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Ambulatory surgery for multi-ligament knee reconstruction with continuous dual catheter peripheral nerve blockade.\nPURPOSE: Major reconstructive surgery of the knee traditionally requires an extended hospital stay for pain management. Continuous peripheral nerve blockade is an alternative method of pain control but is seldom used in the ambulatory setting. This case illustrates the use of lumbar plexus and sciatic nerve peripheral catheters for major knee surgery using intermittent bolus dosing for outpatient analgesia. CLINICAL FEATURES: A 20-yr-old male presented for multi-ligamentous knee reconstruction (posterior collateral ligament and revision anterior collateral ligament and lateral collateral ligament). Anesthesia was managed with a lumbar plexus and a sciatic nerve peripheral catheter and a light general anesthetic. Post-operative analgesia was provided with a 12-hr infusion of 0.2% ropivacaine in an over night recovery care centre. Subsequent catheter dosing was performed as an outpatient, twice a day using 0.2% ropivacaine, 10 ml in each catheter (four injections total). This provided 96 hr of analgesia and low supplemental opioid use. CONCLUSION: The use of a lumbar plexus and sciatic nerve peripheral catheter offered an alternative to conventional pain control that worked well in the ambulatory setting. By providing prolonged unilateral lower limb analgesia, extensive knee surgery was performed that would normally require a hospital stay for pain control. Using a bolus dosing method the risk of local anesthetic complications occurring outside of the hospital with a continuous infusion was minimized.\nKlein, SM; Greengrass, RA; Grant, SA; Higgins, LD; Nielsen, KC; Steele, SM\nVolume / Issue\nStart / End Page\nPubmed Central ID\nInternational Standard Serial Number (ISSN)\nDigital Object Identifier (DOI) |
We provide professional support in Anesthesiology and Reanimation.\nAnesthesia is a term used in surgery in medical science. With the\nanesthesia procedure in the field of anesthesiology, certain parts of the body\nor the whole body are rendered insensitive during the operation. The\npurpose of doing this procedure is to prevent the patient from suffering during\nthe surgery. In our Anesthesiology and Reanimation Unit, patients are\nprepared for surgery with anesthesiologists and are under the control of\nspecialist physicians during the operation. General anesthesia, local\nanesthesia and regional anesthesia are applied according to the type of\noperation to be performed in our hospital.\nThe pain that may occur after the surgery is controlled\nby anesthesiologists and precautions are taken. The patient’s conditions\nsuch as blood pressure, pulse, electrocardiography, blood oxygenation are\nconstantly monitored by anesthesiologists.\nThe Anesthesiology and Reanimation Unit plays an\nimportant role in the treatment of patients with chronic painful\ndiseases. With the evaluation and diagnosis of the disease, our specialist\nphysicians apply pain treatment and other treatments in line with medical bases\nto increase the quality of life of our patients. In addition, in our\nGeneral Intensive Care, neurological, respiratory and circulatory pathologies\nand diseases that endanger life are followed and treated. These include\npoisonings, pneumonia, sepsis due to infections (blood poisoning) and more\nsevere forms, all life-threatening conditions in the head and similar diseases,\nand finally, diseases that are followed and treated. Patients are treated\nwith all treatment options with proven treatment efficiency. |
Ramsay Générale de Santé SA operates hospitals in France. Its hospitals offer a range of services in the areas of anesthesia, oncology, cardiology, dermatology, gastroenterology, gynecology, maternity, nephrology, neurosurgery, obesity, ophthalmology, orthopedics, stomatology, pneumonology, psychiatry, radiology, and urology, as well as thoracic, vascular, and endovascular surgeries. The company was formerly known as Générale de Santé SA and changed its name to Ramsay Générale de Santé SA in December 2015. Ramsay Générale de Santé SA was founded in 1987 and is based in Paris, France. Ramsay Générale de Santé SA operates as a subsidiary of Ramsay Health Care Limited. |
Skip to Content\nTubal ligation, often referred to as\n"having your tubes tied," is a surgical procedure in which a woman's\nfallopian tubes are blocked, tied, or cut.\nTubal implants, such as Essure, are small metal springs that are placed in each fallopian tube\nin a nonsurgical procedure (no cutting is involved). Over time, scar tissue\ngrows around each implant and permanently blocks the tubes. Either procedure\nstops eggs from traveling from the ovaries into the fallopian tubes, where the\negg is normally fertilized by a sperm.\nTubal ligation and tubal\nimplants are considered to be permanent methods of birth control for women.\nThey are usually done by a\ngynecologist. They may also be done by a\nfamily medicine doctor or a\nThere are several different\nways of closing the\nfallopian tubes, including clipping or banding them\nshut or cutting and stitching or burning them closed. Your surgeon will\nprobably prefer one of these tubal ligation methods.\nA tubal ligation can be done using a:\nAn open tubal ligation (laparotomy) is done through a\nlarger incision in the abdomen. It may be recommended if you need abdominal\nsurgery for other reasons (such as a\ncesarean section) or have had\npelvic inflammatory disease (PID),\nendometriosis, or previous abdominal or pelvic\nsurgery. These conditions often cause scarring or sticking together (adhesion) of tissue and organs in the abdomen.\nScarring or adhesions can make one of the other types of tubal ligation more\ndifficult and risky.\nLaparoscopy is usually done with a\ngeneral anesthetic. Laparotomy or mini-laparotomy can\nbe done using general anesthesia or a\nregional anesthetic, also known as an epidural.\nReversing a tubal ligation is possible, but it isn't\nhighly successful. This is why tubal ligation is considered a permanent method\nof birth control.\nImplants, such as Essure, are inserted in\nthe fallopian tubes without surgery or general anesthesia. The procedure is\ndone in a doctor's office, an outpatient surgery center, or a hospital, and it doesn't require an overnight stay. The implant procedure itself takes about 10\nAfter the procedure, an\nX-ray is taken to make sure the implants are in place\nand the tubes are closed.\nIn some cases, a tubal implant can be\ndifficult to insert. Should this happen, a second procedure is needed to\ncompletely block both tubes.\nFor the first 3 months after\ninsertion, you must use another method of birth control. At 3 months, dye is\ninjected into your uterus and an X-ray is taken (hysterosalpingography) to make sure that the implants\nare in place and the tubes are fully blocked by scar tissue. If they are, you\nwill no longer have to use another method of birth control.\nTubal ligation and tubal implants are\npermanent methods of birth control and allow you to be sexually active without\nworrying about becoming pregnant.\nAlthough tubal ligation and\ntubal implants are expensive, it is a one-time cost. These procedures are\nusually covered by medical insurance, and there are no costs after the surgery\nis done. The cost of other birth control methods, such as pills or condoms and\nspermicide, may be greater over time.\nTubal ligation and tubal implants do\nnot protect against\nsexually transmitted infections (STIs), including\ninfection with the\nhuman immunodeficiency virus (HIV). To help protect\nyourself and your partner from possible STIs, use a condom every time\nyou have sex.\nYou must use another form of birth control for 3\nmonths after receiving tubal implants.\nAfter a tubal ligation, you will\nmost likely go home the same day. Your surgeon will give you instructions on\nwhat to expect and when to call after the surgery.\nA follow-up exam in 2 weeks is usually scheduled.\nA tubal ligation or tubal implant\nplacement is a permanent method of birth control. Only\nconsider this method when you are sure that you will not want to become\npregnant in the future.\nTubal ligation and tubal implants are\nnot 100% effective at preventing pregnancy.\nCall your doctor immediately if you have had tubal ligation or tubal implants and you\nTubal ligation. Major\ncomplications of tubal ligation aren't common.\nAlthough fewer complications occur with laparoscopy than\nwith other kinds of tubal ligation surgery, these complications can be more\nserious. For example, in rare cases, the bowel or bladder is injured when\nthe laparoscope is inserted.\nThe general risks of surgery are\ngreater if you have\ndiabetes, are overweight, smoke, or have a heart\nTubal implants. Most women who have tubal implants don't have problems. Some women do have problems, such as:\nAbout 2 to 3 out of 100 women who have Essure will need another operation within 1 year.footnote 2\nBefore you receive implants, you may be tested to make sure\nthat you don't have a vaginal infection or a\nsexually transmitted infection (STI).\nIf a tubal ligation or\nimplant fails and you become pregnant, you have an increased risk of having an\nectopic pregnancy. Ectopic pregnancies can occur years\nafter the tubal ligation and are most likely 3 or more years after the\nprocedure.footnote 3To learn more, see the topic\nTubal ligation and tubal implants\ndo not change your monthly\nmenstrual cycle. You will still release an egg each\nmonth (ovulate) and have menstrual periods. You will go through\nmenopause at the same time that you would have if you\nhadn't had the surgery. Your sexual desires won't change, although you may\nfeel more relaxed about having sex because you don't have to worry about\nReversing tubal ligation\nor removing tubal implants requires major surgery, and success rates are very low. If you are considering tubal ligation or tubal implants, be absolutely certain that you\nwill never want to have a biological child in the future.\nComplete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.\nRoncari D, Jou MY (2011). Female and male sterilization. In RA Hatcher, et al., eds., Contraceptive Technology, 20th rev. ed., pp. 435–482. New York: Ardent Media.\nMao J, et al. (2015) Safety and efficacy of hysteroscopic sterilization compared\nwith laparoscopic sterilization: An observational cohort study. BMJ. DOI: 10.1136/bmj.h5162. Accessed November 12, 2015.\nSperoff L, Darney PD (2011). Sterilization. In A Clinical Guide for Contraception, 5th ed., pp. 381–404. Philadelphia: Lippincott Williams and Wilkins.\nOther Works Consulted\nU.S. Food and Drug Administration (2015). Essure benefits and risks. U.S. Food and Drug Administration. http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/EssurePermanentBirthControl/ucm452250.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery. Accessed July 9, 2015.\nByHealthwise StaffPrimary Medical ReviewerSarah Marshall, MD - Family MedicineKathleen Romito, MD - Family MedicineMartin J. Gabica, MD - Family MedicineAdam Husney, MD - Family MedicineSpecialist Medical ReviewerRebecca Sue Uranga, MD - Obstetrics and Gynecology\nCurrent as ofJune 30, 2016\nCurrent as of:\nJune 30, 2016\nSarah Marshall, MD - Family Medicine & Kathleen Romito, MD - Family Medicine & Martin J. Gabica, MD - Family Medicine & Adam Husney, MD - Family Medicine & Rebecca Sue Uranga, MD - Obstetrics and Gynecology\nTo learn more about Healthwise, visit Healthwise.org.\n© 1995-2016 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.\n© Copyright 2017 Rush Copley Medical Center • 2000 Ogden Avenue; Aurora, IL 60504\nMain: 630-978-6200 • Physician Referral & Information: 630-978-6700 or 866-4COPLEY (866-426-7539) |
Many women in Santa Rosa choose lip augmentation using injectable fillers or implants to increase the size and volume of their lips.\nThe Lip Augmentation You Deserve\nMinimally-invasive plastic surgery procedures near Napa, Sonoma, and Marin County such as lip implants are commonly used to rejuvenate or enhance the lips. Whether your lips have lost volume due to aging or genetics, lip augmentation can give your mouth a fuller shape and size.\nAt Plastic Surgery Associates, we offer several types of injectable fillers for temporary lip enhancement, including JUVÉDERM®, Restylane®, and RADIESSE®. For a more permanent solution, lip implants may also be used to create a longer-lasting result. Dr. Furnas and I can help you determine which option is best for you.\nLip augmentation can make a difference in the way people see you, and in the way you see yourself. At Plastic Surgery Associates, we are happy to discuss your options and offer valuable information so that you can make an educated choice.\nRequest a free consultation online at Plastic Surgery Associates or call (707) 537-2111 to learn more.\nLip Augmentation at a Glance\n|Purpose:||To enhance or rejuvenate thin/flat lips.|\n|Procedure:||Lip enhancements using injectable fillers are performed in-office and may require topical anesthetic. Lip implants may be performed under local anesthesia using small incisions made inside the lip.|\n|Recovery:||Most can resume normal activities in 2 to 3 days (injectable fillers); 1 to 2 weeks (lip implants).|\n|Results:||Voluptuous, more youthful looking lips.|\n|Related Procedures:||BOTOX® Injectable Fillers| |
Three-dimensional printing technology can make surgery safer for children with congenital heart disease and reduce the duration, as well as the number of invasive procedures, required.\nRichard Kim, MD, a cardiac surgeon at Children's Hospital Los Angeles (CHLA), recently used a 3D printed heart as a model to plan a life-saving procedure for his young patient, Esther Perez. The child was born with a rare, life-threatening cardiac defect.\nAdvertisementEsther had a ventricular septal defect, a fairly common congenital anomaly. However, her particular defect was unusual and would require complex surgery to repair it. Her intra-cardiac anatomy required complex re-routing of the blood supply, a procedure only performed at a handful of other pediatric hospitals nationwide.\nTypically, surgeons are not able to determine their approach until they open the chest, put the child on a heart bypass machine, survey the problem and then, make a quick decision on how to proceed with repair. Since the variation in normal anatomy is increased in hearts with congenital abnormalities, an exact replica - a three dimensional roadmap allows surgeons to strategize before entering the operating room.\nInstead of opening the chest and making a decision about how to proceed, I could immediately begin fixing the problem," said Kim, who is also an assistant professor at theKeck School of Medicine of the University of Southern California. "A 3D model allowed me to plan the surgery in advance, which meant Esther spent less time in surgery and received less anesthesia - making the procedure safer."\nYou May Also Like |
BACKGROUND: The neural mechanisms of anesthetic vapors have not been studied in depth. However, modeling and experimental studies on the intravenous anesthetic propofol indicate that potentiation of γ-aminobutyric acid receptors leads to a state of thalamocortical synchrony, observed as coherent frontal alpha oscillations, associated with unconsciousness. Sevoflurane, an ether derivative, also potentiates γ-aminobutyric acid receptors. However, in humans, sevoflurane-induced coherent frontal alpha oscillations have not been well detailed.\nMETHODS: To study the electroencephalogram dynamics induced by sevoflurane, the authors identified age- and sex-matched patients in which sevoflurane (n = 30) or propofol (n = 30) was used as the sole agent for maintenance of general anesthesia during routine surgery. The authors compared the electroencephalogram signatures of sevoflurane with that of propofol using time-varying spectral and coherence methods.\nRESULTS: Sevoflurane general anesthesia is characterized by alpha oscillations with maximum power and coherence at approximately 10 Hz, (mean ± SD; peak power, 4.3 ± 3.5 dB; peak coherence, 0.73 ± 0.1). These alpha oscillations are similar to those observed during propofol general anesthesia, which also has maximum power and coherence at approximately 10 Hz (peak power, 2.1 ± 4.3 dB; peak coherence, 0.71 ± 0.1). However, sevoflurane also exhibited a distinct theta coherence signature (peak frequency, 4.9 ± 0.6 Hz; peak coherence, 0.58 ± 0.1). Slow oscillations were observed in both cases, with no significant difference in power or coherence.\nCONCLUSIONS: The study results indicate that sevoflurane, like propofol, induces coherent frontal alpha oscillations and slow oscillations in humans to sustain the anesthesia-induced unconscious state. These results suggest a shared molecular and systems-level mechanism for the unconscious state induced by these drugs.\nMendeley saves you time finding and organizing research\nChoose a citation style from the tabs below |
Tear > Treatments\nPreparing for Surgery\nThe decisions you make and the actions you take\nbefore your surgery can be every bit as important as\nthe procedure itself in ensuring a healthy recovery.\nSome insurance companies require a second opinion before\nagreeing to reimburse a patient for a surgical procedure.\nGetting a second opinion from a surgeon who is as qualified\nas the surgeon who gave the initial diagnosis is advisable\nin any case.\nsure you have received any equipment you will need when\nyou get home from the hospital. This may include a knee\nbrace, crutches, ice packs or coolers, or a continuous\npassive motion (CPM) machine. You should receive prescriptions\nfor any of these from your doctor when your surgery\nthe potential risks and benefits of the surgery, and\nask your surgeon any questions that will help you better\nunderstand the procedure. It can also help to talk to\nsomeone else who has undergone the same surgery.\nphysical problems, such as a fever or infection, should\nbe reported to your surgeon, and you should notify your\nsurgeon of any medication you are taking.\npossible, practice walking with your crutches in case\nyou need to use them after surgery.\nsure the orthopedist performing the surgery is board-certified,\nwhich can be determined by calling the American Board\nof Orthopaedic Surgery at 919-929-7103.\nto ask the doctor\nto take to the hospital\nAt most medical centers, you will\ngo to "patient admissions" to check in for\nyour MCL (medial collateral ligament) surgical repair.\nIf your surgery is going to be inpatient, there may\nbe a separate department, so be sure to ask your doctor.\nAfter you have checked in to the hospital or clinic,\nyou will go to a holding area where the final preparations\nare made. The paperwork is completed and your knee area\nmay be shaved (this is not always necessary). You will\nwear a hospital gown and remove all of your jewelry.\nYou will meet the anesthesiologist or nurse anesthetist\n(a nurse who has done graduate training to provide anesthesia\nunder the supervision of an anesthesiologist). Then,\nyou will walk or ride on a stretcher to the operating\nroom. Most patients are not sedated until they go into\nthe operating room. Here are some important steps to\nremember for the day of your surgery:\nwill probably be told not to eat or drink anything after\nmidnight on the night before your surgery. This will\nreduce the risk of vomiting while you are under general\nanesthesia, which can lead to pneumonia.\nyou will most likely be able to go home within a few\nhours of surgery, and because the anesthetic and pain\nmedications may make you drowsy, arrange for someone\nto drive you home when you are released.\na loose pair of pants or other clothing that will fit\ncomfortably over your knee bandage when you leave the\nit easy. Keeping a good frame of mind can help ease\nany nerves or anxiety about undergoing surgery. Distractions\nsuch as reading, watching television, chatting with\nvisitors, or talking on the telephone can also help.\nto take to the hospital\nSurgical repair of a torn MCL (medial\ncollateral ligament) is usually performed through a\nsmall incision on the inside (big-toe side) of your\nknee. It is not done arthroscopically, since this ligament\nis not actually within the knee joint. The procedure\nusually takes one to two hours, depending whether other\nligament or cartilage damage is evident.\nanesthesia is typically used for this surgery, though\nin some cases a spinal or epidural anesthetic is used.\nThe anesthesiologist will administer the anesthesia\nonce you are in the operating room.\narthroscope is inserted into the knee through a small\nincision. Fluid is injected into the knee joint through\nthe same incision, which allows the surgeon to view\nthe knee joint and check to see if there are any cartilage\ntears or ligament damage.\nthe MCL has been torn where it attaches to the thighbone\n(femur) or shinbone (tibia), the surgeon will re-attach\nthe ligament to the bone using large sutures or a metal\nscrew or bone staple.\nthe tear occurred in the middle of the ligament, the\nsurgeon will repair the ligament by sewing the torn\nends together with sutures.\nare sewn up and the patient is taken to the recovery\nFollowing surgical repair of your MCL (medial collateral\nligament), you usually stay in the recovery room for\nat least two hours while the anesthetic wears off. You\nwill be given adequate pain medicine, either orally\nor through an IV (intravenous) line, as well as instructions\nfor what to do over the next couple of days. In addition,\nyou will be given an appointment to return and a prescription\nfor pain medicine. Your knee will be bandaged and may\nhave ice on it. There will likely be pain, and you can\nexpect to be given pain medication as needed. Be sure\nto ask for medication as soon as you feel pain coming\non, because pain medication works best on pain that\nis building rather than on pain that is already present.\nThe nurses will not give you more than your doctor has\nprescribed and what is considered to be safe. You should\ntry to move your feet while you are in the recovery\nroom to improve circulation. Your temperature, blood\npressure, and heartbeat will be monitored by a nurse,\nwho, with the assistance of the doctor, will determine\nwhen you are ready to leave the hospital or, if necessary,\nbe admitted for an overnight stay. It is likely that\nyou will be able to bear some weight on your leg, but\nyour surgeon may suggest that you use crutches or a\ncane for a couple of days. For most people, crutches\nare used only until you feel steady on your feet. As\nsoon as you are fully awakened, you are usually allowed\nto go home. You will probably be unable to drive a car,\nso be sure to have arranged a ride home.\nPost-op in Hospital\nSome patients remain in the hospital after surgery\nfor as long as 24 hours. As soon as possible after surgery\nis completed, you will begin doing continuous passive\nmotion exercises while in bed. Your leg will be flexed\nand extended to keep the knee joint from becoming stiff.\nThis may be done using a continuous passive motion (CPM)\nmachine. The CPM is attached to your bed and then your\nleg is placed in it. When turned on, it takes your leg\nthrough a continuous range of motion. There will likely\nbe pain and you can expect to be given pain medication\nas needed. Be sure to ask for medication as soon as\nyou feel pain coming on, because pain medication works\nbest on pain that is building rather than on pain that\nis already present. The nurses will not give you more\nthan your doctor has prescribed and what is considered\nto be safe. Ice also helps control pain and swelling.\nAfter surgical repair of your MCL (medial\ncollateral ligament), you will need to take steps to\nreduce the pain and inflammation in the knee. Rest,\nicing, elevation, pain relievers such as aspirin or\nibuprofen can ease pain and swelling, and immobilizing\nthe knee will keep it stabilized. To immobilize the\nknee, your physician may recommend that you wear a lightweight\ncast or brace that will allow your knee to move backward\nand forward but restricts side-to-side movement. Immobilization\nusually is recommended for 72 hours. The cast or brace\nmay be designed so that you cannot bend your knee. If\nthis is the case, you will need to modify your behavior\nso that you can avoid having to squat, kneel down, or\nbend over. You should try to keep your leg elevated\neven if you are sitting in a chair, to reduce blood\nflow to the knee joint. Depending on the success of\nthe above measures in reducing pain and swelling, you\nmay be able to start on a rehabilitative program after\na few days.\nto call the doctor after surgery\nshould be able to begin exercises to restore strength\nand normal range of motion to your knee about four to\nsix weeks after surgical repair of your MCL (medial\ncollateral ligament). Once an MCL has fully healed,\nyou should have a minimum of long-term effects. Your\nphysician and physical therapist can help design a custom\nrehab program that will start slowly with stretching\nand build to strengthening exercises. Though the ligament\ntissues are weak after surgery, they are generally strong\nenough to handle mild stretching and slow movements.\nWorking to restore early range of motion may help reduce\nswelling and stiffness, and speed your healing time.\nIf you are still experiencing soreness while you are\ndoing exercises, you should proceed slowly to prevent\nfurther irritation. Rehab progresses into strengthening\nexercises that focus on the quadriceps and hamstrings\nÐ the main stabilizing muscles for your knee. Physicians\nsuggest you gradually increase the amount of weight\nas your leg muscles get stronger. Strengthening exercises\nrequire dedication, because results often take weeks\nand pain may recur. Once the muscles of your injured\nleg are about as strong as the uninjured leg, the focus\nof rehab turns to increasing your coordination, and\nphysical therapy tends to become activity-oriented as\nyou regain the ability to perform complicated movements.\nstrengthening exercises: Ligament injuries\nThough collateral ligament injuries often\noccur during sports and are difficult to avoid, there\nare several steps you can take to improve the overall\nstrength and flexibility of your knee:\nyour weight. Every pound in excess of your normal weight\nputs three or four additional pounds of pressure on\nyour knee every time you take a step.\nhamstrings, in the back of the thigh, and quadriceps,\nthe muscles in the front of the thigh, are crucial shock\nand impact absorbers. These muscles must be kept strong\nand flexible to protect the joint surfaces in your knee.\nbefore exercising should be a regular part of your warmup;\nhowever, it is important not to over-stretch. Never\npush or pull on your leg with your hands while you are\nstretching, and avoid squatting during your warmup,\nwhich can put stress on your knee joint.\nwell-fitting athletic shoes can reduce the impact of\nthe load exerted on the knee.\nyou are engaging in activities that require a lot of\ntwisting and turning such as racket sports, skiing,\nsoccer, and basketball, do not assume you can play yourself\ninto shape; make sure you are in good physical shape\nbefore you play. |
Dental Implant FAQ\nDental Implants are changing lives as they replace missing teeth and restore smiles. Strong as natural teeth because they are anchored into the jaw, implants allow you to eat anything you want without having to worry about your teeth slipping when you talk, eat, and laugh.\nWhat is a dental implant?\nDental implants have revolutionized the way we treat missing teeth. The 3-part artificial tooth has a titanium screw that is placed in your jaw. An abutment, or connector, protrudes from the implant and holds the crown, the visible part of the implant, in place.\nHow do dental implants work?\nImplants are made of titanium and permanently bond with the jawbone through a process called osseointegration. This effective fusion allows for eating, chewing and biting that looks and feels completely natural.\nHow long does it take to get a dental implant?\nThe process of getting a dental implant can take up to 18 months, but we tailor each procedure to every individual patient, taking into careful consideration the complexity of your case, including your need for bone grafting.\nWill I need to have bone grafting?\nGenerally speaking, patients who have been missing a tooth for more than a month will require some bone grafting. Dr. Raska will evaluate the surgical site and your particular needs and advise accordingly.\nWill I miss work?\nOur patients normally take the rest of the day off, following an implant procedure, but return to work the following day with very little discomfort.\nDo dental implants hurt?\nThe surgical site is always kept numb during implant surgery, and a variety of anesthetic options are available. As the anesthesia wears off later in the day, any mild discomfort can be easily managed with over the counter medications.\nCall us today at Raska Dental Implant & Oral Surgery Phone Number Raska Dental Implant & Oral Surgery Office Phone Number 941-923-0033 to learn more about dental implants!\nDental implants are an incredible tooth replacement solution that look and feel natural. Dr. Raska is an experienced oral surgeon who improves the smiles of people like you with dental implants regularly. Reach out to our friendly dental team to learn more or to schedule your consultation.941-923-0033 Appointments |
CENTENNIAL, Colo. (KDVR) — The doctor who received an emergency suspension of his medical license learned Thursday that his license has been reinstated under a probationary status.\nDr. Geoffrey’s Kim license was suspended after a botched procedure left 18-year-old Emmalyn Nguyen in a vegetative state, a story that the FOX31 Problem Solvers have followed since the beginning.\nOn Feb. 27, Kim entered into an agreement with the Colorado Medical Board that allows him to practice again under a probationary status for the next 3 years.\nWhen told of the agreement Kim reached with the Colorado Medical Board, Emmalyn’s father Sonny Nguyen said, “I don’t know what the board is thinking but I think that’s kind of unfair. He nearly killed someone and he only gets 3 years probation?”\nWhen asked if he was worried Kim might hurt another patient, Nguyen responded, “From how careless he is, yeah, I think he will.”\nThe Problem Solvers were the first to report Kim’s license was suspended Jan. 9, 2020, three weeks after the Problem Solvers shared the story of Emmalyn Nguyen.\nThe 18-year-old was scheduled for a breast augmentation on Aug. 1, 2019. Before the procedure began, she stopped breathing while under anesthesia.\nKim performed CPR on Nguyen and resuscitated her, but the teen never regained consciousness. She now lives in a hospital facility unable to breathe or eat on her own.\nAccording to state documents, Kim instructed his staff not to call 911 for more than five hours after Emmalyn lost consciousness.\nEmmalyn’s parents Sonny Nguyen and Lynn Fam have filed a lawsuit against Colorado Aesthetic and Plastic Surgery, its owner (Kim), nurse anesthetist Rex Meeker, registered nurse Shay Hubert and CRNA Associates.\nUnder the agreement with the state medical board, Kim must complete a professional ethics program and a separate education program that assesses “anesthesia reactions in the surgical setting and a focus on the culture of safety.”\nIn addition, Kim will only be allowed to perform surgical procedures during his probationary term with a board-certified anesthesiologist. At the time of Nguyen’s procedure, Kim used Meeker, a nurse anesthetist.\nPreviously, the state Board of Nursing entered into an “Interim Cessation of Practice Agreement” with Meeker that went into effect on Jan. 2, 2020. Meeker has both a certified registered nurse anesthetist (CRNA) license and a registered nurse (RN) license in Colorado. The state did not do anything to impact Meeker’s RN license.\nUnder the voluntary agreement, Meeker can no longer administer anesthesia to patients but can still act as a nurse.\nAccording to state documents obtained by the Problem Solvers, “As an Advanced Practice Nurse, Respondent (Meeker) has the responsibility to timely contact emergency services and refer Patient 1 (Emmalyn) to a hospital. The Board reviewed information that anesthetic doses may have been inappropriate under the circumstances.” |
Pixie wants to be one of the cool fairies and have fuller lips. Her dream is becoming true today! Go to the doctor with Pixie and help her get lip fillers. The procedure is very fun and exciting and it starts with getting rid of all the little hairs from around the lips. After that use anesthesia so that Pixie doesn't feel a thing when you do the injections and the final step is the most creative one - makeup! Play with different lip liners, lipsticks and eyeshadows to create a stunning look. Enter to enjoy playing Pixie Lips Injections game without any charges at friv99.com. Pixie Lips Injections is one for our amazing Friv 99 games to play and having fun.🎮 Instructions\nUse Left Mouse button to Play📂 Categories\ndoctor, girls, makeover, make up, beauty, surgery.. |
