have nausea if you receive a regional anesthesia (nerve block). Because the surgical area will be numb, you will not need very much opioids after surgery for pain. Opioids can cause nausea, as well as many other harmful side effects.\nWill I have pain after the surgery?\nPain is still possible after surgery even with a nerve block. However, patients tend to have better pain control if they receive nerve blocks, since it is a more targeted approach to your pain.\nNew Medical Techniques Aim to Reduce Risk of Opioid Addiction\nWatch Dr. Shiraz’s video from NBC.
- Allogeneic bone marrow transplant. The term allo means self. Stem cells are removed from another person, called a donor. Most times, the donor’s genes must at least partly match patients genes. Special tests are done to see if a donor is a good match. A brother or sister is most likely to be a good match. Sometimes parents, children and other relatives are good matches. Donors who are not related to you, yet still match, may be found through national bone marrow registries.\nThe stem cells are delivered into your bloodstream usually through a tube called a central venous catheter. The process is similar to getting a blood transfusion. The stem cells travel through the blood into the bone marrow.\nDonor stem cells can be collected in two ways:\n- Bone marrow harvest. This minor surgery is done under general anesthesia. This means the donor will be asleep and pain-free during the procedure. The bone marrow is removed from the back of both hip bones. The amount of marrow removed depends on the weight of the person who is receiving it.\n- Leukapheresis :First, the donor is given several days of Growth Factor injections to help stem cells increase and move from the bone marrow into the blood. The donor is then connected to a leukapheresis machine where the person’s blood is continually being circulated and WBCs are filtered ( similar to the setup when a person is giving blood for SDP platelets in blood bank). The part of white blood cells that contains stem cells is then separated in a machine and filtered out to be later given to the recipient. The red blood cells are returned to the donor.\n- Bone marrow transplantations are used to treat people with certain diseases like\n- Multiple myeloma
Dr. Claude L Adriatico is a male Anesthesiologist (taxonomy code 207L00000X) located in South Bend, Indiana. Dr. Claude L Adriatico's NPI Number is #1891887063 and has been listed in the NPI registry for 10 years. Dr. Claude L Adriatico's practice location is listed as: 416 E Monroe St Ste. 200 South Bend, IN 46601-2371 and can be reached via phone at (574) 232-8119.\nThe taxonomy code for Dr. Claude L Adriatico's main specialty, Anesthesiology, is 207L00000X. An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an operation or an obstetric or diagnostic procedure. The anesthesiologist assesses the risk of the patient undergoing surgery and optimizes the patient's condition prior to, during and after surgery. In addition to these management responsibilities, the anesthesiologist provides medical management and consultation in pain management and critical care medicine. Anesthesiologists diagnose and treat acute, long-standing and cancer pain problems; diagnose and treat patients with critical illnesses or severe injuries; direct resuscitation in the care of patients with cardiac or respiratory emergencies, including the need for artificial ventilation; and supervise post-anesthesia recovery.\n‡ Descriptions, provider messages, and reviews are user submitted. While we make our best effort to verify the accuracy of information submissions, DocBios cannot guarantee that the information is accurate and/or up to date. Please verify any and/or all information with the provider. DocBios is not an advice or referral service and does not guarantee, approve, or endorse any particular healthcare provider.\n\|Health Care Provider Information\|\n416 E Monroe St\nSouth Bend, IN 46601-2371\n\|Health Care Providers Nearby\|
I need to proportion 3 easy hints I've gotten in my young adults from absolutely random human beings, however I've helped plenty in lifestyles.\n1. I became 14 years antique and I turned into within the health facility. Apparently, considering the fact that all illnesses are due to nerves, the remedy includes classes with a psychiatrist. The psychologist turned into a bit lady, she attempted to speak to us and attain the lowest of our troubles, however she did now not paintings properly, added us in pairs, which did now not do away with candor. So, he has narrated memories of existence and analyzed easy psychic strategies from the collection "Count to ten earlier than yelling at a person."\n"If you are making a mistake, admit it higher at once, admit it publicly and with out excuses, this may no longer simplest lessen the intensity of the results, the capability punishment, however additionally raise you up inside the eyes of others," he stated.\nIn this example, I did now not accept as true with straight away. In my own family, it became no longer traditional to confess errors and make an apology, however it turned into like a recreation seeking out excuses for my haunts. However, lifestyles after time confirms that the potential to understand mistakes is a precious aid, and that they distinguish a sturdy character handiest.\n2. Two years later, I turned into within the sanatorium once more, they needed to go through surgical operation below popular anesthesia. The night time earlier than, I had a communication with an anesthesiologist approximately any contraindications. He requested me if I changed into gambling sports activities. I responded that I couldn't, I had extreme myopia, gastritis, scoliosis, expanded ICP, complications, and so forth. Etc. Doctors have averted me from lifting extra than five kg. "Doctors, in trendy, will usually save you you from workout, however with out bodily schooling and sports activities, you're soaked in a pile of sores and handiest irritate your situation. Anybody, make sure to move for the game. And any other factor: clear out all of the hints from the "government".\nSince then, I first commenced going to bodily training lessons, I went wrestling and were given the primary discharge, I jumped with the parachute some instances, and now I simply do bodily health often. Healthy, besides myopia. Well, of direction, the coins role of the go with the flow of data obtained.\nthree. The 1/3 recommendation is Habibi (he did no longer even supply me a pal who shared her mom's recommendation: "If you need to discover ways to spend a great time with a person, discover ways to revel in your self first." Yes, sure, I pointed out it. But now not simplest through adopting this recommendation, I found out later that its that means became a good deal deeper. If you do no longer realize the way to be glad for your very own, do now not sense ideal, homogeneous with out a person else, then a person else can't make you glad, you turns into any courting dependency dating. So, to obtain this concord - you want to jerk loads, comic story, learn how to love your self, apprehend and take delivery of your strengths and weaknesses, discover ways to revel in communion with your self. Otherwise - "Who wishes you together with your horrific temper constantly?"\nAll the pleasant! If you have got any "vintage pointers", I could be glad in case you participated.\n05/01/2019 00:19 30
According to The American Society for Aesthetic Plastic Surgery (ASAPS), 330,631 breast augmentation procedures were performed in the United States by board-certified surgeons in 2012. Of those cases, 72% of them were done with silicone breast implants, which have enjoyed a surge in popularity since they were re-introduced to the market in 2012 after the FDA lifted the ban imposed in 1992. This is no surprise to us here at St. Louis Cosmetic Surgery, as silicone implants are the most popular implant selected by our patients. Therefore, when I decided to follow each of our four doctors into surgery to document a day in the operating room, there was only one choice for the first case I would choose: silicone breast augmentation.\nPlease note, the images and videos below do show an actual surgery and may contain images that some might find offensive.\nOur day started at Manchester Surgery Center, an outpatient facility in Des Peres, MO where our surgeons do many breast augmentation cases.\nDr. Herluf Lund had a silicone breast augmentation scheduled to last one and a half hours, which is the typical amount of time for this type of surgery. The patient arrived to the surgery center an hour and a half prior to the start of surgery, which gave plenty of time for the surgery center staff to complete admission, check vitals, and discuss anesthesia. After that, Dr. Lund went in and “marked up” the patient, placing guides on her body with a marker where he would make his incisions.\nAfter changing into surgical attire, I was ready to head into the OR with Dr. Lund and the amazing staff of nurses at Manchester.\nOnce in the room, the patient was anesthetized. Dr. Lund also injected some local anesthetic around the breast area.\nAfter this, Dr. Lund made his initial incision. There are a few different types of incisions surgeons can use for breast augmentation, the most popular being areola incisions and inframammary incisions at the breast crease. Our surgeons typically perform the inframammary incision, as shown in the clip of Dr. Lund below.\nFor this patient, Dr. Lund chose to place the implant under the muscle, which is referred to as a submusclular placement. Our surgeons often find that this type of placement helps lower the risk of bottoming out (when the implant decsends below the inframmary crease), rippling (when you can see the folds or wrinkles on the implant through the skin), and capsular constracture (when the tissue around the implant thickens and causes the implant to feel firm, causing discomfort and distortion). Here he is creating the pocket for the implant to reside.\nOnce he completed the pocket, he inserted a “sizer,” an inflatable implant that helps him to see what final size he will use. After a patient does their sizing at their pre-operative appointment in our office, the doctor will order a range of implants for that day, and use the sizer to see exactly which one will look best and please the patient. Below, Dr. Lund inflates the sizer.\nThe perfect size for the patient’s body was determined and the next step was for Dr. Lund to insert the actual silicone implants. The surgeon is the only one in the OR to touch the implants, and before insertion he soaked them in an antibiotic solution.\nOnce both implants were in place, the bed was risen up so that Dr. Lund could see if the breasts were symmetrical.\nOnce the implants were determined to be in the proper position, Dr. Lund started suturing the incisions closed.\nThe surgery was completed on time, and the patient went home that evening.\nIf you are considering breast augmentation in St. Louis, there are many resources for information out there. Hopefully, this gives you some insight into the procedure and helps you make this important decision.
Platelet-rich plasma (PRP) can significantly improve hair growth. But at what cost?\nOn average, PRP hair restoration cost in Dubai is AED 800, though there are a myriad of possible expenses to be taken into account when booking a PRP treatment.\n– Average cost: AED 800\n– Price range: AED 700 to AED 900\nWhat factors make up the total cost of PRP?\nIf you’ve realized that a PRP hair treatment is correct for you, it’s time to think about the economic repercussions. Just remember, the information in this guide is generalized. Consultations with experts always provide the most definite estimates of the cost of any cosmetic procedure. The most important factors that affect PRP cost are:\nGenerally speaking, cosmetic procedures cost more on the coasts than central regions because of the higher volume of treatments performed\nNumber of injections:\nThe number of PRP injections will vary by individual but maybe three or four. Depending on the exact number of injections needed, the cost will fluctuate.\nAs with the hair specialist, the experience and skills of the anesthesiologist affect PRP hair restoration cost in Dubai. As we mentioned above, prp may require local anesthesia, so you may need a specialized anesthesiologist to administer it.\nStay with us; we’ve got one more for you. During your PRP, you will almost certainly incur additional personal charges. In addition to what the institution gives, we’re talking about consultation fees from medical providers, travel charges, pre-surgical care, missed work, and recuperation goods you purchase. Obviously, these charges will vary greatly depending on the individual.\nDoes insurance cover the cost of PRP?\nPlastic surgeries are occasionally covered by medical insurance, but cosmetic procedures aren’t. However, hybrid therapy that provides both aesthetic and functional benefits may be partially or entirely covered. All of this being said, PRP is purely an aesthetic surgery. Thus it is not covered by health insurance.\nHow long does it take to see the results of PRP?\nPlatelets are blood cells with the ability to generate growth factors. When injected into the scalp, these platelets accelerate growth in the hair, which is getting miniaturized. It is important to note that PRP treatment is usually done over several sessions; one session does not deliver the desired outcomes. In most cases, 4-6 sessions are required to achieve more comprehensive results. In general, about 70 to 80 percent of our patients who underwent PRP reported a notable improvement in hair growth in three to four months.\nQuick shoutout to hair transplant:\nA brilliant PRP alternative that involves transferring follicles from one part of the scalp to another. However, to be a hair transplant candidate, one needs to have a sufficient amount of healthy follicles; Only in that situation, he will have successful hair growth. Anyhow, whether you’re seeking the best hair transplant clinic in Dubai or just want to find out how much hair transplant cost in Dubai, Dynamic Clinic is the place to go.\n- People considering PRP treatment will find it really helpful to familiarize themselves with cost determinants.\n- The best method to receive a more accurate estimate on PRP cost is to meet with a hair specialist.\nBook an appointment!\nIf you are ready to take the leap and treat your hair loss for some notable improvements in self-confidence, PRP may be the right choice. Dynamic clinic is one of the UAE’s finest PRP providers. Make an appointment here so you may enjoy the most incredible cosmetic experience possible. Call +971588230420 or fill out the contact form to schedule an appointment.
We all want to alleviate pain and suffering. Most critically ill patients are treated with opioids for this reason. Unfortunately, opioids have numerous side-effects including delirium, constipation, vomiting, and delayed extubation. Opioid infusions may eventually lead to withdrawal, causing pain, nausea, and depression. This post explores the optimal use of systemic medications to control pain while minimizing complications (1).\nThe classic World Health Organization analgesia ladder is shown above. Although we don't follow it exactly, it underlies our conceptualization of analgesia. However, it was developed in 1986 and wasn't designed specifically for critically ill patients. Modern management of pain among severely ill patients requires a revised strategy.\nGetting started: Drugs that aren’t very useful among critically ill patients\nUnhelpful: Weak opioids\nTraditionally, weak opioids were utilized as the second rung of the analgesic ladder (e.g. codeine and possibly tramadol). However, there is no apparent benefit of using a weaker opioid, as compared to using a low dose of a more potent opioid. The 2013 SCCM guidelines reported that opioids have equivalent efficacy, provided that they are dosed appropriately.\nTramadol is sometimes given under the guise of being a “non-opioid,” but it does stimulate opioid receptors. It has some unique disadvantages compared to other opioids. Due to differences in patient metabolism, its efficacy varies erratically. Compared to most opioids, it has additional side-effects including seizures and serotonin syndrome (2).\nUnhelpful: Nonsteroidal anti-inflammatory drugs (NSAIDs)\nThe use of NSAIDs in critically ill patients is limited by nephrotoxicity. Kidney injury is extremely common in critical illness, correlating closely with increased mortality. NSAIDs are one of the most common nephrotoxins that contribute to hospital-acquired renal failure (Nash 2002). Other complications from NSAIDs that are problematic include gastric ulceration and coagulopathy.\nThe role of NSAIDs among critically ill patients remains controversial. It's probably safe to use some agents for limited periods of time, among carefully selected patients. However, my preference is usually to avoid them entirely, for the following reasons:\n- It's hard to predict which patients may develop renal failure.\n- Renal failure is an insidious process, making it impossible to discontinue the NSAID before a significant amount of injury has occurred.\n- Many sources recommend limiting NSAID use to a few days, but pain often lasts longer than that.\nProposed analgesic ladder for critically ill patients\nAcetaminophen has traditionally been a front-line agent for analgesia, constituting the first rung of the analgesic ladder. Evidence continues to support that acetaminophen deserves this position, based on moderate efficacy with an outstanding safety profile.\nThe availability of IV acetaminophen has caused a resurgence of research proving its efficacy. For example, one study of surgical ICU patients showed that IV acetaminophen reduced opioid requirements, improved pain control, accelerated extubation, and reduced nausea/vomiting (Memis 2010). Although oral acetaminophen is less sexy, it probably has similar efficacy.\nThe main concern with acetaminophen administration is hepatotoxicity, but it may still be used in most patients with liver disease. Patients with cirrhosis or severe alcoholism may receive two grams daily (Imani 2014). In acute liver injury or alcoholic hepatitis, acetaminophen should be avoided. Acetaminophen does suppress fever, but it is generally unclear whether fever suppression is beneficial or harmful. In some situations (e.g. neutropenia), a fever would be diagnostically useful and therefore fever suppression is undesirable.\nPain-dose ketamine infusions\nSafety & side-effects\nPain-dose ketamine infusions are very safe, even among profoundly unstable patients. Hemodynamic effects are generally minimal, occasionally with a slight increase in blood pressure. Although ketamine is sometimes feared because it is an “anesthetic” agent, a pain-dose ketamine infusion is safer than opioids. Unlike opioids, ketamine doesn't suppress respiration.\nSeveral studies have reported the successful use of ketamine infusions for critically ill patients as an analgo-sedative agent at dissociative doses (e.g. 1-5 mg/kg/hr, about 10-50 times higher than pain-dose ketamine infusions; Patanwala 2015). Even at these high doses, the safety profile of ketamine was excellent. This is further evidence that pain-dose ketamine infusions are safe.\nPsychomimetic effects are occasionally seen at the higher end of the dose range. These may include somnolence, agitation, euphoria, or hallucinations. Such symptoms aren’t nearly as dramatic as a classic ketamine re-emergence reaction. If the symptoms are bothersome, they may be managed by holding the infusion temporarily and then restarting at a lower rate. The rate of side-effects with an infusion is lower than with a bolus of 0.3 mg/kg ketamine (Motov 2017). Furthermore, a patient who has an aversive reaction to a ketamine bolus should be able to tolerate a low-dose infusion (no, they don't have a “ketamine allergy”).\nPsychomimetic effects are a greater concern among intubated patients who may be unable to communicate if they are having disturbing hallucinations. This risk may be reduced by co-administration of propofol and/or antipsychotics, which such patients will often be receiving already (4). As with any infusion in critically ill patients, clinical effects should be monitored carefully.\nBenefits of ketamine infusion\nKetamine infusions allow for a lower opioid dose to be used, avoiding opioid toxicity. This may be particularly beneficial among patients at higher risk for opioid side-effects. The classic example are patients with COPD or obesity hypoventilation syndrome, who are at high risk for respiratory suppression. Another example would be patients with ileus or pancreatitis, who are at high risk for bowel hypomotility.\nKetamine attenuates the development of opioid tolerance and opioid-induced hyperalgesia (Barr 2013; Angst 2003). This is particularly useful among patients on opioid infusions, where tolerance and hyperalgesia may become problematic:\nKetamine has been shown to be rapidly effective for depression, even at low doses (Rasmussen 2013, Zarate 2006). Depression is a substantial problem among critically ill patients, but we generally overlook it because we don't have a good treatment for it. It is possible that ketamine exposure could improve depression, thereby accelerating physical therapy and rehabilitation.\nDozens of RCTs support the use of ketamine for post-operative pain. These studies show that ketamine reduces the required dose of opioids by ~40%, reduces nausea/vomiting, and has an excellent safety profile (Jouguelet-Lacoste 2015). There is increasing experience regarding the use of low-dose ketamine infusions among critically ill patients, for example:\n- Guillou 2003 performed a randomized, double-blind trial of ketamine infusion among 101 patients in a surgical ICU. Ketamine caused a 25% reduction in morphine consumption (p<0.05), without any difference in adverse events.