Ketamine: Ideal Pain Management for Traumatic Patients at High-Altitude\nReceived Date: Jun 07, 2017 / Accepted Date: Jun 19, 2017 / Published Date: Jun 26, 2017\nAltitude contributes to a wide variety of physiological changes within the body. Changes that disrupt the amount of oxygen delivered to the cells, altering the acid-base balance, resulting in abnormalities like skip breathing, hypercapnia and hypoxia. All issues that are uncommon breathing ambient air. As more and more adventurous thrillseeking individuals travel to high elevations, it becomes more paramount for medical providers to understand these effects. With special attention on the pharmacodynamics of drugs in a lower oxygen environment. Traumatic patients are of special interest at altitude because they require constant monitoring as well as proper resource management. Within every provider trauma protocol is pain management of the patient. Adverse side effects can always present from improper dosing of opioid narcotics, however lower partial pressures of O2 amplify these concerns. Concerns mainly associated with the depression of the respiratory drive. Thus, increasing the risk of administering narcotics at altitude. Ketamine can successfully accommodate the need for analgesia at altitude, while eliminating the serious potential for CNS depression. This article seeks to educate and promote the usage of ketamine in high-altitude traumatic patients. The end goal is the confidence needed to avoid errors of omission rather commission in any austere environment.\nKeywords: Ketamine; Versed; Reemergence phenonmenon; Special operations medicine; Altitude medicine; Altitude pain management; Special amphibious reconnaissance corpsman\nIdentifying the appropriate analgesic treatment can often be an extremely controversial topic.\nControversial in the sense that no universal protocol is ever implemented across the board. Which isn’t a cause for concern since the best approach isn’t a universal one. Analgesia, a variable that is situational dependent, must be understood and accounted in any environment as a medical provider. However, the inherent effects at altitude will limit the selection of drugs and may call for implementation of a specific analgesia protocol.\nThe adverse effects of opioids are extremely fatal, toss in lower partial pressure of oxygen then that of the 21% existing in ambient air, altitude dosing becomes increasingly more difficult. Diligence when choosing the specific analgesic agent is imperative. Understanding the adverse effects, and pharmacology to include but not limited to onset, duration/half-life, and peak plasma time of agents used to achieve analgesia will aid in the confidence to administer at altitude .\nKetamine, without reservation is an excellent single dose agent for the high-altitude environment. Ketamine a dissociative hypnotic is ideal for the specific environment due to the absence of respiratory depression which at altitude can be potentiated with opioids like morphine, fentanyl, hydromorphone and meperidine. Ketamine however can be a difficult drug to dose due to its short duration of action in the body. Knowing the desired effect, you are trying to achieve initially is the most important factor. Trying to take the edge off a sprained anterior talofibular ligament will be different then establishing an airway via surgical cricothyroidotomy. Both which ketamine can complement effectively. In short, the mechanism of injury, injuries sustained, signs/symptoms, evacuation time and anticipating future interventions will all determine the specific type of ketamine dosing .\nDosing of ketamine can be broken up into 3 distinct phases known as the 3 P’s. The 3 P’s define the range of sedation needed to achieve the desired effect. The first P, the pain dose, is given for mild to moderate pain without fully sedating the patient and severely altering their mental status. The pain dose is ideal for patients who need to stay alert and oriented. Administration of ketamine intravenous/intraosseous at 0.1-0.5 mg/kg is within the safe zone for pain management. Intramuscular ketamine is effective and like all drugs will have a slower onset, however IM ketamine may be ideal for the pain zone and ambulatory patients. Most strains, sprains, and minor fractures are ideal for the pain zone of ketamine at altitude.\nThe 2nd P is the party/partial dissociation dose. This dose can pose problems in the field/altitude environment. When patients fall into this dosing regimen they tend to have a higher likelihood of experiencing re-emergence phenomenon. Re-emergence phenomenon unfortunately is one of the side effects of ketamine that can complicate/ potentiate the traumatic experience for the patient. It is characterized in battlefield medicine as a dream-like state with vivid hallucinations causing combative behavior of the patient (3,205). Entering the party zone too often, more than once, will increase the likelihood of reemergence phenomenon which is problematic for the provider at altitude. Thus, patients should never be left in the party zone dosing of ketamine. No practical use comes from this area in terms of what would need to be done at altitude. The criteria for the party dose is 0.3-0.8 mg/kg.\nBe bold and confident in your drug administration; don’t linger in the party zone. Adhering to the one and only rule of the party zone will simplify the patients care. If using an initial sedation bolus/bump it is wise to implement dual agents to better achieve all components of anesthesia.\nMidazolam a benzodiazepine works exceptionally well with ketamine. Implementing a dual agent concoction with both ketamine and midazolam improves sedation, analgesia, as well as mitigating the possibility of reemergence delirium. Dosing with a 2 mg bump IM/ slow IV push of midazolam post 200 mg bump of ketamine corresponds well when performing tubal thoracotomy’s, cricothyroidotomy’s or any other lifesaving surgical intervention. Know and keep track of your dosing with benzos, the adverse effects will be amplified at altitude. Maintain increments of 25% the originally induction dose of midazolam if signs show that anesthetic effects are lightening.Other agents that can be considered with ketamine are diazepam, fentanyl (for breakthrough pain), and regional nerve blocks per procedure (lidocaine or bupivacaine).\nThe final P of ketamine dosing is the procedural sedation phase. Dosing roughly about 1.0-3.0 mg/kg to achieve the proper effect. Making the decision to sedate a patient to perform a life-saving procedure needs to be done quickly. Use the 200 mg IV/IO bolus as a reference to achieve initial sedation. Titrate your dose to maintain procedural sedation. Keep in mind the factors involved in sedating your patient (i.e. airway, foley catheter, nasogastric tube etc.). Being confident in altitude physiology along with proper anesthesia MSMAID precautions, sedating at altitude will be less precarious. Ketamine does cover two areas of anesthesia, analgesia and amnesia. The third, muscle relaxation is not covered by ketamine, bringing forth the need to implement midazolam to fully achieve complete anesthesia .\nSetting up a ketamine infusion can be extremely useful in prolonged field care scenarios. This allows the provider to focus his attention to different aspects of the patient, while maintain concurrent analgesia with ketamine. Mix 500 mg of ketamine in a 500ml normal saline bag. This gives you a ratio of 1 mg/ml. The maintenance dose throughout can be the patients weight in kilograms, which will equal to the number of drops per minute. The result is roughly 4 mg/kg/hr. Adjust to effect as needed if the patient becomes light at any point. Remember to always include your induction dose before setting your drip. 200 mg IM/IV is a good start.\nKetamine side effects aren’t of big concern at altitude. Ketamine does not cause cardiovascular suppression. Although in certain trauma patients blood pressure support may be required if natural catecholamines are exhausted. This can be augmented with epinephrine and a whole blood transfusion . Keep in mind that analgesia isn’t your only concern with a multi system trauma patient. Brief and subtle increased intercranial pressure may result in the rapid infusion of ketamine in high doses. Of one combat casualty above 10,000 ft in Northwest Africa, ketamine was giving IV rapidly at 100 mg. The initial complaint of the patient before induced was an extreme pounding headache. How much fluid shift took place remains unknown. But at high-altitude with a patient suffering from HACE (High Altitude Cerebral Edema) it is good to be aware of what side effects can arise. Most of the fluid shift is a result of the ketamine blocking the NMDA (N-methyl-D-aspartate) receptor that affects the LTP (long term potentiation) in the CA1 region of the Hippocampus. This however is the trade-off of ketamine to deliver its dissociative effects .\nKetamine’s wide range of usage in traumatic patients with little to no side effects that aggravate the inherent physiological changes at altitude makes it the ideal choice for pain management. Optimal resource management in austere environments is crucial. Ketamine being a dissociative hypnotic can account for you analgesic resource needs. Thus, making ketamine the ideal single agent for pain management at high-altitude.\n- Auerbach PS (2012) Wilderness medicine. (6th edn), Elsevier Mosby, Philadelphia.\n- USSOCOM Office of the Command Surgeon (2013) Advanced tactical paramedic protocols handbook. (7th edn), Breakaway Media, LLC, St Petersburg.\n- Callaway D (2016) Ketamine and pharmacology. Proceedings of the special operations medical association scientific assembly.\n- Farr WD, Fenton LH, Clayton R, Thompson GD, Allen R, et al. (2008) Special operations forces medical handbook. (2nd edn), US Government Printing Office, Washington DC.\n- Naval sea systems command (2011) US Navy dive manual. (Revision 6), US Government printing office, Washington DC.\nCitation: Davis K (2017) Ketamine: Ideal Pain Management for Traumatic Patients at High-Altitude . J Pain Manage Med 3: 124.\nCopyright: © 2017 Davis K. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.\nSelect your language of interest to view the total content in your interested language\nShare This Article\n- Total views: 721\n- [From(publication date): 0-2017 - Sep 19, 2018]\n- Breakdown by view type\n- HTML page views: 668\n- PDF downloads: 53 |
|| Checking for direct PDF access through Ovid\nInterscalene block provides optimal shoulder surgery analgesia, but concerns over its associated risks have prompted the search for alternatives. Suprascapular block was recently proposed as an interscalene block alternative, but evidence of its comparative analgesic effect is conflicting. This meta-analysis compares the analgesic effect and safety of suprascapular block versus interscalene block for shoulder surgery.Databases were searched for randomized trials comparing interscalene block with suprascapular block for shoulder surgery. Postoperative 24-h cumulative oral morphine consumption and the difference in the area under curve for pooled rest pain scores were designated as primary outcomes. Analgesic and safety outcomes, particularly block-related and respiratory complications, were evaluated as secondary outcomes. Results were pooled using random-effects modeling.Data from 16 studies (1,152 patients) were analyzed. Interscalene block and suprascapular block were not different in 24-h morphine consumption. The difference in area under the curve of pain scores for the 24-h interval favored interscalene block by 1.1 cm/h, but this difference was not clinically important. Compared with suprascapular block, interscalene block reduced postoperative pain but not opioid consumption during recovery room stay by a weighted mean difference (95% CI) of 1.5 cm (0.6 to 2.5 cm; P < 0.0001). Pain scores were not different at any other time. In contrast, suprascapular block reduced the odds of block-related and respiratory complications.This review suggests that there are no clinically meaningful analgesic differences between suprascapular block and interscalene block except for interscalene block providing better pain control during recovery room stay; however, suprascapular block has fewer side effects. These findings suggest that suprascapular block may be considered an effective and safe interscalene block alternative for shoulder surgery. |
Are you Dr. Victor Verma?\nVictor Verma M.D.\nDr. Victor Verma is an anesthesiologist practicing in Mount Kisco, NY. Dr. Verma ensures the safety of patients who are about to undergo surgery. Anestesiologists specialize in general anesthesia, which will (put the patient to sleep), sedation, which will calm the patient or make him or her unaware of the situation, and regional anesthesia, which just numbs a specific part of the body. As an anesthesiologist, Dr. Verma also might help manage pain after an operation.\n||American Board of Anesthesiology (ABA)\n|Our Lady Of Mercy Med Ctr, Anesthesiology; Bronx-Lebanon Hosp Ctr, General Surgery |
The global Covid-19 continues to spread, which makes ventilator an urgent need ranking after masks and toilet paper. In modern clinical medicine, as an effective method to use artificially ventilation replacing autonomous ventilation, ventilator has been widely used in respiratory failure and anesthesia breathing during major surgery, respiratory support and therapy.\nThe medical ventilator is used to send a mixture of air and oxygen into and out of the patient's lungs to help the patient breathe. If the patient's breathing function is insufficient or unable to breathe at all, the role of the ventilator is to perform mechanical breathing for the patient. What’s more, the ventilator will generate positive pressure when inhaling oxygen, and will press the gas into the patient’s lungs. When the pressure rises to a certain level, the breathing machine will stop supplying air, the exhalation valve will also open one after another, and the patient’s chest and lungs will be passive collapsed and exhale.\nCubic has developed varieties of oxygen sensors based on ultrasonic principle, which are with stable and accurate performance, long life span (more than 5 years) and high cost-performance-ratio. Cubic oxygen sensors have contributed an important role in the ventilator design. |
Quality Oral Surgery in South Pasadena CA\nWelcome to Huntington Oral Surgery and Implant Center\nWelcome to Huntington Oral Surgery and Implant Center, where we deliver professional and comfortable treatments in our newly renovated office. Our Oral & Maxillofacial Surgeon, Daniel E. Niemann, DDS, MD practices a full scope of oral and maxillofacial surgery with expertise ranging from corrective jaw surgery to wisdom tooth removal. Dr Niemann is excited to serve in a community that played a special role in his upbringing. He values the close relationships that he has, and is looking forward to making new ones! He feels accountable to his patients, and prides himself on nurturing patient trust.\nModern Technology and Safety Practices\nTo guarantee the safety of our patients, we only use state-of-the-art sterilization techniques and advanced technology during our procedures, such as:\n- An electrocardiogram (ECG) – records and displays a person’s heartbeat\n- A precordial stethoscope – quickly and effectively monitors a patient’s breath\n- ETCO2 monitoring – assesses patient’s breathing patterns by measuring the amount of exhaled carbon dioxide\n- 3D Cone Beam Computed Tomography (CBCT) – produces highly detailed and accurate digital x-rays for procedural planning and diagnosis\n- An intraoral scanner – assists in diagnosis and reduces patient discomfort\nA dental implant is the ideal replacement for a missing tooth, as it allows you to chew, laugh, and smile with ease. Using his expert surgical skills, Dr. Niemann will gently and safely place your implant. He looks forward to seeing your confidence increase by restoring your smile!\nAt Huntington Oral Surgery and Implant Center, we give you the care you deserve!\nContact our office today to schedule an appointment!\nSouth Pasadena Office Phone Number 626-441-2331 Email Us\nWisdom Teeth Extraction\nIf your child is between the ages of 17-25, now is the time to schedule a wisdom teeth evaluation at the Huntington Oral Surgery and Implant Center! We know that the thought of surgery can be stressful for parents and teens, but rest assured. Our surgeon is highly experienced in performing this very common procedure, and we have anesthesia to ensure the comfort of our patients.\nWe pride ourselves on personalized, comfortable care for all of our patients, and our staff is adept at delivering various sedation techniques in a soothing and safe manner. As every patient has different needs, our practice provides local anesthetic, nitrous oxide sedation and general anesthesia.\nTo help you receive the services you need, we take many types of insurance and offer financing. |
Obstructive Sleep Apnea (OSA) often causes low blood oxygen levels and disrupts their sleep. The obstruction occurs when the tongue is sucked against the back of the throat, blocking the airflow. The oxygen level in the brain decreases and the sleeper partially awakes, clearing the obstruction. The repetition of this cycle leads to serious cardiovascular problems. These individuals suffer from excessive daytime drowsiness, depression, and loss of concentration. Oral and maxillofacial surgeons offer consultation and treatment options, but the first step in treatment resides in recognition of the symptoms and seeking appropriate consultation.\nWho should have sleep apnea treatment?\nThose experiencing obstructed breathing at night may benefit from consulting a doctor about Sleep Apnea treatment.\nDuring a consultation, our doctors will consider your medical history and a Cephalometic analysis (skull x-ray) to determine the level of obstruction. An examination also may be done using a fiber-optic camera, or the doctor may recommend a sleep study be done to monitor you overnight.\nAn initial treatment option may include using a machine that provides pressurized oxygen through a nasal mask at night.\nSurgical options include a UPPP (uvulo-palato-pharyngo-plasty) or a LAUPP (laser assisted uvulo-palato-plasty). A UPPP is performed in the back of the soft palate and throat, and a LAUPP is a similar procedure done with the assistance of a laser.\nIf the situation is more complex, a surgery may be required to reposition the upper and lower jaw to increase the size of the airway. A jaw surgery would be done in a hospital under general anesthesia and would require a one to two day overnight stay in the hospital.\nComments are closed. |
|Publication number||US8182837 B2|\n|Application number||US 11/544,187|\n|Publication date||May 22, 2012|\n|Filing date||Oct 6, 2006|\n|Priority date||Sep 10, 2003|\n|Also published as||EP1667723A1, EP2311496A1, US20050053659, US20070031489, US20120316189, WO2005025621A1|\n|Publication number||11544187, 544187, US 8182837 B2, US 8182837B2, US-B2-8182837, US8182837 B2, US8182837B2|\n|Inventors||Maree T. Smith|\n|Original Assignee||Qrxpharma Limited|\n|Export Citation||BiBTeX, EndNote, RefMan|\n|Patent Citations (16), Non-Patent Citations (46), Referenced by (2), Classifications (16), Legal Events (4)|\n|External Links: USPTO, USPTO Assignment, Espacenet|\nThis application is a divisional of U.S. patent application Ser. No. 10/661,458 filed Sep. 10, 2003.\nThe technical field of the invention relates to the use of sub-analgesic doses of opioids for the treatment of pain in patients with a diagnosed or undiagnosed respiratory illness or respiratory disorder.\nWhen a patient experiences significant pain as the result of a serious traumatic injury, a surgical procedure, or chronic illness (e.g., cancer), relief requires strong medication under a doctor's prescription. Opiate drugs are a class of pain-relieving prescription drugs frequently prescribed for moderate to severe pain. The opioids are a group of drugs, both natural and synthetic, that are employed primarily as centrally-acting analgesics and are opium or morphine-like in their properties (Gilman et al., 1980, GOODMAN AND GILMAN'S THE PHARMACOLOGICAL BASIS OF THERAPEUTICS, Chapter 24:494-534, Pergamon Press; hereby incorporated by reference). The opioids include morphine and morphine-like homologs, including, e.g., the semisynthetic derivatives codeine (methylmorphine) and hydrocodone (dihydrocodeinone), among many other such derivatives. Morphine and related opioids exhibit agonist activity in the central nervous system (CNS) (referring to the brain and spinal cord) at p (mu) opioid receptors, as well as showing affinity for the ō (delta) and κ (kappa) opioid receptors, to produce a range of effects including analgesia, drowsiness, and changes in mood, among others. In addition to potent analgesic effects, the morphine-related opioids may also use a number of undesirable effects, including, for example, nausea, vomiting, dizziness, mental clouding, dysphoria, pruritus, constipation, increased biliary tract pressure, urinary retention, hypotension and, most notably, respiratory depression.\nOpioids depress all phases of respiratory activity to some extent. Respiratory depression becomes significant when it leads to the need for medical intervention. Opioids interfere with carbon dioxide chemoreceptors in the medulla leading to increased retention of carbon dioxide. The increase in carbon dioxide levels does not stimulate a concomitant increase in respiratory rate; thus, the body is forced to rely on a less sensitive oxygen-driven respiration-regulating mechanism. Respiratory depression may be treated by artificial ventilation or be reversed by administration of chemical agents such as naloxone. Naloxone will immediately reverse opioid-induced respiratory depression, but the dose may have to be repeated due to the short duration of action of naloxone. More importantly, naloxone will also antagonise the analgesic effect, thus negating the primary clinical purpose of administration of the opioid.\nPatients with respiratory illness, whether diagnosed or undiagnosed, represent a significant subpopulation of patients requiring pain management with opiates for reasons unrelated to their respiratory illness. Patients with compromised lungs (i.e., with respiratory illnesses) are at increased risk for opiate induced respiratory depression and/or cessation because of their impaired respiratory capability. Respiratory depression is a decrease in the rate or depth of respiratory effort and a resulting decrease in level of alertness.\nRespiratory illnesses with increased susceptibility to opiate-induced respiratory depression and/or cessation include infectious or inflammatory conditions such as asthma, bronchiectasis, pulmonary tuberculosis, chronic obstructive pulmonary disease, bronchitis, bronchopneumonia, chronic laryngitis, chronic sinusitis, emphysema, fibrosing alveolitis, idiopathic pulmonary fibrosis and sarcoidosis. Neoplastic diseases of the lung also are included, for example, non-small cell lung cancer, adenocarcinoma, squamous cell carcinoma, large cell carcinoma, undifferentiated carcinoma, small cell lung cancer, oat cell cancer and mesothelioma—\nDu Bose and Berde (Technical Corner, International Association for the Study of Pain Newsletter, July/August, 1997) provide a number of specific examples of the importance of respiratory depression in patient groups as follows. Respiratory depression can occur in circumstances where the duration of an opioid's analgesic and respiratory depressant effects outlasts the duration of a painful stimulus. For example, a burn dressing change or a bone marrow aspiration may be intensely painful for only a brief time. An opioid such as morphine, which has comparatively slow onset and prolonged duration, may be titrated to give an appropriate degree of analgesia and sedation. However, excessive sedation and respiratory depression may occur following the procedure when respiratory stimulation declines along with a rapid reduction in the intensity of pain and distress. This complication can be prevented in most circumstances by constant observation, awakening the patient, and encouraging deep breathing until the opioid's effects dissipate. Even modest doses of opioids in awake subjects can have dramatic effects on the ventilatory response to hypoxemia. While depression of ventilatory responses to hypoxemia is of little consequence to most healthy subjects, the consequences can be severe in patients who may be dependent on hypoxic respiratory drive, such as those with chronic obstructive pulmonary disease (COPD) and long-standing hypercapnia. Also, certain disease states may increase respiratory risks from the administration of opioids. For example, disorders of neural tube development, including spina bifida, can be associated with abnormal respiratory control, even in patients with mild degrees of neurologic impairment. The use of opioids in these high-risk groups may require more judicious dose titration and closer observation. Morbidly obese and Pickwickian patients may have difficulties with opioid dose titration. Patient-controlled analgesia (PCA) use in obese postoperative patients showed as much as a 10-fold difference in opiate requirements.\nDuBose and Berde (ibid.) further note that while pain antagonizes opioid-induced respiratory depression, sleep can intensify the depressant effects of opioids. During normal respiration, subatmospheric pressure in the pharynx tends to draw the tongue against the palate, narrowing the airway. The finely coordinated contraction of the tongue (especially the genioglossus) and pharyngeal musculature helps to maintain airway patency and prevent snoring or inspiratory collapse of the airway. Sleep and opioids separately, and in concert, depress genioglossus and pharyngeal muscle tone and diminish airway protective reflexes. Critical incidents from opioid-induced respiratory depression appear to be more common in the hours from midnight to 6 a.m., which is of more critical importance due to the lessened level of scrutiny of possibly affected patients during night time hours.\nDepression of level of consciousness is an extremely useful guide to observing clinical effect in patients receiving opioids. Respiratory depression is almost always preceded by sedation or clouded sensorium. It has also been noted that abdominal surgery is associated with postoperative sleep disturbance. Also sleep disturbance and episodic hypoxemia are extremely common in patients receiving opioids following surgery. REM sleep is typically suppressed initially, and then a rebound increase in REM sleep often occurs on the second and third postoperative nights. It has been suggested that opioids contribute to disturbed sleep postoperatively.\nPerhaps the respiratory illnesses presenting the greatest concern are those conditions which, by definition, involve a major defect in respiratory control, most particularly in sleep disordered breathing such as sleep apnea syndrome (SAS).\nSleep apnea syndrome (SAS) is a breathing disorder characterized by apneas and hypopneas. Apneas are a cessation of airflow for ten seconds or more and hypopnea: a decrease in flow by at least 50% for 10 seconds or more. Both apneas and hypopneas are associated with sleep arousal and/or oxygen desaturations of 3% or more. Apneas and hypopneas result from upper airway occlusion, either full or partial, or from a loss of or a significant decrease in the autonomic drive to breathe. There are three types of apnea: obstructive, central, and mixed. Obstructive sleep apnea (OSA) is the most common type of sleep apnea. OSA occurs when the upper airway occludes (either partially or fully) but efforts to breathe continue. The primary causes of upper airway obstruction are lack of muscle tone during sleep, excess tissue in the upper airway, and anatomic abnormalities in the upper airway and jaw. Central sleep apnea (CSA) affects only 5-10% of the sleep apnea population. CSA occurs when both airflow and respiratory effort cease. This cessation of breathing results from a loss of the autonomic drive to breathe. Mixed apneas occur when an initial central component followed by an obstructive component causes a cessation of breathing. In the absence of formal sleep studies, the diagnosis can be made clinically by interviewing patients and their sleeping partners. Clinical signs include loud snoring, observed apneic episodes, and excessive daytime somnolence.\nThe cause of upper airway obstruction in SAS patients was long thought to be the tongue, but fluoroscopy during sleep has shown this is rarely the case. The oropharynx itself is the most collapsible segment of the upper airway and the most likely site of obstruction. Physiologic studies have demonstrated that patients with SAS have narrowed upper airways to start with, so they are more susceptible than other patients to drugs or anesthetics that suppress pharyngeal muscle tone.\nIn normal, awake patients, there is a phasic activity of the pharyngeal muscles that contracts them immediately before inspiration, helping to resist the negative pressure generated by the diaphragm and keeping the airway from collapsing. This phasic pharyngeal contraction is markedly reduced both by REM sleep and by opiate administration. Patients with sleep apnea appear to be much more sensitive than normal individuals, even to minimal levels of sedation. The increased sensitivity of their hypoglossal nerves to low doses of anesthesia has been well described.\nThis increased tendency to airway obstruction can occur out of proportion to the level of sedation the opiates achieve. This would explain why many of the patients complained of significant pain shortly before falling asleep and developing obstructive episodes. Apneic episodes can occur with all routes of opioid administration. This increased sensitivity of SAS patients to opiates may be impossible to reverse with antagonists. One well-documented case in the literature described an obese patient who became comatose after a minimal dose of meperidine given intramuscularly as a premedication. Neither the airway obstruction nor the obtundation could be satisfactorily reversed with naloxone. When the patient had spontaneously recovered, his physicians ordered a sleep study, which confirmed the diagnosis of sleep apnea. This patient had a documented decrease in arterial pot to 30 mm Hg spontaneously during sleep associated with multiple PVC's and episodes of sinus bradycardia. Had this not been noticed intraoperatively, it might have happened unmonitored on the ward.\nOn a daily basis, surgical patients are wheeled into operating rooms with unrecognized obstructive sleep apnea (OSA). Diagnosed OSA patients, as well as undiagnosed patients who present with classic signs and symptoms, are at risk for significant post-operative respiratory complications after receiving a general anesthetic and postoperative opiate analgesia. Yet health care providers frequently fail to screen for OSA, and when it is suspected or diagnosed, often fail to incorporate this information into the perioperative plan of care. Approximately 9% of women and 24% of men ages 30 to 60 have apnea/hypopnea episodes. Additionally, it has been estimated that 80% to 90% of patients with OSA are undiagnosed.\nThe administration of opiate pain medication in patients with sleep apnea syndrome must be closely monitored. One problem observed by physicians was that pain medication orders for any given patient might be written by different individuals (surgeon, anesthesiologist, or primary care practitioner), not all of whom may be aware of the diagnosis of OSA. Clearly, wider understanding of this syndrome is crucial, and suggestions included red-flagging the charts of these patients to warn of the risks of opiate usage.\nFarney et al. (Chest 203: 632-639 (2003)) described three patients who illustrate distinctive patterns of sleep-disordered breathing who are receiving long-term, sustained-release opioid medications. Polysomnography shows respiratory disturbances occur predominantly during non-rapid eye movement (NREM) sleep and are characterized by ataxic breathing, central apneas, sustained hypoxemia, and unusually prolonged obstructive “hypopneas” secondary to delayed arousal responses. In contrast to what is usually observed in subjects with obstructive sleep apnea (OSA), oxygen desaturation is more severe and respiratory disturbances are longer during NREM sleep compared to rapid eye movement sleep. Further they noted that is these patients treatment with a nasal CPAP (continuous positive airway pressure) device without supplemental oxygen was ineffective. They conclude that opioids could interfere with providing effective nasal CPAP treatment and that there is potential for harm because patients with OSA syndrome continue to be under-diagnosed while at the same time the use of opioids for chronic pain control continues to increase.\nAs pain is treated more aggressively, the tragic complication of respiratory arrest in patients with sleep apnea syndrome and other respiratory illnesses may be seen more frequently.\nAt present, it is impossible to imagine major postoperative and post-traumatic pain relief without opioid therapy. It would be highly desirable if therapies were available that provided adequate and satisfactory pain relief with a minimum of respiratory risk in inducing severe respiratory depression, episodes of sleep apnea and/or complete cessation of respiration.\nThe present invention, in a first embodiment, provides a method for reducing the risk associated with the administration of opioid analgesics in patients with diagnosed or undiagnosed respiratory illness, or at risk for same, by administering an analgesic composition comprising a sub-analgesic dosage of a p-opioid agonist selected from the group consisting of morphine, fentanyl, sufentanil, alfentanil, oxymorphone and hydromorphone, or a pharmaceutically acceptable salt thereof, and a sub-analgesic dosage of oxycodone, a κ2-opioid agonist, or a pharmaceutically acceptable salt thereof, wherein the method achieves an analgesic effect in the patient to which the composition is administered. Alternatively, this embodiment of the present invention contemplates a p-opioid agonist in the form of a pharmaceutically acceptable salt. Preferably, the p-opioid agonist is morphine. Alternatively, the p-opioid agonist is fentanyl. In yet another alternative, the p-opioid agonist is hydromorphone. In an alternative embodiment, the oxycodone is in the form of a pharmaceutically acceptable salt.\nAlso contemplated by the present invention is use of a composition wherein the combined mass of morphine and oxycodone is about 50% of the mass of morphine alone required to achieve the same analgesic effect in the patient to which the composition is administered. In an alternative embodiment, the present invention contemplates administration of a composition wherein the combined mass of morphine and oxycodone is about 75% of the mass of oxycodone alone required to achieve the same analgesic effect in the patient to which the composition is administered.\nThe method of the present invention encompasses a composition that is administered in an immediate release oral dosage form or, alternatively, is administered in a sustained release oral dosage form. Alternatively, the composition used in the practice of the present invention may be administered through a subcutaneous, intravenous, intramuscular, epidural, transdermal, inhalation, buccal or sublingual route.\nIn another aspect, the present invention contemplates a respiratory illness selected from the group consisting of asthma, bronchiectasis, pulmonary tuberculosis, chronic obstructive pulmonary disease, bronchitis, bronchopneumonia, chronic laryngitis, chronic sinusitis, emphysema, fibrosing alveolitis, idiopathic pulmonary fibrosis and sarcoidosis.\nIn an alternative aspect, the present invention contemplates a respiratory illness that is cancer. The cancer may be lung cancer. The cancer may be non-small cell lung cancer, adenocarcinoma, squamous cell carcinoma, large cell carcinoma, undifferentiated carcinoma, small cell lung cancer, oat cell cancer and mesothelioma.\nThe method of the present invention also contemplates the clinical situation where the respiratory illness is a respiratory sleep disorder. It is possible that the respiratory sleep disorder is a sleep apnea, selected from the group consisting of central sleep apnea, obstructive sleep apnea and mixed sleep apnea.\nIn yet another embodiment, the present invention provides a method of minimizing the risk of developing sleep apnea in susceptible patients treated for the alleviation or prevention of pain, wherein the method comprises the step of administering an analgesic composition comprising a sub-analgesic dosage of a p-opioid agonist selected from the group consisting of morphine, fentanyl, sufentanil, alfentanil, oxymorphone and hydromorphone, or a pharmaceutically acceptable salt thereof, and a sub-analgesic dosage of oxycodone, a κ2-opioid agonist, or a pharmaceutically acceptable salt thereof. The sleep apnea may be selected from the group consisting of central sleep apnea, obstructive sleep apnea and mixed sleep apnea.\nThe present invention relates to methods for reducing the risk associated with the administration of opioid analgesics in patients diagnosed or undiagnosed with respiratory illness by administering an analgesic composition comprising a sub-analgesic dosage of a p-opioid agonist selected from the group consisting of morphine, fentanyl, sufentanil, alfentanil, oxymorphone and hydromorphone, or a pharmaceutically acceptable salt thereof, and a sub-analgesic dosage of oxycodone which is a K2-opioid agonist or a pharmaceutically acceptable salt thereof.\nAccording to one aspect of the invention there is provided an analgesic composition, for use in the methods of the present invention, comprising a sub-analgesic dosage of a p-opioid agonist suitably in the form of a pharmaceutically acceptable salt and a sub-analgesic dosage of a k2-opioid agonist suitably in the form of a pharmaceutically acceptable salt.\nThe term “p-opioid agonist” as used herein refers to a substance which activates a p-opioid receptor.\nThe u-opioid agonist may be selected from the group including morphine, fentanyl, sufentanil, alfentanil, oxymorphone and hydromorphone inclusive of analogs or derivatives thereof. Preferably, the p-opioid agonist is morphine or an analog or derivative thereof.\nFor the purposes of this invention, the term “k2-opioid agonist” as used herein refers to selective kappa-opioid receptor agonists wherein the antinociceptive effects thereof are substantially attenuated by, nor-BNI (nor-binaltorphimine; a putatively selective kl/k2-opioid receptor ligand) and wherein the binding of the k, -selective radioligand 3H[U69,593] to rat brain membranes is not substantially displaceable by the k2-opioid agonist. Preferably, the k2-opioid agonist is oxycodone.\nOf course it will be appreciated that a sub-analgesic dosage of an opioid agonist having dual selectivity for both la and k2 receptors may not be expected to synergize with a sub-analgesic dosage of another p- or k2-opioid agonist because such dual selective ligand may bind to each of the above receptors which may result in lack of occupancy of said other p- or k2, -opioid agonist to its selective receptor.\nThe term “pharmaceutically acceptable salt” as used herein refers to a salt which is toxicologically safe for human and animal administration. This salt may be selected from a group including hydrochlorides, hydrobromides, hydroiodides, sulphates, bisulphates, nitrates, citrates, tartrates, bitartrates, phosphates, malates, maleates, napsylates, fumarates, succinates, acetates, terephthalates, pamoates and pectinates.\nPreferably, the pharmaceutically acceptable salt of oxycodone is a hydrochloride, a terephthalate or a pectinate.\nSuitably, the pharmaceutically acceptable salt of morphine is a hydrochloride, a sulphate or a tartrate.\nThe term “sub-analgesic dosage” as used herein refers to a dosage of a p-opioid agonist solus or a k2-opioid agonist solus which dosage does not result in the production of analgesia when administered to a human or antinociception when administered to a lower animal requiring alleviation of pain. To this extent, it is well known that the lower threshold for an initial dosage of morphine which results in production of analgesia in a naive human adult is 30 mg every four hours administrable by the oral route (Chemy and Portenoy, entitled “Practical Issues In The Management of Cancer Pain,” in Textbook of Cancer Pain, Third Edition, Eds. Wall and Melzack, Churchill Livingstone) and 4-5 mg every four hours administrable by the intravenous route (Twycross, R. G., entitled “Opioids,” in Textbook of Cancer Pain, Third Edition, Eds. Wall and Melzack, Churchill Livingstone, pp 943-962). Reference also may be made to an article by Beaver et al. (J. PharmacoL Exp. Ther. 207: 92-100 (1978)) that specifies that the lower threshold for an initial dosage of oxycodone resulting in production of analgesia in a naive human adult is 10 mg every four hours administrable by the oral route, although it is recognized that significant variability exists among patients and that significantly higher doses may be needed for some or for even a significant proportion of a typical patient population. Accordingly, the term “sub-analgesic dosage” includes within its scope dosages falling below such lower thresholds. This term will also cover direct administration of the p- or k2-opioid agonist, as well as administration that includes controlled or sustained release of the p- or k2-opioid agonist as described hereinafter. Of course, it will be appreciated that a specific sub-analgesic dosage of a p- or k2-opioid agonist in a particular dosage form, in accordance with the present invention, will be dependent upon the mode or route of administration of the analgesic formulation.\nIt will be further appreciated by those of skill in the relevant art that the daily dosage required for an individual patient may be administered in immediate release or controlled-release dosage forms. For example, controlled-release dosage forms as described hereinafter may be administered every 12 or 24 hours comprising, respectively, about 3 or 6 times the four hourly dosages disclosed above. In this regard, it is well known that the change from immediate release dosages to controlled release dosages of an opioid is a simple milligram to milligram conversion that results in the same total ‘around-the-clock’ dose of the opioid (Cherny and Portenoy, “Practical Issues In The Management of Cancer Pain,” in Textbook of Cancer Pain, Third Edition, Eds. Wall and Melzack, Churchill Livingstone).\nWith regard to formulating an analgesically effective dose of typical opioid analgesics, it is important to keep in mind the effects of patient variability in response to administration of such analgesic agents. The range of dosages required to produce the desired analgesic effect in an individual patient are recognized to vary considerably from patient to patient as a function of a variety of factors, including disease state. It has been recognized in the art that health care practitioners, in dealing with chronic and/or acute pain, find it necessary to “titrate” appropriate dosages of typical opioid analgesics across a relatively broad range (as much as ten-fold) in order to achieve the desired analgesic affect. Indeed, a series of patents assigned to Euroceltique, S. A., apparently bases the patentability of the disclosed invention on a controlled release oxycodone formulation for once-a-day administration primarily on the capability of the formulation to provide effective analgesia to 90% of potential patients across a four-fold dosage range (10 to 40 mg), the novelty being the much narrower range of dosages. See, for example, U.S. Pat. Nos. 5,508,042 and 5,549,912 (the disclosures of which are specifically incorporated herein by reference).\nThe present inventors have observed that, in general, it is possible to formulate an analgesically effective dose of a combination of morphine and oxycodone that is approximately 50% of the mass of morphine alone required to produce the desired analgesic effect in an individual patient. As will be apparent to one of skill in the art, a number of advantages accrue from the capacity to provide sufficient analgesia at such low loadings, including a significant reduction in the risk of respiratory complications arising from less desirable side effects of opioid agents. Thus, not only is it possible to formulate a combined oxycodone/morphine analgesic without increasing the risk of adverse effects as evidenced by the onset or exacerbation of respiratory difficulties (see U.S. Pat. No. 6,310,072, the disclosure of which is hereby incorporated specifically by reference), it is actually possible to use such a combined analgesic agent formulation in a therapeutic regimen that significantly reduces the risk of adverse respiratory effects in susceptible patients through the use of formulations with significantly reduced loadings of opioid analgesics. By way of quantitative example, for a given patient, where a total daily dosage required to realize a steady-state level of analgesia may be on the order of 40 mg (for quantitative comparison only), it is possible through the practice of the present invention to provide a combined analgesic product where the total dosage of oxycodone and morphine can be as low as approximately 20 mg, while still providing acceptable steady-state levels of analgesia for that patient. Consistent with the understood meaning of the term “sub-analgesic dosage,” such a dosage of morphine alone, administered at a loading of 20 mg, would be insufficient to produce the desired level of analgesia in the specific patient. Further to this principle, where a dosage of morphine alone, at a 20 mg-loading, may be sufficient to produce sufficient analgesia in a given patient, the practice of the present invention provides for achieving a comparable level of analgesia through administration of about 10 mg of a combination of oxycodone and morphine to that patient.\nIt is also recognized that, in terms of analgesic effect, oxycodone is about 1.5 times more potent (as a function of mass of dose) than morphine. Thus, a sub-analgesic dose for an individual patient can also be defined as about 75% of the amount of the combined mass of morphine and oxycodone relative to the mass of the minimum oxycodone dose required to provide the desired analgesic effect.\nAccording to another aspect of the—invention there is provided a method for producing analgesia in humans and lower animals which comprises administering concurrently to a human or lower animal in need of such treatment a composition comprising a sub-analgesic dosage of a p-opioid agonist suitably in the form of a pharmaceutically acceptable salt and a sub-analgesic dosage of a k2-opioid agonist suitably in the form of a pharmaceutically acceptable salt.\nThe term “administration concurrently or co-administration” refers to the administration of a single composition containing both p- and k2-optoid agonists, or to the administration of each such opioid agonists as separate compositions and/or delivered by separate routes within a short enough period of time that the effective result is equivalent to that obtained when both such opioid agonists are administered as a single composition.\nBy “respiratory illness” is meant all disorders, diseases and conditions involving a compromised or impaired respiratory capability including infectious or inflammatory conditions such as asthma, bronchiectasis, pulmonary tuberculosis, chronic obstructive pulmonary disease, bronchitis, bronchopneumonia, chronic laryngitis, chronic sinusitis, emphysema, fibrosing alveolitis, idiopathic pulmonary fibrosis and sarcoidosis. Neoplastic diseases of the lung also are included, for example, non-small cell lung cancer, adenocarcinoma, squamous cell carcinoma, large cell carcinoma, undifferentiated carcinoma, small cell lung cancer, oat cell cancer and mesothelioma. Also included as respiratory illnesses are sleep apneas that are classified into three types: central, obstructive, and mixed. In central sleep apnea the neural drive to all respiratory muscles is transiently abolished. In obstructive sleep apneas, airflow ceases despite continuing respiratory drive because of occlusion of the oropharyngeal airway. Mixed apneas, which consist of a central apnea followed by an obstructive component, are a variant of obstructive sleep apnea. The most common type of apnea is obstructive sleep apnea.\nBy “pharmaceutically-acceptable carrier” is meant a solid or liquid filler, diluent or encapsulating substance which may be safely used in systemic administration.\nPharmaceutical compositions of the present invention suitable for oral or parenteral administration may be presented as discrete units such as capsules, sachets or tablets each containing a pre-determined amount of each of the strong opioids, as a powder or granules or as a solution or a suspension in an aqueous liquid, a non-aqueous liquid, an oil-inwater emulsion or a water-in-oil liquid emulsion. Such compositions may be prepared by any of the methods of pharmacy but all methods include the step of bringing into association the sub-analgesic dosages of each of the strong opioids as described above with the carrier that constitutes one or more necessary ingredients. In general, the compositions are prepared by uniformly and intimately admixing the strong opioids with liquid carriers or finely divided solid carriers or both, and then, if necessary, shaping the product into the desired presentation.\nThe opiate compounds (also referred to herein as “active compounds”) useful in the methods of the invention can be incorporated into pharmaceutical compositions suitable for administration to human patients. Such compositions typically comprise the active compounds and a pharmaceutically acceptable carrier. As used herein the language “pharmaceutically acceptable carrier” is intended to include any and all solvents, dispersion media, coatings, antibacterial and antifungal agents, isotonic and absorption delaying agents, and the like, compatible with pharmaceutical administration. The use of such media and agents for pharmaceutically active substances is well known in the art. As discussed above, supplementary active compounds can also be incorporated into the compositions\nA pharmaceutical composition of the invention is formulated to be compatible with its intended route of administration. Examples of routes of administration include, but are not limited to, parenteral, e.g., intravenous, intradermal, subcutaneous, oral, inhalation, transdermal (topical), transmucosal, and rectal administration. Solutions or suspensions used for parenteral, intradermal, or subcutaneous application can include the following components: a sterile diluent such as water for injection, saline solution, fixed oils, polyethylene glycols, glycerine, propylene glycol or other synthetic solvents; antibacterial agents such as benzyl alcohol or methyl parabens; antioxidants such as ascorbic acid or sodium bisulfite; chelating agents such as ethylenediaminetetraacetic acid; buffers such as acetates, citrates or phosphates and agents for the adjustment of tonicity such as sodium chloride or dextrose. pH can be adjusted with acids or bases, such as hydrochloric acid or sodium hydroxide. The parenteral preparation can be enclosed in ampoules, disposable syringes or multiple dose vials made of glass or plastic.\nPharmaceutical compositions suitable for injectable use include sterile aqueous solutions (where water soluble) or dispersions and sterile powders for the extemporaneous preparation of sterile injectable solutions or dispersion. For intravenous administration, suitable carriers include physiological saline, bacteriostatic water, Cremophor EL™ (BASF, Parsippany, N.J.) or phosphate buffered saline (PBS). The composition preferably is sterile and should be fluid to the extent that easy syringability exists. The compositions suitably should be stable under the conditions of manufacture and storage and preserved against the contaminating action of microorganisms such as bacteria and fungi. The carrier can be a solvent or dispersion medium containing, for example, water, ethanol, polyol (for example, glycerol, propylene glycol, and liquid polyetheylene glycol, and the like), and suitable mixtures thereof. The proper fluidity can be maintained, for example, by the use of a coating such as lecithin, by the maintenance of the required particle size in the case of dispersion and by the use of surfactants. Prevention of the action of microorganisms can be achieved by various antibacterial and antifungal agents, for example, parabens, chlorobutanol, phenol, ascorbic acid, thimerosal, and the like. In many cases, it will be preferable to include isotonic agents, for example, sugars, polyalcohols such as manitol, sorbitol, sodium chloride in the composition. Prolonged absorption of the injectable compositions can be brought about by including in the composition an agent which delays absorption, for example, aluminum monostearate and gelatin.\nSterile injectable solutions can be prepared by incorporating the active compound in a therapeutically effective or beneficial amount in an appropriate solvent with one or a combination of ingredients enumerated above, as required, followed by filtered sterilization. Generally, dispersions are prepared by incorporating the active compound into a sterile vehicle which contains a basic dispersion medium and the required other ingredients from those enumerated above. In the case of sterile powders for the preparation of sterile injectable solutions, the preferred methods of preparation are vacuum drying and freeze-drying which yields a powder of the active ingredient plus any additional desired ingredient from a previously sterile-filtered solution thereof.\nOral compositions generally include an inert diluent or an edible carrier. Suitable oral compositions may be, e.g., enclosed in gelatin capsules or compressed into tablets. For the purpose of oral therapeutic administration, the active compound can be incorporated with excipients and used in the form of tablets, troches, or capsules. Oral compositions can also be prepared using a fluid carrier for use as a mouthwash, wherein the compound in the fluid carrier is applied orally and swished and expectorated or swallowed. Pharmaceutically compatible binding agents, and/or adjuvant materials can be included as part of the composition. The tablets, pills, capsules, troches and the like can contain any of the following ingredients, or compounds of a similar nature: a binder such as microcrystalline cellulose, gum tragacanth or gelatin; an excipient such as starch or lactose, a disintegrating agent such as alginic acid, Primogel, or corn starch; a lubricant such as magnesium stearate or Sterotes; a glidant such as colloidal silicon dioxide; a sweetening agent such as sucrose or saccharin; or a flavoring agent such as peppermint, methyl salicylate, or orange flavoring.\nFor administration by inhalation, the compounds are delivered in the form of an aerosol spray from pressured container or dispenser that contains a suitable propellant, e.g., a gas such as carbon dioxide, or a nebulizer. Alternatively, the compositions of the present invention may also be formulated into suitable compositions for pulmonary delivery via dry powder inhalers.\nSystemic administration can also be by transmucosal or transdermal means. For transmucosal or transdermal administration, penetrants appropriate to the barrier to be permeated are used in the formulation. Such penetrants are generally known in the art, and include, for example, for transmucosal administration detergents, bile salts, and fusidic acid derivatives. Transmucosal administration can be accomplished through the use of nasal sprays or suppositories. For transdermal administration, the active compounds are formulated into ointments, salves, gels, or creams as generally known in the art.\nThe compounds can also be prepared in the form of suppositories (e.g., with conventional suppository bases such as cocoa butter and other glycerides) or retention enemas for rectal delivery.\nIn one embodiment, the active compounds are prepared with carriers that will protect the compound against rapid elimination from the body, such as a controlled release formulation, including implants and microencapsulated delivery systems. Biodegradable, biocompatible polymers can be used, such as ethylene vinyl acetate, polyanhydrides, polyglycolic acid, collagen, polyorthoesters, and polylactic acid. Methods for preparation of such formulations will be apparent to those skilled in the art. The materials can also be obtained commercially, e.g., from Alza Corporation and Nova Pharmaceuticals, Inc. Liposomal suspensions (including liposomes targeted to infected cells with monoclonal antibodies to viral antigens) can also be used as pharmaceutically acceptable carriers. These can be prepared according to methods known to those skilled in the art, for example, as described in U.S. Pat. No. 4,522,811.\nIt is especially advantageous to formulate oral or parenteral compositions in dosage unit form for ease of administration and uniformity of dosage. Dosage unit form as used herein refers to physically discrete units suited as unitary dosages for the subject to be treated; each unit containing a predetermined quantity of active compound calculated to produce the desired therapeutic effect in association with the required pharmaceutical carrier. The specification for the dosage unit forms of the invention are dictated by and directly dependent on the unique characteristics of the active compound and the particular therapeutic effect to be achieved, and the limitations inherent in the art of compounding such an active compound for the treatment of individuals.\nToxicity and therapeutic efficacy of such compounds can be determined by standard pharmaceutical procedures in cell cultures or experimental animals, e.g., for determining the LD50 (the dose lethal to 50% of the population) and the ED50 (the dose therapeutically effective in 50% of the population). The dose ratio between toxic and therapeutic effects is the therapeutic index and it can be expressed as the ratio LD50/ED50. Compounds which exhibit large therapeutic indices are preferred. While compounds that exhibit toxic side effects may be used, care should be taken to design a delivery system that targets such compounds to the site of affected tissue in order to minimize potential damage to uninfected cells and, thereby, reduce side effects.\nData obtained from the cell culture assays and animal studies can be used in formulating a range of dosages for use in humans. The dosage of such compounds lies preferably within a range of circulating concentrations that include the ED50 with little or no toxicity: The dosage may vary within-this range depending upon the dosage form employed and the route of administration utilized. For any compound used in the method of the invention, the therapeutically effective dose can be estimated initially from cell culture assays. A dose may be formulated in animal models to achieve a circulating plasma concentration range that includes the 1C50 (i.e., the concentration of the test compound which achieves a half-maximal inhibition of symptoms) as determined in cell culture. Such information can be used to more accurately determine useful doses in humans. Levels in plasma may be measured, for example, by high performance liquid chromatography.\nThe pharmaceutical compositions can be included in a container, pack, or dispenser together with instructions (e.g., written) for administration, particularly such instructions for use of the active agent to treat against pain incurred as a result of any disorder, disease, trauma or pen-operative care.\nThe present invention will be more specifically explained in the following examples. However, it should be understood that the following examples are intended to illustrate the present invention but not in any manner to limit the scope of the present invention. All documents mentioned herein are incorporated herein by reference in their entirety.\nObjective The main objective was to compare the ventilatory responses to hypoxia and hypercarbia following one hour intravenous infusions of (1) morphine 15 mg, or (2) oxycodone 15 mg, or (3) morphine 10 mg+oxycodone 5 mg, or (4) oxycodone 10 mg+morphine 5 mg, or (5) morphine 7.5 mg+oxycodone 7.5 mg. Each infusion was administered over 1 h and was designated by its respective composition as M15, M10—05, M7.5—07.5, M5—010 or 015.\nDesign A triple blind placebo-controlled, 5-period, randomised crossover study in 10 males was conducted. On each of the 5 study days for each of the 10 subjects, there was a baseline period, followed by either a 1 h drug or “placebo” i.v. infusion, followed by 1 h “placebo” or drug infusion, followed by a 1 h “washout”. Serial measures of drug effect were accompanied by serial peripheral venous blood sampling. The hypoxemic and hypercapnic ventilatory responses were determined by subjects breathing hypoxemic and hypercapnic gas mixtures. The changed gases for making the hypercapnic and hypoxaemic states were breathed by the subject from a specially constructed anaesthetic apparatus that had been modified to allow the high flow rates required for calibrating the pneumotachography apparatus. The gases were stored in pre-measured concentrations in large bags (weather balloons) to act as Douglas bags for fresh gas reservoirs as a “demand valve” system. Carbon dioxide enriched gas was delivered in this manner. Hypoxic gas mixtures were also delivered into a reservoir balloon but during the subject's breathing of this mixture to enable changes to be made to gas concentrations in response to observed Sp02.\nAnalysis of variance (ANOVA) was first performed on the baseline data in comparison to the three serial measures during the “placebo” infusion if this was administered first. No systematic differences were found, so the data were melded into a “control” data set for assignment as “before” drug administration. With the data re-organized into “before”, “during” and “after” drug administration periods, the statistical analysis proceeded in stages.\nInteractive effect of drugs on respiration Although ventilatory effects of all the test articles were found, no unexpected or disproportionate effects of any of the tested combinations of morphine and oxycodone were found. It was therefore concluded that there was no synergism between the drugs on the extent of depression of respiration.\nEffect of plasma level of drug on respiration The results of individual subjects were examined for the effect of the blood level of the combined plasma level of drug vs. minute ventilation (the volume of air per minute moved into or out of the lung). The results shown in\nObjective: to determine the dose of a taste masked oral syrup of morphine and oxycodone in a ratio of 1:0.66 by weight compared to a taste masked syrup containing morphine alone.\nDesign: A triple-blind (patient, investigator and analyst) randomized, controlled, two-period cross-over study was designed to assess the effectiveness of morphine compared to an oxycodone and morphine mixture. The study was carried out in 21 patients with chronic non-cancer pain. The morphine was formulated to a solution concentration of 5 mg/mL and the combination formulation to a concentration of morphine 1.5 mg/mL and oxycodone 1 mg/mL. The solution strengths were determined so that the expected total dose per day in mL would be similar between the two treatments thereby retaining blinding. Each opioid solution was administered every 4 hours with the 10 pm and 2 am doses being combined to provide 5 doses per day. The exact number of mL of each solution was recorded at each dose. Rescue doses were allowed as required. The total daily dose (regular plus rescue doses) was calculated for each day and the next day's total regular dose was set to this amount (divided into 6 equal dose amounts). The dose was titrated based on visual analogue scale (VAS) pain scores and tolerability. When the dose remained stable (±10%) for three days steady-state was assumed and a pharmacokinetic study was undertaken, and then the treatment was stopped for that patient. The patient was then changed immediately to the alternative opioid treatment and the study repeated, including the pharmacokinetic study.\nResults: VAS In all patients, steady-state was achieved with both formulations. There was no significant difference between the pre-treatment VAS and steady-state VAS for the oxycodone/morphine combination (P=0.46). For the morphine formulation the pre-treatment VAS was statistically significantly greater than the steady-state VAS (P=0.033), but the difference mean of 1.2 cm is of borderline clinical significance. In addition the pre-treatment VAS for period I was statistically significantly greater than the steady-state VAS for this period (P=0.029)—however this difference of 8% did not reach clinical significance. There was no difference due to treatment order. Analysis of covariance for treatment adjusting for period and order effects, did not reveal a significant difference (P=0.16).\nResults: Analgesic Effect The effective dose of the 1:0.66 combination versus morphine required to provide analgesia is shown in Table 1. The results show a weight of the combined product to weight of morphine to be 51%. This results was statistically significant (P<0.001).\nComparison of doses required for stabilized pain control.\n(Morphine + Oxycodone\nObjective: to determine the dose of a taste masked oral syrup of morphine and oxycodeone in a ratio of 1:2.0 by weight compared to a taste masked syrup containing morphine alone.\nDesign & Analysis: a similar design and analysis to that used in Example I was followed.\nResults: Analgesic Effects As with Example 2, no significant differences in VAS scores were noted between any of the treatment groups. The effective dose of the 1:2.0 combination versus morphine required to provide analgesia is shown in Table 2. The results show a weight of the combined product to weight or morphine to be 46%. The results was statistically significant (P<0.002).\nComparison of doses required for stabilized pain control.\n(Morphine + Oxycodone\nIn summary, the combined results of the three examples indicates that as the dose of morphine and oxycodone is decreased to give lower plasma levels, the extent of respiration depression decreases. Further, that doses of combinations of morphine and oxycodone in the ratios of about 1 to 0.66 by weight of about 1 to 2.0 by weight provide analgesia when administered at 50% of the minimum dose of morphine required to give analgesia in humans. Thus, combinations of sub-analgesic doses ff morphine and oxycodeone produce decreased depression of respiration and, thus, represent a safer product than morphine alone.\n|Cited Patent||Filing date||Publication date||Applicant||Title|\n|US4522811||Jul 8, 1982||Jun 11, 1985||Syntex (U.S.A.) Inc.||Serial injection of muramyldipeptides and liposomes enhances the anti-infective activity of muramyldipeptides|\n|US5317022||Feb 3, 1992||May 31, 1994||Alkaloida Chemical Company Ltd.||Pharmaceutical composition and use|\n|US5457110||May 19, 1994||Oct 10, 1995||Alkaloida Chemical Company, Ltd.||Apioid analgesic without respiratory depression|\n|US5508042||Jun 6, 1995||Apr 16, 1996||Euro-Celtigue, S.A.||Controlled release oxycodone compositions|\n|US5549912||Nov 25, 1992||Aug 27, 1996||Euro-Celtique, S.A.||Controlled release oxycodone compositions|\n|US6310072 *||Aug 29, 1997||Oct 30, 2001||The University Of Queensland||Production of analgesic synergy by co-administration of sub-analgesic doses of a MU opioid agonist and a kappa-2 opioid agonist|\n|US20050053656||Sep 2, 2004||Mar 10, 2005||Ping Jeffrey H.||Compositions and methods for treating pain|\n|US20050053659||Sep 10, 2003||Mar 10, 2005||Pace Gary W.||Methods and compositions for reducing the risk associated with the administration of opioid analgesics in patients with diagnosed or undiagnosed respiratory illness|\n|US20080039463||Dec 16, 2004||Feb 14, 2008||Cnsbio Pty Ltd||Methods and Compositions|\n|US20090291975||May 20, 2009||Nov 26, 2009||Warren Stern||Dual opioid pain therapy|\n|AU706691B2||Title not available|\n|EP1667723A1||Sep 10, 2004||Jun 14, 2006||QRX Pharma Pty, Ltd.||Methods and compositions for reducing the risk associated with the administration of opioid analgesics in patients with diagnosed or undiagnosed respiratory illness|\n|JP2007505139A||Title not available|\n|WO1996016063A1||Nov 20, 1995||May 30, 1996||British Technology Group Limited||Morphine and codeine derivatives for use in therapy|\n|WO1997014438A1 *||Oct 21, 1996||Apr 24, 1997||The University Of Queensland||Production of analgesic synergy by co-administration of sub-analgesic doses of a mu opioid agonist and a kappa-2 opioid agonist|\n|WO2005025621A1||Sep 10, 2004||Mar 24, 2005||Qrx Pharma Pty, Ltd.||Methods and compositions for reducing the risk associated with the administration of opioid analgesics in patients with diagnosed or undiagnosed respiratory illness|\n|1||Amendment and Response to Office Action and Record of Interviews filed Jan. 28, 2011, in relation to U.S. Appl. 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Pain Symptom Manage., 6, 1991, 428-30).|\n|7||Cherny et al., Chapter 81: Practical Issues in the Management of Cancer Pain, Textbook of Cancer Pain, 3rd ed., pp. 1437-1467, Jan. 1, 1994.|\n|8||Combes et al., The Effects of Residual Pain on Oxygenation and Breathing Pattern During Morphine Analgesia, Anesth. Analg., vol. 90, pp. 156-160, Jan. 1, 2000.|\n|9||Connor et al., mu-Opioid Receptor Desensitization: Is Morphine Different?, British Journal of Pharmacology, vol. 143, pp. 685-696, Jan. 1, 2004.|\n|10||Connor et al., μ-Opioid Receptor Desensitization: Is Morphine Different?, British Journal of Pharmacology, vol. 143, pp. 685-696, Jan. 1, 2004.|\n|11||Coyle et al., Cancer Pain Management, 2nd Ed., McGuire DB, Yarbro CH and Ferrell BR, eds., Jones and Bartlett Publishers Inc., Massachusetts, 1995, 113.|\n|12||Du Bose et al., Respiratory Effects of Opioids, International Association for the Study of Pain Newsletter, pp. 1-6, Jul. 1, 1997.|\n|13||Foley. The treatment of cancer pain. New England Journal of Medicine, 1985, 313: 84-95.|\n|14||Grach et al., Can Coadministration of Oxycodone and Morphine Produce Analgesic Synergy in Humans? An Experimental Cold Pain Study, Brit. J. Clin. Pharmacol., 58(3), 2004, 235-242.|\n|15||Grach et al., Can Coadministration of Oxycodone and Morphine Produce Analgesic Synergy in Humans? An Experimental Cold Pain Study, British Journal of Clinical Pharmacology, vol. 58 (3), pp. 235-242, Jan. 1, 2004.|\n|16||Grach et al., Response to Smith MT and de la Iglesia FA: ‘Coadministration of Oxycodone and Morphine and Analgesic Synergy Re-Examined’, Brit. J. Clin. Pharmacol., 59(4), 2005, 487-488.|\n|17||Grach et al., Response to Smith MT and de la Iglesia FA: 'Coadministration of Oxycodone and Morphine and Analgesic Synergy Re-Examined', Brit. J. Clin. Pharmacol., 59(4), 2005, 487-488.|\n|18||Gutstein et al., Chapter 23: Opioid Analgesics, The Pharmacological Basis of Therapeutics, 10th Ed., pp. 569-619, Jan. 1, 1980.|\n|19||Heiskanen et al. Controlled-release oxycodone and morphine in cancer related pain. Pain, 1997, 73: 37-45.|\n|20||Heiskanen et al., Controlled-Release Oxycodone and Morphine in Cancer Related Pain, Pain, vol. 73, pp. 37-45, Jan. 1, 1997.|\n|21||International Search Report for Application No. PCT/US09/62917, pp. 1-4, Dec. 30, 2009.|\n|22||Jolly et al., Cancer Pain Management, Fisch MJ and Burton AW, eds., McGraw-Hill Companies, New York, 2006, 308.|\n|23||Kalso et al., Intravenous Morphine and Oxycodone for Pain After Abdominal Surgery, Acta Anaesthesiologica Scandinavica, vol. 35, pp. 642-646, Jan. 1, 1991.|\n|24||Korttila et al., Buprenorphine as Premedication and as Analgesic During and After Light Isoflurane-N2O-O2 Anaesthesia. A Comparison with Oxycodone Plus Fentanyl, Acta Anaesthesiologica Scandinavica, vol. 31, pp. 673-679, Nov. 1, 1987.|\n|25||Levy. Pharmacological treatment of cancer pain. New England Journal of Medicine, 1996, 335: 1124-1132.|\n|26||Mercadante et al., Rapid Titration with Intravenous Morphine for Severe Cancer Pain and Immediate Oral Conversion, Cancer, vol. 95 (1), pp. 201-208, Jan. 1, 2002.|\n|27||Mercer, M., Anaesthesia for the Patient with Respiratory Disease, Practical Procedures, vol. 12, pp. 1-15, Jan. 1, 2000.|\n|28||Non-final Office Action issued on May 13, 2010 for U.S. Appl. No. 12/469,438, pp. 1-22.|\n|29||Office Action dated Dec. 28, 2011, in relation to U.S. Appl. No. 12/881,677.|\n|30||Office Action dated Dec. 28, 2011, in relation to U.S. Appl. No. 12/881,728.|\n|31||Office Action Issued Against U.S. Appl. No. 10/661,458, pp. 1-11, May 28, 2008.|\n|32||Office Action Issued Against U.S. Appl. No. 10/661,458, pp. 1-12, Apr. 15, 2009.|\n|33||Office Action Issued Against U.S. Appl. No. 10/661,458, pp. 1-14, Oct. 28, 2009.|\n|34||Osei-Gyimah et al., Synthesis and Analgesic Activity of Some 14 Beta-Substituted Analogues of Morphine, J Med Chem, vol. 23 (2), pp. 1, Feb. 1, 1980.|\n|35||Raehal et al., Mu Opioid Receptor Regulation and Opiate Responsiveness, The AAPS Journal, vol. 7 (3), pp. E587-E591, Oct. 19, 2005.|\n|36||Reid et al., Oxycodone for Cancer-Related Pain, Arch Intern Med, vol. 166, pp. 837-843, Apr. 24, 2006.|\n|37||*||Riley et al. (Otolaryngol Head Neck Surg 1997, 117, 648-52).|\n|38||*||Ross et al. (Pain 2000, 84, 421-428).|\n|39||Ross et al., The Intrinsic Antinociceptive Effects of Oxycodone Appear to be Kappa-Opioid Receptor Mediated, Pain, vol. 73 (2), pp. 151-157, Nov. 1, 1997.|\n|40||Smith et al., Co-administration of Oxycodone and Morphine and Analgesic Synergy Re-Examined, Brit. J. Clin. Pharmacol., 59(4), 2005, 486-487.|\n|41||Smith et al., Neuroexcitatory Effects of Morphine and Hydromorphone: Evidence Implicating the 3-glucuronide Metabolites, Clin. Exp. Pharmacol. Physiol., vol. 27 (7), pp. 524-528, Jul. 1, 2000.|\n|42||Twycross, R. G., Chapter 49: Opioids, Textbook of Cancer Pain, 3rd ed., pp. 943-962, Jan. 1, 1994.|\n|43||U.S. Appl. No. 12/567,209, filed Sep. 25, 2009, Stern et al.|\n|44||U.S. Appl. No. 12/579,173, filed Oct. 14, 2009, Stern et al.|\n|45||Wilson, P., Complications of Opiate Pharmacotherapy, Seminars in Pain Medicine, vol. 2, pp. 228-232, Dec. 1, 2004.|\n|46||Yudofsky et al., The American Psychiatric Publishing Textbook of Neuropsychiatry and Behavioral Neurosciences, American Psychiatric Publishing, Inc., Arlington, VA, Edition 5, 2008, p. 388.|\n|Citing Patent||Filing date||Publication date||Applicant||Title|\n|US8933092 *||May 31, 2012||Jan 13, 2015||Qrxpharma Limited||Methods and compositions comprising sequential administration opioid receptor agonists|\n|US20120309779 *||May 31, 2012||Dec 6, 2012||Holaday John W||Methods and compositions comprising sequential administration of opioid receptor agonists|\n|U.S. Classification||424/464, 514/317, 514/282|\n|International Classification||A61P11/00, A61P25/04, A61K9/22, A61K31/485, A61K45/06, A61K31/445, A61K9/20|\n|Cooperative Classification||A61K31/485, A61K45/06, A61K31/445|\n|European Classification||A61K31/485, A61K45/06, A61K31/445|\n|Jun 8, 2009||AS||Assignment|\nOwner name: QRXPHARMA LIMITED, AUSTRALIA\nFree format text: NUNC PRO TUNC ASSIGNMENT;ASSIGNORS:PACE, GARY W.;SMITH, MAREE T.;REEL/FRAME:022791/0570;SIGNING DATES FROM 20081106 TO 20090511\nOwner name: QRXPHARMA LIMITED, AUSTRALIA\nFree format text: NUNC PRO TUNC ASSIGNMENT;ASSIGNORS:PACE, GARY W.;SMITH, MAREE T.;SIGNING DATES FROM 20081106 TO 20090511;REEL/FRAME:022791/0570\n|Dec 31, 2015||REMI||Maintenance fee reminder mailed|\n|May 22, 2016||LAPS||Lapse for failure to pay maintenance fees|\n|Jul 12, 2016||FP||Expired due to failure to pay maintenance fee|\nEffective date: 20160522 |