\n- Moitra 2016 described the use of ketamine infusions in four patients with prolonged ICU admission at Columbia University Medical Center. Perhaps most notable was one case where ketamine (0.18 mg/kg/hr) was successfully used to treat depression.\n- Buchheit 2017 published a retrospective report of 40 intubated patients on opioid infusions who were treated with pain-dose ketamine infusions within the surgical ICU at Massachusetts General Hospital. Ketamine was found to be effective in reducing opioid consumption, without any reported side-effects.\nKetamine at low doses was able to serve as a backbone for weaning both opioids and sedatives while maintaining adequate comfort – Buchheit 2017\nWhere should ketamine fit in the algorithm?\nMost evidence describes using a pain-dose ketamine infusion in combination with opioids (Steps 3-4 on the ladder above). In practice, this is the most common application of ketamine infusions.\nHowever, ketamine provides analgesia on its own right and doesn't necessarily need to be combined with opioids (Motov 2015). For example, acetaminophen plus ketamine infusion could be used to provide a moderate amount of analgesia in a patient with hypercapnia and very weak respiratory drive (Step 2b on the ladder above).\nAmong critically ill patients, the most commonly used PRN opioids are intravenous morphine or hydromorphone. Hydromorphone may be superior because it causes less histamine release. Although fentanyl is excellent for peri-procedural analgesia, it’s not great for longer-duration pain control. Fentanyl has a short half-life, so when used PRN it must be given very frequently.\nPatient-controlled analgesia (PCA) pumps are occasionally useful for patients who are conscious enough to operate them. When used for patients who aren't on chronic opioids, they should be programmed without any basal rate. Using a basal rate doesn’t improve pain control, but it does increase the risk of respiratory suppression (Palmer 2010).\nAmong intubated patients, it may be reasonable to use a relatively generous dose of PRN opioid (e.g. 1 mg IV hydromorphone). Using an adequate PRN dose increases the likelihood that a PRN strategy will succeed, thereby avoiding an opioid infusion. Among non-intubated patients, a lower PRN dose may be preferable to avoid respiratory suppression.\nTheoretical exploration of opioid infusions\nLet's take a moment and consider different opioid strategies from a purely theoretical standpoint. Patients typically have some pain at baseline, upon which is superimposed intermittent bouts of pain. Our goal is to treat the patient's pain with the minimal exposure to opioid possible.\nThe simplest strategy is to use an opioid infusion with no PRN doses (#1 above). This will effectively treat the patient's pain, but it exposes them to much greater opioid dose than is actually needed.\nThe second strategy is to only use PRN boluses of an opioid with a half-life of ~2 hours (e.g. hydromorphone or morphine). This works reasonably well. Bolus doses are used to treat bouts of pain. Because the opioid takes a while to wear off, these bolus doses also end up covering the patient's baseline pain. Patients are exposed to a bit more opioid than they need, but not much.\nThe third strategy is a fentanyl infusion plus PRN fentanyl boluses. This is theoretically the most attractive strategy (#3 above), which may be fit most precisely to the patient's level of pain. Fentanyl has a short half-life, so boluses may be used to increase the opioid level briefly to treat a bout of pain.\nUnfortunately, in practice a fentanyl infusion strategy usually ends up looking more like #4 above. It is difficult to adjust the infusion precisely to match the basal level of pain. Generally, the infusion ends up being left at an unnecessarily high rate (e.g. the infusion is up-titrated during a bout of pain and continued at an excessive rate). Accumulation of fentanyl in fat tissue will also tend to cause drug levels to rise over time. Eventually, this will result in exposing the patient to unnecessarily high drug levels.\nIn summary, a fentanyl infusion could theoretically be the best strategy, but it must be meticulously titrated with very diligent weaning of the basal rate (otherwise it will overdose the patient). In contrast, a PRN-only strategy using morphine or hydromorphone is a good strategy, which is harder to screw up (it will naturally auto-wean itself, making large overdose impossible).\nEvidence regarding opioid infusions?\nThere are numerous studies evaluating the benefit of pain-dose ketamine infusions under various circumstances. In contrast, there doesn't seem to be any data showing a benefit to adding an opioid infusion. The closest I could find are the following:\n- As mentioned above, for patients being treated with PCAs, using a basal opioid infusion has been shown not to improve pain control compared to PRN doses only (Palmer 2010). This seems counterintuitive, but may be explained by figure #2 above: the PRN boluses used to cover bouts of pain last long enough to cover both breakthrough pain and baseline pain.\n- Strom 2010 documented the ability to safely manage intubated ICU patients with PRN morphine boluses only, proving that the routine use of opioid infusions isn't needed.\n- Wanzuita 2012 showed that replacing fentanyl infusions with methadone accelerated extubation, implying that fentanyl infusions prolong intubation.\nRisks of opioid infusions and how to mitigate them\nOpioid infusions are very powerful, but with great power comes a great number of side-effects:\n- Continuous opioid infusions lead to the development of tolerance, dependence, and eventually withdrawal (when the infusion is reduced).\n- High-dose infusions may cause opioid-induced hyperalgesia, a phenomenon wherein opioids paradoxically exacerbate pain (Lyons 2015).\n- Ideally, opioid infusions should be down-titrated on a regular basis to ensure that an unnecessarily high dose of medication isn’t being used. However, in practice this often doesn’t happen as frequently or aggressively as it should. Failure to down-titrate fentanyl infusions may cause accumulation in fat tissues, leading to over-sedation that delays extubation.\nIn fairness, fentanyl infusions generally work nicely for a few days (before tolerance, dependence, and fat accumulation become problematic). So fentanyl infusions are fine for initial patient stabilization. They may be especially useful for patients with ARDS or asthma, wherein suppressing respiratory drive facilitates ventilator synchrony. However, once the dust has settled, if the patient is going to stay on the ventilator for more than a couple days then a more balanced analgesic strategy may be better.\nWhen an infusion is necessary, its safety may be maximized using the following strategies:\n- Opioid infusions should be used to manage baseline pain, not intermittent pain (e.g. pain due to turning and suctioning). Thus, a fair amount of opioid should still be required in the form of boluses. If the patient is receiving very few boluses, this indicates that the opioid infusion is being used to treat all pain, which results in the use of unnecessarily high opioid doses (#1 in the figure above).\n- A relatively low infusion rate should probably be used for most medical ICU patients. Providers often don't realize the total cumulative dose of opioid that they are exposing the patient to. For example, a continuous infusion of fentanyl 100 mcg/hr is equivalent to giving the patient ~480 mg of oral oxycodone daily. Most opioid-naïve patients in a medical ICU probably shouldn't need this much opioid.\n- Care should be taken to titrate the opioid infusion for control of pain, not control of agitation or delirium (which are better managed with a sedative or antipsychotic). Too often, high-dose opioid infusions are used as a nonspecific “calm down” drug, abusing their weak sedative and euphoric properties.\n- Any infused drug will require 4-5 half-lives to reach steady state concentrations. Therefore, increasing the infusion rate will have little immediate impact on pain control. For persistently inadequate pain control, it's better to give a large bolus with a small increase in the infusion rate, rather than vice versa.\n- There should be a protocoled approach to regularly down-titrate the infusion.\n- Co-infusion with ketamine may limit tolerance and opioid-induced hyperalgesia.\n- Uncontrolled pain and opioid side-effects are both major problems for critically ill patients.\n- Multimodal analgesia that utilizes non-opioids to minimize opioid toxicity is broadly accepted in anesthesiology and postoperative pain management. However, there has been poor penetration of this concept among critically ill patients in general (Payen 2013).\n- An analgesic strategy utilizing different classes of medication (acetaminophen, ketamine, and opioids) may allow for effective pain control with fewer side-effects.\n- There is little evidence supporting the use of prolonged opioid infusions among the critically ill. Opioid infusions should be avoided when possible, or used with caution.\n- An analgesic ladder for critically ill patients is proposed:\n- Fentanyl infusions for sedation: the opioid pendulum swings astray? (PulmCrit)\n- Opioid-free ED with Sergey Motov (EMCrit)\n- Ketamine Brain Continuum (Reuben Strayer)\n- Editorials about tramadol from Matthew DeLaney & David Juurlink\n- Nonpharmacologic therapy (e.g. repositioning, lidocaine patches, music therapy) and epidural/regional anesthesia are excellent approaches to analgesia.\n- The risk of seizure or serotonin syndrome is low, but this may become a greater problem among critically ill patients who are often on a number of medications. Overall tramadol seems to add a lot of drug-drug interactions and potential toxicity without being very effective.\n- Please note that this ladder is designed to deal with ongoing pain, not procedural pain. For a pre-planned procedure, different strategies will be helpful (e.g. ketamine boluses).\n- Ketamine emergence reactions respond nicely to low doses of benzodiazepines. Propofol has the same mechanism of action as benzodiazepines (GABA-receptor stimulation), so it would be expected to prevent/treat psychiatric reactions from ketamine. Some anesthesiology literature supports the concept that the combination of ketamine plus propofol causes a low rate of psychiatric reactions (Ishahara 1999).\nLatest posts by Josh Farkas (see all)\n- PulmCrit Wee- Secondary endpoints:Can we separate the wheat from the chaff? - March 21, 2018\n- PulmCrit- Chasing mortality endpoints is a fool's errand - March 12, 2018\n- PulmCrit-Get SMART:Nine reasons to quit using normal saline for resuscitation - February 27, 2018
If we hav wisdom teeth...?\n...why TF do we pull them out?>?\nno no no u dont get it if we wanna b wise then y hav our wisdom teeth pulled???\n- Donnie PorkoLv 71 month agoFavorite Answer\nBecause it’s a way for dentists to make extra money. Most don’t need to be removed but they recommend it anyway. I forgot what tv show did a story on this and it discovered that most wisdom teeth don’t need to be removed and some dentists will go the extra mile, such as anesthesia and unnecessary surgery, to add to the cost.\n- BrianLv 71 month ago\nNo rule that says you have to. Go ahead and keep yours.\n- InLv 71 month ago\nBecause the human jaw bone has been getting smaller and there is less room to fit 32 teeth.
Eyelid Surgery (Blepharoplasty)\nOffered at our convenient location in Baltimore, Maryland\nAs you age, excess skin forms in the eye area and the skin loses elasticity. Fatty tissue accumulates under the skin, and eyes appear tired, wrinkled or puffy.\nYou look older than you feel—even with a good skin care regimen. Friends, family members and co-workers tell you how tired you look, even when you have gotten a full night’s sleep. Genetic factors and body chemistry can cause these aging effects in younger people. Eyelid surgery by Baltimore-area specialist Dr. Alyson Wells restores a youthful and refreshed appearance to your eyes.\nRequest a consultation online or call (410) 628-8200 to discuss your desires for facial enhancement with Dr. Wells. She looks forward to working with you to achieve your unique aesthetic goals.\n- 1 About Eyelid Surgery\n- 2 Before and After Photos\n- 3 Are You a Candidate for an Eyelift?\n- 4 Incisions\n- 5 We Welcome Your Questions at Valley Plastic Surgery\n- 6 Frequently Asked Questions\n- 6.1 What can I expect during recovery after eyelid surgery?\n- 6.2 Will my medical insurance pay for eyelid surgery?\n- 6.3 Does eyelid surgery differ between your male and female patients?\n- 6.4 Will eyelid surgery get rid of the dark circles under my eyes?\n- 6.5 How do I know if I need eyelid surgery, a brow lift, or both?\n- 6.6 How much does eyelid surgery cost?\nAbout Eyelid Surgery\nUpper and lower eyelid puffiness is often caused by bulging fatty deposits. Upper and lower eyelid lifts (blepharoplasty) strategically remove the excess skin and fat and rejuvenate the eye area. Blepharoplasty surgery provides Baltimore-area women and men with a solution for improving bagginess above and below the eyes and reducing puffiness of the eyelids.\nBlepharoplasty, however, cannot correct drooping eyebrows or completely eradicate wrinkles. It is often combined with a brow lift, BOTOX® or facelift to improve droopy eyebrows, crow’s feet and facial sagging. Sometimes fine wrinkling of the lower eyelid can be addressed by laser treatments or chemical peels. Eyelid surgery with these options can successfully restore a youthful, revitalized appearance to your eyes for years to come.\nBefore and After Photos\nAre You a Candidate for an Eyelift?\nExcess skin at the upper eyelid can be recognized as the thin, crepey skin that accumulates at the outside corners of the eyes and also folds over the more central portion of the upper lid, obscuring the main part of the eyelid just behind the lashline. This extra skin hinders makeup application. Do you hold and stretch the excess skin in order to evenly apply your eye shadow?\nGood candidates for lower eyelid lifts have excess crepey skin below the lash line, and may have bulging areas of fat that give the appearance of “bags” under their eyes. You and Dr. Wells can discuss your problem eye area and what options will work best for you.\nThe incision for upper lid blepharoplasty is placed so that it falls naturally in the crease. The incision for the lower lid blepharoplasty is placed close to the lash line, along the fold of the lower eyelid, to ensure the resulting scar is hidden in the natural contours of your face. Both types of incision heal very well and are usually almost imperceptible.\nWe Welcome Your Questions at Valley Plastic Surgery\nA sense of anxiety about your procedure is normal, whether from excitement or unanswered questions. Because of her years of experience, Dr. Wells understands your feelings and looks forward to the opportunity to provide answers and give you confidence about your procedure.\nFrequently Asked Questions\nWhat can I expect during recovery after eyelid surgery?\nFollowing your surgery in our accredited surgery center, you will return home or to your hotel with a family member or friend.\nThose patients who undergo a general anesthetic (not all procedures need this level of sedation) will remain in our recovery room until awake and comfortable prior to returning home. The majority of our patients experience only mild bruising and swelling following their eyelid procedures, and many can return to work within a week. Patients who undergo more extensive procedures may need a longer time off work (approximately 10 days).\nWill my medical insurance pay for eyelid surgery?\nMost eyelid lifts (blepharoplasties) are not covered by insurance benefits or health savings accounts. A select group of upper eyelid lifts, usually in older patients with tremendous skin excess, may be covered if objective visual field testing demonstrates that a patient’s vision is impaired and blocked by the overhanging skin and that taping the excess out of the way actually improves the vision.\nLower eyelid lifts are not covered by insurance benefits.\nDr. Wells is very familiar with the criteria set forth by insurance companies that impact the determination of “medical necessity” and will discuss the testing and likelihood of insurance coverage for the procedure during your consultation if you are possibly a candidate for this approach.\nDoes eyelid surgery differ between your male and female patients?\nThere are some subtle yet extremely important nuances that differentiate eyelid lifts in men and women. The position of the surgical incision, the length of the surgical incision, and the optimal amount of skin removed can be a bit different in men and women. Your procedure will be individualized and customized to address your specific concerns and goals, and your results will be appropriately feminine or more masculine.\nWill eyelid surgery get rid of the dark circles under my eyes?\nLower eyelid blepharoplasty can be helpful in improving or eradicating the dark shadows from this region.\nIt depends on the factors contributing to the dark color. In many circumstances, transfer of micro-particulate fat (either as combined or sometimes as a stand-alone procedure) into this area will be needed to give the most satisfactory results. There are also patients that will benefit from a mid-facelift procedure to address the dark coloration. The techniques used by Dr. Wells to improve the area around the eyes are highly individualized and customized to each patient’s particular desires and goals.\nHow do I know if I need eyelid surgery, a brow lift, or both?\nThe good news is that you don’t need to know that when you make your consultation appointment at Valley Plastic Surgery! That is precisely why sophisticated patients choose Dr. Wells — she is board-certified in both plastic surgery and otolaryngology/head and neck surgery, and she helps you decide which procedure, or combination of procedures, is right for you.\nHow much does eyelid surgery cost?\nThe fees associated with an eyelid lift (blepharoplasty), similar to other cosmetic procedures, depend upon several factors, so it is difficult to give an absolute cost. This is especially true for eyelid procedures, as they are frequently combined with other facial procedures (laser resurfacing, fat transfer, chemical peels, brow lift), but in some cases can be very comfortably performed with just local numbing medicine and an oral sedative, thus eliminating the cost of anesthesia services.\nMake sure you are comparing apples to apples.\nValley Plastic Surgery is knowledgeable about regional and national trends in costs associated with providing this procedure, including the costs associated with the anesthesia and the operating room, and we strive to be competitive with plastic surgeons in the Baltimore-Washington area.\nHowever, some variability in fees throughout the region may reflect use of cheaper and perhaps less satisfactory materials and supplies, less training or experience of the physician performing the procedure if other than a board-certified plastic surgeon, less training of the individual providing the anesthesia if other than a board-certified anesthesiologist, or lack of accreditation of the surgery facility in which the procedure is being performed. In other words, Dr. Wells is a board-certified plastic surgeon and a board-certified otolaryngologist/head and neck surgeon who operates in her own accredited surgery center with a board-certified anesthesiologist providing the anesthesia.\nA detailed estimate of the fees, customized for your procedure, will be provided to you following your consultation with Dr. Wells.\nHer rare combination of impeccable training, keen aesthetic sensibilities, technical skill and precision in plastic surgery sets this Baltimore surgeon apart from the rest.
the ambulatory services center at Good Samaritan Regional Medical Center\n- Pre-Admission Testing\n- Endoscopy Minor Surgery\n- Pain Management\n- Wound Management\n- Women's Health Center\nThe Ambulatory Services Center houses many of Good Samaritan Regional Medical Center's outpatient services. The Center contains state-of-the-art equipment and is staffed by a highly skilled, multi-disciplinary team of board certified physicians, registered nurses and anesthesiologists.\nWe have modern facility where a wide range of operative and other invasive procedures are performed by board certified specialists in gynecology, urology, orthopedics, plastic, vascular, thoracic, ENT, podiatry, neurosurgery, oral and general surgery.\nOur anesthesiologists are specially trained in the latest techniques for ambulatory and minor surgery, pediatric anesthesia and post-operative pain management.\nConveniently located on the hospital's main lobby is same day surgery, endoscopy, minor surgery, pre-admission testing and an eye treatment room. Our new Ambulatory Services Center has been designed to help alleviate the anxiety of our patients and their family members. Our facilities feature amenities such as a modern waiting area, child's play room, a coffee bar and a paging system to contact family members after surgery has been performed.\nFor more information, please call us at 845-368-5034
Heart of America Medical Center is a Level V Trauma Center, lab, X-ray, respiratory therapy, anesthesia and surgical staff are on call 24 hours a day.\nIn our 18-bed medical/post-surgical unit we provide acute inpatient care and observation. Our state-of-the-art intensive care unit is staffed by registered nurses and physicians certified in advanced cardiac life support.\nWe also provide swing bed services for people with chronic illnesses or who are recovering from recent illnesses or injuries who need additional therapy before going home or to another care setting. We also provide chemotherapy, infusions or other treatments on an outpatient basis.