- Phone: (617) 982-3643\nSpecialties & Experience\nGeneral Specialties:Anesthesiology and Cardiovascular Disease\nSpecialty Focus:Anesthesia, difficult airway, endotracheal intubation, laryngeal mask, PACU, perioperative care, preoperative assessment, procedural sedation, epidural, spinal anesthesia, propofol, intensive care, crisis management\nEducation:M.D., University of Heidelberg; M.P.H., Johns Hopkins University; Anesthesiology Residency, Harvard Medical School, Massachusetts General Hospital; Critical Care and Cardiothoracic Anesthesia Fellowships, University of Pennsylvania\nYears in Practice:13+\nNumber of Times Deposed/Testified in Last 4 Yrs:<5\nTriple-boarded Anesthesiologist with 13+ years of both academic, teaching, and private practice experience. Broad clinical skill set including the administration of anesthesia for general surgery, gynecology, eye surgery, otolaryngological surgery, the entire continuum of sedation, resuscitation, regional anesthesia for orthopedic surgery including peripheral nerve blocks, spinal and epidural anesthesia for surgery and childbirth, crisis management, care of the critically ill and of the cardiac patient. |
Livedo reticular por hipotermia durante anestesia para tratamento odontológico em paciente com síndrome de Down\nNenhuma Miniatura disponível\nPenna, Heber de Moraes [UNESP]\nModolo, Norma Sueli Pinheiro [UNESP]\nPaiva, Dário Humberto de\nTítulo da Revista\nISSN da Revista\nTítulo de Volume\nBackground: Livedo reticularis (LR) is a benign dermatological condition characterized by ischemic areas permeated by erythematous‐cyanotic areas in a lacy pattern, and may be transient or permanent and is frequently associated with body exposure to cold. Cutaneous arterial vasospasm promotes ischemia, and venous dilation of the congested areas occurs by tissue hypoxia or autonomic dysfunction. Patients with Down's syndrome (DS), due to their physiological peculiarities, constitute a representative part of those who require dental care under general anesthesia, and LR has a reported incidence of 8% to 12% in DS patients. Objectives: Describe the physiological livedo reticularis (LR) in a DS patient, with the onset during the anesthetic‐surgical procedure. Case report: 5‐year‐old female patient with DS, admitted for dental treatment under balanced general anesthesia with sevoflurane, fentanyl, and atracurium. There was the occurrence of transoperative hypothermia, with axillary temperature reaching 34.5 °C after 30 minutes after the beginning of anesthesia. At the end of the procedure, red‐purplish skin lesions interspersed with areas of pallor were observed exclusively on the ventromedial aspect of the right forearm, with no systemic signs suggestive of allergic reactions. The established diagnosis was physiological LR. There was a total fading of the lesions within 5 days. Conclusion: This report evidences the need for thermal control of patients undergoing anesthesia, as well as the manifestation of LR as a consequence of transoperative hypothermia.\nAnesthesia, Dental treatment, Down's syndrome, Hypothermia, Livedo reticularis, Trisomy 21\nBrazilian Journal of Anesthesiology. |
Real-time ultrasound-guided spinal anesthesia using the SonixGPS® needle tracking system: a case report\n- First Online:\n- Cite this article as:\n- Wong, S.W., Niazi, A.U., Chin, K.J. et al. Can J Anesth/J Can Anesth (2013) 60: 50. doi:10.1007/s12630-012-9809-2\n- 890 Views\nThe SonixGPS® is an electromagnetic needle tracking system for ultrasound-guided needle intervention. Both current and predicted needle tip position are displayed on the ultrasound screen in real-time, facilitating needle-beam alignment and guidance to the target. This case report illustrates the use of the SonixGPS system for successful performance of real-time ultrasound-guided spinal anesthesia in a patient with difficult spinal anatomy.\nA 67-yr-old male was admitted to our hospital to undergo revision of total right hip arthroplasty. His four previous arthroplasties for hip revision were performed under general anesthesia because he had undergone L3-L5 instrumentation for spinal stenosis. The L4-L5 interspace was viewed with the patient in the left lateral decubitus position. A 19G 80-mm proprietary needle (Ultrasonix Medical Corp, Richmond, BC, Canada) was inserted and directed through the paraspinal muscles to the ligamentum flavum in plane to the ultrasound beam. A 120-mm 25G Whitacre spinal needle was then inserted through the introducer needle in a conventional fashion. Successful dural puncture was achieved on the second attempt, as indicated by a flow of clear cerebrospinal fluid. The patient tolerated the procedure well, and the spinal anesthetic was adequate for the duration of the surgery.\nThe SonixGPS is a novel technology that can reduce the technical difficulty of real-time ultrasound-guided neuraxial blockade. It may also have applications in other advanced ultrasound-guided regional anesthesia techniques where needle-beam alignment is critical.\nLa rachianesthésie échoguidée en temps réel avec le système de suivi de l’aiguille SonixGPS®: une présentation de cas\nLe SonixGPS® est un système électronique de suivi de l’aiguille destiné aux interventions échoguidées avec une aiguille. Les positions actuelle et anticipée de la pointe de l’aiguille sont affichées sur l’écran d’échoguidage en temps réel, ce qui facilite l’alignement de l’aiguille avec le faisceau et le guidage de l’aiguille jusqu’à sa cible. Cette présentation de cas illustre l’utilisation du système SonixGPS afin de réaliser avec succès une rachianesthésie échoguidée chez un patient présentant une anatomie complexe de la colonne.\nUn homme de 67 ans a été admis à l’hôpital pour subir une arthroplastie de correction totale de la hanche droite. Ses arthroplasties de correction de la hanche précédentes avaient été réalisées sous anesthésie générale parce qu’il avait subi une instrumentation au niveau L3-L5 en raison d’une sténose spinale. Le patient a été positionné en décubitus latéral gauche afin de voir l’espace intervertébral L4-L5. Une aiguille brevetée 19G de 80 mm (Ultrasonix Medical Corp, Richmond, BC, Canada) a été insérée et dirigée à travers les muscles paradorsaux jusqu’au ligament jaune sur le même plan que le faisceau d’ultrason. Une aiguille spinale Whitacre 25G de 120 mm a ensuite été insérée via l’aiguille-guide de façon conventionnelle. La ponction durale a réussi au deuxième essai, comme l’a indiqué un flux de liquide céphalorachidien clair. Le patient a bien toléré l’intervention et la rachianesthésie était adaptée pour la durée de la chirurgie.\nLe SonixGPS est une nouvelle technologie qui peut réduire la difficulté technique des blocs neuraxiaux échoguidés en temps réel. Cet outil pourrait également avoir des applications dans d’autres techniques avancées d’anesthésie régionale échoguidée dans lesquelles l’alignement entre l’aiguille et le faisceau est crucial.\nIn the past two decades, ultrasound imaging has become popular in locating and anesthetizing peripheral nerves. This new application of technology has also shown to facilitate central neuraxial blockade in patients with challenging anatomy, such as those with scoliosis, obesity, or previous spinal surgery.1 Nevertheless, the use of ultrasound for neuraxial blockade has thus far been limited mainly to the pre-procedural ultrasound imaging of the spine. This is used to delineate the underlying anatomy and thus facilitate the performance of spinal and epidural anesthesia, particularly in patients in whom difficulty is expected.1,2 On the other hand, despite its promise of greater precision,3,4 real-time ultrasound-guided neuraxial blockade remains a largely experimental technique due to its technical difficulty. The SonixGPS® (Ultrasonix Medical Corp, Richmond, BC, Canada) is an electromagnetic needle tracking system for ultrasound-guided needle interventions. Both current and predicted needle tip positions are displayed on the ultrasound screen in real-time, facilitating needle-beam alignment and guidance to the target. Our report illustrates the use of this novel technology to perform real-time ultrasound-guided spinal anesthesia in a patient with lower back instrumentation and difficult spinal anatomy.\nInformed patient consent was obtained for the publication of this case report. A 67-yr-old male was scheduled for revision of total right hip arthroplasty following four previous arthroplasties on the same hip at another institution. All previous procedures had been performed under general anesthesia primarily due to prior L3-L5 instrumentation for spinal stenosis.\nOn examination, the patient’s height was 178 cm and his weight was 84 kg. Results of the cardiovascular, respiratory, airway, and neurological examinations were within normal limits. On inspection of the patient’s spine, there was a midline longitudinal scar from his previous spine surgery. The L3-L5 spinous processes were not palpable, and the precise neuraxial midline was difficult to determine clinically. The spinous process of L2 was palpable, but considering the difficulty in clinically identifying the L2-L3 interspace and midline due to scar tissue, we concluded that the procedure would be technically difficult and may require a number of attempts. Consequently, we anticipated that ultrasound-guided spinal anesthesia would be feasible, and following a discussion of the risks and benefits, the patient agreed to the procedure.\nThis case describes a novel approach to single-operator real-time ultrasound-guided spinal anesthesia using an electromagnetic needle tracking system. The first description of real-time ultrasound-guided neuraxial blocks involved two operators (one operator holding the probe and the other advancing the needle).6 There have been subsequent case reports of single-operator real-time ultrasound-guided epidural and spinal anesthesia,3,4,7 but the technique is deemed to be technically demanding. This is due primarily to the challenges of visualizing the needle at the depth and steep trajectory required to reach the vertebral canal and of maintaining needle alignment with both the beam and the target. To overcome the latter issue, Tran et al.8 have described the use of an experimental needle guide attached to the ultrasound probe that directs an epidural needle along a fixed pre-planned trajectory. On the other hand, the SonixGPS needle tracking system addresses both issues. The location of the needle and its tip are displayed at all times as an overlay on the ultrasound screen, and there are clearly visible cues as to the adequacy of needle-beam alignment. The tracking system has the additional advantage of allowing the operator to make adjustments to needle trajectory during advancement, which ensures greater precision in reaching the target.\nPrevious back surgery and instrumentation pose a challenge to performing neuraxial anesthesia. The insertion of distraction rods involves decortication of vertebrae and removal of spinous processes along the extent of the curve. Scar tissue and bone grafts can hinder the entry of neuraxial needles into the desired space. Successful neuraxial blockade in these patients may therefore require multiple attempts at needle insertion and re-direction, which in turn may lead to a higher incidence of complications and failure. Chin et al. have described the use of ultrasound for neuraxial anesthesia in a patient with spinal instrumentation. In their report, ultrasound was used to perform a pre-puncture scan of the spine.9 This served to locate a suitable interspace for needle insertion, but the needle had to be changed from a pencil-point needle to one with a cutting tip in order to penetrate the overlying scar tissue. In our patient, the SonixGPS system allowed us to insert the introducer needle under real-time ultrasound guidance as far as the ligamentum flavum, thus bypassing any resistance to subsequent insertion of the 25G Whitacre spinal needle.\nAlthough the SonixGPS system with its transmitter and needle sensor provides an advantage over conventional ultrasound, there are some current limitations to its use. As the sensor is housed within the needle, the gauge of the needle is quite large. This may cause discomfort and pain on insertion. In our case, we performed local infiltration along the intended path of the needle under ultrasound guidance, and our patient tolerated the procedure very well. The SonixGPS system works only with its own proprietary needles, and needles designed for dural puncture are not currently available from the manufacturer. We overcame this issue by using a needle-through-needle technique, which also allowed us to use a 25G needle for dural puncture instead of the 22G needles described in other reports.7,9 Although the SonixGPS facilitates needle-beam alignment, expertise in probe handling is still required to maintain a good view of the interlaminar space and vertebral canal. We find it helpful to perform a pre-procedural scan and to mark on the patient’s skin the position of the probe that provides the optimal image of the interlaminar space. Following sterile preparation, the probe can then be replaced in the marked position. The SonixGPS technology allows needle-beam alignment to be achieved by moving the needle rather than the probe, and thus an optimal view of the target (the interlaminar space in this instance) can be maintained throughout.\nIn our view, the SonixGPS electromagnetic needle tracking system is an important technological advance that can facilitate real-time ultrasound-guided spinal anesthesia as well as other technically demanding procedures in ultrasound-guided regional anesthesia. Further investigation is underway to establish its utility in a larger number of patients and a wider variety of block techniques.\nThis project was funded entirely by departmental funds. Equipment support was supplied by Ultrasonix.\nConflicts of interest |
How to: Ultrasound Guided Popliteal Sciatic Nerve Block\n- The Popliteal Sciatic Nerve Block is a good block to do for the sciatic nerve because this is where the sciatic nerve is found most shallow. This block can be performed for post year knee pain after knee surgery, as well as, calf, foot and ankle surgery. This is the main nerve that supplies the lower leg. I find a lateral position gives you good control of the patients airways if you sedate them as well as good ergo-dynamics to do the block.\nHere we have our patient positioned laterally with a pillow between the legs for comfort. To do the Popliteal Sciatic Nerve Block we use a linear probe. The linear probe allows us to see structures well in the shallow plane, but gives us a wide field of view to see our needle approaching the nerve. To perform the Politeal Sciatic Nerve Block we put the probe directly in the back of the knee. Placement of the probe in the back of the knee reveals a structure of the nerve, the vein, the artery. I call this structure, the snowman in the back of the knee. You have three circles on top of each other.\nThe upper most circle represented by the tibial component of the sciatic nerve. The middle structure represented by the vein and the deep structure represented by the popliteal artery. If we put color Doppler on the screen we are able to see the pulsating artery in this area. Sometimes it's difficult to see the popliteal vein because this is a low-flow state, such as we see here. To visualize the popliteal vein better we can squeeze the back of the calf, increasing venous flow through the popliteal vein, such as this. There we can see increased venous flow through the popliteal vein represented better by color Doppler. Now, as I mentioned, this is only the tibial component of the sciatic nerve.\nWe wanna get the nerve where it comes together and has both components, the peroneal and the tibial component. As we scan up the leg, here we now see the peroneal component laterally, the tibial component medially, the popliteal vein and popliteal artery. On the medial side we see the semitendinosus and semimembranosus muscles. On the lateral side we see the biceps femoris, long and short heads. As we keep going up the leg the tibial and peroneal components join into one nerve. Sometimes we block the nerve at this level where the two components are joining. This allows us to get both components with a single injection at the nerve.\nMy needle approach for these blocks are gonna be from lateral to medial. What I typically do is measure the depth of the sciatic nerve in this setting. Here the sciatic nerve is approximately one-and-a-half to two centimeters deep to the probe.\nSo if I measure one-and-a-half to two centimeters deep, my needle is gonna come in completely perpendicular and have a very bright view of the needle and needle shaft as it advances to the nerve. Now, I typically like to inject deep to the nerve as well as superficial to the nerve in order to get complete surrounding of the popliteal sciatic nerve for the most rapid onset for this block. Typical volumes used are 20 to 30 milliliters of local anesthetic.\nThis block takes some time to onset and studies have shown even with complete surrounding of the nerve, it takes up to 30 minutes for the nerve block to onset in most patients. Here we see the popliteal sciatic nerve surrounded by the biceps femoris laterally and the semitendinosis/semimembranosis medially. Our needle is advanced directly above the nerve and the local anesthetic is injected, pushing the nerve deeper. We then withdraw the needle and readvance the needle again close to the nerve so we can get local anesthetic spreading to the medial side of the nerve, which is more of the tibial component. Now you can visualize both the peroneal and tibial component with a local anesthetic completely surrounding the nerves.\n- The Popliteal Sciatic Nerve Block is a good block to do for the sciatic nerve because this is where the sciatic nerve is found most shallow. This block can be performed for post year…By: SonoSite\nThe first exercise that we are going to do is a piriformis stretch. There are 2 different variations that we use in the clinic. The first is laying down, bend one knee up. So if you…By: Madden PT\n(no sound with legal disclaimer) Probably the most painful feeling you can ever have is known as sciatica. Or an inflammation of the sciatic nerve. A pinched sciatic nerve sends pain…By: How to Relieve Sciatica Pain at Home\nTamara Newell: Hey guys, welcome. Tamara here. Today's video is a series of stretches to help you alleviate your sciatic pain.I've worked with people who are athletes, to pregnant…By: Tamara Newell\nDo you have pain shooting down your leg? Does the back of your leg feel like it's being torn apart? Then you may have sciatica But what causes this pain and how do you avoid sciatica…By: How to Relieve Sciatica Pain at Home |
Patients with chronic pain are at risk for difficult to control postoperative pain. Preoperative evaluation with an emphasis on expectation management is key. In addition, a multimodal approach should be used throughout the patient’s perioperative course including opioid and non-opioid systemic pharmacotherapy, procedural interventions such as local infiltration, peripheral nerve block, and neuraxial blockade, as well as cognitive and physical nonpharmacologic modalities.\nKeywordsChronic pain Preoperative Perioperative Multimodal analgesia\nDr. Christina Bockman, PharmD, Pharmacist, Department of Anesthesiology and Pain Medicine, University of Washington\n- 3.Chou R, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ committee on regional anesthesia, executive committee, and administrative council. J Pain. 2016;17(2):131–157. Open image in new windowGoogle Scholar\n- 7.Marquez-Lara A, Hutchinson ID, Nuñez F, Smith TL, Miller AN. Nonsteroidal anti-inflammatory drugs and bone-healing: a systematic review of research quality. JBJS Rev. 2016;4(3).Google Scholar |
Rotator cuff repair is a type of surgery to repair a torn tendon in the shoulder. The procedure can be done with a large (open) incision or with shoulder arthroscopy, which uses small buttonhole-sized incisions.\nThe rotator cuff is a group of muscles and tendons that form a cuff over the shoulder joint. These muscles and tendons hold the arm in its joint and help the shoulder joint to move. The tendons can be torn from overuse or injury.\nYou will likely receive general anesthesia before this surgery. This means you will be asleep and unable to feel pain. Or, you may have regional anesthesia. Your arm and shoulder area will be numbed so that you do not feel any pain. If you receive regional anesthesia, you will also be given medicine to make you very sleepy during the operation.\nThree common techniques are used to repair a rotator cuff tear:\nAt the end of the surgery, the incisions are closed, and a dressing is applied. If arthroscopy was performed, most surgeons take pictures of the procedure from the video monitor to show you what they found and the repairs that were made.\nReasons rotator cuff repair may be done include:\nSurgery is a good choice when:\nA partial tear may not require surgery. Instead, rest and exercise are used to heal the shoulder. This approach is often best for persons who do not place a lot of demand on their shoulder. Pain can be expected to improve. Weakness will not improve. The tear will likely become larger over time. You may be limited in the sports or other activities you can do.\nRisks of anesthesia are:\nRisks rotator cuff surgery are:\nTell your health care provider what medicines you are taking. This includes medicines, supplements, or herbs you bought without a prescription.\nDuring the 2 weeks before your surgery:\nOn the day of surgery:\nYou will be wearing a sling when you leave the hospital. Some patients also wear a shoulder immobilizer. This keeps your shoulder from moving. How long you wear the sling or immobilizer will depend on the type of surgery you had.\nRecovery can take 3 to 6 months, depending on the size of the tear and other factors. You may have to wear a sling for 4 to 6 weeks after surgery. Pain is usually managed with medicines.\nPhysical therapy can help you regain the motion and strength of your shoulder. The length of therapy will depend on the repair that was done.\nSurgery to repair a torn rotator cuff is usually successful in relieving pain in the shoulder. The procedure may not always return strength to the shoulder. Rotator cuff repair can require a long recovery period, especially if the tear was large.\nWhen you can return to work or play sports depends on the surgery that was done. Expect several months to resume your regular activities.\nSome rotator cuff tears may not fully heal. Stiffness, weakness, and chronic pain may still be present.\nThese poorer results are more likely when the following are present:\nGartsman GM. Shoulder Arthroscopy. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2008.\nMiller RH III, Asar FM, Throckmorton TW. Shoulder and elbow injuries. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics. Philadelphia, PA: Elsevier Mosby; 2012:chap 46.\nWarren RF, ed. Shoulder arthroscopy. In: Rockwood CA, Matsen FA III, Wirth MA, et al., eds. The Shoulder. 4th ed. Philadelphia, PA: Elsevier Saunders; 2009:chap 20.\nUpdated by: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial Team.\nThe information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 1997-2015, A.D.A.M., Inc. Duplication for commercial use must be authorized in writing by ADAM Health Solutions. |
Do you wish you could feel comfortable and confident in swimwear, shorts, or even lingerie? Is your cellulite preventing you from buying certain clothes or going for certain fashions? As many as 90% of adult women, and some men too, have cellulite, so you're certainly not alone. Now, there's a way to eliminate cellulite that is minimally invasive and treats the problem at the source.\nHeaded by Dr. Kouros Azar, Thousand Oaks board-certified plastic surgeon, the entire team is highly trained and skilled in every procedure that is performed. We are thrilled to offer Avéli cellulite treatment in Thousand Oaks at our luxurious, modern office location and accredited surgical facility.\nWhat is Avéli Cellulite Treatment?\nConnective tissues known as septa bands that lie beneath the skin can become tight and rigid, causing the formation of dimples on the skin's surface known as cellulite.\nWith the new cellulite treatment called Avéli Thousand Oaks patients can benefit from a cutting-edge method designed to eliminate dimples and produce a cellulite-free appearance on the thighs and buttocks. This advanced tool targets, severs, and releases the fibrous septa bands responsible for the dimpling effect by using a tiny treatment device strategically positioned just below the skin's surface. This results in a smoother skin texture across the thigh, hip, and buttock areas.\nSay goodbye to hiding your skin because of cellulite. This groundbreaking treatment offers a simple, scientifically proven solution to effectively eliminate cellulite so you can feel confident in swimwear, shorts, and more.\nOur Thousand Oaks Avéli Cellulite Treatment patients can:\nAvéli Cellulite Treatment, a safe and FDA-approved procedure, is minimally invasive, non-surgical, and has no need for anesthesia. The treatments come with short appointment times and have little to no downtime.\nSince Avéli Cellulite Treatment is a low-risk, minimally-invasive procedure, many patients who are concerned about cellulite can be excellent candidates for this treatment. Candidates should be in overall good health and need to have a sufficient amount of elasticity left in the skin. Patients with skin infections, diabetes that is not well controlled, or those who are breastfeeding or pregnant should avoid this procedure in most cases.\nPreparation and Consultation\nWe will spend time at a consultation discussing your aesthetic goals for Avéli Cellulite Treatment and any risk factors that might not make this treatment the best option for you. If we decide to move forward, you will receive a detailed treatment plan that outlines expectations for results, any necessary preparations, and instructions for aftercare.\nOur Thousand Oaks Avéli appointments usually take about an hour. First, a local anesthetic will be administered in the targeted area.\nThen, very tiny incisions are made, which a delicate surgical instrument will be inserted through. This instrument is used to sever the septa bands and release the cellulite dimples entirely. Since the incisions are so small, no sutures are needed, and the area will be bandaged and protected.\nAftercare, Recovery, and Results\nAvéli requires no downtime, and most patients are comfortable driving home and resuming normal activities right after the procedure. Some mild bruising or soreness could occur, especially when sitting down. You will want to avoid strenuous lower body exercise for about 1-2 weeks and be sure to use sunscreen in the treated area for about 4-6 weeks.\nWhy choose Azar Plastic Surgery?\nRenowned for his expertise and exceptional talent, Dr. Kouros Azar, Thousand Oaks plastic surgeon, has skillfully treated celebrities as well as tackled intricate reconstructive challenges. However, he and the whole Azar team remain dedicated to maintaining a welcoming and comfortable environment. Beyond achieving unparalleled aesthetic outcomes, their primary focus is ensuring that every patient feels genuinely cared for and valued throughout their entire experience.\nContact us today by calling (805) 373-7073 for a private and personalized Avéli Cellulite Treatment consultation, or conveniently contact us online.\nAvéli is a painless procedure due to it being performed using local anesthesia. After the treatment, there may be some soreness or tenderness in the area where the treatment was performed.\nAvéli Cellulite Treatment is very a safe, low-risk treatment that is FDA-approved. Bruising is a possible side effect but typically resolves quickly.\nThis procedure permanently removes cellulite bands after just one session. However, it will not prevent cellulite from forming in the future.\nSome DIY cellulite treatments can temporarily reduce cellulite's appearance, but they are not long-term solutions and typically do not eliminate cellulite completely.\nThe cost of Avéli Cellulite Treatment varies between patients but often ranges from around $3,000 to $5,000, depending on the extent of treatment.\nDr. Kouros Azar, founder and medical director of Azar Plastic Surgery and Med Spa, is an attentive listener, a devoted surgeon and doctor, and a highly-skilled biomedical engineer. He matches his patients with the best possible treatments by drawing on his extensive expertise, compassion, and research skills. Make an appointment with Dr. Azar now to discuss your rejuvenation options. |
No doubt that rhinoplasty (nose job) is the most sophisticated surgery but also the most popular amongst aesthetic surgery. The nose is a hollow structure. The surgeon has to change the shape of the nose without touching its supports and its respiratory function. Nose reshaping consists of the removal of cartilage and the sculpting of bone excess to create the desired shape and profile.\nIt’s extremely important to discuss in detail your expectations with your rhinoplasty surgeon and it’s important that these expectations be perfectly aligned with what is technically and aesthetically possible.\nNose job is performed under sedation or general anaesthesia and lasts generally one or two hours.\nVery small incisions are made and a minimum of surgery is performed in order to get a maximum of results with as less as possible swelling side effects.\nThe scars are dissimulated inside the nose. If the size of the nose has to be decreased, an extremely small incision will be made at the bottom of each nostril. If the size of the nose has to be increased, synthetic implants similar to a sponge might be used if necessary to improve the nose reshaping results.\nAfter surgery, compresses might be used to avoid bleeding and a small splint covers the nose after surgery.\nThe compresses will be removed on the next day and the splint a week after. Most ecchymosis and swelling around the eyes disappear after a week. The results of the nose job will continue improve and will be fully visible after a year. Hence, do not think that the final result will be noticeable right after surgery and removal of the splint. Don’t worry because your nose will continue change during a few months after surgery.\nPatients will be able to return to work approximately one week after rhinoplasty surgery. Teeth hebetude and a light nose obstruction might appear during a few weeks after surgery. |
A significant number of anesthesiologists who commit errors by administering the wrong drug or an improper dose of anesthetics never report the mistake, researchers determined. An estimated 10 percent of these mistakes cause harm to patients.\nThe evidence shows that (mistakes) are grossly underreported at least in our institution, and I suspect in many others,” said the leader of the study, Dr. Mark Hausman, in an Anesthesiology News article. Hausman is the chief anesthesiologist for the Veteran’s Administration’s Ann Arbor Healthcare System and an assistant professor of anesthesiology at the University of Michigan’s medical school.\nThe researchers reviewed quality assurance statistics and other sources that showed possible medication mistakes that happened from July 2006 to November 2015. When anesthesiologists under-report medication errors in Boynton Beach, it can have very real implications for patients. If you have been affected by the negligence of an anesthesiologist, get in touch with a qualified medical malpractice lawyer that can advocate for you.\nWhy Mistakes Happen\nMost of the medication mistakes happen because some anesthesiologists fail to follow protocols, use medication containers that look similar to each other but have different drugs, or simply there is an absence of knowledge, the study reported. Researchers also said these mistakes can happen in any surgery. The usual protocol, according to Johns Hopkins Medicine, is for the anesthesiologist to meet with the patient before surgery to review patient history and medical condition to plan the correct anesthetic for the type of surgery to be performed.\nSedatives are used to induce sleeping, analgesics to reduce pain and several medications are used in the various procedures for local, regional, and general anesthesia purposes. The most common drugs used for sedation are barbiturates, benzodiazepines, Etomidate, Propofol, and Ketamine. Following surgery, the anesthesiologist stops the anesthetic from entering the blood and monitors the patient in the recovery room. Overdoses of an anesthetic can be deadly or can cause serious medical problems. The specific anesthetic used and how fast they enter the bloodstream can be toxic and result in severe medical issues.\nWhat to Do if Harmed\nWhen anesthesiologists under-report medication errors in Boynton Beach, it can have serious consequences for you and your loved ones. Anyone who is seriously harmed or families of those who died from an anesthesiologist’s mistake should promptly consult with a medical malpractice attorney. A medical malpractice lawyer is committed to holding an anesthesiologist financially responsible for a mistake and to serve as encouragement to other practitioners to follow the accepted protocols the profession has in place. |
ASRA Award Winners Share Their Thoughts on Their Achievements\nJul 1, 2020\nWith the cancellation of the 45th Annual Regional Anesthesiology and Acute Pain Medicine Meeting in April 2020, several award winners did not have the opportunity to receive formal recognition at the Excellence in ASRA Awards Luncheon. We asked some of these recipients to share their thoughts on their respective honors for the ASRA News. Please join us in congratulating these deserving individuals who have worked very hard to get where they are today!\nDr. Guy Weinberg - ASRA 2020 Gaston Labat Award\nDr. Guy Weinberg has been honored for his contributions to the development, teaching, and practice of regional anesthesia with ASRA’s 2020 Gaston Labat Award and Lectureship. Dr. Weinberg developed a life-saving protocol and standard of care now used throughout the world. Patients undergoing medical procedures are at risk for local anesthetic cardiac toxicity (LAST), a rare but potentially fatal side effect associated with administration of local anesthetics. The toxicity often comes on quickly with dizziness, drowsiness, and confusion, followed by central nervous system symptoms such as seizure and loss of consciousness, ultimately leading to cardiovascular failure and death.\nThese effects were first described as early as 1887 with the use of cocaine as a local anesthetic. Today, although drugs and delivery mechanisms have evolved, LAST remains a serious concern – mitigated by the use of a Checklist for Treatment of Local Anesthetic Systemic Toxicity, developed by Dr. Guy Weinberg and a team of anesthesiologists.\nIt was 1998 when Dr. Weinberg discovered that lipid emulsion therapy could be used to treat and even prevent LAST. He developed LipidRescue in 2006 to inform the medical community about the cardiotoxicities of local anesthetics, but since then the approach has also been found to reverse neurological toxicities associated with local anesthetics as well as cardiac toxicities associated with other agents.\nASRA published the first LAST guideline in 2010, and it has been updated twice since. The guideline has also been incorporated into an iPhone App to facilitate immediate access in the clinical setting.\n“It is extremely rare for an anesthesiologist to discover an intervention that actually saves patients’ lives. Dr. Weinberg’s two-plus decade research focus on using lipid emulsion as antidote for fat soluble medication overdose has spanned both local anesthetics (regional anesthesia) and other pharmaceutics (emergency medicine and critical care medicine). The impact of his research on our sub-specialty has been enormous,” wrote Dr. Joseph M. Neal in his letter of recommendation.\nGiven annually, the award honors Gaston P. Labat, MD (1843-1908), a pioneer in regional anesthesia and the first president of the American Society of Regional Anesthesia founded in 1923 (later abandoned and then “re-founded” in 1975). Labat’s Regional Anesthesia: Its Technique and Clinical Application was first published in 1922 and became “wildly successful” and a quintessential resource throughout the 20th century.\nDr. Weinberg began his career in internal medicine and medical genetics and later completed his residency in anesthesiology at the University of Virginia in Charlottesville. He has served as professor of anesthesiology at the University of Illinois College of Medicine in Chicago since 2003 and also works at the Jesse Brown VA Medical Center. He received the ASRA Distinguished Service Award in 2011.\n“The Gaston Labat award is, literally, the honor of a lifetime. Reviewing the names of earlier awardees provides context and requires, of necessity, self-effacement. The first two Labat awards were given to John Bonica and Daniel Moore in 1977, the year I finished my internship in medicine at UCSF. It took an additional six years for me to find my way to anesthesiology. I recognized the field as a good fit the day I started residency at University of Virginia.\n“Labat awardees include many talented teachers and pioneers of regional anesthesia and I am honored to consider many among the more recent entries as friends and colleagues. It is those who came before, as well as current members of the regional anesthesia community, to whom I owe the most. I am also thankful for the continued support of the faculty members at the University of Illinois, Jesse Brown VA Medical Center, and (the late) Michael Reese Hospital – a clinical ‘camelot’ where I met my wife, Mary. She clearly deserves my sincerest gratitude for standing by me and for her amazing forbearance over 30 plus years. Our children, Hannah, Isaac, and Joy get that credit, too. Thanks to the ASRA Board for their encouragement over the years.\n“Finally, I wish to thank all the students and residents I’ve worked with over more than four decades; I love to teach because it’s the best way to learn and to satisfy my curiosity. I hope to continue honoring the legacy of Gaston Labat by teaching, learning and staying curious.”\n— Guy Weinberg, MD\nDr. Joseph M. Neal - ASRA 2020 Distinguished Service Award\nA former president of ASRA (2012-2015) and editor-in-chief of Regional Anesthesia and Pain Medicine (2002-2012), Dr. Neal has been an active member of ASRA for many years and is widely respected in the field. He received the Gaston Labat Award and Lectureship in April 2019. Although he retired from clinical practice in 2018 at Virginia Mason Medical Center, he continues research and writing. He serves as an affiliate investigator at Benaroya Research Institute at Virginia Mason and as a clinical professor of anesthesiology at University of Washington School of Medicine.\n“Dr. Neal has long established himself as an international leader in regional anesthesia,” wrote Kevin E. Vorenkamp, MD, who worked for many years with Dr. Neal at Virginia Mason Medical Center. “He has instructed hundreds of anesthesiology residents and regional anesthesia fellows … and his presentations and publications have easily reached thousands more.”\nDr. Neal received his undergraduate and medical training at Wake Forest University in Winston-Salem, NC, and the West Virginia University School of Medicine in Morgantown. He returned to Bowman Gray/Wake Forest University to complete residencies in emergency medicine and anesthesiology. After fellowship training in regional anesthesia at the Virginia Mason Medical Center in Seattle, WA, he joined that group in 1989. He directed the Virginia Mason regional anesthesia fellowship for over a decade as well as its anesthesiology residency program. He served as director of research from 2013-2017.\nDr. Neal has been a researcher on 12 grants, presented at hundreds of national and regional meetings, organized 24 meetings, authored over 74 peer-reviewed articles, and published four books on various topics in the regional anesthesia and pain medicine field.\nThe Distinguished Service Award is presented annually to an individual for his or her outstanding service to ASRA or to the fields of pain medicine or regional anesthesia and acute pain medicine.\n“Thank you to the American Society of Regional Anesthesia and Pain Medicine for selecting me as its 2020 Distinguished Service Award recipient. I find it difficult to describe just how humbling, not to mention downright good, it feels to be recognized by the members of a society for which I have so much love and respect.\n“As I reflect on 35 years as an ASRA member, I am grateful for the opportunities that I was given to serve. From my early days as a resident and fellow through my first few years of retirement, ASRA has been a major part of my professional life. The decade plus spent as editor-in-chief of Regional Anesthesia and Pain Medicine was perhaps my most rewarding professional endeavor. To have been a part of taking the Journal from a relatively small sub-specialty publication to a high impact international scientific medium was only possible because of the dedicated editors, reviewers, and talented physician scientists who entrusted us with publishing their work. I was equally blessed to have been part of ASRA leadership during its remarkable metamorphosis. As gratifying as those accomplishments have been, they were immeasurably enhanced by the development of professional and lifelong personal friendships with countless ASRA members and staff. To all of my ASRA friends and colleagues, thank you for your passion, your professionalism, and your friendship. Together we have made remarkable contributions to regional anesthesiology, acute and chronic pain medicine, and most importantly, to our patients.”\n— Joseph M. Neal, MD\nDr. Priyanka Ghosh - ASRA 2020 Resident/Fellow of the Yea\nDr. Ghosh is a fellow in interventional pain medicine at Weill Cornell Tri-Institute for Pain (New York Presbyterian, Memorial Sloan Cancer Center, and Hospital for Special Surgery). She is involved in research at each of these institutions in the areas of practice administration education in interventional pain medicine fellowships; osteoid osteoma diagnoses; dorsal root ganglion stimulation and dorsal column spinal cord stimulation in CRPS; and spinal cord stimulation studies. In fact, research has played a large role in her entire career as far back as when she attended Brown University as an undergrad. She earned her MD at the University of California, San Francisco, where she also served as an NIH Clinical & Translational Research Fellow. Her residency was in the department of anesthesia, critical care and pain medicine at Beth Israel Deaconess Medical Center at Harvard Medical School.\nIn addition to ASRA, Dr. Ghosh is active in the Society of Women Innovators in Pain Management, the World Academy of Pain Medicine Ultrasonography, and the Substance Abuse Prevention and Education Committee. She has presented posters at the North American Neuromodulation Society, the American Society of Anesthesiologists, and ASRA.\nASRA’s Resident/Fellow of the Year Award is given annually to a resident or fellow member of ASRA who has demonstrated outstanding contributions to regional anesthesia or pain medicine; has contributed to the advancement of the profession, welfare of residents, or quality of residency education; serves as a role model and mentor to his or her peers; and embodies the values of ASRA.\n“It is truly an honor to be selected as a recipient of a 2020 ASRA Fellow of the Year award! I am incredibly thankful to the amazing Dr. Shalini Shah, not only for serving as an incredible mentor and role model to me, but also for nominating me for this award and to the entire ASRA board for granting me the honor of this award.\n“I have been a part of ASRA since my first year of anesthesia residency, introduced to this amazing organization by Dr. Christine Peeters-Asdourian (CPA). From my first introduction to ASRA at the fall meeting of my CA-1 year, I’ve always had the same feeling about the ASRA community, that it is a hub of knowledge, support and innovation in which physicians from walks of life are welcomed. I am continuously amazed by the diversity of ideas and topics consistently presented at ASRA meetings and the incredible number of experts that converge in one organization to share their knowledge and help move the field forward. I’ve been fortunate enough to be included in ASRA in multiple arenas, from presenting my research to taking active leadership roles in special interest groups (SIGs) and committees.\n“Through these activities and increasing involvement in various facets of ASRA, I was fortunate enough to pursue and grow my interests in the field of pain medicine, especially my clinical research and advancing diversity and inclusion in the field of pain medicine. I’ve been so impressed with the deep level of scientific discovery and discourse at each ASRA meeting and I hope to continue to work with many mentors through ASRA, nationally and internationally, to contribute to meaningful clinical research to push the field forward. ASRA’s commitment to diversity and inclusion is the other arena in which they are leading the way. I hope to continue to contribute by creating and joining new and innovative initiatives to promote diversity and inclusion of all people. I am so heartened by the many initiatives in ASRA and hope to continue to help grow and participate in each of these.\n“However, above all things, the most striking and wonderful facet of my time with ASRA has been the incredible mentorship I have gained. In each arena, through ASRA, I was able to gain amazing mentorship. Whether it was the SIGs I participated in, the resident and fellows section committee or just the general ASRA community, mentors of all levels and backgrounds were available to me anytime. I have been beyond lucky to have mentors nationwide, who are willing to advise me, help me and most importantly, sponsor me on papers, projects and initiatives that interest me. The mentorship I have gained, including the trust and respect that I am always given, has been truly the highlight of my time with ASRA. I feel incredibly lucky for my amazing experiences with ASRA thus far, and am beyond thrilled to receive this award. I hope to be involved with ASRA, in all areas, and hope to grow with and contribute to this amazing organization for my entire career.”\n— Priyanka Ghosh, MD |
- Study Protocol\n- Open Access\n- Open Peer Review\nRapid analgesia for prehospital hip disruption (RAPID): protocol for feasibility study of randomised controlled trial\nPilot and Feasibility Studies volume 3, Article number: 8 (2017)\nAdequate pain relief at the point of injury and during transport to hospital is a major challenge in all acute traumas, especially for those with hip fractures, whose injuries are difficult to immobilise and whose long-term outcomes may be adversely affected by administration of opiate analgesics. Fascia iliaca compartment block (FICB) is a procedure routinely undertaken by doctors and nurses in the emergency department for patients with hip fracture but not yet evaluated for use by paramedics at the scene of emergency calls.\nIn this feasibility study, we aim to test whether FICB administered by paramedics at the scene of participants’ hip fractures is feasible, safe and acceptable. This will enable us to decide whether to proceed to a fully powered, multi-centre pragmatic randomised trial to evaluate whether the procedure is effective for patients and worthwhile for the NHS.\nIn this study, we propose to recruit ten paramedics in an urban area of South Wales. We will train them to carry out FICB when they attend patients with hip fracture. We will randomly allocate eligible patients to FICB or usual care using audited scratch cards. We will follow up participants to assess measurability of key outcomes including quality of life, pain scores, adverse events, length of stay in hospital, acceptability to patients and compliance of paramedics. We will assess whether the findings meet specified feasibility criteria and, if so, plan a full trial.\nThis study will enable us to recommend whether to undertake a definitive trial of FICB by paramedics for hip fracture.\nIt is predicted that 6.3 million hip fractures a year will occur worldwide by 2050 . In the UK, hip fractures result in more admissions to orthopaedic trauma wards than patients with any other injury ; this has a huge financial impact on the National Health Service (NHS) .\nHip fracture is associated with a high mortality rate (30% at 1 year). Delay to surgery—over 48 h—has a detrimental effect on patient mortality [4–6]. Early surgery has also been shown to reduce the incidence of postoperative pneumonia (relative risk 0.59) and pressure sores (relative risk 0.48) . The National Institute for Health and Care Excellence therefore advises that surgery should take place on the day of admission or the following day.\nPrehospital management of patients with hip fracture can cause severe pain as the injury site is difficult to immobilise and ambulance staff must move the patient by lifting and negotiating through obstacles such as stairs and doorways. Paramedics have a range of available pain relief options including paracetamol, opiates and Entonox, with the most frequently administered being intravenous (IV) morphine . However, several studies have suggested that prehospital pain relief for patients with suspected hip fracture is inadequate, with up to 40% of patients not receiving any pain relief at all [10–13]. Following interviews with patients, who believed their prehospital care could be improved, Aronsson et al. recommended that alternative methods of pain relief should be considered before admission to hospital.\nUnfortunately, the pharmacokinetics and pharmacodynamics of opiates mean that unpredictable responses can occur, particularly in the elderly; adverse drug effects when morphine is administered are therefore likely and have the potential to delay a patient being taken to theatre . Rainer et al. showed that IV ketorolac was more cost-effective than IV morphine in isolated limb injury; odds of an adverse event with IV morphine were 144 times (95% confidence interval from 41 to 502) more likely. Alternatives to opiate-based pain relief are therefore desirable in the care of hip fracture.\nThe prehospital management of hip fractures is vital to provide adequate pain relief, ideally without potential side effects that may delay surgical fixation and have a detrimental effect on patient outcomes. We hypothesise that the use of fascia iliaca compartment block (FICB) to provide pain relief to patients with a broken hip before they are taken to the emergency department (ED) may improve the outcome for patients with hip fracture in this way.\nFICB is increasingly used in ED and orthopaedic wards in the care of patients with hip fracture. The technique was first described by Dalens et al. in 1989 . Lees et al. demonstrated statistically significantly reduced pain scores in patients receiving FICB in hospital, compared with controls. Lengths of stay and mortality rates were also reduced, although there may have been confounding variables . Increasingly, the evidence in the literature suggests that FICB is easy to learn, provides better pain relief and triggers fewer side effects than opiates [19–26].\nThe Association of Anaesthetists of Great Britain and Ireland supports FICB delivered by non-physician practitioners when a physician is not immediately available . The Association states that non-medical registered health professionals can perform FICB if they have been appropriately trained and are following agreed clinical governance procedures.\nFeasibility study aim\nThe aim of the study is to assess the feasibility of undertaking a fully powered, multi-centre pragmatic randomised trial to test the clinical and cost-effectiveness of paramedics providing FICB as early pain relief for patients who have fractured a hip at the scene of their injury.\nFeasibility study objectives\nAccuracy of recognition of hip fracture by paramedics and thus the safety and feasibility of FICB\nWillingness of both patients and paramedics to participate in the study\nCompliance with the FICB protocol by paramedics\nSample size required for a full randomised controlled trial (RCT) and recruitment period required to achieve this target\nAcceptability of FICB as method of providing pain relief in prehospital care of patients with hip fracture\nWhich outcome measures to use in a full RCT and at what point: for example, pain scores before and after pain relief; whether the administration of FICB in prehospital care yields benefits for patients besides pain relief, notably side effects of opioids (nausea, constipation, respiratory depression and confusion); length of time before surgery; and length of stay in hospital. We shall also assess the ability of participants to complete forms, the incidence of missing data and the time taken to complete data collection\nWhether study processes and outcomes achieve specified feasibility criteria for trial implementation\nSingle-centre randomised parallel-group feasibility trial.\nThe scenes of patients’ injuries, in the predominantly urban catchment area of one ED in South Wales, where the average job cycle time is 90 min.\nWe have recruited ten paramedics based at ambulance stations in that catchment area and trained them in FICB.\nAdult patients (aged 18 years or older) who are:\nAttended out of hospital by a participating emergency paramedic following a 999 call\nAssessed by the attending paramedic as having an isolated hip fracture; conscious (Glasgow Coma Scale score at least 13) and haemodynamically stable\nConveyed to the participating hospital\nWe exclude patients if they refuse analgesia or if the emergency paramedic is working alone without back-up from the advanced paramedic practitioner, emergency medical technician or other paramedic.\nIn this randomised feasibility study, we are not seeking to evaluate FICB and have not therefore undertaken a formal power calculation. However, considering that the participating hospital treated about 370 patients with hip fracture over 12 months in 2013–2014, and accounting for shift patterns of paramedics and the number of patients excluded for other reasons, we estimate that ten trained paramedics can recruit 50 eligible patients into the trial over 12 months—enough to assess whether the trial meets our specified feasibility criteria for progressing to a full trial.\nOur proposed training reflects published methods for training non-medical healthcare professionals [28, 29] and expert advice from consultants in anaesthetics and trauma surgery who have previously trained nurses to carry out FICB in the ED. We train paramedics through an online package including a video showing the administration of FICB, followed by group sessions led by a consultant anaesthetist (SF). Pairs of paramedics then attend sessions at the participating hospital where they administer FICB to real patients observed by an anaesthetist. They alternate between administering and critiquing the FICB to ensure their learning is active . The paramedics must pass a competency assessment before they can recruit patients to the study.\nThe paramedics will attend a 6-month refresher halfway through the year of patient recruitment. We advise them to contact the paramedic research support officer if they feel they need additional training or support during the recruitment period, typically from the consultant anaesthetist.\nOur paramedics routinely measure pain scores on a numerical rating scale, a standard tool used by healthcare professionals. The patient clinical record used by paramedics already has a designated box to collect these data as a standard part of the patient’s assessment. We therefore provide no additional training for recording pain scores within this trial.\nWe give paramedics a printed treatment protocol as an aide mémoire during recruitment. Should a patient be randomly allocated to receive FICB, the paramedic will ensure the participant has no contraindication to FICB including allergy to local anaesthetic; use of anticoagulants; neurovascular damage to the affected leg; previous femoral bypass surgery; infection at the site of injection; inability to palpate the femoral artery on the affected leg; hip prosthesis on the affected side; pregnancy; or body mass apparently less than 50 kg.\nAt present, paramedics provide a range of analgesia to patients with hip fracture, including IV morphine, paracetamol and Entonox . Participants allocated at random to the control group receive this usual pain relief, as judged appropriate by the paramedic. To participants in the intervention group, paramedics can offer paracetamol and Entonox in addition to FICB. We advise paramedics not to give morphine for at least 20 min after patients have received FICB. If FICB has not relieved the pain after 20 min, however, they can give morphine if they judge that appropriate.\nBefore recruiting participants, we produced 100 sequentially numbered scratch cards with concealed trial allocations generated by the trial statistician (GF). To avoid subversion of the randomisation procedure, in particular tampering with the scratch cards, we check that study paramedics use these scratch cards for eligible patients in sequence and account for them on their ambulance stations’ randomisation log. We regularly audit these logs against the remaining scratch cards.\nWe take consent in two stages:\nConsent to treatment: paramedics obtain oral consent to treatment (i.e. analgesia) according to usual practise, for example for cannulation or venepuncture.\nConsent to participation in the trial: An NHS researcher seeks retrospective consent from patients to take part in the trial within ten working days of their injury. This usually occurs in hospital, or in the community if necessary. For patients with cognitive impairment, we seek consent to take part in the trial from relatives or carers. Thus, we recognise that it is not ethically appropriate to consent patients to research in a medical emergency . Indeed, in our SAFER randomised trials in emergency care [32, 33], we gained ethical information governance and research approvals to inform patients of their potential inclusion in research within 10 days of attendance by emergency ambulance. The PARAMEDIC trial used similar of enrolling patients, using a waiver of consent under the Mental Capacity Act, and asking patients for consent to follow up after this . Consistent with those trials, all patients who dissent from RAPID then leave the study.\nAll study paramedics keep a laminated copy of the study flowchart as an aide mémoire (Fig. 1).\nWe are testing the following outcome measures for the full RCT:\nHealth-related quality of life, using SF-12 at 30 days and 6 months\nMortality at 6 months\nMobility score, using the Rivermead Mobility Index at 30 days and 6 months \nInitial pain score at the scene of participants’ injuries before pain relief, using an 11-point numeric rating scale with 0 showing no pain at all and 10 showing the worst pain imaginable \nSatisfaction with care received from paramedics using a modified Quality of Care Monitor 30 days after the participant’s injury\nLength of inpatient stay\nPain score on arrival in the ED using the same 11-point numeric rating scale \nParticipant safety assessed by adverse events (AEs) occurring in each trial arm, notably their severity, causality and expectedness\nDuration of paramedic’s management of participant (‘job cycle time’)\nUse of anti-emetics and alternative analgesia\nTime between arrival at ED and surgery\nQualitative data collection\nWe will interview ten intervention participants to explore their experiences of receiving FICB at the scene of their injury. This will enable us to explore whether this method of providing analgesia for hip fracture is acceptable to patients (Study Objective 5). We will sample respondents purposively to ensure that they cover the range of the following characteristics:\nPrevious hip fracture\nTime of injury\nStudy paramedic who treated the participant\nWe shall record and transcribe these interviews.\nTowards the end of the recruitment period, we will also conduct paramedic focus groups by inviting all ten trained paramedics to take part. We will explore their experiences of randomising participants and providing FICB at the scene of injury (Study Objectives 2 and 3) and ask how this could work on a larger scale, to aid our planning of a fully powered RCT.\nWe use an electronic data capture and management system designed for clinical trials, to store anonymised data securely . We use participants’ contact details only to arrange interviews and send postal questionnaires and store them on a password-protected computer separate from the trial database. Transcripts of qualitative interviews and focus groups will have participants’ study number but no identifiable information. We shall also store digital recordings on a password-protected computer.\nQuantitative analysis will enable us to assess our data against the following feasibility criteria , which we seek to meet within reasonable limits:\nRecruit at least ten paramedics to conduct the trial\nParamedics recognise hip fracture with sensitivity of 75% and positive predictive value of 85%\nAt least 50% of intervention participants receive the intervention\nAt least 60% of recruited participants consent to follow up\nRetrieve primary outcomes for at least 70% of consented participants\nMean participant satisfaction in intervention group is at least 80% of that in control group\nClinicians are in equipoise about safety and effectiveness of paramedic-administered FICB\nBalance of serious AEs between groups\nWe base the criteria for progression on direct measures of a count (criterion 1) and direct measures of proportions (criteria 3–6). We will use receiver operating characteristic analysis to generate the positive predictive value (criterion 2) with the first X-ray providing the gold standard.\nTo judge whether criterion 7 has been met, we shall compare health-related quality of life, mobility, satisfaction with care and change in pain scores following analgesia using t tests of mean scores, mortality risk ratios, median lengths of inpatient stay, paramedic job cycle time and time between arrival at ED and surgery using a Wilcoxon non-parametric test. These exploratory analyses will also enable us to estimate the sample size for a full trial.\nWe shall report the results of this feasibility trial according to the CONSORT guidelines .\nWe will conduct thematic analysis of data from interviews and focus groups. This is a systematic and transparent method of analysis which generates themes from the implicit and explicit ideas contained in the original accounts of participants. One researcher will lead the analysis. Two others, including a lay representative, will independently monitor key stages of coding, generating themes and interpretation and adopt a critical stance to test and confirm findings [43–45].\nLay representatives with experience and knowledge of hip fractures and emergency care contributed to developing the research plan, drafting the application for funding and preparing all documentation, notably the Patient Information Sheet. Two lay representatives will sit on the Trial Management Group and two others on the Trial Steering Committee throughout the trial, to present patients’ perspectives and play a full part in interpretation, reporting and dissemination of findings. We follow best practise in supporting their contribution so they collaborate as equal members of the study team throughout [46, 47].\nGiven the nature of the intervention, it is not possible to blind paramedics or participants to the treatment they receive; sham FICB would be unethical. To reduce the risk of bias in reporting and analysing pain scores, paramedics record participants’ baseline pain scores before randomisation. The entire research team except the data manager will remain blind to participants’ allocations until the Trial Steering Committee has approved the primary analysis.\nVariable paramedic compliance with the protocol is a danger. Hence, we shall monitor the following: use of the randomisation scratch cards to prevent subversion; missed recruitment of eligible participants; and compliance with study allocation to prevent contamination.\nAs we randomise participants before they consent, there is potential for biassed groups if more participants consent to follow up in one arm of the feasibility study than the other. Though we do not expect such an imbalance, the data we collect will allow us to assess this risk.\nAs this feasibility trial has requested volunteers to take part, they are not necessarily a representative sample of all the paramedics in the area; we acknowledge that this is a limitation. If we recommend a fully powered trial of paramedic-provided FICB, we shall invite all paramedics in the study areas to take part.\nWe shall compare outcomes between groups only to ensure that there are no large differences between groups and that we remain in equipoise about the clinical effectiveness of prehospital paramedic-administered FICB for hip fracture. We do not aim to evaluate clinical effectiveness in this feasibility study. Hence, we will interpret observed differences in outcomes between groups with caution in this underpowered feasibility study.