Dr. Kumar Kamlesh is Specialist Paediatric Anesthesiologist at Al Jalila Children’s specialty Hospital, Dubai. He graduated from Govt Medical college Baroda, India in 2002. He completed his Residency in Anesthesia from same college in 2006. Post Residency, he worked as Senior Registrar in different subspecialty of anesthesia in Maulana Azad medical college and LBS Hospital, New Delhi, India. He worked at Super specialty hospital (Max Hospital Delhi) before moving to UAE in 2011. He has extensive exposure of different type of Anesthesia cases in UAE in different Prestigious Government and Private hospitals. He did Diploma in Regional Anesthesia and Analgesia from University of Montpellier, France in 2014. He has extensive exposure of pediatric anesthesia in Al Qassimi Women's and children Hospital, Sharjah. Dr. Kamlesh's areas of clinical interest are Regional Anesthesia and Analgesia, Paediatric perioperative anesthesia care, in addition to post-operative pain management, Difficult Airways management and paediatric sedation. Dr. Kamlesh is also associated with various professional Societies in Anesthesia.\nComparative Study of two different doses of Fentanyl with 0.25% bupivacaine through caudal route for pediatric anesthesia and post operative analgesia. J Anaesthes Clin Pharmacol 2008 : 24(1): 31-34 (www.joacp.org).\nAnesthetic management for Total Hip replacement in a case of Ankylosing spondylitis , Internet journal of anesthesiology;2007;volume 12;part 2
Having unwanted fat in various areas of your body can have a considerable effect on your health and self-confidence. While standard weight-loss through workout and diet plan is a terrific method to drop weight in general, even the best exercises cannot target issue locations like the belly, inner thighs, arms, and butts. Liposuction is a time evaluated treatment that is utilized to eliminate excess fat from particular areas of the body, allowing a specific to form and contour their body to their liking. Is liposuction right for you? Discover now.Pros of Liposuction\nThere are many advantages to this cosmetic procedure, consisting of:\n• Immediately noticeable changes. Unlike traditional weight-loss, liposuction produces changes that are right away noticeable in the body. Some distinction is obvious right away, and the desired outcomes are typically attained in simply a few days.\n• Proven and safe. This cosmetic procedure has actually been performed by knowledgeable cosmetic surgeons all over the world for several years and the technique has actually been refined over and once again to be safe and reliable.\n• Healing time is normally fast. The downtime required after having this type of procedure is normally much less than what is needed for other kinds of cosmetic treatments, consisting of tummy tucks, breast reduction, and more. People who have had the treatment can typically go back to work much more rapidly than they anticipated and can return to living a healthy, active lifestyle.\n• Weight loss can be long-term. With the ideal maintenance strategies, the fat that was eliminated throughout the liposuction procedure will not return.\n• Complete control over your physique. With liposuction, an individual can have complete control over how they want to look, beyond what standard diet and exercise can offer. Giving people this power over their bodies increases self-confidence and assistance individuals feel their very best.\nWhile there countless benefits to liposuction, there are obviously a few caveats that must be thought about prior to making the final decision to progress with the treatment.\nCons of Liposuction\nBefore having actually liposuction done, it is essential to analyze the possible drawbacks of the procedure and identify if the benefits exceed the threats in your particular case. Your surgeon can help you find out more about the threats associated with the treatment and can assist you choose if moving on is the best thing for you.\n• Issues with general anesthesia. Since liposuction is carried out under basic anesthesia, the treatment brings the very same dangers as other type of surgical treatment where general anesthesia is utilized. Hidden medical conditions may increase these dangers.\n• Unfavorable responses. Bruising, bleeding, and pain are all to be expected, nevertheless, in rare cases can trigger more significant complications.\n• The potential to get the weight back. After having actually liposuction done, it is important to maintain a healthy diet plan and exercise properly as advised by your physician. Failure to do so might lead to acquiring back the weight that was lost or potentially much more.\nAlthough there are risks connected with liposuction, for many people, the benefits far surpass them. Inform yourself about the treatment by having thorough conversations with your specialist and think about how liposuction has the possible to affect you as a special individual. Just you and your cosmetic surgeon can identify 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 Musella GA\nLaser liposuction is a more recent, minimally intrusive treatment that includes heating the fat cells to melting point and eliminating the melted fat through a small cannula. The treatment is generally done right in your physician's office and is an exceptional alternative for people who have less than 500 ml of fat to remove from any one area. Laser liposuction can be a safe, complementary treatment to weight loss in order to sculpt the body you've always wanted.\nContact a Surgeon in your Musella GA today.\nIf you're thinking about liposuction as a weight reduction option, it's important that you discuss your desires with a qualified plastic surgeon in your area. Your cosmetic surgeon will carry out a total examination and health history questionnaire to determine if liposuction can benefit you and assist you reach your physical and emotional goals. Call today for a consultation and learn more about how liposuction can help you accomplish the body of your dreams.
NetWellness is a global, community service providing quality, unbiased health information from our partner university faculty. NetWellness is commercial-free and does not accept advertising.\nFriday, October 31, 2014\nSpine and Back Health\nOne Big Mess!!\nI have had neck pain off and on for over 20 years. There was never any accident involved. Recently I had a pretty bad bout of it. At the same time my right hip, which also has hurt some in the past, started hurting and at one point I could not put my weight on it. A few frightful moments later it was OK. Now my lower back has started to hurt so badly that I cannot stand to walk for very long at a time and the walking I do is bend over. The pain seems to move from one side of my back to the other and radiates around my groin area. I feel like I have been in a car accident with the neck/hip/back pain going on all at the same time. What kind of specialist should I see to be evaluated?\nHello, thank you for your question. Your options include asking your primary care doctor for a referral, or if your insurance plan allow you to go for a direct referral you could try a physiatrist (otherwise known as “rehab doc” or “PM&R” (which stands for physical medicine and rehabilitation). They aren’t necessarily common, so you may not have one in your community. Or, a pain management specialist (usually anesthesiologists). Good luck.\nDavid J Hart, MD\nAssociate Professor of Neurosurgery\nSchool of Medicine\nCase Western Reserve University
Both men and women suffer from hair loss, or thinning hair, but hair transplant surgery offers the help they need. Modern hair transplant techniques like Follicular Unit Extraction (FUE) have become very popular, because they are less invasive than traditional methods, and do not leave scars.\nFollicular Unit Extraction\nFUE is generally performed in the doctor’s office on an outpatient basis, under local anesthesia. FUE improves on the more traditional strip harvesting technique, in which a strip of hair is harvested from the donor area at the back of the head. The strip method leaves behind a linear scar, which often poses a problem for people who want to wear their hair very short.\nFUE does not leave behind that linear strip, as hair is harvested from the donor site one graft at a time. There are several automated devices that can be used to extract the grafts, which are randomly removed in groups. In addition, the doctor is able to take more time to implant hair creatively at the recipient site.\nAfter Follicular Unit Extraction Treatment\nThere is almost no downtime after FUE treatment, as most patients can resume normal activities within 2-3 days. The results of FUE are permanent, but it takes about 3 months for new hair to be seen. The hair looks very natural, and there is minimal scarring.\nIf you are contemplating doing a hair transplant procedure, then contact our office for more information.
NetWellness is a global, community service providing quality, unbiased health information from our partner university faculty. NetWellness is commercial-free and does not accept advertising.\nWednesday, August 31, 2016\nRisks of anesthesia for laparoscopy\nI am 20 yrs old and having a laparoscopy done next month for a mass on my uterus. What kind of anesthesia do they usually put you under for this procedure, and what are the risks for `anesthesia awareness`. I`ve never had any kind of surgery or have never had to be put alseep for anything and to tell you the truth I am TERRIFIED. It`s not even the surgery I`m worried about its the thought of `being put to sleep`. Are there any risks I should be worried about?\nA certain amount of anxiety preceding an anesthetic and surgery is perfectly normal but I wonder what you've read about or heard about that has made you feel so terrified!\nAlmost all patients who have laparoscopic surgery of any kind will have a general anesthetic.\nThe good news is that, statistically, anesthesia is safer than ever. The risk of serious harm to you as a result of the anesthetic is rather low. Completely accurate figures are a bit hard to come by, but the risk of death related to anesthesia in an otherwise healthy young person having a laparoscopic procedure of the kind you describe is probably less than 1 in 250,000. Is that low enough?\nThe risks for anesthesia awareness, based on recent studies, are a bit higher - around 0.15%, or 15 cases in every 10,000 patients undergoing anesthesia. What are your risks of awareness? Probably much lower than this, because the number I've quoted includes patients at higher risk of awareness, such as those who are pregnant, having heart surgery, or trauma surgery. In those patients, the amount of anesthesia given is often less than in other patients. That number also lumps together those patients who have a few moments of awareness, without pain, with those who have a really bad experience. At the extreme end, these unfortunate people are in pain from the surgery while unable to move or communicate their distress. Most people who have awareness do not have this kind of terrifying experience.\nIs there are guarantee that you won't be aware during your surgery? I am afraid not. It's in the nature of anesthesia, and of medical care in general. People are not machines, and we can't precisely measure what is going on in the brain. But, assuming you are having your procedure in a good hospital with competent medical staff I think you can be pretty confident that you will have a safe anesthetic without awareness during the operation. Be sure to mention your concerns to the doctors taking care of you, including of course your anesthesiologist. I am sure they will make a special effort to allay your worries.\nGareth S Kantor, MD\nAssistant Professor of Anesthesiology\nSchool of Medicine\nCase Western Reserve University
Orthopedic and Soft-Tissue Surgery in Archdale\nWe are passionate about surgery. We perform everything from spays and neuters to mass removals and orthopedic procedures. Your pet will receive at least one pre-anesthetic exam, blood work, and the very best and safest anesthetic drugs. Each patient is thoroughly monitored during their procedure by surgical monitors, competent veterinary technicians and the doctors themselves.\nOur surgical monitors provide us with an EKG, blood pressure, Sp02, respiratory patterns, and body temperature. Your pet will be laying on a re-circulating heated water pad that ensures their body temperature doesn't get too low. All of our surgery patients receive post-operative pain medicine.\nNot all surgery centers are created equal! Most of these important safety and pain control aspects are neglected at low-cost surgery centers. If you are considering a low-cost alternative, make sure to ask questions.\nOur Surgical Services\nWe’re pleased to offer a combination of orthopedic and soft-tissue surgeries for pets in Archdale.\nIf a specialist is out of your budget, do not give up! We are equipped to handle many surgical procedures that are commonly referred to a pet surgical specialist, usually for significantly less expense.\n- Spays and neuters\n- Tumor and cyst removal\n- Foreign body removal\n- Bladder stone removal\n- Fracture repair\n- ACL (CCL Repairs)\n- MPL Repairs\n- Fracture Repair\n- Mass Removal\n- Cesarean (C-section)\n- TECA (ear canal surgery)\n- Foreign Body Surgery\nIs your pet in need of a surgical consultation?\nOur Surgical Suite Offers...\nWe offer the highest standard of safety during their surgical procedure, which includes:\n- A full in-house laboratory for performing pre-surgical blood work for safety\n- State-of-the-art anesthesia monitoring equipment and surgical tools\n- An environment that meets or exceeds safety standards\n- A highly capable surgical team performing surgery at less cost than specialists\n- Customized pain management and anesthesia protocols for every pet\n- Warm blankets and post-op monitoring to keep pets comfortable and safe\nScheduling Surgery for Your Pet\nA surgical procedure is much more elaborate than a routine physical exam, and we meet your needs by walking through pre- and post-operation questions with you. We will do this by having a pre-op appointment, to go over any health history and tests, and answer any questions you have.\nOn the day of the surgery, our veterinarians and technicians to monitor your pet's vitals to be sure he or she is ready to go home.\nDepending on the complexity of the surgery, we may also want to see your pet for a follow-up visit to make sure their recovery is going smoothly, answer any additional questions you have, and be sure your pet's pain is controlled.
To investigate the dose response according to tendon width of the medial rectus in patients with recurrent exotropia who underwent unilateral medial rectus resection.\nPatients with basic recurrent exotropia after bilateral lateral rectus recession were included. All patients underwent unilateral medial rectus resection according to the preoperative angle of deviation. Under general anesthesia, the tendon width of the medial rectus in the operated eye was measured. The patients were divided into 2 groups (narrow and wide) according to the median value of the tendon width of the medial rectus. The angle of deviation at postoperative day 1 was measured. The dose response was calculated based on the amount of correction and resection.\nThis study included 38 patients. Age and preoperative angle of deviation were 11.0 ± 3.0 years (range, 6 – 19 years) and 21.3 ± 3.2 prism diopters (PD; range, 15 – 25 PD), respectively. Tendon width of the medial rectus was 7.6 ± 0.7 mm (range, 6.0 - 8.5 mm) and the median value of tendon width was 7.5 mm. The dose response was 4.6 ± 0.8 PD/mm (range, 2.4 - 5.6 PD/mm). The dose response was significantly greater in the wide than in the narrow tendon width group (p < 0.001). Tendon width of the medial rectus was significantly correlated with age, the preoperative angle of deviation and surgical dose response (all, p < 0.05).\nThe tendon width of the medial rectus could be a predictor for estimating the surgical dose response when considering unilateral medial rectus resection in patients with the moderate angle of recurrent exotropia.
What is the Omni Hysteroscope?\nThe Omni scope is designed to allow you to perform your best work. Its quality and flexibility help you get the most out of your day with an all-in-one scope. The Omni scope gives you confidence, by offering rod lens for quality visualization throughout procedures.\nHere’s what the Omni scope provides:\n- 3 sheaths giving you the convenience of seeing and treating pathology with a single hysteroscope\n- Long working length helps facilitate easier access and treatment for obese patients (Working length of 200mm)\n- Greater patient comfort and easier insertion with small diameter sheaths\n- 3.7 mm diagnostic sheath\n- 5.5 mm operative sheath\n- 6 mm operative sheath\nTwo kit options to fit your practice needs:\nCompatibility with the MyoSure® suite\nFor detailed benefit and risk information, please refer to the IFU.\nIMPORTANT SAFETY INFORMATION\nThe Omni™ hysteroscope is intended to provide viewing of the cervical canal and uterine cavity for the purpose of performing diagnostic and operative procedures. The Omni hysteroscope is not appropriate for patients who are exhibiting acute pelvic inflammatory disease or exhibit the following conditions: inability to distend uterus, cervical stenosis, cervical/vaginal infection, uterine bleeding or menses, invasive carcinoma of the cervix, recent uterine perforation, medical contraindications, or intolerance to anesthesia.