\nThe findings of this feasibility study will enable us to recommend whether to conduct a definitive RCT of FICB by paramedics for hip fracture. If so, we shall prepare for a fully powered multi-centre trial, notably by liaising with other ambulance services and EDs to engage further sites; and drafting a proposal for research funding to evaluate whether FICB is clinically effective for patients and cost-effective for the NHS.\nOngoing: participant recruitment has commenced.\nFascia iliaca compartment block\nNational Health Service\nRandomised controlled trial\nWelsh Ambulance Services NHS Trust\nFriedman SM, Mendelson DA. Epidemiology of fragility fractures. Clin Geriatr Med. 2014;30:175–81.\nNational Institute for Health and Care Excellence. Hip Fracture in Adults Quality Standard [QS16]. 2012. http://www.nice.org.uk/guidance/qs16. Accessed 5 Jan 2017.\nLawrence TM, White CT, Wenn R, Moran CG. The current hospital costs of treating hip fractures. Injury. 2005;36:88–92.\nDy CJ, McCollister KE, Lubarsky DA, Lane JM. An economic evaluation of a systems-based strategy to expedite surgical treatment of hip fractures. J Bone Joint Surg. 2011;93:1326–34.\nMoran CG, Wenn R, Sikand M, Taylor AM. Early mortality after hip fracture: is delay before surgery important? J Bone Joint Surg. 2005;87:483–9.\nHolt G, Smith R, Duncan K, McKeown DW. Does delay to theatre for medical reasons affect the peri-operative mortality in patients with a fracture of the hip? J Bone Joint Surg. 2010;92:835–41.\nSimunovic N, Devereaux PJ, Sprague S, Guyatt GH, Schemitsch E, Debeer J, et al. Effect of early surgery after hip fracture on mortality and complications: systematic review and metaanalysis. CMAJ. 2010;182:1609–16.\nNational Institute for Health and Care Excellence (NICE). Hip fracture: the management of hip fracture in adults. 2014. https://www.nice.org.uk/Guidance/CG124. Accessed 5 Jan 2017.\nAssociation of Ambulance Chief Executives & Joint Royal Colleges Ambulance Liaison Committee. UK Ambulance Services Clinical Practice Guidelines 2013. Class Publishing, Bridgwater.\nHoldgate A, Shepherd SA, Huckson S. Patterns of analgesia for fractured neck of femur in Australian emergency departments. Emerg Med Australas. 2010;22:3–8.\nMcEachin CC, McDermott JT, Swor R. Few emergency medical services patients with lower-extremity fractures receive prehospital analgesia. Prehospital Emergency Care. 2002;6:406–10.\nSimpson PM, Bendall JC, Tiedemann A, Lord SR, Close JC. Provision of out-of-hospital analgesia to older fallers with suspected fractures: above par, but opportunities for improvement exist. Acad Emerg Med. 2013;20:761–8.\nVassiliadis J, Hitos K, Hill CT. Factors influencing prehospital and emergency department analgesia administration to patients with femoral neck fractures. Emerg Med (Fremantle). 2002;14:261–6.\nAronsson K, Bjorkdahl I, Wireklint SB. Prehospital emergency care for patients with suspected hip fractures after falling—older patients’ experiences. J Clin Nurs. 2014;23:3115–23.\nChau DL, Walker V, Pai L, Cho LM. Opiates and elderly: use and side effects. Clin Interv Aging. 2008;3:273–8.\nRainer TH, Jacobs P, Ng YC, Cheung NK, Tam M, Lam PKW, et al. Cost effectiveness analysis of intravenous ketorolac and morphine for treating pain after limb injury: double blind randomised controlled trial. BMJ. 2000;321:1247–51.\nDalens B, Vanneuville G, Tanguy A. Comparison of the fascia iliaca compartment block with the 3-in-1 block in children. Anesth Analg. 1989;69:705–13.\nLees D, Harrison WD, Ankers T, A’Court J, Marriott A, Shipsey D, et al. Fascia iliaca compartment block for hip fractures: experience of integrating a new protocol across two hospital sites. Eur J Emerg Med. 2014. doi:10.1097/MEJ.0000000000000167.\nAbout-Setta AM, Beaupre LA, Rashiq S, Dryden DM, Hamm MP, Sadowski CA, et al. Comparative effectiveness of pain management interventions for hip fracture: a systematic review. Ann Intern Med. 2011;155:234–45.\nGodoy Monzon D, Vazquez J, Jauregui JR, Iserson KV. Pain treatment in post-traumatic hip fracture in the elderly: regional block vs. systemic non-steroidal analgesics. Int J Emerg Med. 2010;3:321–5.\nHogh A, Dremstrup L, Jensen SS, Lindholt J. Fascia iliaca compartment block performed by junior registrars as a supplement to pre-operative analgesia for patients with hip fracture. StratTraum Limb Recon. 2008;3:65–70.\nMouzopoulos G, Vasiliadis G, Lasanianos N, Nikolaras G, Morakis E, Kaminaris M. Fascia iliaca block prophylaxis for hip fracture patients at risk for delirium: a randomized placebo controlled study. J Orthop Traumatol. 2009;10:127–33.\nObideyi A, Srikantharajah I, Grigg L, Randall A. Nurse administered fascia iliaca compartment block for pre-operative pain relief in adult fractured neck of femur. Acute Pain. 2008;10:145–9.\nRandall A, Grigg L, Obideyi A, Srikantharajah I. Fascia iliaca compartment block: a nurse-led initiative for preoperative pain management in patients with a fractured neck of femur. J Orthop Nurs. 2008;12:69–74.\nRashid A, Beswick E, Fitton L, Galitzine S. Regional analgesia in the emergency department for hip fractures: survey of current UK practice and its impact on developing the service in a teaching hospital: 8AP4-5. Eur J Anaesthesiol. 2012;29:125.\nRawal N, Allvin R. Acute pain services in Europe: a 17-nation survey of 105 hospitals. The EuroPain Acute Pain Working Party. Eur J Anaesthesiol. 1998;15:354–63.\nAssociation of Anaesthetists of Great Britain and Ireland. Fascia Iliaca Blocks and Non-Physician Practitioners. London: AAGNI; 2013. http://www.aagbi.org/sites/default/files/Fascia%20Ilaica%20statement%2022JAN2013.pdf. Accessed 5 Jan 2017.\nDochez E, van Geffen GJ, Bruhn J, Hoogerwerf N, van de Pas H, Scheffer G. Prehospital administered fascia iliaca compartment block by emergency medical service nurses, a feasibility study. Scand J Trauma Resusc Emerg Med. 2014;22:38.\nMcRae PJ, Bendall JC, Madigan V, Middleton PM. Paramedic-performed fascia iliaca compartment block for femoral fractures: a controlled trial. J Emerg Med. 2015;48:581–9.\nWolff M, Wagner MJ, Poznanski S, Schiller J, Santen S. Not another boring lecture: engaging learners with active learning techniques. J Emerg Med. 2015;48:85–93.\nGeneral Medical Council. Good practice in Research and Consent to Research. London: GMC; 2010. http://www.gmcuk.org/Good_practice_in_research_and_consent_to_research.pdf_58834843.pdf. Accessed 5 Jan 2017.\nSnooks H, Cheung WY, Close J, Dale J, Gaze S, Humphreys I, et al. Support and Assessment for Fall Emergency Referrals (SAFER 1) trial protocol. Computerised on-scene decision support for emergency ambulance staff to assess and plan care for older people who have fallen: evaluation of costs and benefits using a pragmatic cluster randomised trial. BMC Emerg Med. 2010;10:2.\nSnooks H, Anthony R, Chatters R, Cheung WY, Dale J, Donohoe R, et al. Support and assessment for fall emergency referrals (SAFER 2) research protocol: cluster randomised trial of the clinical and cost effectiveness of new protocols for emergency ambulance paramedics to assess and refer to appropriate community-based care. BMJ Open. 2012;2:e002169.\nPerkins GD, Lall R, Quinn T, Deakin CD, Cooke MW, Horton J, et al. Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised controlled trial. Lancet. 2015;385(9972):947–55.\nHurst NP, Ruta DA and Kind P. Comparison of the MOS short form-12 (SF12) health status questionnaire with the SF36 in patients with rheumatoid arthritis. Br J Rheumatol. 1998;37(8):862–9.\nCollen FM, Wade DT, Robb GF, Bradshaw CM. The Rivermead Mobility Index: a further development of the Rivermead Motor Assessment. Int Disabil Stud. 1991;13(2):50–4.\nPaice JA, Cohen FL. Validity of a verbally administered numeric rating scale to measure cancer pain intensity. Cancer Nurs. 1997;20(2):88–93.\nCarey RG, Seibert JH. A patient survey system to measure quality improvement: questionnaire reliability and validity. Med Care. 1993;31:834–45.\nBarbour RS. Checklists for improving rigour in qualitative research: a case of the tail wagging the dog? BMJ. 2001;322:1115.\nhttps://www.elsevier.com/solutions/InferMed/edc-in-clinical-research. Accessed 5 Jan 2017.\nCharlesworth G, Burnell K, Hoe J, Orrell M, Russell I. Acceptance checklist for clinical effectiveness pilot trials: a systematic approach. BMC Med Res Methodol. 2013;13:78.\nSchulz KF, Altman DG, Moher D, CONSORT Group. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. PLoS Med. 2010;7(3):e1000251.\nMarshall C, Rossman G. Designing qualitative research. 5th ed. Los Angeles: Sage; 2011.\nZiebland S, McPherson A. Making sense of qualitative data analysis: an introduction with illustrations from DIPEx (personal experiences of health and illness). Med Educ. 2006;40:405–14.\nMiles MB, Huberman AM. Qualitative data analysis: an expanded sourcebook 2nd ed. London: Sage; 1994.\nEvans BA, Bedson E, Bell P, Hutchings H, Lowes L, Rea D, et al. Involving service users in trials: developing a standard operating procedure. Trials. 2013;14:219.\nINVOLVE. Briefing notes for researchers: involving the public in NHS, public health and social care research. Eastleigh: INVOLVE; 2012.\nThe Health and Care Research Wales, part of the Welsh Government, has funded RAPID through their Research for Patient and Public Benefit (RfPPB) stream (1003).\nAvailability of data and materials\nData sharing not applicable to this article as no datasets have yet been generated or analysed during the current feasibility study.\nJKB and ACS drafted the manuscript with editorial input from all the authors. NR, IP and SF conceived and developed the research with methodological advice from GF, HAS and ITR. All authors read and approved the final manuscript.\nJKB is a junior doctor and research officer at Swansea University, who is undertaking a PhD about prehospital analgesia for patients with hip fracture. ACS, BAE and AK are research officers at Swansea University. JKB and ACS are the trial managers for RAPID, with AK providing the maternity leave cover for JKB. AB and SJ represent the lay representatives on the Trial Management Group. GF is a professor of clinical trials and director of Swansea Trials Unit. SF is a consultant anaesthetist in Swansea. KG is a consultant of emergency medicine in Swansea. IP is a professor of trauma and orthopaedics in Swansea. NR is the head of research and innovation for the Welsh Ambulance Services NHS Trust and chief investigator for RAPID. LK is the paramedic research support officer for RAPID. ITR is an emeritus professor of clinical trials at Swansea University. HAS is a professor of Health Services Research at Swansea University.\nThe authors declare that they have no competing interests.\nThe Wales Research Ethics Committee 6 granted ethical approval (reference 15/WA/0439).\nAbout this article\nCite this article\nBulger, J.K., Brown, A., Evans, B.A. et al. Rapid analgesia for prehospital hip disruption (RAPID): protocol for feasibility study of randomised controlled trial. Pilot Feasibility Stud 3, 8 (2017) doi:10.1186/s40814-016-0115-6\n- Hip fracture\n- Fractured neck of femur |
Greetings on this fantastic Fall day! The colors in Virginia are in full swing and we are taking it in as much as we can.\nOn Friday, we had an appointment with Asher's heart and lung doctors - the first since July. They were amazed again at his progress, and his sweet smiles and spunk through the exams. They were also able to get a very thorough echocardiogram (ultrasound) of his heart, as he zoned out watching Elmo on the big screen in front of him. This echo was able to show us something that previous ones had not, and made it much easier for our cardiologist to advise us against Asher's need for heart surgery! That may not sound like great news, but let me explain. The ultrasound was able to show us, by measuring pressures and seeing the blood flow through the pulmonary valve in the heart, that the two holes in Asher's heart are actually releasing pressure on his underdeveloped lungs, and allowing him to stay alive and grow! In a way, those holes are the reason he is still with us!\nThis brings us great joy because it means the decision has (for now) been made for us and we do not need to risk using general anesthesia for surgery! We are, however, considering a procedure under conscious sedation and local anesthesia or epidural whereby a g-tube could be placed in his stomach. This would give him the ability to take in real (blenderized) foods instead of formula and the like, which are hard on his system. He wouldn't need his NG feeding tube (through his nose) any more, which might help his oral feeding skills, and the new tube wouldn't come out as easily as the current one does. There would still be risk, but not nearly as much as there was with the heart catheterization or repair that we thought we would need before. More to come on this issue, just wanted to let you know how you can be praying.\n|Asher's Baptism, October 25, 2014|\n|At his appointment this week| |
I'm not sure what 2vo refers to, but I've done quite a few surgeries on\nrats. However, the best person to consult in the matter would be a\nVeterinary Technician or a Veterinarian if you have access to one.\nRats should be able to push themselves up (and have control over their body\ntemperature) about 4-5 hours after the last dose of anesthesia. And 5-10ml\nof Lactated Ringer's saline (0.9% NaCl) is also typical.\nIf your rats aren't waking up at all, some things to consider in your case\n-Are the rats receiving the correct dose of anesthesia before surgery\n(should be about 40-80mg/kg Ketamine with 5-10mg/kg Xylazine)?\n-And if your surgery lasts more than an hour, are they receiving the correct\nmaintainance doses (maintanance doses are lower, usually the inital volume\nmultiplied by about 0.38)?\n-Are they kept warm (but not too warm) during the surgery?\n-Are the rats bleeding a lot during your surgery, and is the bleeding\nstopped before the end of surgery?\nHope this helps,\nOn Wed, Dec 16, 2009 at 7:56 AM, saif <saif_saad83 from hotmail.com> wrote:\n> Dear sir,\n> im using ketamine/xylazine for 2vo surgery in male sprogue dawely rat, I\n> lose a lot of my rats post-operatively, the problem how much time dose the\n> rat require to have adequate temperature(isnt it within 4-5 hours\n> postoperatively), and about the fluid supplement is recommended to give all\n> the rats 10 ml normal saline.\n> dr.saif master researcher.\n> thank you\n> Neur-sci mailing list\n>Neur-sci from net.bio.net>http://www.bio.net/biomail/listinfo/neur-sci> |
Description of the procedure\nRadical prostatectomy is a surgical procedure to remove the prostate gland and some of the tissue around it. Radical prostatectomy is used to treat prostate cancer. An urologist performs this procedure in a hospital or clinic.\nWhen should this procedure be performed?\nYour doctor will recommend this procedure when required.\nWhy is this procedure performed?\nThe procedure is performed to treat prostate cancer. It is usually used when prostate cancer has not yet spread through the body and the man is otherwise in good health.\nAre there any risks and precautions?\nCertain risks are common to all surgery and anesthesia. These risks depend on many factors, including the type of surgery and your own medical condition. The possible, but very rare, side effects include reactions to the anesthesia, breathing problems, infection, bleeding, scarring, and death.\nAlthough radical prostatectomy is generally considered safe, it does have some risk of side effects or complications. These include:\n- lack of bladder control (also called urinary incontinence)\n- decreased ability to hold your urine flow with increased pressure, such as when you sneeze, cough, or laugh (also called stress incontinence)\n- loss of control of bowel movements (also called fecal incontinence)\n- erectile dysfunction (problems getting or keeping an erection) due to nerve damage\n- damage to nearby organs (such as the rectum)\nIf you are concerned about any symptoms following this procedure, speak to your doctor. Take the time to be sure you understand all the risks of complications and side effects as well as any precautions you or your doctor can take to avoid them. Be sure your doctor understands all your concerns.\nWhat happens during the procedure?\nThis procedure is usually done with general anesthesia so you won't be awake. After the anesthesia is given, the doctor makes an incision from the top of the pubic bone to the navel. Some men may have the surgery performed laparoscopically (a few small incisions are made in the abdomen and a thin tube with a camera on the end allows the surgeon to see inside the abdomen). For some surgeries, the surgeon may use robotic arms in order to produce more accurate and precise movements.\nOther instruments are inserted into the small incisions to perform the surgery. The prostate gland and surrounding tissue (seminal vesicles and part of the urethra) are removed. Sometimes, a small sample of tissue from the lymph nodes in the region is taken and checked for cancer before removing the prostate. If the lymph nodes have no cancer, then the prostate gland is removed.\nIn some situations, the surgeon may be able to save the nerves around the prostate to reduce the risk of the man being unable to have erections after the surgery. Because the urethra (the tube through which urine passes out of the body) is cut during the procedure, it must later be attached directly to the bladder.\nAnother less common approach for surgery is to make an incision between the anus and the scrotum, an area called the perineum. There is less bleeding with this approach, but there is a higher risk of rectal injury. As well, if any lymph nodes need to be removed, a second incision will be necessary.\nHow should I prepare for this procedure?\nBefore having this procedure, discuss the advantages, disadvantages, long-term risks, and consequences associated with the procedure with your doctor. Be sure you fully understand what will happen and are comfortable with your doctor's answers to your questions.\nYou may need blood tests several days or weeks before the surgery. Your doctor may also order a complete physical exam. To clear your colon before the procedure, your doctor may ask you to take a laxative the night before or use an enema the morning you go to the hospital.\nRecovery time is often faster for people who exercise regularly. You can speed up the healing process by not smoking and losing weight, if necessary, before the procedure. Your doctor may also recommend that you do Kegel exercises to strengthen your pelvic muscles to help with recovery.\nTell your doctor about all prescription, over-the-counter (non-prescription), dietary supplements, and herbal medications that you are taking. Also tell them about any medication allergies and medical conditions that you may have.\nDo not eat or drink anything after midnight the night before your surgery. . If your doctor has recommended different times, follow the timing recommended by your doctor.\nTell your doctor about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any medication allergies and medical conditions that you may have.\nAsk your doctor or pharmacist whether you need to stop taking any of your medications before the procedure.\nArrange for someone to drive you home from the hospital.\nWhat can I expect after the procedure?\nThe surgery will take 2 to 4 hours. Staying at the hospital for 1 to 4 days after the procedure is normal. Your hospital stay may be shorter if you had laparoscopic or robot-assisted surgery. Pain medication will help you if you are uncomfortable or in any pain.\nWhen you wake up from the surgery, you will probably have a catheter in your penis to drain urine from the bladder. Having the catheter is normal; however, it may be uncomfortable because it may make you feel as though you need to urinate. The catheter usually remains in place for about 1 to 3 weeks after you return home from the surgery.\nOver time (usually 3 to 6 months), most men regain their bladder control through the use of Kegel exercises. These exercises help build the muscles on the pelvic floor that make it possible to control urination. Your doctor will recommend that you avoid strenuous exercise and heaving lifting for about 4 to 6 weeks after the surgery.\nIt generally takes men 4 to 6 weeks to recover from the surgery.\nYour doctor will usually wait 6 to 8 weeks after the surgery before testing your prostate specific antigen (PSA) levels (a prostate cancer screening test). Ask your doctor how often this test should be repeated for you.\nMost, if not all, men notice a loss in their ability to get or keep erections. This is normal and may go away depending on your age, overall health before the procedure, and type and extent of surgery. Also, if no nerves were damaged during the procedure, you are less likely to experience problems related to sexual function.\nTalk to your doctor about treatment options and what to expect.\nAll material copyright MediResource Inc. 1996 – 2019. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/procedure/getprocedure/Radical-Prostatectomy |
Is it normal to have hair loss after gastric bypass surgery?\n50% of patients mentioned that they have experienced hair loss after bariatric surgery. Hair can be supported by protein and biotin. Your hair will be back in its usual form in 3 to 6 months.\nNose job, with general or local anesthesia, usually takes around one or two hours and it is advised to be in touch with doctors after the operation. Bruises and swelling will be observed for one to two weeks. The stabilizing plaster should not be in contact with water for a while and bandages should not be stained by makeup. These operations are easy and can be made for a low cost. Even nose job prices differ from doctor to doctor; there is a specific price along the sector. |
Department / Division\nAnesthesiology / Anesthesiology-Pain Division\nDurham, NC 27710\nGeneral anesthesiology, chronic pain, ambulatory anesthesia for cosmetic surgery\nAnalgesic tolerance or habituation has long been the limiting factor in the use of narcotics as an adjuvant in treatment of chronic pain situations. Several investigators have studied the causes for tolerance development in the animal. Only Contreras, et al presented clinically useful information in their study using the mouse model when they proposed that calcium channel blockers may be useful in antagonizing morphine tolerance. Although analgesic tolerance (loss of pain relieving ability) has been well established in using the animal model, few studies have been done using human subjects. In our institution, it has been suggested that analgesic tolerance to the narcotic fentanyl can occur in humans after four hours or less of continuous infusion. The purposes of this prospective crossover study on human volunteers are to document the occurrence of acute tolerance to narcotics in four hours or less during a continuous infusion and to investigate whether Contreras' findings of reversing narcotic tolerance with calcium channel blockers are reproducible in the human. These results could significantly affect management of chronic and acute pain where the use of narcotics is unavoidable. Narcotic response will be tested by experimentally induced pain using the submaximal tourniquet test.\nThis faculty member has no reported relationships with industry. |
Dr Hilary Brown\n- FRACGP, MBBS, Prof Dip Skin Cancer Medicine, Adv Cert Primary Care Skin Cancer Medicine\nBook your full-body skin check now\nSkin Cancer Doctor at Coorparoo Skin Cancer Centre\nB.Pharm, MBBS, FRACGP\nDr Monisha Lalji is a general practitioner with a special interest in skin cancer medicine. Having previously worked as a GP Skin Specialist, she has extensive procedural skills in skin-related treatments such as surgical excisions, suturing, skin biopsies, digital nerve blocks, and cryotherapy. Dr Lalji is also the author of several journal publications. She looks forward to welcoming you to Coorparoo Skin Cancer Centre for friendly and thorough management of your skin health.\nDr James Millsom |
The Podiatric Resident Training Program at McLaren Oakland is fully approved by the Council on Podiatric Medical Education as a Podiatric Medical and Surgical Residency program of 36 months duration (PM&S-36).\nThe emphasis of this program is to give exposure and training in the full scope of podiatric medicine and surgery. This includes educational experiences in general podiatry, geriatrics, diabetes and wound management, biomechanics and surgery.\nThe first year of training covers a broad range of general medical and surgical rotations, including podiatric office time and surgery. There are rotations in internal medicine, infectious disease, emergency medicine, medical imaging, general surgery (including subspecialty in vascular surgery, anesthesia, and pathology. The second year of training provides additional rotations in orthopedic surgery, behavioral science and podiatric office time and surgery. There are elective rotations in neurology, dermatology and rheumatology.\nResidents participate in an ongoing Hospital Foot Clinic at McLaren Oakland staffed by four (4) podiatric surgeons, Journal Club program, the "on-line" lecture program, the McLaren Oakland podiatric lecture series and other local educational opportunities.\nGraduates of the McLaren Oakland program are prepared for the Board Qualification examination by the ABPS and ABPOPPM, and are fully prepared for podiatric practice. |
And whether you know...\nThe anesthesia, or the general anesthesia is the artificially caused condition of the central nervous system which is reversible at which there is a loss of control over some reflexes, relaxation of skeletal muscles, anesthesia, amnesia, a dream and a loss of consciousness. This state comes at administration of several or one anesthetics which optimum combination and a dose is selected individually the anesthesiologist taking into account specific features of the patient, and also depending on medical procedure.\nMain goal of an anesthesia is delay of reaction when carrying out an operative measure, first of all for blocking of pain. Medication sleep which usually is associated with this concept is only its compound component. Considerable decrease or full suppression of expressiveness of vegetative reactions of a human body to a surgical injury is also important at an anesthesia. It is characterized by the increased arterial pressure, and also other phenomena taking place at the switched-off consciousness. This suppression of reactions is called an analgesia or anesthesia. There is also the third component of an anesthesia – relaxations of muscles, or muscle relaxation that is necessary for ensuring work of surgeons.\nThe main priority of an anesthesia is pain and fight against pain: if there is no pain, there will be no start of physiological mechanisms also. Thus, the main protection of the anesthesiologist is prevention of such succession of events.\nThe concept "anaesthesia" is understood as only the general anesthesia. In case of local suppression of pain, speak about "local anesthesia" or "local anesthesia". Thus, characteristic feature of an anesthesia is switching off of consciousness therefore "anesthesia" and "anesthesia" have absolutely different values.\nThe first anesthetizing drugs were made already long ago when for these purposes various plants were used: henbane, hemp, opium, etc. Such drugs were used in the form of broths, infusions or sleepy sponges. The last represented sponges which impregnated with juice of certain plants and set fire then patients breathed their smoke.\nTypes of an anesthesia:\n- Parenteral (intramuscular, intravenous, rectal and so forth)\n- Combined (consecutive use of drugs, and also ways of their introduction).\nAlso distinguish an anesthesia with spontaneous breath, that is with independent, and an anesthesia with artificial ventilation of the lungs. The last is combined, as a rule, with a trachea intubation – introduction of a special tube to respiratory tracts after backfilling of the patient, and also with other methods which provide an opportunity to blow oxygen, air or gas mixes to the patient into lungs with use of a special bag or the medical ventilation apparatus.\nCurrent of an anesthesia\nThe current of an anesthesia means several stages, each of which is characterized by the features and involvement in process of braking of some structures back and a brain.\nAt the first analgetic stage there is a condition of the expressed devocalization. Pulse becomes frequent, breath rhythmical and deep, eyeballs move randomly, the tone of muscles is a little raised, reflexes remain kept, pain disappears or becomes dull. The analgesia develops as a result of switching off of the centers of sensitivity of pain in visual hillocks and trunk part of a reticular formation, and activity of a cerebral cortex increases.\nAt continuation of introduction of means there comes deepening of its effect therefore there comes the following stage – motive excitement which is characterized by chaotic reduction of extremities, increase of a tone of skeletal muscles, nekordinirovanny movements in space and attempts to rise, pulse and breath continue to remain uniform, the blood pressure raises, the pupil extends, and eyeballs "wander", there is often a swallowing, secretion stalemate, bronchial, the lacrimal and sialadens amplifies. There is a deepening of an analgesia. Fibrillation of ventricles of heart, a reflex apnoea, vomiting, an urination, and even death are possible.\nFurther there comes the stage of a surgical anesthesia. It is divided into 4 levels in anesthesiology:\n- The superficial anesthesia at which there is a total disappearance of tactile and painful sensitivity, narrowing of pupils, pulse increase stabilization of a blood pressure, breath remains deep, rhythmical, begins to snore a little as a result of relaxation of phonatory bands.\n- For an easy anesthesia relaxation of skeletal muscles is peculiar, pulse and breath remain rhythmical, and the anesthesiologist can give to the surgeon a signal of a possibility of the beginning of superficial operation.\n- At a full anesthesia breath still remains superficial and equal, pulse and a blood pressure decrease a little. Reflexes and cavities and body surfaces are not shown, but the centers of blood circulation and breath work normally, pupils begin to extend. Weakening of reflexes of a rectum and bladder, loss of language, and also asphyxia if it is not recorded, because of closing with language of passing to an air throat is possible.\n- The state on the verge of life and death can arise in case of approach of a deep anesthesia. The blood pressure strongly decreases, as well as pulse which becomes weak, small filling. Breath is tolchkoobrazny, superficial, phrenic. Cyanosis of mucous is observed, there are no manifestations of eyeglobes, the pupil extends, and the cornea becomes dry.\nControl of a state during an anesthesia\nContinuous check of pulse, content of oxygen in blood, the arterial pressure which changes automatically is necessary for successful control of a condition of the patient during an anesthesia or manually in the direct and indirect ways, the ECG, temperature of a surface and "kernel" of a body, gases in blood, diuresis speed, an acid-base state and electrolytic structure continuously is registered.\nSpecial devices support an inhalation anesthesia at the necessary level. It is possible to distinguish rotameters, evaporators which give the chance precisely to define and regulate concentration of gaseous means and vapors of the liquid anesthetics used an anesthesia in respiratory mix from such devices. Besides, these devices allow to control parameters of artificial ventilation of the lungs, and modern devices – even concentration of gases in the exhaled and inhaled air.\nAbsolute contraindications for an anesthesia are the following states:\n- Acute drug or alcoholic intoxication;\n- State after disturbance of blood circulation or a heart attack before half a year;\n- Acute form of asthma;\n- Disturbances of a cordial rhythm;\n- Heavy pathologies of endocrine system and internals, generally dekompensirovanny;\n- Existence of the diseases depending on hormones.\nThe anesthesiologist is the specialist doctor who is carrying out an anesthesia. He ensures safety of life, constantly and continuously monitors work of all bodies and functions of an organism, reacts to the arising changes. The limit trust to the anesthesiologist and implementation of all its recommendations is guarantee of successful course of an anesthesia on which also the result of the operation, and also safety of life in many respects depends. |