BMC Surgery Patient Instructions\nSome time before your surgery, you will be scheduled for a pre-operative interview. This will happen through either a phone call or during a pre-operative visit to the hospital. You will be contacted regarding the date and location of your pre-operative interview.\nIf you plan to have your pre-operative interview via telephone, be sure to read through the information packet given to you by your surgeon prior to the phone call. We strongly urge you to complete the health history questionnaire referred to as "One Medical Passport." Please click on the link to this questionnaire on the BMC website and have it available for reference during your phone inter\nIn the Days Before Your Surgery\nPlease follow these guidelines carefully as you prepare for surgery: this will help make sure things go as smoothly as possible.\n- Please tell your doctor if you get a cold, cough, fever, stomach flu, or asthma attack any time in the week before surgery. Please don't wait until the day of your operation. Call your doctor as soon as any of these occur.\n- If you will be going home on the same day as your surgery (or if there is a chance you may go home), please make sure a responsible adult will be able to take you. For your safety, you will not be allowed to leave or drive yourself home. If you live alone, it is best if a family member or friend stays with you on the night after your surgery.\n- Please do not smoke for at least two days before surgery. If you smoke, it may take you longer to recover from anesthesia.\n- Your doctor or nurse will discuss your medications with you in the days before your surgery. Please be sure to ask any questions you might have about your medication. You should discuss ALL medications with your doctor or nurse before surgery, non-prescription or "over-the-counter" medicines, herbal supplements, and any a physician has prescribed.\n- You will be told which of your usual medications to take before surgery. In some cases, you should NOT take aspirin or aspirin-like products or herbal supplements for a minimum of two weeks prior to surgery.\n- The operating room schedule sometimes changes due to unexpected events. You will be contacted by OR scheduling the evening before surgery on regular business days to be given the exact arrival time for admission. For surgery scheduled on Mondays, you will receive this information of Friday. This will help us avoid delays and cancellations on the day of your surgery.\nThe Evening Before Your Surgery\nYou should not eat or drink after 12 midnight the evening before your procedure, unless an anesthesiologist tells you otherwise. Keep your stomach empty!\nNo gum, mints, or hard candy are allowed.\nYour anesthesiologist or pre-procedure nurse will tell you which of your regular medications to take the morning of surgery. You make take them with a small sip of water.\nYour surgery will be cancelled if you do not follow these instructions.\nWhen You Arrive at the Hospital\n- Wear comfortable, loose clothing that you can easily put on after your procedure.\n- Makeup and nail polish will need to be removed before surgery.\n- Please do not use body lotion on the morning of your surgery.\n- Do not bring valuables such as large sums of money or credit cards.\n- All jewelry and contact lenses must be removed before surgery, so please leave them home. Remember to bring a case for your glasses.\n- If you anticipate that you may need crutches, a cane or a walker, and have these at home, please bring it with you.\n- If you have a health care proxy, please bring a copy with you to the hospital.\nHEALTH CARE PROXY\nUnder state and federal law, you have rights about making your own health care decisions. You also have ways to be sure that your wishes will be followed even if you become incapable of making decisions on your own. You can do this my making advance directives (statements written ahead of time) about your health care. In Massachusetts, the Health Care Proxy is the recognized document (M.G.I. Chapter 201C).\nYou may be asked, whether or not you have signed a health care proxy. If you have done so, we will file it in your current medical record.\n- If you are going to be (or may be) admitted overnight, please bring a small bag of personal items. It is best if you have someone bring these to you once you are in your room.\n- Please arrive at the hospital at the time specified. We need you to arrive early for two reasons. Our OR schedule sometimes changes because of unexpected events, and we need some flexibility in scheduling patients for their surgery. Second, we will need time to finish preparing you for surgery. You may want to bring a book or newspaper to read in case you have to wait before you are called for surgery.\n- If you are having a local anesthetic ONLY (no sedation) for your procedure, please check with your surgeon about your arrival time.\nOnce You've Checked In\nYou will be asked to sit in the waiting area until a nurse comes to greet you. The nurse will take you to a private area so you can get ready for your surgery. One family member can come with you at this time. Please feel free to ask the nurse any questions you may have.\nYour nurse will give you a hospital gown. You can give your clothes and other belongings to a staff member.\nA surgical liaison will greet you and your family prior during the admission process. This staff communicates with the operating room and will keep your family informed of your progress. The surgical waiting area for family is located on the Main floor of the hospital adjacent to the OR's. This area provides beverages, muffins and bagels for families. Should your family decide to leave this area during your surgery they will be instructed by the liaison to leave contact instructions.\nWhen It's Time for Your Surgery\nIn the operating room, a blood pressure cuff will be put on your arm and an EKG will be attached. Other equipment may also be used, depending on the type of surgery you are having. This is all routine. Again, feel free to ask any questions.\nThere are several types of anesthesia. Your surgeon and anesthesiologist will talk with you to determine which type is best for you. The main types are listed here:\n- Local Anesthesia:\nThis is the simplest type of anesthesia. Medicine is injected to numb the area of the operation, like having Novocain at the dentist. This is only done for very minor operations and can be given by your surgeon.\n- Local Anesthesia with Moderate Sedation:\nSometimes along with local anesthesia, medicine is given to help you relax. The medicine is given through your IV line and is monitored by a registered nurse.\n- Monitored Anesthesia Care:\nThis is similar to local anesthesia with conscious sedation, except the amount of sedation given may be greater. A member of the department of anesthesia administers this type of medication.\n- Regional Anesthesia:\nThis is when anesthesia is given near a nerve so that an entire area of the body becomes numb. A "spinal" is an example of regional anesthesia. It is sometimes called a "nerve block" and is administered by a member of the department of anesthesia.\n- General Anesthesia:\nThis is the type of anesthesia that will "put you to sleep". It is given through IV. With this type of deep "sleep", you can't feel or hear anything during the operation. A member of the department of anesthesia administers general anesthesia.\nAfter Your Surgery\nAfter your operation, you will be brought to a recovery room (PACU - post anesthesia care unit). A PACU nurse will care for you as the effects of anesthesia or sedation are wearing off. You may have some nausea or vomiting right after surgery. This is not unusual and your nurse will be there to help you if you are nauseated. Other symptoms can occur after surgery. These are related to the anesthesia and the surgical process. They include: shivering, headache, muscle soreness, sore throat, nervousness, or sleepiness. These symptoms are usually gone within 24 hours. If you have pain, please tell your nurse. Medications can be given to ease the pain.\nIf You Are Going Home on the Day of Surgery\nYou will stay in recovery until you are awake, able to drink fluids, and able to walk safely. Your nurse will make sure that any pain or discomfort is adequately controlled. Before you leave, your nurse will review written discharge instructions with you and your family or friend. You must be accompanied home by a responsible adult and it is recommended that a responsible adult stays with you for 24 hours following discharge from the hospital.\nIf You Are Being Admitted to the Hospital\nYou will stay in recovery until you are ready to go to your room. Staff will make sure that your belongings are transported to your room. Your family and friends are welcome to visit you in your room. They can check with your nurse about visiting policies on the unit.
You may request a reservation, consultation and send inquiries simply and conveniently using your preferred method, such as WhatsApp, Viber, Line, mobile number, e-mail, and through our homepage.\nJK Plastic Surgery Clinic is operated on a pre-booked basis to ensure safe surgical time for the medical staff and sufficient counseling.\nVisit and Reception\nWhen you visit our hospital as scheduled, we will check the patient's information and fill out a medical card to receive the application. JK Plastic Surgery Clinic is the first healthcare institution to receive the Ministry of Health and Welfare's designation as a foreign patient-attracting hospital. We have a team of professionals providing customer service, such as nurses and counseling coordinators including 1:1 full-time medical translation coordinators (English, Chinese, Russian, and Japanese) to serve patients from abroad.\nBy adopting the multidisciplinary approach with plastic surgeons specializing in respective plastic surgery areas, JK Plastic Surgery Clinic communicates with patients to discuss and propose the best surgical plan for them, and explains precautions for surgical procedures and possible adverse effects of such procedures.\nMinistry of Health and Welfare Certified Care System\nJK Plastic Surgery is the only institution in Korea to be recognized by the quality of service and the stability of the patient at the Ministry of Health and Welfare's certification of a medical institution to attract foreign patient in 2016.\nJK Plastic Surgery provides a systematic treatment system that meets over 120 strict criteria, including patient safety, fire safety and surgical/procedural management.\nPreoperative examinations are essential for safe surgery. Chest X-Ray and EGC tests are conducted to guarantee safe anesthesia and blood tests. Based on the exam results, we check the patient's conditions of liver function, heart function, kidney function, long disease and anemia. These preoperative examinations determine whether the patient is in good enough health to endure surgery and general anesthesia before we check the patient's condition and medical examination results.\nBefore entering the surgery, you must complete a consent form and receive sufficient guidance on the postoperative precautions. The final consultation with the doctor again to demonstrate the direction of the surgery, and then the medical team will go ahead with the surgery. Surgery is performed under the guidance of a surgeons with more than 10 years of experience dedicated to each area. Specialist anesthesiologists monitor the entire procedure in real time.\nPostoperative Recovery – Hospitalization\nFollowing the surgery,\nevery patient will be placed in intensive care in the recovery room until they return to their normal physical condition. Patient will also be hospitalized following the surgery if necessary. JK's safety system is on all around the color under the supervision of our anesthesiologists, nurses and medical staff.\nFollow-up care after discharge\nFollow-up care after discharge To reduce swelling and help patients recover quickly after discharge from the hospital, JK is running a surgery-specific "Recovery" program to provide thorough care for the patient's prompt recovery.
It was a “standard” interscalene block for shoulder surgery, a single injection of a ropivacaine/tetracaine mixture under ultrasound guidance. But then the convulsion started; the patient lost consciousness and stopped breathing. The blood pressure dropped, but sinus rhythm was maintained. The anesthesiologist reported: "I sort of froze: Four people were doing a lot of things at once, it was chaotic, but I remembered to get the checklist." The checklist he remembered was the ASRA guideline for managing local anesthetic toxicity (LAST) that he had just simulated at a meeting, and which was now posted on the operating room wall. The checklist was read out loud; administration of a large dose of propofol (drawn up and being connected to the IV) was immediately stopped and Intralipid™ given instead in the correct dose. After following the steps on the list, the patient awakened with no permanent complications, and received surgery at a later date. .... [more]\nAPSF Survey Helps To Establish Pre-Induction Checklist\nThe Anesthesia Patient Safety Foundation (APSF) Executive Committee believes that a Pre-anesthetic Induction Patient Safety (PIPS) checklist offers an opportunity to pursue the foundation’s vision that “no patient shall be harmed by anesthesia.”\nANESTHESIA PATIENT SAFETY FOUNDATION (APSF) 2014 GRANT PROGRAM\nAnnouncing Guidelines for Grant Applications\nto be selected on Saturday, October 12, 2013 (ASA Annual Meeting)\nand Scheduled for Funding Starting January 1, 2014\nRequest for Applications (RFA) for the\nApplication deadline: November 1, 2013\nRequest for Proposals (RFP) to study the implementation and performance of the APSF Pre-anesthetic Induction Patient Safety Checklist (PIPS)\nThe deadline for receipt of a proposal is November 1, 2013 for a grant scheduled for funding to begin May 1, 2014.\nAnesthesia Patient Safety Foundation\nAnesthesia Professionals and the Use of Advanced Medical Technologies: Recommendations for Education, Training, and Documentation\nThe Fire Prevention Algorithm is now available as a downloadable poster or handout size:\nThe Official Journal of the Anesthesia Patient Safety Foundation\nThe Anesthesia Patient Safety Foundation Newsletter is the official publication of the nonprofit Anesthesia Patient Safety Foundation and is published quarterly in Wilmington, Delaware. Annual contributor cost: Individual–$100, Corporate–$500. This and any additional contributions to the Foundation are tax deductible. © Copyright, Anesthesia Patient Safety Foundation, 2013.\nThe opinions expressed in this Newsletter are not necessarily those of the Anesthesia Patient Safety Foundation. The APSF neither writes nor promulgates standards, and the opinions expressed herein should not be construed to constitute practice standards or practice parameters. Validity of opinions presented, drug dosages, accuracy, and completeness of content are not guaranteed by the APSF.\nAPSF Executive Committee:\nRobert K. Stoelting, MD, President; Steven R. Sanford, JD, Vice President; Jeffrey B. Cooper, PhD, Executive Vice President; George A. Schapiro, Executive Vice President; Matthew B. Weinger, MD, Secretary; Casey D. Blitt, MD, Treasurer; Steven K. Howard, MD; Robert A. Caplan, MD; David M. Gaba, MD; Patricia A. Kapur, MD; Lorri A. Lee, MD; Maria Magro van Pelt, CRNA; Robert C. Morell, MD; A. William Paulsen, PhD; Richard C. Prielipp, MD; Steven R. Sanford, JD; Mark A. Warner, MD. Consultants to the Executive Committee: Sorin J. Brull, MD; John H. Eichhorn, MD; Bruce P. Hallbert, PhD.\nNewsletter Editorial Board:\nRobert C. Morell, MD, Co-Editor; Lorri A. Lee, MD, Co-Editor; Sorin J. Brull, MD; Joan Christie, MD; Jan Ehrenwerth, MD; John H. Eichhorn, MD; Steven B. Greenberg, MD; Glenn S. Murphy, MD; John O’Donnell, DrPH, CRNA; Karen Posner, PhD; Andrew F. Smith, MRCP, FRCA; Wilson Somerville, PhD; Jeffery Vender, MD.\nAddress all general, contributor, and subscription correspondence to:\nAdministrator, Deanna Walker\nAnesthesia Patient Safety Foundation\nBuilding One, Suite Two\n8007 South Meridian Street\nIndianapolis, IN 46217-2922\ne-mail address: [email protected]\nFAX: (317) 888-1482\nAddress Newsletter editorial comments, questions, letters, and suggestions to:
88 pages matching increased in this book\nResults 1-3 of 88\nWhat people are saying - Write a review\nWe haven't found any reviews in the usual places.\nDERMATOLOGY AND SYPHILOLOGY\n13 other sections not shown\nOther editions - View all\nabdominal abnormal acid ACTH acute adrenal agents anesthesia antibiotics artery associated authors biopsy blood bone cancer carcinoma cardiac cause cells cent cervical cervix cesarean section chlorpromazine chronic Clin clinical congenital cortisone developed diabetes diagnosis disease dosage dose drug edema effect electrocardiogram esophageal esophagus factors fever fracture frequently gastric graft heart hemoglobin hemorrhage hormone Hospital hydrocortisone hypertension hysterectomy Ibid increased infants infarction infection intestinal isoniazid lesions liver ment metabolism mitral mitral stenosis months muscle myocardial myocardial infarction normal obstruction occurred operation pain patients penicillin period postoperative pregnancy present pressure procedure protein pulmonary reactions renal reported resection reserpine respiratory rheumatic rheumatic fever serum showed skin sodium stenosis streptomycin Surg surgery surgical symptoms syndrome therapeutic therapy thyroid tients tion tissue tive treated treatment tuberculosis tumor ulcer ulcerative colitis usually vascular ventricular x-ray
“Why would I need general anesthesia?”, an amicable 60-years old patient asks me. She has indicated in her questionnaire that she suffered from hypertension. She needs a dental implant and I had just recommended that the procedure is performed under sedation.\n“First of all – this is sedation (or medical sleep, as you may also call it). Your breathing will be preserved, you will be able to hear me and open and close your mouth, and if I ask you if you are hungry – you will answer my question.” I reply.\n“But general anesthesia is dangerous and harmful.”, she insists.\n“Sedation ranks first in terms of safety.”, I am trying to answer as fully as possible. ”Our anesthesiologists monitors all your vital signs and has the necessary expertise to regulate any occurring problem. They monitor the respiration, heart rate, pulse, saturation etc. If your blood pressure starts to climb up, due to your condition, they will immediately adjust it.\nFurthermore, sedation means comfort. Mainly for you, but also for me, as your implantologist. You will feel great on the next day. I don’t expect any pain or oedemas on your part. You can get back to your normal social life right away.\nFor me, as a surgeon - implantologist, comfort is also significant. I can perform the surgery in a much shorter time or combine it with other necessary procedures. In this way, a single sedation can save you many further visits. For you, it would be one and the same whether you sleep for 1 hour and 45 minutes or for 2.5 hours.”\n“And what if my blood pressure rises during that sedation of yours?” the patient asks, suddenly remembering her health issues.\n“That’s why the anesthesiologist is here – they will monitor you throughout the procedure.\nWhen I appointed an anesthesiologist-reanimator with more than 30 years of experience, as our full-time employee, most of my colleagues and friends asked me: “Why? Isn’t it more cost-efficient to call them and make appointments, only when you need them?”\nHaving an anesthesiologist at the dental clinic means safety and security. Both for the patients and the dentists. This means covered medical risk during every dental anesthesia.\nLet me explain it that way: Whenever you’re buying a new family car, do you want more airbags and safety systems? And do you hope that you would never need them? And are you ready to pay more, just to make sure that these systems are there and could save your life in case of an accident?\nNo dental anesthesia is applied at our clinic, without the presence of an anesthesiologist. This is part of the standards of “Dental Clinic Petar Duchev”.
Cosmetic surgery is highly popular all over the world. In 2019, 18.1 million procedures were performed in the United States alone. The numbers are steadily rising every year. The most popular surgeries are breast augmentation, liposuction, facelift, rhinoplasty, and eyelid enhancement.\nWhat started out as an attempt to correct facial deformities due to injuries evolved into a huge beauty industry. Plastic surgeries do wonders for self-esteem, confidence, and the overall quality of the patients’ lives.\nRegardless of all of the benefits, an invasive cosmetic procedure is still a surgery. It comes with risks, complications, side effects, and pain. Let’s take a closer look at the pain factor that accompanies cosmetic procedures.\n1. Each Person’s Pain Threshold is Different\nIt’s hard to evaluate the level of pain caused by cosmetic surgeries because each person’s pain tolerance is different.\nStudies have been done to discover that pain is individual. Your biological, psychological, and sociological factors can affect the post-surgery pain. Emotional problems can intensify the pain while satisfaction with the procedure can reduce it. Past experiences can also affect the level of pain you experience.\nIt’s worth noting that all procedures are done using a local or general anesthetic, so you don’t feel any pain during the surgery. The discomfort may appear after the anesthetic wears off.\n2. Pain May be Caused by Complications\nAny invasive cosmetic procedure comes with the risk of complications. These complications may include:\n- Seroma formation\n- Nerve damage\n- Blood loss\nWhile these side effects are rare, they are possible. Each one of them comes with an additional pain factor.\nAccording to experts in Arizona cosmetic surgery, to minimize the chance of these complications, it’s imperative to listen to the doctor’s recommendations before and after the surgery. It’s also vital to be straightforward with the surgeon about your medical history, bad habits, and prescription medication.\nThe success of cosmetic surgery depends on numerous factors. Hiding or forgetting to share details could increase the risk of side effects.\n3. Each Cosmetic Surgery Comes with its Own Pain Intensity\nDepending on the procedure you choose, you may experience more or less pain.\n- Breast augmentation – key discomfort comes with the muscle spasm, which is the result of the tissue stretching. Your doctor will prescribe pain management meds. They also may make a nerve block injection to prevent excessive pain as the anesthetic wears off.\n- Liposuction – this procedure is likely to cause some pain because, unlike breast augmentation, it involves formidable tissue injuries. To prevent painful moments you may want to limit the areas you have liposuction done. Modern techniques reduce pain by minimizing tissue damage when possible.\n- Eyelid surgery – this type of surgery may cause some soreness and swelling for about a week after the procedure. However, the pain factor is rather low. You might not even have to use prescription meds, opting for NSAIDs, or nothing at all.\n- Rhinoplasty – even though you may experience serious bruising after the procedure, nose-shaping surgeries are rarely very painful. The main discomfort you could experience is a clogged nose for a week or so. Some patients may decide to use prescription meds to control the pain for a few days after the surgery.\n- Facelift – since facelifts involve manipulating muscle tissue, you may experience some pain after the procedure. You would need to take pain medication for about 4 to 5 days to reduce the discomfort.\nOverall, the level of pain and discomfort depends on the type of cosmetic surgery you choose. It can also vary from person to person.\n4. Pain is Unavoidable but Manageable\nWhile some plastic operations are less painful than others, you are likely to deal with at least some pain after the procedure. Regardless of how intense it is, your doctor will prescribe medication to handle it.\nYou don’t need to bear severe pain after cosmetic surgery. Instead, you can talk to your surgeon and get the right prescription to manage it.\nThere is no reason to prepare for painful plastic surgery recovery. Only a small percentage of patients suffer from complications. As long as you follow your doctor’s advice and take the right medications, you won’t experience any serious discomfort.
Also known as mastopexy, a breast lift raises and firms the breasts by removing excess skin and tightening the surrounding tissue to reshape and support the new breast contour. It is a cosmetic procedure performed to fulfill your personal desire for more shapely breasts or to restore breast contour after weight reduction or pregnancy. Breast implants may be inserted at the same time as breast lift or at a later procedure to provide a fuller, natural appearing breasts and a more balanced figure.\nConsultation with Dr Philip Fleming is the best way to determine how breast lift can help you achieve your personal goals. Dr Fleming is certified by the American Board of Plastic Surgery, Inc and he has more than 25 years of experience in performing breast lift. The following is an overview of the breast lift procedure.\nStep 1 – Anesthesia\nBreast lift is most commonly performed under general anesthesia. You will be asleep and under the care of a board-certified MD anesthesiologist and a board-certified nurse anesthetist (CRNA). These health professionals will monitor you during your procedure, ensuring that you have a safe and pleasant experience.\nStep 2 – The incision\nYour incision will be made in an inconspicuous location to minimize visible scarring. Incision options include:\nIncision locations vary based on the degree of excess skin present, nipple areola size and position, and patient-surgeon preference.\nStep 3 – Reshaping Your Breasts\nAfter your doctor makes the incisions:\n- The underlying breast tissue is lifted and reshaped to improve breast contour and firmness.\n- The nipple and areola are repositioned to a natural, more youthful height.\n- If necessary, enlarged areolas are reduced by excising skin at the perimeter.\n- Excess breast skin is removed to compensate for a loss of elasticity.\nOptions for Breast Implants\nSaline implants are filled with sterile salt water. They can be filled with varying amounts of saline which can affect the shape, firmness and feel of the breast. Should the implant shell leak, a saline implant will collapse and the saline will be absorbed and naturally expelled by the body.\nSilicone implants are filled with an elastic gel. The gel feels and moves much like natural breast tissue. If the implant leaks, the gel may remain within the implant shell, or may escape into the breast implant pocket.\nA leaking implant filled with silicone gel may not collapse. If you choose these implants, you may need to visit your plastic surgeon regularly to make sure the implants are functioning properly. An ultrasound or MRI screening can assess the condition of breast implants.\nImplant manufacturers occasionally introduce new styles and types of implants, so there may be additional options available.\nCurrently Saline implants are FDA-approved for augmentation in women 18 years of age and older.\nCurrently Silicone implants are FDA-approved for augmentation in women 22 years of age and older.\nSaline or silicone implants may be recommended at a younger age if used for reconstruction purposes.\nStep 4 – Insertion and Placement of the implants (If required)\nAfter the incision is made, a space (pocket) is formed by separating tissue layers. The pocket may be created in either of the following locations:\n- Under the pectoral muscle (a submuscular placement), or\n- Directly behind the breast tissue, over the pectoral muscle (a submammary/ subglandular placement)\nThe method for inserting and positioning implants depends on the type of implant, degree of enlargement desired, your body type, and your surgeon’s recommendations.\nStep 5 – Closing the incisions\nAfter your breasts are reshaped and excess skin is removed, the remaining skin is tightened as the incisions are closed.\nSome incision lines resulting from breast lift are concealed in the natural breast contours; however, others are visible on the breast surface. Incision lines are permanent, but in most cases will fade and significantly improve over time.\nSutures are layered deep within the breast tissue to create and support the newly shaped breasts. Sutures, skin adhesives and/or surgical tape may be used to close the skin.\nStep 6 – The Results\nThe results of your breast lift surgery are immediately visible. Over time, post-surgical swelling will resolve and incision lines will fade.\nSatisfaction with your new image should continue to grow as you recover and realize the fulfillment of your goal for breasts which have been restored to a more youthful and uplifted position.
On New Year’s day 2015 we had a kid goat join the family here at Peaceful Fields Sanctuary! How’s THAT for a baby New Year. He doesn’t have a name as of yet but this young guy has quite the story to tell. Thanks to several people, this story has a happy ending! This little LaMancha mix (possibly Boar) was found wandering the streets near Durham, North Carolina alone. The county animal control picked him up and he was rescued by a local group Triangle Chance For All. Imagine how scared he must have been wandering the streets and being held in a county shelter, not knowing his fate. After a quick checkup by a vet, he went on a road trip up here to his permanent home at PFS. He’s settling in and getting used to his new surroundings. After blood work results come back and he’s been wethered (neutered) by our vet to prevent breeding, he’ll join Bonnie, Buster & Sweet Pea to engage in typical goat shenanigans happy and free from exploitation. If you’d like to sponsor him or help with the humane neutering (surgically performed under anesthesia) costs use the “donate” tab above or follow this link- http://www.gofundme.com/PeacefulFieldsSanctuary . Welcome little guy and what a great way to start off 2015, with one more life saved from exploitation or death!
Postoperative Analgesia After Wound Infiltration With Tramadol and Dexmedetomidine as an Adjuvant to Ropivacaine for Lumbar Discectomies: A Randomized-controlled Clinical Trial.\nMitra, Saikat MD; Purohit, Shobha MD; Sharma, Mamta MD\nJournal of Neurosurgical Anesthesiology.\n29(4):433-438, October 2017.\n(Format: HTML, PDF)\nIntroduction: Crippling postoperative pain linked with lumbar discectomies not only shackles patient's normal daily activities but also lengthens their hospital stay. So, allaying postoperative pain in these patients has become a substantive component in neuroanesthesia to expedite neurological recovery. Wound infiltration with local anesthetics is widely used to optimize postoperative pain. Different adjuvants like dexmedetomidine and tramadol when added to local anesthetics prolongs postoperative analgesia. The aim of this trial was to evaluate the analgesic efficacy of tramadol and dexmedetomidine when added to ropivacaine for wound infiltration in lumbar discectomies.\nMethodology: This study was prospective, randomized, double-blind, controlled in nature conducted among 45 adult patients belonging to American Society of Anesthesiologists' physical status 1 and 2, of either sex aged between 30 and 70 years undergoing elective lumbar discectomies. They were randomly allocated into 3 equal groups: group R received 100 mg of 0.5% ropivacaine (20 mL) and 2 mL normal saline, group RT received 100 mg of 0.5% ropivacaine (20 mL) and 2 mg/kg tramadol (2 mL), and group RD received 100 mg of 0.5% ropivacaine (20 mL) and 0.5 [mu]g/kg dexmedetomidine (2 mL) (total volume, 22 mL). Visual analog scale at 0, 2, 4, 6, 12, 18, and 24 hours; time to first rescue analgesia, total supplemental analgesic consumption and side effects (if any) were assessed during first 24 hours postoperatively.\nResults: The median time to first rescue analgesia (median; 95% confidence interval [CI]) in group RD was 930 (854.3 to 1005.7) minutes. This was significantly longer (P=0.000) than group RT (420 [366.3 to 473.7] min) or group R (270 [243.2 to 296.8] min). Postoperative diclofenac consumed (median [interquartile range]) was 150 (150 to 200) mg in group R, 150 (75 to 150) mg in group RT and 75 (75 to 150) mg in group RD (P=0.008). Significant differences in mean visual analog scale scores were observed among the 3 groups at hours 0 (P=0.033), 2 (P=0.001), 4 (P=0.000), 6 (P=0.001), and 24 (P=0.013). No statistical significant side effects could be discerned among the groups.\nConclusions: We concluded that wound infiltration with combined ropivacaine and dexmedetomidine found to be significantly superior for postoperative analgesia compared with either combined ropivacaine and tramadol or ropivacaine alone for lumbar discectomies.\nCopyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved
Is a vitrectomy painful?\nUnless the patient is in poor health or has severe disease, nearly all vitrectomies are outpatient procedures performed either in a hospital or in a dedicated ambulatory surgery center; they involve little or no pain and require only minimal anesthesia.\nHow long does vitrectomy surgery take?\nA vitrectomy can take anywhere from one to several hours, depending on what condition you’re treating. It may be just one in a series of procedures to repair a problem. You’ll have the option to stay awake and use numbing drops or shots in your eye.\nWhat type of anesthesia is used for vitrectomy?\nAnaesthesia for vitrectomy surgery\nVitreoretinal surgery, vitrectomy or surgery involving the vitreous and retina, has traditionally been performed under general anaesthesia, but local anaesthesia has increased in popularity in recent years.\nAre u still asleep when using local anesthesia for vitrectomy?\nIf you have a local anaesthetic, you will be awake during surgery.\nCan you watch TV after vitrectomy?\nWatching TV and reading will cause no harm. Your vision will remain blurred / poor for several weeks. Often the vision is distorted after surgery. This will vary depending on the type of operation, e.g. if a gas bubble is inserted into the eye, as the bubble shrinks you might see the edge of the bubble.\nHow long do I have to stay face down after vitrectomy?\nPatients having vitreo-retinal surgery for a macular hole will need to posture face down for 14 days; for other conditions this is only necessary for 5 days.\nCan I sleep on my side after vitrectomy surgery?\nIt is recommended to sleep on either side or even your front, but not sleep on your back as that would make the bubble move away from the macular hole.\nWhat does eye look like after vitrectomy?\nAfter the surgery, your eye may be swollen, red, or tender for several weeks. You might have some pain in your eye and your vision may be blurry for a few days after the surgery. You will need 2 to 4 weeks to recover before you can do your normal activities again.\nWhat can you not do after a vitrectomy?\nIn general, activities like driving, reading, and exercise will need to be avoided for a few days after the procedure. Some people will be required to lay face down for a period of time to help their eye heal properly. Often, eye drops will be prescribed to help prevent infection and to reduce inflammation.\nHow long does it take to get vision back after vitrectomy?\nIt may take around two-four weeks or even more to get a clear vision after the vitrectomy procedure. The clarity of the vision after the procedure may be affected by the following factors: The eye drops used to dilate eyes during surgery may also cause blurry vision.\nHow long after vitrectomy can I see?\nYou might have some pain in your eye and your vision may be blurry for a few days after the surgery. You will need 2 to 4 weeks to recover before you can do your normal activities again. It may take longer for your vision to get back to normal.\nHow long does it take for an air bubble to dissolve after vitrectomy?\nThe timing depends on the type of gas used: short-acting gas (SF6) takes 2 to 3 weeks to disappear; long-acting gas (C3F8) takes about 2 months. When the gas bubble is down to half size, you will see a horizontal line across your vision, bobbing up and down with head movement.