Notes - notes.io\nContent by-Rossi Patton\nHernia surgical procedure is done to fix a hernia, a bulging inner body organ. There are 2 kinds of Hernia repair work surgery. The very first type entails repairing the bulge itself. The second kind involves fixing the issue with a mesh-like tool. Both types have advantages as well as drawbacks.\nIn both cases, a slim, telescope-like instrument is inserted into the abdomen via a tiny incision near the Hernia. The doctor after that utilizes an electronic camera and also mesh to repair the Hernia. The recovery time is less than for open surgery, but it depends on the kind of Hernia, exactly how huge it is, as well as exactly how it influences an individual's overall health and wellness and way of living.\nThe majority of clients will totally recoup within a week, and are able to go back to function as well as a few other tasks. Nevertheless, they may be restricted from heavy lifting or pulling for a minimum of three weeks. Patients must ask their cosmetic surgeon prior to driving or doing other sturdy activities. If you are a heavy lifter, the stitches and staples may hinder your capacity to do so.\nHow Long Does Umbilical Hernia Surgery Take\nRuptures are a typical issue that calls for therapy. If left untreated, they may not heal as well as might lead to a harmful problem called strangulation. When this occurs, blood flow to the herniated tissue will be slowed down or cut off, which can create major injury.\nHow Long Does Hiatal Hernia Surgery Take\nHernia surgical treatment can be done under neighborhood or basic anesthetic. General anesthetic makes the person totally unconscious, yet spine and also local anesthesia allow the client to continue to be conscious and also sharp during the treatment. A small cut will be made at the website of the Hernia, and a tiny electronic camera will certainly be inserted right into the incision. During this process, the specialist will push the Hernia back into its appropriate position. Later, he will staple the medical mesh to the Hernia website. After the surgery, the individual will likely experience some pain, yet this must vanish after a few days.\nHow Much Is Hernia Surgery With Insurance\nMinimally invasive Hernia surgical treatment will allow clients to go residence the day of the procedure, as well as some might even walk the night after the surgical procedure. Nevertheless, much more intricate surgical treatments, involving rebuilding the stomach wall, might call for the patient to remain in the medical facility for numerous days. Patients must work out gently as well as refrain from lifting heavy items for the very first couple of weeks.\nWhile both types of Hernia repair service have their advantages, it is very important to select the best one for your case. It's ideal to review your alternatives with your cosmetic surgeon prior to determining which one is finest for you. A surgeon who specializes in Hernia repair work will certainly be able to use you the very best options.\nLaparoscopic surgical procedure needs general anesthesia as well as utilizes numerous little lacerations in the abdominal wall. The doctor utilizes a lighted scope to view the within the body. https://raindrop.io/iskandarcenter/the-iskandar-complex-hernia-center-19286124 of Hernia fixing might cause much less postoperative pain as well as scarring. Contrasted to open surgical procedure, a laparoscopic procedure might additionally take much less time and also allow the patient to go back to normal tasks quicker.\nLaparoscopic surgical procedure is the most typical kind of Hernia fixing. It uses just three to 4 tiny cuts in the abdominal wall to repair a hernia. It is typically executed on large ruptures that have currently established in the abdominal wall. Nevertheless, this method is except everybody. Additionally, it may not be suitable for patients with adhesions or who have undertaken other stomach surgical procedures.\nAn extensive Hernia center examines each person's instance and figures out one of the most reliable therapy plan for each person. Depending upon the dimension and extent of the Hernia, a medical professional will certainly make use of one or more of the following methods. Then, a surgical mesh will certainly be utilized to shut the hole and also avoid the bulge from persisting.\nHernia Surgery 6 Year Old is an additional typical type of Hernia that may call for surgical procedure. The abdominal wall comes to be weak and also a lump or sac of fat or intestine pushes out. It can likewise be triggered by previous surgical treatment. If this is the case, the cosmetic surgeon may suggest an open Hernia surgical procedure. However, this kind of Hernia surgery will certainly require even more time to recuperate.\nIncisional ruptures are brought on by a medical cut or a mark cells from an earlier procedure. They are frequently excruciating and unpleasant. They do not heal by themselves as well as can cause various other potentially unsafe complications. Surgical repair service is often the only alternative.\nNotes.io is a web-based application for taking notes. You can take your notes and share with others people. If you like taking long notes, notes.io is designed for you. To date, over 8,000,000,000 notes created and continuing...\n- * You can take a note from anywhere and any device with internet connection.\n- * You can share the notes in social platforms (YouTube, Facebook, Twitter, instagram etc.).\n- * You can quickly share your contents without website, blog and e-mail.\n- * You don't need to create any Account to share a note. As you wish you can use quick, easy and best shortened notes with sms, websites, e-mail, or messaging services (WhatsApp, iMessage, Telegram, Signal).\n- * Notes.io has fabulous infrastructure design for a short link and allows you to share the note as an easy and understandable link.\nFast: Notes.io is built for speed and performance. You can take a notes quickly and browse your archive.\nEasy: Notes.io doesn’t require installation. Just write and share note!\nShort: Notes.io’s url just 8 character. You’ll get shorten link of your note when you want to share. (Ex: notes.io/q )\nFree: Notes.io works for 12 years and has been free since the day it was started.\nYou immediately create your first note and start sharing with the ones you wish. If you want to contact us, you can use the following communication channels;\nEmail: [email protected] |
What Is Eyelid Aesthetics?\nAlthough the cause of sagging eyelids is not exactly known, possible causes include genetic transition factors, gravity, and age phenomenon. As a result of severe sagging eyelids, you may experience a lack of vision, you may have a sleepy – sad – angry appearance. Eyelid surgery is divided into lower and upper eyelid surgery. After providing eyelid aesthetics, it will support you to look younger. In addition, your sleepy, angry, sad images of your general facial expression will also disappear. Eyelid plastic surgery called blepharoplasty provides interference with excess skin, novelties and adipose tissues in your eyelid.\nIn the following years, with the age factor, the eyelids stretch, and your muscle groups that move your eyelids may remain more force. As a result, excessive fat accumulations are collected in both the lower and upper areas of the eyelids. In this case, bags are also observed. Sagging eyelids can result in an older image than you are, narrowing your angle of view. Blepharoplasty can fix all your possible problems and make you look younger. In addition, With Eyelid Surgery, which can be combined with eyebrow lift and face lift operations, you can support you to look much younger in a single operation.\nHow Is Eyelid Aesthetics Performed?\nEyelid Aesthetics Risks\nThe risk of infection is rare in the eyelids. The risk of bleeding under the skin of the eyes is normal. At the same time, bruising may occur in the eye. In other words, these are the risks encountered in all eyelid operations. If there is bleeding in operations where the eye bags have been removed, and this bleeding puts pressure on the optic nerve behind the eye, this can even lead to vision defects. It can even lead to blindness. It is a very rare complication. A common complication is the complication of having a downward pull on the lower eyelid. This possibility occurs especially in patients who have undergone surgery for the second time. The reason for the occurrence of this complication is that the eye area has been removed too much. For the solution of this problem, the deficiencies must be placed in a deep place for treatment, so the procedure to remove another one from the upper eyelid can be applied during eye aesthetics surgery, there is also a possibility of damage to the transparent layer of the eye.\nEyelid aesthetics surgery is performed in the form of general anesthesia or local anesthesia. Eye aesthetics surgery must be performed in a hospital where all technological equipment is provided. The duration of the operation lasts approximately 1 to 3 hours. At the same time, the duration of the operation differs depending on the procedure to be performed. There is no hospitalization period. The patient can be discharged the same day.\nRecovery Process After Surgery\nMost patients complete the healing process within 10-14 days. However, full recovery can take several months. After eyelid surgery, the shape of the eyelids appears as the swelling and bruises disappear; the face becomes more vigorous and youthful.\nAfter surgery, a small amount of pain may occur in the patient due to a decrease in the effect of anesthesia. These pains can be relieved with the use of pain medication. But it is absolutely not recommended for the patient to make hard touches to the patient’s eyes and rub their eyes during the 24 hours after the operation.\nDressings that do not interfere with the patient’s vision are removed by the doctor four or five days after surgery. It is necessary to be careful when sleeping for three nights following surgery and position the pillow at an angle of 30 to 40 degrees. The reason for this is to ensure that bruises and swelling that occur in the area where the application is made can be kept under control.\nAccording to the information provided by the doctor, a cold compress of the eye should be performed for one or two days after the operation. In this way, bruises and swelling can improve faster depending on the operation. |
Dr. Ellen Jantzen is an anesthesiologist practicing in Philadelphia, PA. Dr. Jantzen ensures the safety of patients who are about to undergo surgery. Anestesiologists specialize in general anesthesia, which will (put the patient to sleep), sedation, which will calm the patient or make him or her unaware of the situation, and regional anesthesia, which just numbs a specific part of the body. As an anesthesiologist, Dr. Jantzen also might help manage pain after an operation.\nDr. Jantzen’s career in medicine began in 1977, when he graduated with his Medical Degree from the Harvard Med Sch, Boston Ma . After medical school, Ellen C Jantzen M.D. completed residency at Univ Of Pa Hlth System, Anesthesiology; Children’S Hosp-Philadelphia, Pediatrics; Stanford Univ Hosp, Pediatrics. Dr. Jantzen is board certified in Anesthesiology by the American Board of Anesthesiology. Ellen C Jantzen M.D. currently provides care to patients at 34th Street & Civic Center Blvd, Philadelphia, PA 19104.\nView Ellen C Jantzen M.D.’s Profile Here:\nEach month, millions of patients use FindaTopDoc to find a doctor nearby and instantly request an appointment online or create a review. To book your visit with Dr. Jantzen, simply click “Request Appointment”.\nFindaTopDoc is a digital health information company that helps connect patients with local physicians and specialists who accept your insurance. Our goal is to help guide on your journey towards optimal health by providing you with the know how to make informed decisions for you and your family. |
Meet Dr. Dalton\nOral Surgeon in Pittsburgh\nDr. Patrick Dalton was born and raised outside of Boston, Massachusetts and completed his undergraduate degree at the College of the Holy Cross. He received his dental degree from University of Pittsburgh‘s School of Dental Medicine in 2008. Following dental school, he completed a residency in Oral and Maxillofacial surgery at Allegheny General Hospital in Pittsburgh. Here, he received extensive training in medicine and surgery, anesthesia, and oral maxillofacial surgery.\nAfter residency, he completed an intensive one-year surgical fellowship focused on complex craniofacial, orthognathic, and temporomandibular joint surgery at Advanced Facial and Oral Surgery in Texas under the direction of Dr. Douglas Sinn. While in Dallas, Dr. Dalton taught as a Clinical Assistant Professor with the Department of Surgery at UT Southwestern/Parkland Medical Center, and was involved with teaching and supervising Oral Surgery residents in training.\nDr. Dalton is board certified in Oral and Maxillofacial surgery and was recognized as a Diplomate by the American Board of Oral and Maxillofacial Surgery in March of 2014. He is a Fellow of the American Association of Oral and Maxillofacial Surgeons as well as a member of the Pennsylvania Society of Oral Maxillofacial Surgeons.\nDr. Dalton enjoys both the clinical and academic aspects of surgery. He practices in Mt. Lebanon and Pittsburgh, where he is an attending surgeon within the Division of Oral and Maxillofacial Surgery at Allegheny General Hospital and is actively involved in the direction of resident education and management of patients. His practice is limited to Oral and Maxillofacial surgery, and focuses on the disciplines of ambulatory parenteral anesthesia administration, third molar (wisdom tooth) removal, dental implantology, facial trauma and reconstructive surgery, orthognathic jaw surgery, and temporomandibular joint surgery. Dr. Dalton holds staff privileges at Allegheny General Hospital, Forbes Regional Hospital, St. Clair Hospital.\nDr. Dalton is married and resides in the North Hills with his wife Jenn, their two children, and their Vizsla, Casey.\nWe are currently accepting new patients and would love to help you take your smile to the next level. Call Mt. Lebanon Office Phone Number 412-563-7707 or complete our Contact Form to request an appointment. |
Considering a mini surgery but a bit apprehensive about this relatively new procedure? If you’ve done any research, we’re sure you’ve checked one of the most credible plastic surgery review sites in existence – RealSelf.com. The Mini Lift procedure received an impressive 82 percent “Worth It Rating,” proving that these procedures are effective, safe and quite popular.\n“Also known as the Weekend Facelift or Quick Lift, [the] mini facelift is less expensive, with shorter incisions, and modest results,” reports RealSelf.com. Dr. Barr is one of Palm Beach’s premier “mini” surgeons, offering mini face surgery, mini neck surgery, mini cheek surgery, mini brow surgery, mini eye surgery, mini lip surgery, mini jowl surgery and mini tummy-tuck surgery. The predominant appeal of mini surgeries is that they achieve an improved and younger appearance without the patient having to undergo major surgery.\nWith the use of local anesthesia only, mini procedures can be safely performed in the office without pills, IVs or a hospital stay. Due to the limited scope of the procedures, incisions are typically much smaller than those associated with major surgery, and also result in limited bruising, swelling and recovery/down time. Go in for a mini surgery Monday and take a shower, drive to work and resume most of your normal activities Tuesday!\nFor patients who desire additional anesthesia, our adjoining hospital outpatient surgery unit is also available. Find more information about Dr. Barr’s mini procedures here. For before and after pictures of some of Dr. Barr’s mini surgery patients, click here. Call (561) 833-4122 today to schedule a consultation!\nTags: mini brow surgery, mini cheek surgery, mini eye surgery, mini face surgery, mini jowl surgery and mini tummy-tuck surgery, mini lip surgery, mini neck surgery, mini procedure, Mini Procedures, mini surgeries, mini surgery |
We offer a full range of cosmetic dentistry procedures, including dental implants, porcelain veneers, ZOOM! teeth whitening, Invisalign clear braces, same-day porcelain crowns and more. Which is the best option for creating the smile of your dreams? We’ll be happy to offer our suggestions at a free cosmetic dentistry evaluation. This no-cost, no-obligation appointment includes:\nSchedule your free cosmetic dentistry consultation today.\n(regular $1600 per tooth for 6 or more teeth)\nPorcelain veneers are the fastest, simplest way to a full smile makeover. If you’re ready to have the beautiful smile you’ve always dreamed of, contact us today to set up a free consultation.\nIf you have missing or damaged teeth, dental implants are the ideal method to restore your smile. Implants are a breakthrough solution for tooth replacement. They’re permanent, look completely natural and match the strength and durability of real teeth. For this special offer, we’ve reduced the cost of dental implants to $3500 per tooth*. Come in for a free consultation and we’ll show you the implant options and determine which is best for you (*excludes tooth extraction, if needed, and surgical guide). Make your dental implant appointment today and take advantage of these special savings.\nWith an All-on-4 implant, we can replace all your teeth with a permanent restoration that matches the appearance, strength and durability of natural teeth. The appliance is fixed in the mouth so there’s no slipping and no foods to avoid. And caring for your All-on-4 implant couldn’t be simpler: Just daily brushing and flossing like real teeth. Don’t go another day with a compromised smile or struggling with dentures that don’t meet your needs. Get in touch with us today to schedule your free All-on-4 consultation.\nStraight teeth are a crucial component of a beautiful smile. Invisalign clear braces can straighten your teeth without the discomfort and unsightly appearance of metal braces. Our special savings package means now is the time to begin your treatment. We’ll take $500 off the regular price for Invisalign, give you a free Acceledent device to cut your treatment time in half ($400 value), and provide a free take-home system for touch-ups ($300 value). Schedule your Invisalign appointment today and take advantage of this special offer.\nZOOM! teeth whitening is the fastest, easiest way to have a gleaming new smile. In a little over an hour, we can make your teeth up to seven shades brighter. You can pass the time relaxing, listening to music or watching a movie or TV show on our video screens. This popular cosmetic procedure is regularly priced at $625. Make a ZOOM! whitening appointment today and take advantage of these special savings.\nIf severe dental anxiety is keeping you from seeking the dental work you desire, we can alleviate your worries with sedation dentistry. To learn more about this life-changing form of treatment, we invite you to schedule a free no-pressure, no-obligation sedation consultation. You’ll meet our understanding and compassionate staff, who will thoroughly explain the oral sedation process. Schedule your sedation dentistry appointment today. The only thing you stand to lose is a smile that doesn’t meet your expectations.\nWe offer a no-cost, no-obligation consultation for new patients. Come tour our facility, meet our friendly staff and speak with Dr. Harrell. During this 10-15 minute visit, we will inform you about the different procedures we can assist you with, including veneers, dental implants, ZOOM! teeth whitening, sedation dentistry, Invisalign clear braces and more. Schedule your free general dentistry consultation today.\nMoving forward with treatment just got a whole lot easier. Schedule treatment without delay and fit the cost into your monthly budget with a responsible payment plan offered through our financing partners. They offer an excellent range of services and makes it much easier to handle the out-of-pocket expenses for dental healthcare. It has fast processing and usually we can get you an answer within minutes at our office.\n* Not all dental cases are the same. Some additional services, such as bone grafting or sedation, may necessitate additional fees or restrictions. |
Dr. Anne D Oakley is a female Anesthesiologist (taxonomy code 207L00000X) located in Spokane, Washington. Dr. Anne D Oakley's NPI Number is #1285647511 and has been listed in the NPI registry for 11 years. Dr. Anne D Oakley's practice location is listed as: 101 W 8Th Ave Spokane, WA 99204-2307 and can be reached via phone at (509) 474-2072.\nThe taxonomy code for Dr. Anne D Oakley'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|\n101 W 8Th Ave\nSpokane, WA 99204-2307\n|Health Care Providers Nearby| |
Melanie Thernstrom has a congenital neck-and-shoulder problem that has kept her in constant pain for the past 10 years. Pain is something you can’t stop thinking about, and Thernstrom is the kind of person who can’t stop thinking anyway. The fruit of her misery is “The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing and the Science of Suffering.”\nAs that subtitle suggests, it’s a big, discursive book. Chronic pain affects 70 million Americans. They all have a story. Thernstrom has looked into pain from every angle, so she nestles her own inside a tangle of history, science, religion and reflection.\nSometimes she’s incredulous: “Although it is difficult to believe, the invention of surgical anesthesia (through the inhalation of ether gas) by an American dentist in the mid-19th century was controversial at the time. Many agreed with the president of the American Dental Association, who declared, ‘I am against these satanic agencies which prevent men from going through what God intended them to go through.’”\nHer accounts of surgery before anesthesia are fascinating and appalling. So are her descriptions of people who have subjected themselves to pain for nonmedical reasons -- Christian saints and Jewish martyrs, with their hair-raising stories, as well as believers who still put themselves through ordeals out of religious zeal today.\nShe travels to Malaysia to witness the Hindu festival of Thaipusam, during which some pilgrims pierce their tongues or their cheeks; others hoist heavy altars onto their shoulders attached by hooks to their chests, or drag ceremonial carts by ropes hooked into their backs.\nWhat’s most striking about these zealots isn’t the cheerfulness with which they submit to being mutilated but their apparent lack of suffering. This is the real motive for Thernstrom’s trip: She wants to understand how they overcome their pain so that she can learn to control her own.\nThe answer lies somewhere in the brain. A neurophysiologist tells her, “Everyone is born with a system designed to turn off pain,” which is what happens, for example, after a serious injury -- the brain first counters the pain impulses and later exaggerates them, an evolutionary refinement enabling flight when the shark bites off your arm and enforcing rest later on.\nThe neurophysiologist continues, “There isn’t an obvious mechanism to turn off other diseases, like Parkinson’s. With pain, the system is there, but we don’t have control over the dial.”\nThe last part of the book is about controlling the dial. New brain-scan technology allowing subjects to observe and modify their own mental activity offers great promise. But as with cancer research, the progress is heartening, the cure elusive.\nNo Magic Words\nIn the case of pain -- a hugely complex form of consciousness involving many areas of the brain -- it may never arrive, an eventuality Thernstrom understands all too well. As much as she wants to be free from pain, as positive as she strives to make herself, she isn’t delusional. And so her book is the sum of myriad small observations and discoveries and epiphanies, but no revelations. There are no magic words to lift the spell.\nAll the same, during her decade of chronic pain, the author managed to date several men, married one of them, became a mother, and wrote a series of magazine articles as well as this very smart book. Her pain hasn’t gone away, but she has found ways to modify it or at least deal with it. That isn’t a storybook ending, and this isn’t a storybook. It isn’t a tragedy, either.\n“The Pain Chronicles” is from Farrar, Straus and Giroux (364 pages, $27). To buy this book in North America, click here.\n(Craig Seligman is a critic for Muse, the arts and leisure section of Bloomberg News. The opinions expressed are his own.)\nTo contact the writer on the story: Craig Seligman at [email protected]. |
Changes in managing patients before, during and after colorectal surgery cut hospital stays by two days and reduced readmission rates, according to researchers who led a study of the approach at Duke University Hospital.\nThe practice, called enhanced recovery, is easier on patients before surgery, doing away with the fasting period and bowel evacuation that are typically prescribed. After surgery, patients are encouraged to eat and move about as soon as possible, leading to faster recoveries.\nAmong findings published in the May 2014 issue of the journal Anesthesia & Analgesia, the researchers reported that the enhanced recovery approach used for colorectal surgery cut hospital admissions from an average seven days to five, and reduced the rate of readmissions by half.\n"Enhanced recovery is about change management," said senior author Tong J. Gan, M.D., MHS, professor of anesthesiology at Duke. "It's getting the team together, including nurses, anesthesiologists, surgeons and patients, with everyone understanding the expectations of how to do things differently and improve patient care."\nGan and colleagues collected data from 241 consecutive patients at Duke University Hospital undergoing open or laparoscopic colorectal surgery during two time periods: before the enhanced recovery approach was implemented, and after. Ninety-nine patients were studied in the traditional approach, and 142 using enhanced recovery.\nWith traditional perioperative care -- defined as the care provided through a patient's hospitalization for surgery -- few procedures are standardized, but patients are typically told to fast the night before and undergo laxative treatments, and then are not given food or drink after surgery until bowel sounds are restored, sometimes several days later. Additionally, traditional perioperative care includes a variety of different anesthesia regimens, fluid management and pain control, depending on the surgical team's preferences.\nUnder traditional perioperative care, patients who experience pain, stress, immobilization, and postoperative constipation can remain in the hospital for 10 days or more, with complication rates of up to 48 percent. Such complications can be expensive, estimated at an average of $10,000.\nEnhanced recovery after surgery (ERAS), which has gained favor in Europe but has not been widely used in the United States, aims to standardize perioperative care using procedures backed by scientific evidence that demonstrate their benefits.\nIn the Duke study, patients in the ERAS group were educated about what they should expect. Routine bowel preparation was not performed, and patients were allowed to drink clear fluids until 3 hours before their surgeries, notably a sports drink.\nAll of the ERAS patients received an epidural as well as non-opioid painkillers to reduce opioid side effects such as nausea, vomiting, constipation, urinary retention and drowsiness. They then underwent general anesthesia. After surgery, the patients transitioned to oral acetaminophen or other non-steroidal anti-inflammatory drugs, plus oral opioids, if necessary, after about 72 hours. Patients were also encouraged to drink liquids and get out of bed on the day of surgery, and for at least six hours every subsequent day.\n"We have shown that providing care within an ERAS pathway, we are increasing the quality of care for patients while at the same time reducing complications and medical costs," said co-author Timothy Miller, assistant professor of anesthesiology at Duke. "I believe that going forward, enhanced recovery care could become the new standard for best practice."\nGan said the researchers saved costs for about 85 percent of the ERAS patients, at about $2,000 per patient. He said the ERAS approach could be used for numerous surgeries; it has been expanded at Duke University Hospital to include bladder, pancreas and liver surgeries.\n"Our study demonstrates that the patient-focused enhanced recovery approach uses evidence-based concepts to decrease perioperative stress and improve outcomes from surgery," said lead colorectal surgeon and co-author, Julie K. Marosky Thacker, M.D.\nCite This Page: |
Wikipedia has a comprehensive overview of the history of General Anaesthesia. The history of Ether anesthesia is described at the Mass. General site.\nThere are both US and UK Anaesthesia History Associations, with excellent images and resources. I often visit 'this month in anesthesia history' on the US AHA site.\nSir Robert Macintosh was a New Zealander.\nIn Australia, see ANZCA's Geoffrey Kaye Museum and the ASA's Harry Daly museum.\nHistoire de l'Anesthésie et de la Réaimation is the main French language history site. Wawrsik summarises important German contributions. See also this Dräger PDF.\nPaul Wood's Library-Museum of Anesthesiology is excellent.\nThe UCLA Index of Medieval Medical Images demonstrates how far we've come!\nRoger Traill puts a strong case that the 'Triad of Anaesthesia' has been usurped by 'Unrousable Unconsciousness' in his paper "Anaesthesia - a Modern Concept".\nHere's a nice overview of the history of anaesthesia from the Medical Coding Career site, and a detailed review of historical opposition to the concept of pain relief for surgery and how these were overcome.\nvisitors to this chapter since April 29th 2000.\nOriginal concept for the Virtual Anaesthesia Textbook by:\nDr. Chris Thompson\nSenior Staff Specialist Anaesthetist\nRoyal Prince Alfred Hospital |
Category: Clinical Stones: PCNL\nIntroduction & Objective : The effect of Tranexamic Acid on the reduction of bleeding in various surgical procedures, especially in the field of urological surgeries has been proven. However, the effect of this drug on PCNL surgery is very limited. Given that, this surgery is highly susceptible to bleeding and it is difficult to control bleeding, the purpose of this study was to evaluate the effect of Tranexamic Acid injection on bleeding and PCNL surgery time.\nMethods : In this prospective study, the patients were randomly divided into three groups. After the removal of patients who had the exclusion criteria, a control group (group 1) was considered, and in the case groups (group 2) 15 mg/kg Tranexamic Acid was Injected at the time of anesthesia induction and After 12 hours, three doses of 500 mg were injected every 8 hours. In the case group 3 , 10 mg/kg Tranexamic Acid Injected at the time of induction anesthesia and After 12 hours, three doses of 250 mg were injected every 8 hours. All information about the time of surgery, patient's demographic information and complications during surgery and blood transfusion and hemoglobin were checked 6 hours and 24 hours later and recorded in the questionnaire.\nResults : A total of 272 patients were entered in this study, in which 87 patients were female and 185 were male. 96 patients were in group 1 with a mean age of 48.66 and 100 patients in group 2 with an average age of 44.21, 76 patients in the group 3 with an average age of 45.53. The mean size of the stones in the groups were 5.95,5.89 and 5.92 cm2 and this difference was not significant in the three groups (P:0.06). The mean reduction in hemoglobin in the first 6 hours was 1.62 gr/dl in group 1 and 1.61 gr/dl in group two and 1.59 gr/dl in group 3 which was not significant. (P:0.19) 9 patients in group one , 11 patients in group two and 6 patients received blood in group 3.\nConclusions : The use of Tranexamic Acid in PCNL surgery reduces the time of operation, but does not play a role in reducing bleeding during and after surgery.\nRobab Maghsoudi– Associated professor, Urology Department,Iran University of Medical Science,Tehran,Iran., Tehran, Tehran, Iran\nMasoud Etemadian– , Tehran, Tehran, Iran\nMojtaba Ameli– , Tehran, Tehran, Iran\nIraj Meshki– , Tehran, Tehran, Iran\nAsaad Moradi– , Tehran, Tehran, Iran\nUrology Department,Iran University of Medical Science,Tehran,Iran.\nTehran, Tehran, Iran |
If you're planning to get breast enhancement surgery, you need to look for a certified and respected surgeon, consult with the cosmetic surgeon, consistently follow pre-op directions, go through the procedure, and carefully comply with any post-op directions.\nBreast enlargement, or breast augmentation, is a surgical procedure well-known among females who desire to enhance their breasts. If you're considering San Diego Breast Augmentation, the following are guidelines to check out so that you figure out what you should do:\nGet a qualified and reputable surgeon\nThere are several available resources that can be used for locating a physician who is certified to do the breast enlargement procedure. Try going through the internet for reliable web-sites that offer a directory of physicians which you could contact. Numerous informative web-sites even sort the listings by location so you can obtain a professional that is close to your area. You may also try and ask relatives and friends who have undergone the treatment to refer you to their cosmetic surgeon. Make sure you ask for feedback so you know if they were happy about the service. Once you've the details you need, contact the cosmetic surgeon and arrange an appointment. You may also want to inquire the doctor for referrals or before and after client photographs.\nGet in touch with the surgeon\nDuring your appointment with the physician, you can expect a physical check-up, a discussion on your health background, your reasons for being interested in the surgery treatment and details about it. Some things that you have to cover with the physician include the kind of breast enlargement surgery is most suitable for you, the estimated duration of the operation and the downtime after it, details and choices concerning anesthesia and probable pain drugs, the extent of skin damage that is a result of the treatment and what you could expect the results of the operation to be.\nConsistently adhere to pre-op instructions\nThe physician may require you to go through specific lab work or prescribe medicine for you before the actual surgical procedure. The surgeon may also ask you to refrain from smoking cigarettes or stop taking specific drugs before the surgical procedure. Having mammograms are also typical requirements so you will have a reference for the changes which happen after the procedure.\nGo through the operation\nOn the scheduled time of the surgical procedure, anesthesia will be administered. Often, clients opt for general anesthesia however it really depends on what you have previously agreed with the physician. An incision will then be created and the form of the incision will also vary depending on what type of augmentations you are getting, your body type as well as your desired outcomes. Right after the enhancements have been effectively inserted, the physician will close the incision.\nConsistently observe any post-op instructions\nYou may anticipate the medical doctor to provide you recommendations that you must observe after the operation. The guidelines provided will depend on what type of surgical procedure you went through but, typically, downtime should be expected that requires you to miss work or avoid intense physical activity for a period of time. Pain, swelling and bruising are often expected and you may discuss with your doctor on the probable pain medicines you could take to manage the pain.\nAs in any surgical procedure, breast enlargement is a delicate surgery. Carefully think over your decision and choose only the best and most qualified doctors in the field. |
Cytoreductive surgeries (CRS) are the common management modality for advanced cancers. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy offer survival advantages in well selected patients with peritoneal tumors. These procedures are technically challenging with potential for high perioperative morbidity and mortality. The complexity of CRS/HIPEC requires surgical specialization. In this case report, we wanted to dicuss anesthesia management in a 73 year old woman with ovarian cancer who underwent CRS/HIPEC under general anesthesia. |
Good grooming comes naturally to most cats. They diligently lick their fur multiple times per day, ensuring that their coats look sleek and healthy no matter what the season. When your normally we ...View Article\nYou are using an outdated browser. Please upgrade your browser to improve your experience.\nAnesthesia and cardiovascular parameters monitoring are important, integral aspects of every surgery we perform. Your pet will be closely monitored while under anesthesia by one of our highly trained veterinary technicians. For this reason, your pet has access to the best and most advanced anesthetic administration and cardiovascular monitoring equipment and protocols available. Our state of the art digital anesthesia monitoring machines, continuously monitors your pet's arterial oxygen level, blood pressure, heart rate, respiratory rate, and core body temperature. |