Anesthesia Central is an all-in-one web and mobile solution for treating patients before, during, and after surgery. This collection of drug, procedures and test information is derived from Davis’s Drug, MGH Clinical Anesthesia Procedures, Pocket Guide to Diagnostic Tests, and MEDLINE Journals. Explore these free sample topics:\n-- The first section of this topic is shown below --\nComplementary/Alternative Medicine: This monograph describes a natural or herbal product that is not subject to FDA guidelines for medicines. Patients and clinicians are advised to read package labels carefully to ensure safe and efficacious use.\nQuiring, Courtney, et al. "Hawthorn." Davis's Drug Guide, 16th ed., F.A. Davis Company, 2019. Anesthesia Central, anesth.unboundmedicine.com/anesthesia/view/Davis-Drug-Guide/110439/all/hawthorn.\nQuiring C, Sanoski CA, Vallerand AH. Hawthorn. Davis's Drug Guide. 16th ed. F.A. Davis Company; 2019. https://anesth.unboundmedicine.com/anesthesia/view/Davis-Drug-Guide/110439/all/hawthorn. Accessed October 19, 2019.\nQuiring, C., Sanoski, C. A., & Vallerand, A. H. (2019). Hawthorn. In Davis's Drug Guide. Available from https://anesth.unboundmedicine.com/anesthesia/view/Davis-Drug-Guide/110439/all/hawthorn\nQuiring C, Sanoski CA, Vallerand AH. Hawthorn [Internet]. In: Davis's Drug Guide. F.A. Davis Company; 2019. [cited 2019 October 19]. Available from: https://anesth.unboundmedicine.com/anesthesia/view/Davis-Drug-Guide/110439/all/hawthorn.\n* Article titles in AMA citation format should be in sentence-case\nTY - ELEC\nT1 - hawthorn\nID - 110439\nA1 - Quiring,Courtney,\nAU - Sanoski,Cynthia A,\nAU - Vallerand,April Hazard,\nBT - Davis's Drug Guide\nUR - https://anesth.unboundmedicine.com/anesthesia/view/Davis-Drug-Guide/110439/all/hawthorn\nPB - F.A. Davis Company\nET - 16\nDB - Anesthesia Central\nDP - Unbound Medicine
- Poster presentation\n- Open Access\nDissipated energy during protective mechanical ventilation\nIntensive Care Medicine Experimental volume 3, Article number: A663 (2015)\nFrom literature we know that a cornerstone of the protective lung ventilation in Acute Respiratory Distress Syndrome (ARDS) patients and during general anesthesia is a low tidal volume. On the other hand, driving pressure seems to be the variable that best stratifies mortality risk. Our hypothesis is that the combination of volume and pressure, that is the energy dissipated into respiratory system, is the main determinant of a ventilator-induced lung injury (VILI).\nTo measure dissipated energy into the respiratory system during mechanical ventilation, maintaining the same minute ventilation in each patient, setting tidal volume of 6 ml/kg or 12 ml/kg and PEEP 5 cmH2O.\nAll patients were deeply sedated, curarized, intubated and ventilated. After a recruitment maneuver, ventilatory parameters (in a random order 6 or 12 ml/kg, PEEP 5 cmH2O, and the respiratory rate needed to maintain the same minute ventilation in the 2 conditions) were set and a recording of airways pressure and flow curves was made, in order to reconstruct the corresponding dynamic pressure-volume (PV) curve. We measured dissipated energy in each breaths by the hysteresis area of the PV curve of the respiratory system; we calculated the total dissipated energy into respiratory system multiplying energy dissipated during every breath by the respiratory rate.\nWe included 23 ARDS patients (PaO2/FiO2 183 ± 75 and PEEP 9 ± 3 cmH2O at ICU admission), 7 obese patients (BMI 42 ± 10) and 11 patients with healthy lungs, both after elective surgery. In the 3 groups considered, the total dissipated energy is greater during 12 ml/kg if compared to 6 ml/kg ventilation, in particular: ARDS patients 7.60 [6.32-8.78] J/min VS 6.06 [4.57-7.12] J/min (p < 0.001), obese patients 8.71 [7.69-10.98] J/min VS 7.35 [6.68-10.52] J/min (p < 0.001), healthy lungs patients 5.04 [3.48-6.67] J/min VS 4.02 [3.18-4.85] J/min (p < 0.001) (Wilcoxon matched pairs test). The same minute ventilation was maintained increasing respiratory rate: from 9 [8-9] to 18 [17-20] breaths/min in ARDS patients (p < 0.001), from 8 [7-10] to 18 [14-20] breaths/min in healthy lungs patients (p = 0.004) and from 10 [9-10] to 20 [20-21] in obese patients (p = 0.02) (Wilcoxon matched pairs test).\nAt the same minute ventilation, in the same patient, tidal volume of 6 ml/kg protects respiratory system from an excess of dissipated energy, despite the increase in respiratory rate; these results were observed in ARDS patients and in patients under general anesthesia, including the obese ones. The relationship between tidal volume and dissipated energy in the clinical range seems to be not linear.\nThe ARDS Network: NEJM. 2000, 342: 1301-1308.\nFutier E, et al: for the IMPROVE Study Group. NEJM. 2013, 369: 428-437. 10.1056/NEJMoa1301082.\nAmato MBP, et al: NEJM. 2015, 372: 747-755. 10.1056/NEJMsa1410639.\nAbout this article\nCite this article\nGotti, M., Cressoni, M., Chiumello, D. et al. Dissipated energy during protective mechanical ventilation. ICMx 3, A663 (2015) doi:10.1186/2197-425X-3-S1-A663\n- Respiratory Rate\n- Obese Patient\n- Tidal Volume\n- Respiratory System\n- Acute Respiratory Distress Syndrome
Effects of adductor canal block combined with infiltration between the popliteal artery and capsule of the knee on pain management and early rehabilitation compared with epidural analgesia for patients undergoing total knee arthroplasty: a prospective randomised controlled trial\n1Department of Anesthesiology and Reanimation, Gulhane Training and Research Hospital, University of Health Sciences, 06010 Ankara, Turkey\n2Department of Orthopedics and Traumatology, Gulhane Training and Research Hospital, University of Health Sciences, 06010 Ankara, Turkey\nDOI: 10.22514/sv.2023.014 Vol.19,Issue 2,March 2023 pp.145-153\nSubmitted: 04 September 2022 Accepted: 12 December 2022\nPublished: 08 March 2023\n*Corresponding Author(s): Fatih Simsek E-mail: [email protected]\nTotal knee arthroplasty (TKA) is often regarded as one of the most painful orthopedic operations. Variety of regional anesthetic procedures are used to reduce this pain. Infiltration between the popliteal artery and capsule of the posterior knee (IPACK) is increasingly being utilized in conjunction with adductor canal block (ACB) to provide adequate analgesia for TKA. The aim of study is to assess the analgesic effectiveness of ACB + IPACK block and epidural analgesia (EA) after TKA during the early stages of physical therapy. This prospective study included 58 patients who underwent unilateral TKA surgery. Patients were randomized into two groups as EA group (n = 30) and ACB + IPACK group (n = 28). The visual analogue scale (VAS) scores of the patients at the postoperative 8th (PO8th) hour, 1st postoperative day (POD1), and postoperative 2nd day (POD2) during the active and passive physical therapy movements, VAS scores during the ambulation, and active and passive range of movement values in POD1 were recorded. In addition, ambulation rates of the patients at the PO8th hour, 25 meters ambulation times in POD1, and completion times of 10 assisted squats in POD1 were recorded. The ACB + IPACK group had a substantially higher PO8th hour VAS score (p = 0.038). However, there was no significant difference in POD1, POD2 VAS scores. The analgesics consumption and VAS scores during ambulation were comparable among groups. Ambulation rate (22 (78.5%) vs. 16 (53.3%), p = 0.043) and speed (139.65 ± 57.12 sec. vs. 188.66 ± 77.95 sec., p = 0.023) were significantly better in the ACB + IPACK group. The strength of quadriceps contractions was similar in both groups. The use of a combination of ACB + IPACK block for postoperative analgesia in TKA patients is not only successful in reducing postoperative pain, but also a promising treatment with favourable effects on early ambulation and rehabilitation.\nPostoperative pain management; Peripheral nerve block; Epidural analgesia; Knee arthroplasty; Rehabilitation; Ultrasound-guidance\nFatih Simsek,Eylem Deniz Ozdemir,Seyyid Furkan Kina,Umut Kara,Mehmet Emin Ince,Yusuf Erdem,Mehmet Burak Eskin,Ahmet Cosar. Effects of adductor canal block combined with infiltration between the popliteal artery and capsule of the knee on pain management and early rehabilitation compared with epidural analgesia for patients undergoing total knee arthroplasty: a prospective randomised controlled trial. Signa Vitae. 2023. 19(2);145-153.\n Gerbershagen HJ, Aduckathil S, van Wijck JM, Peelen LM, Kalkman CJ, Meissner W. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology. 2013; 118: 934–944.\n Kim DH, Beathe JC, Lin Y, YaDeau JT, Maalouf DB, Goytizolo E, et al. Addition of infiltration between the popliteal artery and the capsule of the posterior knee and adductor canal block to periarticular injection enhances postoperative pain control in total knee arthroplasty: a randomized controlled trial. Anesthesia & Analgesia. 2019; 129: 526–535.\n Raeder JC. Local infiltration analgesia for pain after total knee replacement surgery: a winner or just a strong runner-up? Anesthesia & Analgesia. 2011; 113: 684–686.\n Bos EME, Hollmann MW, Lirk P. Safety and efficacy of epidural analgesia. Current Opinion in Anaesthesiology. 2017; 30: 736–742.\n Patterson ME, Bland KS, Thomas LC, Elliott CE, Soberon JR, Nossaman BD, et al. The adductor canal block provides effective analgesia similar to a femoral nerve block in patients undergoing total knee arthroplasty—a retrospective study. Journal of Clinical Anesthesia. 2015; 27: 39–44.\n Laoruengthana A, Rattanaprichavej P, Rasamimongkol S, Galassi M. Anterior vs posterior periarticular multimodal drug injections: a randomized, controlled trial in simultaneous bilateral total knee arthroplasty. The Journal of Arthroplasty. 2017; 32: 2100–2104.\n Caballero-Lozada AF, Gómez JM, Ramírez JA, Posso M, Zorrilla-Vaca A, Lasso LF. IPACK block: emerging complementary analgesic tech-nique for total knee arthroplasty. Colombian Journal of Anestesiology. 2020; 48: 78–84.\n Salman T, Lauren S, Clint EE, Bobby DN, Leslie CT, Dane Y, et al. Novel regional techniques for total knee arthroplasty promote reduced hospital length of stay: an analysis of 106 patients. Ochsner Journal. 2017; 17: 233–238.\n Sankineani SR, Reddy ARC, Eachempati KK, Jangale A, Gurava Reddy AV. Comparison of adductor canal block and IPACK block (interspace between the popliteal artery and the capsule of the posterior knee) with adductor canal block alone after total knee arthroplasty: a prospective control trial on pain and knee function in immediate postoperative period. European Journal of Orthopaedic Surgery & Traumatology. 2018; 28: 1391–1395.\n Li D, Alqwbani M, Wang Q, Liao R, Yang J, Kang P. Efficacy of adductor canal block combined with additional analgesic methods for postoperative analgesia in total knee arthroplasty: a prospective, double-blind, randomized controlled study. The Journal of Arthroplasty. 2020; 35: 3554–3562.\n Kampitak W, Tanavalee A, Ngarmukos S, Amarase C. Opioid-sparing analgesia and enhanced recovery after total knee arthroplasty using combined triple nerve blocks with local infiltration analgesia. The Journal of Arthroplasty. 2019; 34: 295–302.\n Choi PT, Bhandari M, Scott J, Douketis J. Epidural analgesia for pain relief following hip or knee replacement. Cochrane Database of Systematic Reviews. 2003; 3: CD003071.\n Fang B, Wang Z, Huang X. Ultrasound-guided preoperative single-dose erector spinae plane block provides comparable analgesia to thoracic paravertebral block following thoracotomy: a single center randomized controlled double-blind study. Annals of Translational Medicine. 2019; 7: 174.\n Sogbein OA, Sondekoppam RV, Bryant D, Johnston DF, Vasarhelyi EM, MacDonald S, et al. Ultrasound-guided motor-sparing knee blocks for postoperative analgesia following total knee arthroplasty: a randomized blinded study. The Journal of Bone and Joint Surgery. 2017; 99: 1274–1281.\n Grevstad U, Mathiesen O, Valentiner LS, Jaeger P, Hilsted KL, Dahl JB. Effect of adductor canal block versus femoral nerve block on quadriceps strength, mobilization, and pain after total knee arthroplasty: a randomized, blinded study. Regional Anesthesia and Pain Medicine. 2015; 40: 3–10.\n Albrecht E, Guyen O, Jacot-Guillarmod A, Kirkham KR. The analgesic efficacy of local infiltration analgesia vs femoral nerve block after total knee arthroplasty: a systematic review and meta-analysis. British Journal of Anaesthesia. 2016; 116: 597–609.\n Zhu L, Yang L, Wang Z, Cui H. Effects of adductor canal block on pain management compared with epidural analgesia for patients undergoing total knee arthroplasty: a randomized controlled trial protocol. Medicine. 2020; 99: e21672.\n Vora MU, Nicholas TA, Kassel CA, Grant SA. Adductor canal block for knee surgical procedures: review article. Journal of Clinical Anesthesia. 2016; 35: 295–303.\n Cullom C, Weed JT. Anesthetic and analgesic management for outpatient knee arthroplasty. Current Pain and Headache Reports. 2017; 21: 23.\n Abdullah MA, Abu Elyazed MM, Mostafa SF. The interspace between popliteal artery and posterior capsule of the knee (IPACK) block in knee arthroplasty: a prospective randomized trial. Pain Physician. 2022; 25: E427-E433.\n Et T, Korkusuz M, Basaran B, Yarımoğlu R, Toprak H, Bilge A, et al. Comparison of iPACK and periarticular block with adductor block alone after total knee arthroplasty: a randomized clinical trial. Journal of Anesthesia. 2022; 36: 276–286.\n Kayupov E, Okroj K, Young AC, Moric M, Luchetti TJ, Zisman G, et al. Continuous adductor canal blocks provide superior ambulation and pain control compared to epidural analgesia for primary knee arthroplasty: a randomized, controlled trial. The Journal of Arthroplasty. 2018; 33: 1040–1044.e1.\n Elliott CE, Myers TJ, Soberon JR. The adductor canal block combined with iPACK improves physical therapy performance and reduces hospital length of stay (Abstract 197). ASRA 40th Annual Regional Anesthesia and Acute Pain Medicine Meeting. LasVegas, Nevada and 14–16 May 2015. American Society for Regional Anesthesia & Pain Medicine (ASRA): LasVegas, Nevada. 2015.\n Zheng F, Liu Y, Huang H, Xu S, Ma X, Liu Y, et al. The impact of IPACK combined with adductor canal block under ultrasound guidance on early motor function after total knee arthroplasty. Brazilian Journal of Anesthesiology. 2022; 72: 110–114.\n Reddy G, Jangale A, Reddy RC, Sagi M, Gaikwad A, Reddy A. To compare effect of combined block of adductor canal block (ACB) with IPACK (Interspace between the Popliteal Artery and the Capsule of the posterior Knee) and adductor canal block (ACB) alone on total knee replacement in immediate postoperative rehabilitation. International Journal of Orthopaedics Sciences. 2017; 3: 141–145.\n Alsheikh KA, Alkhelaifi AS, Alharbi MK, Alhabradi FA, Alzahrani FA, Alsalim AA, et al. Adductor canal blockade versus continuous epidural analgesia after total knee joint replacement: a retrospective cohort study. Saudi Journal of Anaesthesia. 2020; 14: 38-43.\n Singh S, Choudhary NK, Lalin D, Verma VK. Bilateral ultrasound-guided erector spinae plane block for postoperative analgesia in lumbar spine surgery: a randomized control trial. Journal of Neurosurgical Anesthesiology. 2020; 32: 330–334.\nVol., Issue , Invalid dateTable of contents\nScience Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.\nJournal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.\nChemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.\nIndex Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.\nGeneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.\nScopus: CiteScore 0.5(2021) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.\nEmbase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.
Marina del Rey Hospital provides you with the safest procedure for eliminating the kidney stones that cause you health related issues. Thanks to the state-of-the-art equipment and procedures found at our health center, the highly skilled urologists from Marina del Rey Hospital are able to perform this non-surgical procedure for you to resume your usual activities in the shortest time possible.\nHaving one of the highest success rates in achieving kidney stone removal, the shock wave lithotripsy is the procedure most likely to restore your health and well-being.\nExtracorporeal Shock Wave Lithotripsy (ESWL) is a totally non-invasive treatment for patients with kidney stone disease. The innovative procedure uses focused ultrasonic energy or shock waves to target stones that cannot be eliminated naturally. The shock waves travel through the skin and tissue, reach the targeted stones and break them into sand-like fragments that will more easily pass through the urinary tract. Complete elimination of stones can generally be achieved during the first couple of months following the procedure. However, for larger stones, the ESWL treatment may need to be repeated.\nESWL is the treatment of choice for patients with certain types of kidney stones, localized in certain areas of the urinary system, causing pain or blockage of the urine flow. The size of the stones is also important, as ESWL is used to fragment stones larger than 4 mm, but usually smaller than 2 cm in diameter.\nAlthough it is an outpatient, non-surgical procedure, ESWL is performed under sedation or general anesthesia and lasts approximately one hour, depending on the size and number of the kidney stones. It usually takes a couple of hours in the recovery before you are ready to go back home. Here are the steps to be taken for the procedure:\nExtracorporeal Shock Wave Lithotripsy is a safe and effective non-surgical procedure, requiring minimal recovery time. It has a 50-90% success rate, so usually stones are removed completely, but in some cases further ESWL or other non-invasive treatments may be needed to clear all the stones.\nA specialist will evaluate your condition and decide whether ESWL is the right treatment for you. A different medical treatment may be recommended in any of the following situations:\nThe risks involved in ESWL are minor and severe complications are unlikely. Besides the risks that are generally associated with anesthesia, some of the specific potential risks are:\nThe recovery time after the ESWL procedure is short. You may be prescribed analgesics as the pieces of stone that start migrating through the urinary tract may cause discomfort and pain. As the treatment is non-invasive, you may resume your usual activities in one or two days following the ESWL procedure.\nIf left untreated, kidney stones may cause bleeding, repeated urinary tract infections and even kidney damage. Therefore, if you experience severe pain in the back, side or abdomen, blood in the urine, frequent and/or painful urination, be aware that these are some of the most frequent kidney stone symptoms. If this is your diagnosis, you should know that ESWL is the safest procedure used to eliminate kidney and upper ureteral stones. Call us at 310.823.8911 to schedule a check-up today and find out everything you need to know about this completely non-invasive alternative to kidney stone surgery!\nKaryn Eilber, M.D.See Profile »\nSameer Malhotra, M.D.See Profile »\nFaisal Ahmed, M.D.See Profile »\nJennifer Anger, M.D.See Profile »\nNickolas Tomasic, M.D.See Profile »\nThomas Johnson, M.D.See Profile »\nSepehr Nowfar, M.D.See Profile »\nGeorge Yamauchi, M.D.See Profile »\nVictoria C. Scott, M.D.See Profile »\nCarrie A. Stewart, M.D.See Profile »
Radiofrequency ablation is a minimal invasive treatment used to treat varicose veins. (Ablation can be described as a physician using heat to create scar tissue by damaging tissue.) The scar tissue results in a closed vein. Swift Vein Institute offers the Closurefast procedure for the treatment of varicose veins and chronic venous insufficiency.\nRather than laser energy, radio frequency energy is used to heat and damage the internal wall of a vein. This results in the closing off of the varicose vein in the leg. The radio frequency energy is guided through a small tube (also called catheter) that is inserted through a tiny vein incision.\nEndovenous Thermal Ablation\nEndovenous thermal ablation is a minimally invasive treatment that involves the insertion of a thin, flexible tube called a catheter into a diseased vein and uses heat to seal it shut. Blood that would normally return toward the heart through these veins will then travel through other veins instead. Over time the treated vein shrinks and is absorbed by the body. Compared with surgical options like vein stripping, endovenous thermal ablation results in less pain and quicker average recovery time.6\nSwift Vein Institute offers the Closurefast procedure, formerly known as the VNUS Closure™ procedure, for the treatment of varicose veins and CVI. The Closurefast™ procedure is a minimally invasive segmental ablation treatment that utilizes radiofrequency (RF) energy to provide an even and uniform heat to contract the collagen in the vein walls, causing them to collapse and seal. Once the diseased vein is closed, blood will re-route itself to other healthy veins.\nThe Closurefast™ procedure allows for a quick, comfortable recovery and a return to everyday activities for the average patient, while also improving the appearance of varicose veins.6,7\nThe Closurefast™ procedure has been proven in clinical studies to have excellent long term effectiveness, with less pain and bruising than endovenous laser.7\nThis procedure can be performed on large veins in the legs in an office setting with local anesthesia. Following the treatment, patients are able to walk and recovery is commonly short. Compression stockings (recommended by the physician) are necessary to wear for at least 1 week following treatment. The physician may use ultrasound diagnostics to ensure the vein is closed.\nWhat to Expect from ClosureFast\nWondering what to expect prior to the ClosureFast procedure? The ClosureFast procedure is a minimally invasive treatment that uses radiofrequency ablation (heat) to seal off the diseased vein so blood gets rerouted to nearby healthy veins.\nPrior to the ClosureFast procedure:\n- Leg will be evaluated using ultrasound\n- Vein may be marked using a skin marker\nVein access and catheter positioning\n- Local anesthesia will be given at the catheter entry site to numb the area\n- The physician will access the vein through either a small incision or skin puncture\n- Once the veins is accessed, the ClosureFast™ catheter is inserted and advanced to the treatment starting point\n- The catheter’s position is verified using ultrasound\nTreatment path will be numbed\n- Minimally invasive, outpatient procedure\n- Proven results with positive patient outcomes\n- Lower rates of pain, bruising and complications and a faster improvement in patients’ quality of life when compared to 980 nm laser ablation5\n- Average patient typically resumes normal activities within a few days following treatment6\n- Most patients report a noticeable improvement in symptoms within 1- 2 weeks following procedure6\n- Can be performed under local anesthesia\n- Covered by most insurance providers\nA comparison of the patient experience between those treated with the Closurefast ™procedure, using the Covidien ClosureFast™ Endovenous Radiofrequency Ablation (RFA) Catheter, and those treated with 980nm laser ablation.\nClosureFast is a trademark of a Medtronic company.
Over 37 Years Of Safe, Private Women’s Health Services In Rochester, NY\nUltrasound is performed for each patient during your appointment. The initial ultrasound is to confirm the dating of the pregnancy. A follow-up ultrasound confirms successful treatment.\nMedical abortion is an effective means of ending pregnancies less than nine weeks by taking medications, which avoids surgery.\nSurgical abortion is the traditional method of ending a pregnancy. It is very safe and effective. It may be performed for any patient up to thirteen weeks gestation.\nGeneral anesthesia is the method of anesthesia in which you are “put to sleep”. This is available. Once you have discussed this with our clinician we will perform your procedure.\nSedation is a combination of sedation pills and a medication given by injection before the procedure. These medications combined promote relaxation and minimize any discomfort associated with the procedure.\nLaminaria placement may be required the day before a surgical procedure to dilate the cervix.\nMisoprostol Dilation Misoprostol is a drug that belongs to the prostaglandin family of drugs. It has been available for many years to treat stomach ulcers. Misoprostol can also soften the cervix and cause it to dilate, making a surgical procedure easier, safer and less uncomfortable.\nEarly Pregnancy Complications such as spontaneous miscarriage, fetal demise, FDIU.\nUrine Pregnancy Test: A urine pregnancy test is performed for all patients.\nThe morning after pill is a medication taken within 72 hours after unprotected sex or a condom failure to prevent a pregnancy from occurring.\nBlood Type: Regardless of your choice of procedure your blood type must verified. If your blood type is Rh negative you will receive either MICRhoGAM or RhoGAM. MICRhoGAM will be administered to all patients under 12 weeks gestation and patients who are over 12 weeks gestation will receive full RhoGAM dose.\nPlease visit our YouTube video
Nova Scotia recently missed out on two training opportunities that could have helped bolster anesthesiology services in the province because a health-care group tasked with overseeing the issue couldn’t agree on the offers.\nDocuments received in response to an access-to-information request show the province was offered a family practice anesthetist training spot for this past July at both the University of Toronto and McMaster University in Hamilton, but missed the deadline to have doctors accept either offer because health officials here still cannot agree on whether the role should be used in Nova Scotia.\nA family practice anesthetist (FPA) is a family doctor who has an additional year of training focused on anesthesiology. The training allows the doctor to provide local and general anesthetics in cases except for those that are highly specialized, such as heart and brain surgeries.\nWhile the role is commonly used in Ontario and Western Canada, it isn’t east of Ontario. Resident training programs exist at 11 medical schools in Canada, although Dalhousie University is not one of them.\nProblems at regional hospitals\nAt a time when the provincial health authority has six vacancies for anesthesiologists and the specialty is in demand across the country, some officials, including doctors at regional hospitals in Antigonish and New Glasgow, have called for FPAs to be used here to ensure service levels remain stable outside the Halifax area.\nThe most pressing need recently has been in Yarmouth, where at one point this spring the regional hospital was down to just one anesthesiologist, forcing a reduction in surgical services and the possibility of pregnant women needing to leave the community to deliver babies.\nAlthough that never happened, and the site has since brought on a second anesthesiologist and also has locum support, things remain precarious; elective surgeries have been reduced for the last six months.\nSuch uncertainty is what’s driving the push to allow FPAs in Nova Scotia.\n“I see this as one of several solutions, and perhaps a minor solution, but one that N.S. has not allowed itself to use,” Dr. Rod Wilson wrote in an email to Nova Scotia Health Authority officials in January.\n“Other provinces have been training and educating FPA[s] for decades.”\n‘We came so close’\nWilson, the former executive director of the North End Community Health Centre in Halifax, is a physician adviser for the Health Department, and the documents CBC News received show his efforts to bring the FPA role to the province have faced pushback from some sectors, including anesthesiologists.\n“The program at the moment would have limited success given the lack of support from [the perioperative group] and primary health care members,” the health authority’s vice-president of medicine, Dr. Nicole Boutiller — who at the time was the NSHA interim co-vice-president of medicine — wrote in an email to Wilson in February.\nThe health authority’s perioperative group eventually reviewed the idea, and although its March decision is redacted in the documents, subsequent emails from Wilson to health authority officials and staff at the University of Toronto and McMaster University make clear the group did not endorse using FPAs.\n“We came so close to [getting] an extra anesthesia resource for communities,” Wilson wrote to health authority officials.\n“Anesthesia leaders not supportive or accepting [of the] FPA practice,” he wrote to the chair of the University of Toronto’s department of anesthesia.\nIn an interview, Tim Guest, vice-president of health services for the health authority, said some of the concerns from the perioperative group were based on a lack of information about the role. Although the group initially rejected the idea, the health authority’s medical advisory committee went back to them with research on FPAs and asked the group to provide options to be considered for how to enhance the anesthesiology system.\nThat was months ago, and the group has yet to provide those options.\nHealth Minister Randy Delorey, who was made aware of the role a year ago by an out-of-province doctor who wanted to know why FPAs aren’t used here, has been waiting on a report about the issue since the spring. Guest said he’s hoping for those recommendations soon. He said his primary concern is maintaining access to care as close as possible to where people live.\n“It behooves us to look at every option that we can to stabilize and ensure that we maintain those services,” said Guest.\n‘We need to look into this more’\nAlthough FPAs are sometimes dismissed as an option used only in rural and remote communities, the documents received by CBC show that is not the case. A jurisdictional scan shows there are FPAs based in Ottawa, Kingston, Ont., Mississauga, Ont., Winnipeg, Edmonton, Vancouver and Victoria.\nWhile the health authority awaits the recommendations from the perioperative group, other doctors have expressed interest in the idea.\nDr. Mark Taylor, the executive director of medicine for the central zone, noted in a May email to colleagues that an Accreditation Canada survey he was part of for the Southern Regional Health Authority in Manitoba showed five hospitals with surgical services, all within an hour-and-a-half of Winnipeg, exclusively used FPAs.\n“There is not one fellowship anaesthetist in the entire region. Everyone seemed satisfied with services and there was no indication of poor outcomes that I could find,” he wrote.\n“Very interesting,” Dr. Drew Bethune, medical director of the Nova Scotia’s cancer care program, wrote in response.\n“Obviously we need to look into this more.”\nDr. Greg Hirsch, the chief of cardiac surgery at the QEII hospital in Halifax, responded by saying he is “keen to learn more about the potential role of [family practice] anaesthetists and how it might buttress the critical shortage of anaesthetists in the province.”\nWith the College of Physicians and Surgeons of Nova Scotia having agreed to licence the role, the president of Doctors Nova Scotia is encouraging officials to keep working on a solution.\nDr. Gary Ernest said the organization is supportive of a collaborative model that would see FPAs working in appropriate situations with appropriate support, at certain locations that still include board-certified anesthesiologists.\n“That seems reasonable and indeed, from a Doctors Nova Scotia perspective, it is reasonable to have them working in a collaborative manner,” the Liverpool-based doctor said in a telephone interview.\nErnest said that although he understands it might be ideal to have a full complement of board-certified anesthesiologists in the province, the reality of the shortage is that’s simply not possible. Even if salaries for the specialty were more competitive on a national level, Ernest said he doubts it would lead to a windfall for Nova Scotia.\nThat reality is part of the basis for Doctors Nova Scotia’s position, he said.\n“We have to really look at this situation in a proactive, open-minded way and really look at the potential that exists for a collaborative model.”
Grandma died in Nizhny Novgorod children came to the clinic with high blood pressure. The doctors managed to stabilize her condition, however the lady was forced to prematurely end your treatment the result of the investigation of the events.\nGrandmother dead children is in a state of shock. Because of this it greatly increased the blood pressure. For this reason, she was taken to hospital in a local hospital, reports LifeNews.\n"She was admitted with high blood pressure. With hypertensive crisis, she had extremely high blood pressure, the morning it came in a stable condition," said the adept of the hospital. There told that the fairer sex to the end are unable to recover because it has caused law enforcement agencies on investigative activities.\nAccording to the doctors, she will be discharged in the foreseeable future. When she left the hospital, her condition was satisfactory.\n"At the moment the cardiogram of her life is not in danger. It is quite possible to write today or tomorrow, judging by the morning. But we need to see what she will come after investigative actions", - stated in the hospital.\nNow grandma is dead children is in conjunction with the investigation. She will continue treatment after all events.\nIn addition, it became known that the accused Oleg Belov regained consciousness after surgery done to remove a bullet, reports TASS. Medical professionals are convinced that it is ready for transportation. Previously, as conveyed by the TV channel "NTV", the investigators wanted was going to talk with Belov immediately after he departed from the anesthesia.\nPreviously in law enforcement voiced version, according to which the accused in the murder of their children, spouses and moms Oleg Belov at the time of arrest was located in the home's own mother-in-law, because he wanted to kill her. Days.Roux wrote that according to the police, they had a strong conflict.\nsections: Region News, Accidents, Accidents
Jan. 21, 2010, SOUTH SAN FRANCISCO, CA - First DataBank, a leading provider of drug databases that help drive patient safety, and Surgical Information Systems (SIS), a provider of feature-rich perioperative software solutions, announced today they have signed an agreement whereby First DataBank will license its suite of comprehensive drug information and associated developer software to Surgical Information Systems to enable the integration of new functionality for drug screening, dosing and documentation within the SIS suite of interoperable surgery solutions.\nSurgical Information Systems is the perioperative specialist, providing solutions that cover the complete surgery and anesthesia care process. Flexible SIS solutions enable predictable outcomes to meet clinical, operational and financial goals. This helps physicians, clinicians and others involved in the care process to improve patient safety, optimize revenue, reduce costs and ensure compliance.\nIn its current release, SIS has integrated First DataBank's comprehensive drug information to assist clinicians in performing key clinical drug screening and medication reconciliation functionality. In addition, SIS has utilized First DataBank's drug information to perform pediatric dose range checking, in order to provide appropriate doses for this important patient population where dosing errors are more common.\nFirst DataBank's National Drug Data File (NDDF) PlusTM, one of the healthcare industry's most widely used sources of up-to-date drug information, supports safe medication prescribing throughout the medication use process. NDDF Plus combines drug descriptive and pricing information with an extensive array of clinical decision-support modules. It encompasses medications approved by the FDA, plus information on commonly-used over-the-counter and alternative therapy agents, such as herbals, nutraceuticals and dietary supplements.\n"Embedding First DataBank drug content within our perioperative solutions, not only enables clinicians to access robust drug information and perform clinical screening, but also provides the ability to exchange patient medication and allergy information with other hospital IT systems that already rely on First DataBank for their drug and allergy clinical decision support," said Ed Daihl, Chief Executive Officer, Surgical Information Systems.\nAdditionally, SIS has integrated First DataBank drug information to enable their clients to document medication information into the Continuity of Care Document (CCD) in order to enhance coordination of care between providers and to comply with the "meaningful use" and proposed interoperability standards set forth by the government in the American Recovery and Reinvestment Act (ARRA).\n"We are pleased to license our drug information to SIS for their use in providing vital clinical drug screening capabilities for the perioperative department," said Donald Nielsen, MD, President, First DataBank. "Our drug information will enable anesthesiologists and other providers of care in the operating room environment to improve medication-related decision making, providing essential patient safety protections."\nAbout Surgical Information Systems (SIS)\nSIS provides software solutions that are uniquely designed to add value at every point of the perioperative process. Developed specifically for the complex surgical environment, all SIS solutions - including anesthesia - are architected on a single database and integrate easily with other hospital systems. SIS offers the only surgical scheduling system endorsed by the American Hospital Association (AHA), and a rules-based charging system that has been granted Peer Reviewed status by the Healthcare Financial Management Association (HFMA). For more information visit our website, www.SISFirst.com.\nAbout First DataBank\nFirst DataBank, a subsidiary of Hearst Corporation, drives patient safety and healthcare quality by providing drug databases that are used within information systems that touch every aspect of healthcare. For 30 years, we have partnered with system developers to integrate and optimize our drug information to improve user workflow and enhance clinical decision making by those entrusted with treating patients at the point-of-need. For more information about First DataBank, call 800-633-3453 or visit www.firstdatabank.com.
Service from General & Specialty Dentists in Torrance, CA\nWest Coast Dental of Torrance has a team of specialists operating a state-of-the-art facility, and we welcome patients of all ages to our convenient location. It's easily spotted from West Sepulveda Boulevard; our dental office is in Suite 1. Whether you need someone to serve as your general dentist in Torrance, or you have a condition that might require more than a few visits to address, we'll schedule a convenient weekday or weekend appointment for you.\nIt all begins with your oral exam. If necessary, we'll take digital X-rays, which reduce the amount of radiation you're exposed to, and use an intraoral camera to explore your mouth in more detail. Once we determine your needs, we'll discuss financing and insurance matters. Our office works with most major carriers and sets up financing plans through CareCredit and Dental Alliance Financing.\nBuilding Lasting Relationships\nOur great online reputation is boosted by the fact that we offer all specialties under one roof. You can come to us for teeth cleaning, oral cancer screening, and other regular treatments, or you can request a treatment that falls under these categories:\n- Family Dentistry\n- Emergency Dental Services\n- Oral Surgery\n- Cosmetic Dentistry\nWith an endodontist on our staff and the proper anesthetics at hand, root canals will be no problem. Our periodontist can address any issue with your gums, such as gingivitis; we'll also perform scaling and root planing if the plaque on your teeth has hardened and become tartar. As for surgical procedures, we can extract broken or impacted teeth, treat mouth tumors and cysts, and address any TMJ disorders.\nWe create a range of dental prosthetics. Whatever you get will be snugly fitted to your mouth, thanks to the detailed mouth impressions made by our chairside oral scanner. For example, you could get:\n- Dental Crowns\n- Dental Bridges\n- Full or Partial Dentures\nOur office also provides dental veneers, which are thin porcelain shells that go over the front of discolored, cracked, chipped, or misshapen teeth. You could also ask for sealants to prevent decay in the back teeth.\nMeeting the Dental Needs of Your Family\nLet us serve as your family dentist. Our experienced dentists and capable staff can take care of the dental needs of your entire family, starting with preventive care. As our practice has dentists with skill and knowledge in a wide variety of specialty areas as well as those who specialize in general dentistry, you can schedule appointments for everyone in your family with us. This makes your busy schedule so much easier.\nSuppose one of your children needs braces. We have dentists trained in orthodontics. They’ll assist your child in getting metal braces or plastic aligners so he or she can have straight and sturdy teeth for improved appearance and ease of brushing and flossing.\nYou or your spouse may need oral surgery. On our staff are dentists who have the extra training to pull a diseased or damaged tooth, remove impacted wisdom teeth, and place dental implants. Part of their training includes anesthesia and sedation, so rest assured you can request these while you have surgery.\nOur dentists also provide cosmetic services for those of us who want to enhance our smile. This includes teeth-whitening, teeth-straightening, crowns, veneers, and more. We believe a beautiful smile is a healthy one, too.\nOur compliance department makes sure that all clinicians are of the highest quality. Some of our staff members are bilingual, too, so almost everyone in the Torrance area can take advantage of our services.\nContact West Coast Dental of Torrance to schedule our services. If your braces break or your filling falls out, just know that we have emergency services available.
Advanced Soft Tissue Surgery\nSurgery on eyes, ears, throat and lungs.\nAt Brookeville Animal Hospital, our veterinarians have experience performing a number of soft tissue surgeries. Our soft tissue surgeries include:\n- Aural Hematoma\n- Anal Sac Removal\n- Laceration Repair\n- Mass/Tumor Removal\n- Foreign Body\n- Gastric Dilation\nAs always, your pet's safety remains our top priority which is why we utilize advanced anesthetic and surgical techniques.\nPets undergoing surgery have the option to receive:\n- Pre-anesthetic blood work\n- Experienced monitoring support\n- IV catheter placement\n- Pain medication\nFollowing surgery, your pet will be kept comfortable and monitored while the effects of anesthesia wear off. Wanting to rest for the remainder of the day is normal, but if you’re concerned about your pet’s post-op behavior, please don’t hesitate to call us at (301) 774-9698.\nPrior to surgery, we request that you review and complete the following:\nYou may fax the completed form to (301) 774-0487, bring with you the day of surgery, or email us at [email protected].
Warming up the bat for brother!\nAm I next, Coach?\nOur backyard is his practice field.\nIt is so funny to me to watch how closely he resembles Luke in his tendency to want to play ball. Any kind of ball! This is serious business to him! He is forever asking someone to "pway ball wif me?". Glove, bat, helmet...all too big. Doesn't matter!!\nJust a few random egg-dying pics! Apparently, someone was hungry!\nOK, this is a terrible picture, but this is too important not to document! Our anesthesiologist took this pic with his phone and texted it for me since I had not brought my phone back to the waiting area to be with Brax. Following in his siblings footsteps, Brax inherited large tonsils and adnoids. We noticed Brax's problems (actually, I really do think he was worse than the other two) sooner because he stayed in our bedroom until he was 14 months old. By 5 months of age, we knew he was a heavy breather and often snorted when sleeping. It only got worse and allergies didn't help. The big kids were both 3 when they had both their tonsils and adenoids removed. It was such a difference for their breathing, sleeping, moods! We didn't do it because they were sick all the time....they weren't. Brax's tonsils are profoundly huge. Take a look sometime! We often wonder why he doesn't choke more when he eats. Our human bodies are amazing! We had to guess that his adenoids were the same. Post operation, our ENT told us that he had almost 100% blockage from his adenoids! I am so glad we had them removed. We decided to wait on tonsils, but I am thinking it will be sometime in the next year.
What is a Nerve Block?\nWhen a spinal facet joint (in your neck or lower back) is injured in a car accident, trip and fall or other personal injury, if conservative physical therapy does not work, a nerve block injection procedure may be recommended by your treating doctor.\nA nerve block should be performed by a board-certified anesthesiologist. The doctor will inject a local anesthetic such as lidocaine (usually lasts about an hour) or bupivacaine (lasts about three hours) onto a group of target nerves to interrupt the electric signal along that group of nerves. When the nerve block wears off, normal nerve function is expected to resume.\nFor example, a brachial plexus nerve block involves an injection in the armpit that will allow a surgeon to operate on the same-sided arm or hand. A stellate ganglion block involves an injection to the front of the neck and is typically used to treat Reflexive Sympathetic Dystrophy (also known as Complex Regional Pain Syndrome – RSD/CRPS). Here is a video explaining What is RSD? in more detail.\nSince the origin of one’s pain can sometimes come from various locations, nerve blocks can also be used diagnostically. For example, lumbar pain can originate from a intervertebral disc, a vertebral facet joint (facet joints are innervated by medial branch nerves), a vertebral body itself, interspinal ligaments, spinal muscles or sacroiliac joint. When someone has chronic pain and the doctor is unsure of the specific origin of that pain a diagnostic nerve block may assist the treating physician. In this scenario the anesthesiologist will use a smaller amount of lidocaine or bupivacaine in a series of suspected nerve sites. Using this method, a treating physician can locate or rule out different nerve groups (and therefore corresponding pain origin/pain generator) depending on whether the patient reports a decrease, or no decrease, in symptoms.\nOnce the pain origin is located, it can be treated with further nerve blocks, the more aggressive radiofrequency lesioning (also called medial branch neurotomy, discussed below) or even more aggressive surgery. When patients have chronic pain from a personal injury in the neck or back, cortisone injections in to the facet joints may only provide temporary relief. For lasting relief, it may be necessary to destroys the medial branch nerves that supply the injured facet joint using radiofrequency lesioning.\nNerve Blocks are generally performed under fluoroscopy (essentially a live-action x-ray). The procedure may not be under sedation if the doctor wants immediate feedback from the patient as to whether the painful symptoms have significantly diminished. Fortunately, side effects and complications (other than soreness in the area for several days) are relatively rare.\nWhat Is Radiofrequency Lesioning?\nAlso called, Medial Branch Neurotomy, or RF, radiofrequency lesioning is also performed under fluoroscopy and will generally be conducted under sedation, including local anesthesia. These radiowaves, adminstered via an electrode, produce significant heat at high frequencies and this heat can be applied to specific medial-branch nerves, for only a few minutes, in order to kill the tissue surrounding and including the nerve, thereby destroying the pain pathway. RF can last for a few months to over a year (the body heals itself and will regrow the destroyed nerves). RF Lesioning is usually recommended when the pain originates from a spinal facet joint and doctors will always test how you respond to a diagnostic nerve block before attempting the radiofrequency lesioning procedure.
Prominent ear; It is when the angle of the head and ear is wider than normal. When these people are viewed from the opposite side, the auricle is more prominent and the “Y” shaped natural folds of the auricle are usually less pronounced than normal. Prominent ear or big ear is not actually a physical disease but an aesthetic problem. In people with remarkable prominent ears, this can lead to psychological and social problems that reduce the person’s quality of life. Being ridiculed among friends usually begins at school age; It can lead to the need to cover their ears with their hair, lack of self-confidence, anxiety, impaired body perception and even depression.\nHow is Prominent Ear Surgery Performed?\nThe only treatment for the removal of prominent ears, big ears and deformities in the ears is surgery. Since ear development is completed around the age of 5-6, the best time for prominent ear treatment in children is the preschool period. When prominent ear surgery is performed in preschool period, psychological traumas and social problems that the child may experience in school life will be prevented. Performing prominent ear surgery in the preschool period also allows the child to adapt to his social environment with his new appearance without deteriorating his body perception and prevents self-confidence problems. Performing prominent ear surgery in the preschool period also allows the child to adapt to his social environment with his new appearance without deteriorating his body perception and prevents self-confidence problems. It is important to know that early treatment prevents psychological and social traumas in the light of the data that people with prominent ears often consult a doctor during adolescence and youth. Prominent ear surgery, known as otoplasty in medicine, is one of the surgical procedures with high satisfaction. Surgical intervention; It is an ear shaping operation applied to eliminate the prominent ear appearance, the big ear appearance and the insufficient curves in the natural ear.\nHow is Prominent Ear Aesthetics Performed?\nProminent ear operation is generally based on removing excess tissue through small incisions made behind the ear. These incisions made in the folds behind the ear hardly leave any marks. Aesthetic and plastic surgery specialists make a personalized prominent ear surgery plan. The most common method is to reduce the excess cartilage in the ear by rasping, remove it if necessary, and give the ear a new shape that is curved backwards with special stitches that are not absorbed by the body. Prominent ear surgery is performed in plastic surgery units.\nHow Many Hours Does Ear Aesthetic Surgery Take?\nOur guest can stand up a few hours after the operation, which is performed under local anesthesia in operating room conditions and lasts about 1 hour. General anesthesia may also be preferred, as it is more difficult to keep children still during the operation. The ears are wrapped to protect the ear tissue and to facilitate healing. After 2-4 days, this dressing is removed and the head of our guest is wrapped with a lighter dressing. Unless self-dissolving stitches are used, the stitches are usually removed within a week. After removing the dressings, it is recommended to use a band that covers the ears for 6-8 weeks, especially at night. You can fill out the form below for more detailed information about prominent ear surgery, to consult our experts and for a pre-interview.
Inguinal hernia, also referred to as groin hernia, is the most common type of hernia, accounting for around 75 to 80 percent of all visceral or bowel hernias. The inguinal hernia operation is therefore the most common hernia operation.\n- What is an inguinal hernia?\n- Procedure and methods applied in an inguinal hernia operation\n- Inguinal hernia operation according to Shouldice\n- Inguinal hernia operation according to Lichtenstein\n- Minimally invasive techniques\n- TAPP (transabdominal preperitoneal mesh implantation)\n- TEP (total extraperitoneal patch-plasty)\nInguinal hernia operation - Further information\nWhat is an inguinal hernia?\nAn inguinal hernia is a visceral hernia in the region of the inguinal canal. The inguinal canal runs obliquely through the abdominal wall and is formed by the muscles of the abdomen. In men, the seminal cord, which originates in the testicle, along with its accompanying blood vessels and nerves, passes through the inguinal canal. In women, a thin ligament that holds the uterus passes through the inguinal canal. Men are considerably more frequently affected than women.\nIf the muscles of the abdomen are weakened, the inguinal canal is dilated and a hernial gap, a so-called inguinal hernia, develops in the abdominal wall. Through this hernial gap, parts of the abdominal organs, such as for instance parts of the intestine, may protrude from the abdominal cavity and become palpable and also visible there as protrusion. This may be associated with pain in the groin region, particularly upon physical exertion, and in the worst case with an incarceration of the abdominal bowels (bowels getting stuck), for example the intestine, in the inguinal canal.\nAn inguinal hernia is in most cases harmless and often does not cause any discomfort or only mild discomfort. However, since in the case of an inguinal hernia the hernial gap will never close spontaneously, but rather will become larger and larger over time, and there is furthermore a risk that for instance the intestine is incarcerated or gets stuck in the inguinal canal and is cut off from the blood supply, an inguinal hernia should normally be treated by surgical intervention.\nProcedure and methods applied in an inguinal hernia operation\nToday, many different surgical procedures are available for the surgical treatment of an inguinal hernia. In these procedures, the surgeon displaces the hernial contents back into the abdominal cavity, closes the hernial gap in the abdominal wall and stabilizes the tissue. Which procedure is to be used in an inguinal hernia operation must be decided by the physician and the patient on a case-by-case basis and depends on various factors. Thus, the surgical procedure to be applied in an inguinal hernia operation in a given case depends on the type, location and size of the inguinal hernia and the patient's age and concomitant diseases.\nThe hernial gap in the abdominal wall can be closed in the scope of an inguinal hernia operation either with pure suture procedures, in which the inguinal hernia is treated and reinforcement is accomplished with sutures, or with procedures in which a synthetic mesh is used. This can be effected either conventionally in the scope of an open intervention, or as minimally invasive surgery using an endoscopic or laparoscopic procedure. Meanwhile, most inguinal hernia operations worldwide are carried out using synthetic mesh implants.\nBased on these various surgical options, three different surgical procedures can therefore in principle be applied in an inguinal hernia operation, namely the open surgical technique without synthetic mesh (inguinal hernia operation according to Shouldice), the open surgical technique with synthetic mesh (inguinal hernia operation according to Lichtenstein), and minimally invasive surgical techniques with synthetic mesh (TEP, TAPP).\nInguinal hernia operation according to Shouldice\nThis inguinal hernia operation method was developed in 1944 by the Canadian surgeon Edward Earle Shouldice. Until the introduction of the surgical procedures in which a synthetic mesh is implanted, this method was considered the gold standard in hernia surgery. The inguinal hernia operation according to Shouldice is a conventional, i.e. non-minimally-invasive operation method in which the hernial gap is closed with the body's own tissue.\nThe procedure according to Shouldice is as follows: The surgeon makes a transverse skin incision approximately 5 to 8 centimeters long above the inguinal ligament. From this access, he exposes the hernial sac that has formed due to the inguinal hernia.\nHe then opens the hernial sac, checks the bowels that are in the hernial sac, treats them if required and then displaces them back into their original positions in the abdominal cavity. The hernial sac is then removed and the peritoneum is closed with a suture.\nNext, the transversal fascia is opened transversely and mobilized.\nIn order to additionally stabilize and reinforce the rear wall of the inguinal canal, the surgeon sutures the inguinal ligament onto the transversal fascia which runs in transverse direction and which constitutes the adjoining connective tissue that lines the inside of the abdominal wall. In order to be on the safe side, this suture is made in several rows.\nThe inguinal hernia operation according to Shouldice is considered the best suture procedure and features a comparatively low recurrence rate of inguinal hernias that recur after an operation. This type of operation is primarily used for smaller inguinal hernias in young patients without substantial risk profile.\nThe inguinal hernia operation according to Shouldice is normally carried out in general anesthesia. One of the advantages of this operation method is that the intervention can also be carried out under spinal anesthesia or local anesthesia though. Moreover, this inguinal hernia operation requires no artificial material.\nHowever, patients have to avoid exposure to physical strain for a long time after this open inguinal hernia operation. Thus, they must wait for about two months before they are once more allowed to expose themselves to strain or do sports.\nInguinal hernia operation according to Lichtenstein\nThis inguinal hernia operation method was developed in 1984 by the American surgeon Irving Lester Lichtenstein and meanwhile has become one of the most commonly used surgical procedures for the treatment of an inguinal hernia. As in the case of the inguinal hernia operation according to Shouldice, the inguinal hernia operation according to Lichtenstein is an open, i.e. non-minimally-invasive surgical procedure. In contrast to the inguinal hernia operation according to Shouldice, the hernial gap, in the Lichtenstein method, is not closed with the body's own tissue though, but rather with a special synthetic mesh.\nAt first, the inguinal hernia operation according to Lichtenstein proceeds in the same way in principle as the inguinal hernia operation according to the Shouldice method: The surgeon makes a transverse skin incision approximately 5 to 8 centimeters long above the inguinal ligament and then exposes the hernial sac and opens it. The contents of the hernial sac are pushed back into the abdominal cavity, the hernial sac is removed and the peritoneum is closed with a suture. But in the next step, the surgeon, in contrast to the Shouldice method, covers the hernial orifice with a thin synthetic mesh made of polypropylene and affixes this with sutures to the muscles of the abdominal wall and to the inguinal ligament.\nThe inguinal hernia operation according to Lichtenstein is suitable particularly for elderly people and for patients with a medium-sized or large inguinal hernia. Furthermore, this operation method is also used in patients who have suffered a recurrence of the inguinal hernia (recurrent hernia).\nAn advantage of the Lichtenstein method is that the intervention can also be carried out under spinal anesthesia or local anesthesia and does not necessarily require general anesthesia. The risk of recurrence of an inguinal hernia after the operation is low. Moreover, after the inguinal hernia operation according to Lichtenstein, the patients are allowed to once more expose themselves to physical strain at an earlier stage and are once again physically fit faster than after a Shouldice operation.\nMinimally invasive techniques\nIn contrast to the open procedures according to Shouldice and Lichtenstein, a minimally invasive inguinal hernia operation does not require a large skin incision in the inguinal region, but rather is carried out by means of small abdominal incisions below the navel, through which an endoscope as well as the required surgical instruments are introduced and advanced up to the inguinal hernia. Minimally invasive surgical procedures are therefore also referred to as keyhole surgery.\nWith the so-called TAPP (transabdominal preperitoneal hernioplasty) and the so-called TEP (total extraperitoneal hernioplasty), two different variants of a minimally invasive inguinal hernia operation are available. Both procedures use large-area synthetic meshes which are implanted from the rear side of the abdominal wall, and both are always performed in general anesthesia.\nOne of the advantages of a minimally invasive inguinal hernia operation is that the patient is already allowed to expose himself to physical strain again after a few days. Furthermore, the synthetic mesh is placed loosely over the inguinal hernia without the latter having to be closed with sutures under tension. As a result, the patient normally feels no dragging pain after the operation and is more quickly mobile again. The minimally invasive inguinal hernia operation is carried out under general anesthesia.\nThe minimally invasive techniques can in principle be applied in all patients in whom no contraindications are present. They are also used in repeat interventions in which the surgical access from outside is rendered more difficult due to a previous inguinal hernia operation.\nTAPP (transabdominal preperitoneal mesh implantation)\nFor the minimally invasive inguinal hernia operation by means of TAPP, the procedure is as follows: The surgeon makes small incisions in the region of the navel and in the mid-abdominal region. He then introduces a special needle via which he fills and inflates the abdomen with carbon dioxide. This serves to push back the intestine and enable the surgeon to have a good view of the inguinal hernia to be operated on. In the next step, he introduces the endoscope with the camera and the surgical instruments via the skin incisions.\nAn incision is now made into the peritoneum, the hernial sac is carefully detached from the hernial orifice and the hernial contents are pushed back into the peritoneal cavity.\nA sufficiently large synthetic mesh is advanced from the abdominal cavity (transabdominally) up to the inguinal hernia and is then placed over the hernial orifice before the peritoneum (preperitoneally).\nThe synthetic mesh is normally at least 15 x 10 centimeters in size and is fixed in place with the aid of glue, or holds without fixation. The opening in the peritoneum is closed with a suture in order to prevent the synthetic mesh from coming directly into contact with the intestinal loops.\nIn the case of a bilateral inguinal hernia, both hernias can be treated in a single intervention with the TAPP method. The TAPP procedure is therefore used particularly also in cases of bilateral inguinal hernia. Furthermore, it is often carried out in cases of repeated inguinal hernia (recurrent hernias) that have already been treated in a previous open operation.\nTEP (total extraperitoneal patch-plasty)\nIn the inguinal hernia operation by means of TEP, the peritoneal cavity is not opened up. Surgery is performed in the so-called preperitoneal space before the abdominal wall. The risk of injuring inner organs such as the intestine is therefore even lower. The procedure for the minimally invasive inguinal hernia operation by means of TEP is as follows: The surgeon makes a small skin incision below the navel, and then inserts an air-filled balloon between the abdominal wall and the peritoneum via this incision.\nThis serves to detach the abdominal wall from the peritoneum. In order to widen the gap between these two layers which has been produced in this way, carbon dioxide is then blown into the balloon. The surgeon now has a good view of the area to be operated on.\nThe surgical instruments and the endoscope with the camera are introduced via two additional skin incisions.\nThe hernial sac is now carefully exposed and the hernial contents are displaced back into the abdominal cavity.\nA synthetic mesh is then affixed over the hernial orifice between the abdominal wall layers, i.e. behind the muscle layer and on the peritoneum. This mesh normally fixes itself in place automatically through the natural pressure prevailing in the abdomen and the counterpressure of the abdominal muscles.\nAdditional fixation by means of tissue glue is therefore in most cases not necessary, but can nevertheless be carried out where necessary.
Direct Follicle Implant\nOne of our procedures is called the Direct Follicle Implant. A non-surgical method this is a day care procedure. While undergoing this procedure one does not need to shave off hair for the procedure. The DFI Technique has the most natural results, with one of the highest viability and success rate, in the industry of Hair Transplants.rocedure.\nBy using the DFI Technique, this offers patients a very high yielding density in almost every procedure, depending on the patient's donor area. The doctor begins the replacement procedure after the administration of an update dosage of local anesthesia; the follicles are extracted one by one from the donor area, back of the head. This is done at the back of the head since this area has good donor hair follicles. The extracted hair follicles are implanted one by one directly into the area that is suffering from Baldness using a patented tool, the DHI Implanter with the one movement implantation method, Full control of the depth with the correct angulations, direction and depth to each individual graft so the result is 100% natural.\nOnce the implants are done, the head will look full of small little sprouts of hair. The initial hair will fall off due to shock but will re grow for good and the implanted crop will be full bloom in fourth month onward. After surgery complications will be null and void here as this is a non-surgical, painless method.\nDirect Follicle Implant, DFI in short, is a scene changer technique. Along with a comfortable session for the patient, Root Land give you guarantees a successful outcome of the procedure and maximum satisfaction for the patient.

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