Dr. Paul F Judson has a medical practice at 3525 Independence Drive, Birmingham, AL. Dr. Paul F Judson specializes in anesthesiology and has over 25 years of experience in the field of medicine. He is affiliated with numerous hospitals, including Medical West, An Affiliate Of Uab Health System (AL) and more. New patients are welcome to contact Dr. Paul's office in Birmingham, Alabama. Please call (205) 481 8543 or go to the doctor's office to know doctor's practice, includes clinics, staff, opening hours and medical advice or to make an appointment online.\nDr. Paul practice address, contact phone number and fax are as below. Check locations where Dr. Paul practices near Birmingham, AL for appointment.\nDr. Paul F Judson has been identified as specializing in anesthesiology and has been in practice for more than 25 years.\nDoctors can have one or more medical licenses for different specialities in Alabama or different states. Related medical licenses for Dr. Paul F Judson are as mentioned below:\nWhat is Anesthesiology?\nAn 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 under... [View more]\nDr. Paul F Judson is professionally affiliated with the following hospitals in Birmingham area and more:\nAn affiliated hospital is a hospital where a doctor can practice and admit patients. Affiliation usually means doctors can admit patients to a hospital.\nThis doctor has multiple office locations in Alabama and more. See office information for details.\nPlease call Dr. Paul at (205) 481 8543 to schedule an appointment in Birmingham AL or get more information.\nIf your insurance plan is accepted and have any questions regarding your insurance, please visit the office location or contact to get information about insurances provided by this doctor.\nTell us about your experience by posting a comment or review about Dr. Paul in Birmingham AL to help others decide which doctor is right for them. |
- Doctors & Departments\n- Conditions & Advice\n- Your Visit\n- Research & Innovation\nPyloric stenosis occurs when the outlet of the stomach closes down, preventing normal movement of stomach contents into the small bowel. This condition is a common cause of infants vomiting undigested formula or breast milk.\nHow does hypertrophic pyloric stenosis cause children to vomit?\nAs a child eats, food travels from his or her mouth down the esophagus and into the stomach. The stomach acts as a reservoir, which slowly releases food into the small intestine.\nHowever, in a child with pyloric stenosis the muscle that controls the flow of food from the stomach into the first part of the small intestine becomes enlarged, narrowing the outlet of the stomach. This narrowing inhibits food from passing into the small intestine and causes the infant to vomit.\nIf left untreated, hypertrophic pyloric stenosis can cause:\nThis condition is caused by multiple factors including an infant’s genetics and environment.\nPyloric stenosis is:\nLearn about the pediatric surgeons at Children’s Hospital Colorado.\nInfants who develop pyloric stenosis appear healthy during the first one or two weeks of life.\nBetween the third and fifth week of life, infants:\nOver the next few days:\nWhen you visit Children’s Hospital Colorado, doctors will take a medical history and perform the following tests to determine if your child has hypertrophic pyloric stenosis. They include a:\nHow do doctors at Children’s Hospital Colorado diagnosis an infant with hypertrophic pyloric stenosis?\nTo make a diagnosis, doctors perform a physical examination and order various tests to determine whether or not an infant has pyloric stenosis.\nIf your infant is diagnosed with this condition, he or she will likely require a bowel rest (to prevent vomiting the infant won’t eat or drink) and intravenous fluid. The goal is to correct any electrolyte imbalance before surgery.\nPyloric stenosis surgery\nPediatric surgeons use a minimally-invasive technique called laparoscopic pyloromyotomy. The goal of surgery is to open the enlarged muscle that blocks the outlet of the stomach. Minimally-invasive surgery allows your child to heal faster and with less pain.\nMost infants are discharged within 24 to 48 hours after surgery.\nWhy choose Children’s Hospital Colorado for your child’s hypertrophic pyloric stenosis?\nOur board-certified pediatric surgeons are trained and experienced in a wide variety of minimally-invasive laparoscopic procedures, including laparoscopic pyloromyotomy. Minimally-invasive surgery reduces your infant or child’s healing time, and pain and scars.\nPediatric anesthesiologists keep babies safe\nBefore and during surgery, our anesthesiologists put children into a sleep-like state that keeps them pain-free. Our anesthesiologists are specially trained to care for kids who have different needs than adults before, during and after anesthesia. Before surgery, parents meet with a pediatric anesthesiologist, who will ease any concerns and answer all of their questions.\nPediatric General Surgery\nAdmin Fax: 720-777-7271\nThoracic Surgery, Surgery, Cardiac Surgery\nCertified Pediatric Nurse Practitioner\nPlastic & Reconstructive Surgery |
SCALP Block Model in Sprague-Dawley Rats; In Vivo Experimental Study and Model Identification\nKeywords:SCALP block, Sprague-Dawley rats, Regional anesthesia, Model\nIntroduction: The SCALP block is an important regional anesthesia method. In this study, we analyzed the SCALP block model for the first time in a rat model. Materials and Methods: In this study, 16 rats were divided into four different groups. Six nerve blocks were planned in both halves of the skull for the SCALP block, and three entry points were determined for each. Bupivacaine (Marcaine, AstraZeneca) 0.5 mg/kg was injected in the "low-dose" group, 1 mg/kg in the "medium-dose" group, 2 mg/kg in the "high-dose" group, and 4 mg/kg in the "very high-dose" group. A midline fronto-occipital incision was made, and a craniectomy was performed. At 0, 30, 60, 90, and 120 minutes after the surgical procedure, the rats were evaluated using the Rat Grimace Scale, and their pain scores were evaluated. At the end of 2 hours, the rats were sacrificed, blood samples were taken, and methemoglobin levels were studied. Finally, a comparative analysis was performed between the four groups. Results: In 30, 60, 90, and 120 minutes after surgery, the differences between the grimace scores between low-dose and medium-dose and high-dose and low-dose groups were statistically significant (p<0.001). There was no significant difference between the high-dose and very high-dose groups regarding the grimace scale (p>0.05). Methemoglobin levels were statistically significantly higher after SCALP block with a very high dose of bupivacaine than blockade with a high dose of bupivacaine (p<0.001). Therefore, very high-dose bupivacaine injection was not superior to high-dose bupivacaine injection in pain control. In addition, very high doses of bupivacaine injection can be associated with increased morbidity and mortality due to increased methemoglobin levels. Conclusion: In this SCALP block technique described in rats, a 2 mg/kg bupivacaine injection can be considered an appropriate dosage for both safety and efficacy.\nHow to Cite\nCopyright (c) 2023 Somalia Turkiye Medical Journal (STMJ)\nThis work is licensed under a Creative Commons Attribution 4.0 International License. |
Lybrate.com has an excellent community of Dentists in India. You will find Dentists with more than 31 years of experience on Lybrate.com. You can find Dentists online in Delhi and from across India. View the profile of medical specialists and their reviews from other patients to make an informed decision.\nBook Clinic Appointment with Dr. Sweta\nRoot Canal Treatment\nTeeth Cleaning Procedure\nTeeth Whitening Procedure\nRoot Canal Treatment\nManagement of Dental Hygiene\nChronic Skin Allergy Treatment\nTooth Extraction Procedure\nDental Extractions Procedure\nSkin Rash Treatment\nGap Closing (Dental) Treatment\nArtificial Teeth Treatment\nTreatment of Root Canal Treatment (RCT)\nWisdom Tooth Removal Procedure\nTeeth Scaling & Polishing\nBraces Treatment for Adults and Teens\nSubmit a review for Dr. SwetaYour feedback matters!\nWhen I breath or talk with someone I have bad smell from my mouth which disturbs another to clear this problem what steps I take.\nMy teeth have suddenly become very sensitive to both hot and cold, but my mouth is otherwise healthy. What could cause this?\nI use tobacco my teeth look yellow i want to clean up my teeth what is the genuine standard cost for it ?\nI am having sensitivity in my front teeth and I have had fillings before 6 months and now when I have any hot items I feel sensitivity and it disappears. But I don't have any problem with the cold items. What can I do to overcome this?\nSir .i eat gutkha from 8 years .now a days from 20 .my mouth doesn't open fully .when I tried to open the mouth fully its has severe pain .sir mere jabdo main bahut pain hota hai jab main khana khata hu. please give me solution to cure from this problem.\nUnlike other teeth which erupt at specific period of time, the wisdom teeth, in normal adults, erupt anytime from late teenage years to adulthood. The refined food habits in the recent times have reduced the need for a third molar. Also, our jaw sizes have reduced with evolution, and oftentimes, there is less space for these to erupt completely, causing their impaction. The chances of infection developing within the tooth and in the surrounding tissues is very high, requiring removal. Before you go ahead with removal, know the following four things.\n- Get a buddy: In addition to the effects of anesthesia, there also would be moderate pain and discomfort, depending on how traumatic the extraction was. It is always best to have someone accompany you for the visit. This also helps you reach home safely without having to drive.\n- Numb tongue and lips: The wisdom tooth removal is done under a local anesthesia where the entire quadrant is numbed before the procedure. Therefore, the chances of chewing on the tongue and the lip are quite high. Be careful to consciously avoid this as there are a lot of people who do not feel pain, but continue to chew on the tongue or lip and end up with injuries.\n- Pain Management: Once the effect of anesthesia wears off, the pain will slowly set in, and will depend on how traumatic the extraction was. It is always advisable to take a pain killer before the anesthetic effect wears off, usually 30 to 40 minutes after the extraction process is over.\n- Diet: For the first couple of days, stay on a completely soft diet with nothing spicy, hard, or hot to eat. One of the best things to have after an extraction is an ice cream, which can be continued for a couple of days after the extraction. Yogurt, smoothies, milkshakes, mashed vegetables and well-cooked rice are all good food choices.\n- Smoking: If you have had an extraction, avoid smoking for at least a week. The negative pressure created during smoking can dislodge the clot that is formed in the tooth socket. This can lead to a complication called dry socket, which can be very painful. Avoid smoking at all costs, especially with wisdom tooth extractions.\n- Postoperative follow-up: Based on the complexity of the extraction, a postoperative follow-up would be required. Be prompt in following up with your dentist for suture removal, check on socket healing and postoperative irrigation of the surgical site. Resume routine oral hygiene practices as recommended by the doctor.\nWisdom tooth removal requires a little extra caution as compared to a normal extraction, the ideal thing to do is to follow your dentist’s advice. |
Pia Renaudin joins as new CEO at Senzime\nSenzime announced on the 19th of November 2018 the appointment of Pia Renaudin as new CEO. Pia has of today assumed her position and succeeds Catrin Molund in her capacity as acting CEO.\nFor further information, please contact:\nPia Renaudin, CEO of Senzime AB\nTel: +46 (0)70-813 34 17, email: [email protected]\nTO THE EDITORS\nSenzime develops unique patient-oriented monitoring systems that make it possible to assess patients' biochemical and physiological processes before, during and after surgery. The portfolio of technologies includes bedside systems that enable automated and continuous monitoring of life-critical substances such as glucose and lactate in both blood and tissues, as well as systems to monitor patients’ neuromuscular function perioperatively and in the intensive care medicine setting. The solutions are designed to ensure maximum patient benefit, reduce complications associated with surgery and anesthesia, and decrease health care costs. Senzime operates in growing markets that in Europe and the United States are valued in excess of SEK 10 billion. The company's shares are listed on Nasdaq First North (ticker SEZI). FNCA Sweden AB, +46 (0)8-528 00 399 is Certified Adviser for Senzime. www.senzime.com\nThis information is insider information that Senzime AB is obliged to make public pursuant to the EU Market Abuse Regulation. The information was submitted for publication through the agency of the contact person set out above, on February 7th, 2019 08:45 |
This position provides anesthesia for clinical cases and instructs junior and senior veterinary students as they apply the principles learned in lecture to a clinical setting. The technician position also facilitates the function of the anesthesia by organizing and controlling the daily surgery schedule, repairing and replacing equipment, stocking, and cleaning the area. This position has a flexible daytime schedule and is cross trained in all areas of the Anesthesia service (i.e. large and small animal and research and Continuing Education).\nWhen inquiring or applying for this position, please also reference AcademicCareers.com\nApplicants with dual-career considerations can find university jobs such as professor jobs, dean jobs, chair / department head jobs, and other faculty jobs and employment opportunities at Colorado State University and at other institutions of higher education in the region on www.AcademicCareers.com |
To learn more about our services, click a button below.\nIf you’re ready to see our expert veterinary team in Aspen, call Aspen Animal Hospital today at 970-925-2611.\nWellness and Vaccinations\nOur wellness and vaccination programs are designed to prevent disease and prolong the lives of your companion animals.\nOur knowledgeable staff and our facilities allow us to deal with a variety of medical conditions your pet may experience.\nOur experienced veterinarians provide many surgical services at our clinic, ranging from routine to advanced procedures.\nIn addition to our full-service veterinary offerings, we have even more services for anything you and your pet may need.\nAnesthesia and Patient Monitoring\nWe monitor our patients closely to keep them as safe as possible during procedures that require general anesthesia.\nIt’s easy to get confused or overwhelmed by all the pet foods on the market. We can help you weed through the choices.\nWhen you need us most, we’ll be here to help. Please be sure to contact us during your pet emergency. |
Candidates for Hand Surgery\n- Do not smoke\n- Do not have any other serious medical conditions\n- Have made the decision for surgery on their own\n- Have realistic expectations for their surgery\nHand Surgery Procedures\nHand surgery is usually performed under general anesthesia or local anesthesia with sedation, on an outpatient basis. The surgeon will make an incision to access the targeted area. Some hand procedures can be performed laparoscopically, allowing patients to benefit from smaller incisions, less bleeding and shorter recovery times.\nThe actual procedure will vary depending on the type and severity of each patient’s individual condition, but may include:\n- Carpal tunnel surgery – Tissue that is causing pressure on the nerve is removed to relieve pressure.\n- Rheumatoid arthritis surgery – Damaged tissue is removed from the joint, tendons and ligaments are repositioned, or the entire joint is replaced with a prosthetic.\n- Dupuytren’s contracture surgery – Thickened, scar-like tissue is separated to improve range of motion and prevent nerve damage.\n- Grafting – Transfers bones, nerves or other tissue from healthy areas of the body to the damaged area, commonly performed after trauma.\nAfter the condition is treated, the incision is closed, with or without sutures, depending on each individual patient. |
Long-standing, established Nassau County practice seeking a motivated, ethical, hard-working and highly skilled full-time OMS.\nContact InformationPlease Click Apply!\nDate Posted: 4/22/2021\nJob Id: 2064592\nOral & Maxillofacial Surgeons Elliot Siegel DMD, Thomas Cerbone DDS, Paul Mazzei DDS, J. Ryan Glazer DDS, A. Basit Karim DDS, and Eduard Munarov DDS in Massapequa, NY, practice a full scope of oral and maxillofacial surgery with expertise ranging from Dental Implants to wisdom tooth removal. We can also diagnose and treat facial pain, facial injuries and TMJ disorders.\nLong Island Oral Surgeons‘s staff is trained in assisting with I.V. sedation within our state of the art office setting.\nOur office is located at 930 North Broadway, Massapequa, NY.\nCall us at Massapequa Office Phone Number516-541-2400.\nDental implants are designed to provide a foundation for replacement teeth that look, feel, and function like natural teeth. The person who has lost teeth regains the ability to eat virtually anything and can smile with confidence, knowing that teeth appear natural and that facial contours will be preserved.\nDental implants are changing the way people live. With them, people are rediscovering the comfort and confidence to eat, speak, laugh and enjoy life. For more information about dental implants or to schedule a consultation appointment, call our office in Massapequa, NY at Massapequa Office Phone Number516-541-2400.\nSign up to receive job postings that match your search criteria —\ndelivered to your inbox daily! |
|Publication number||US5611778 A|\n|Application number||US 08/331,646|\n|Publication date||18 Mar 1997|\n|Filing date||12 May 1993|\n|Priority date||14 May 1992|\n|Also published as||CA2135764A1, CA2135764C, DE69329299D1, DE69329299T2, EP0695202A1, EP0695202B1, WO1993023109A1|\n|Publication number||08331646, 331646, PCT/1993/465, PCT/FR/1993/000465, PCT/FR/1993/00465, PCT/FR/93/000465, PCT/FR/93/00465, PCT/FR1993/000465, PCT/FR1993/00465, PCT/FR1993000465, PCT/FR199300465, PCT/FR93/000465, PCT/FR93/00465, PCT/FR93000465, PCT/FR9300465, US 5611778 A, US 5611778A, US-A-5611778, US5611778 A, US5611778A|\n|Export Citation||BiBTeX, EndNote, RefMan|\n|Patent Citations (16), Referenced by (89), Classifications (9), Legal Events (7)|\n|External Links: USPTO, USPTO Assignment, Espacenet|\nThe present invention relates to the field of surgical instruments comprising a needle and an associated catheter capable of sliding inside the needle, in particular for performing epidural anesthesia.\nEpidural anesthesia is a technique that is widespread at present, and as shown in FIG. 1 it consists in putting a catheter C into place in the epidural space P of a patient in order to inject an anesthetic by means of a needle A which is provided at its distal end 5 with a tapering chamfer tip, also known as a Tuohy needle.\nTo perform epidural anesthesia, the anesthetist generally begins by inserting the needle A in the back of the patient until the distal end 5 of the needle penetrates into the epidural space P, then the catheter C is inserted via the proximal opening 10 of the needle until it penetrates into the epidural space P via the distal end 5 of the needle.\nIn order to avoid trauma to this sensitive region of the patient, it is important to avoid pushing the needle in too deep, and thus to know the length of needle that has been inserted into the back of the patient. To do this, a Tuohy needle A of the prior art is generally provided, as shown in FIG. 2, with marks 15 that are spaced apart axially uniformly along its length, thereby enabling the anesthetist to deduce by calculating the length of needle that has been inserted into the back of the patient, i.e. by knowing the total number of marks on the needle and by subtracting therefrom the number of marks that remain visible after the needle has been inserted.\nIt is also important to know the length of catheter that has been inserted into the epidural space, and the catheter C is generally provided for this purpose with identical marks uniformly spaced axially along its length. To discover the length of catheter extending in the epidural space P, the anesthetist generally counts the number of marks on the catheter C that go in through the proximal opening 10 of the needle as the catheter is being pushed into the needle and after it has left the chamfer thereof, which the anesthetist can feel easily since it becomes more difficult to urge the catheter into the needle once the end of the catheter has gone beyond the distal end of the needle. Thereafter, the Tuohy needle A is withdrawn while the catheter is left in place in the epidural space in order to inject an anesthetic solution therein.\nThe anesthetist encounters several difficulties that occur during the various steps of performing epidural anesthesia as described above.\nFirstly, to know the lengths of needle and of catheter inserted into the back of the patient, the surgeon must note or remember the total numbers of graduations carried by the needle and by the catheter, and must subtract therefrom the numbers of graduations that remain visible after insertion of the needle or of the catheter, and this is not easily done in the context of a surgical operation.\nAlso, when the needle is being extracted, the catheter tends to be entrained with the needle because of friction, and it then becomes difficult to establish with accuracy the length of catheter that remains in the epidural space after the needle has been withdrawn, which problem is illustrated diagrammatically in FIG. 3.\nFinally, since the catheter may remain in place for several hours, there is a danger of it moving during this period and it is important to know its position accurately before any further injection of anesthetic.\nThe present invention provides a surgical instrument comprising a needle and an associated catheter suitable for sliding inside a needle, in particular for performing epidural anesthesia, remedying the main difficulties described above.\nThis surgical instrument is characterized in that the catheter is provided with a set of main axial marks suitable, when the catheter is inserted in the needle, for coinciding with an index mark defined on the needle, to indicate merely by reading and without performing any calculation, the length of catheter extending beyond the distal end of the needle, and is provided with a set of auxiliary marks easily distinguished from the main marks and suitable for indicating, merely by being read and without performing any calculations, the length of the catheter that extends from its distal end to each of said auxiliary marks.\nThe present invention also provides a needle and a catheter taken separately and suitable for use in forming a surgical instrument of the invention.\nOther characteristics and advantages of the invention appear on reading the following detailed description of a non-limiting embodiment of the present invention and on examining the accompanying drawings, in which:\nFIG. 1, described above, shows the insertion of a catheter into the epidural space of a patient;\nFIG. 2 shows a needle provided with marks that are uniformly spaced apart axially, as described above and illustrating the state of the art;\nFIG. 3, described above, illustrates the problems posed in the prior art by withdrawing the needle from the back of the patient while leaving the catheter in place in the epidural space;\nFIG. 4 is a front view of a needle of the invention;\nFIG. 5 is a side view in the plane of the front view of FIG. 4, showing a needle of the invention together with its associated catheter, likewise of the invention;\nFIG. 6 is a bottom view of the catheter shown in FIG. 5;\nFIGS. 7 to 11 show various steps in the performance of epidural anesthesia using a surgical instrument of the invention; and\nFIG. 12 shows how the length of catheter opening out into the epidural space is calculated after the needle has been withdrawn.\nFIGS. 1 to 3 are described above to illustrate the state of the art.\nFIG. 4 shows a needle of the invention given overall reference 100, and comprising a hollow needle body 110 suitable for being inserted via its distal end 1100 into the back of a patient, and provided at its opposite end 1200 with a coupling endpiece 120. As shown, the distal end 1100 is preferably tapered in order to form a chamfer 115.\nIn accordance with an advantageous characteristic of the invention, the needle 100 is provided on its body 110 with graduations 130 that are axially distributed therealong, and suitable for showing directly, merely by being read and without performing any calculations, the length of the needle extending from the distal end 1100 to each of said graduations 130.\nPreferably, and as shown, these graduations 130 comprise Arabic numerals printed or engraved at one centimeter intervals from the distal end 1100, together with spots 135, each placed halfway between said graduations 130.\nIn accordance with another advantageous characteristic of the invention, a cursor 140 is provided that is slidably mounted on the body 110 of the needle, and that is suitable for bearing against an incision made in the body of the patient and through which the needle is inserted, so as to move along the body 110 of the needle through a distance corresponding to the length of needle that has been inserted into the said incision, in a manner that is described in greater detail below.\nFIG. 5 shows a surgical instrument of the present invention comprising a needle 100 as described above with reference to FIG. 4 and an associated catheter given reference 200, which catheter is suitable for sliding inside the body 110 and the endpiece 120, and is suitable for being inserted via an opening 125 provided in the coupling endpiece 120.\nIn accordance with a characteristic of the invention, the catheter 200 is provided with a set of main axial marks referenced 210 suitable, when the catheter 200 is inserted in the needle 100, for coinciding with an index mark I that is defined on the needle to indicate, merely by reading and without performing any calculations, the length of catheter that extends from the distal end 110 of the needle.\nThe index mark I can be positioned at various locations along the needle 100 without going beyond the ambit of the present invention. The plane of the opening 120 in the coupling endpiece preferably serves as the index mark I, however, it would naturally be possible to provide a window in the body 110 of the needle 100, optionally fitted with a magnifying glass or other device suitable for making it easier to read the marks on the catheter.\nPreferably, in accordance with an advantageous characteristic of the invention, this set of main axial marks 210 comprises regularly spaced-apart main graduations extending from an origin 211 situated at a distance D from the distal end 2100 of the catheter, where the distance D corresponds to the distance between the distal end 1100 of the needle 100 and the index I defined thereon. As shown in FIG. 5, these main graduations are spaced apart at one centimeter intervals and they preferably comprise Arabic numerals placed by etching or printing once every centimeter from the origin 211, and separated by lines or spots located halfway between them.\nThe catheter 200 is provided with a set of auxiliary axial marks 220 that are easily distinguished from the main marks 210 and that are suitable for indicating, merely by being read and without performing any calculations, the length of the catheter extending from its distal end 2100 to each of said auxiliary marks 220, as shown in FIG. 6. Preferably, this set of auxiliary marks 220 comprises regularly spaced-apart auxiliary graduations extending from an origin that coincides with the distal end 2100 of the catheter. Also preferably, these auxiliary graduations 220 are Arabic numerals spaced apart at one centimeter intervals and separated by lines or points placed halfway between two numerals. The main marks and the auxiliary marks are advantageously disposed on the catheter to form two scales in the vicinity of each other so as to facilitate reading thereof. In a variant, the main marks and the auxiliary marks may be disposed on diametrically opposite faces of the catheter 200. The main marks 210 and the auxiliary marks 220 are advantageously of different colors.\nThe various steps of using a surgical instrument of the present invention are described with reference to FIGS. 7 to 11.\nThe space between the spinous processes is initially anesthetized using techniques that are known per se, then the needle 100 fitted with its sliding cursor 140 prepositioned at the distal end 1100 is inserted into the back D of the patient, the needle 100 also being connected in sealed manner via the endpiece 120 to a syringe S to constitute what is known to the person skilled in the art as a gas or a liquid mandrel, depending on whether the syringe S is filled with a gas or with a liquid. This gas or liquid mandrel technique enables the anesthetist to tell accurately when the distal end 1100 of the needle penetrates into the epidural space P. Usually, the anesthetist uses one hand to push the needle 100 towards the epidural space P, while using the other hand to keep the gas or liquid mandrel compressed until it collapses, where collapse takes place when the needle 100 penetrates into the epidural space P, as shown in FIGS. 7 and 8. It will also be seen from these figures that the cursor 140 is placed on the needle 100 at a distance L0 corresponding to the length of needle inserted into the body of the patient.\nThereafter, as shown in FIG. 9, the syringe S is disconnected, and the catheter 200 is inserted in the needle via the opening 125 of the endpiece 120 which also serves as the index mark I.\nThe catheter is pushed along the needle until it reaches the distal end 1100.\nThe anesthetist can then at any moment, and without performing any calculations, observe the length L of catheter that has been inserted into the epidural space P by reading the value 1 of the main graduation 210 of the catheter that coincides substantially within the index 125, as illustrated in FIG. 10.\nIn the example FIG. 10, it can be seen that L=2.5 cm since the index I lies between the graduations 2 and 3.\nAfter the needle 100 has been withdrawn and merely by reading the auxiliary marks 220 on the catheter 200, the surgeon can discover without performing any calculations the length L1 of the catheter that extends inside the body of the patient, and can easily deduce therefrom the length L' of the catheter 200 extending inside the epidural space P by subtracting the length L0 given by the value l0 of the graduation 130 of the needle 100 indicated by the cursor 140 from the length L1 given by the value l1 of the auxiliary graduation 220 closest of the body of the patient, as shown in FIGS. 11 and 12. In the example of FIGS. 10, 11, and 12, the needle has been withdrawn without entraining the catheter out from the epidural space since L=2.5 cm and L'=L1 -L0 =6-3.5=2.5 cm=L.\nFinally, a surgical instrument of the invention is particularly simple and rapid in use and may be applied, without going beyond the ambit of the invention, to surgical operations other than epidural anesthesia, e.g. other local or regional anesthesias.\n|Cited Patent||Filing date||Publication date||Applicant||Title|\n|US2198666 *||30 Sep 1936||30 Apr 1940||Lakeland Foundation||Syringe|\n|US2388800 *||27 Aug 1942||13 Nov 1945||Gen Motors Corp||Motor protector|\n|US3750667 *||31 Jan 1972||7 Aug 1973||Maximov V||Device for intraosseous injection of liquid substances|\n|US4500313 *||27 Jan 1983||19 Feb 1985||Protectair Limited||Urethral catheter|\n|US4645491 *||6 Mar 1985||24 Feb 1987||David Evans||Surgical needle|\n|US5084022 *||4 Oct 1989||28 Jan 1992||Lake Region Manufacturing Company, Inc.||Graduated guidewire|\n|US5106376 *||3 Jul 1990||21 Apr 1992||B. Braun Melsungen Ag||Anaesthesia set|\n|US5129889 *||25 Jun 1990||14 Jul 1992||Hahn John L||Synthetic absorbable epidural catheter|\n|US5292309 *||22 Jan 1993||8 Mar 1994||Schneider (Usa) Inc.||Surgical depth measuring instrument and method|\n|US5320608 *||2 Apr 1993||14 Jun 1994||Gerrone Carmen J||Combined pneumo-needle and trocar apparatus|\n|US5353787 *||10 Jun 1993||11 Oct 1994||Price Evelyn C||Endotracheal tube and oral airway connector|\n|US5391159 *||4 Feb 1994||21 Feb 1995||Hirsch; William H.||Gastrostomy tube with improved internal retaining member|\n|CH288589A *||Title not available|\n|EP0406586A1 *||12 Jun 1990||9 Jan 1991||B. Braun Melsungen AG||Set of instruments for anaesthesia|\n|WO1990010466A1 *||9 Mar 1990||20 Sep 1990||Arrow Int Investment||Dual durometer epidural catheter|\n|WO1991005577A1 *||26 Sep 1990||2 May 1991||Univ Leland Stanford Junior||Catheter device with insertion stop means|\n|Citing Patent||Filing date||Publication date||Applicant||Title|\n|US5836914 *||15 Sep 1995||17 Nov 1998||Becton Dickinson And Company||Method and apparatus for variably regulating the length of a combined spinal-epidural needle|\n|US5843038 *||31 Oct 1995||1 Dec 1998||University Of Southern California||Finder-thinwall needle combination for safely inserting a catheter into a central vein|\n|US5882293 *||13 May 1997||16 Mar 1999||Asahi Kogaku Kogyo Kabushiki Kaisha||Treatment accessories for endoscope|\n|US6159179 *||12 Mar 1999||12 Dec 2000||Simonson; Robert E.||Cannula and sizing and insertion method|\n|US6322536||10 Sep 1999||27 Nov 2001||Cornell Research Foundation, Inc.||Minimally invasive gene therapy delivery and method|\n|US6508802||23 May 2000||21 Jan 2003||Cornell Research Foundation, Inc.||Remote sensing gene therapy delivery device and method of administering a therapeutic solution to a heart|\n|US6638237||1 Aug 2000||28 Oct 2003||Percardia, Inc.||Left ventricular conduits and methods for delivery|\n|US6716192 *||30 Sep 1997||6 Apr 2004||Charles F. Schroeder||Medical needle having a visibly marked tip|\n|US6854467||1 May 2001||15 Feb 2005||Percardia, Inc.||Methods and devices for delivering a ventricular stent|\n|US6905480||22 Feb 2002||14 Jun 2005||Rex Medical, L.P.||Apparatus for delivering ablation fluid to treat lesions|\n|US6916330||30 Oct 2001||12 Jul 2005||Depuy Spine, Inc.||Non cannulated dilators|\n|US6929606||13 May 2003||16 Aug 2005||Depuy Spine, Inc.||Retractor and method for spinal pedicle screw placement|\n|US6964652||11 Jul 2003||15 Nov 2005||Percardia, Inc.||Left ventricular conduits and methods for delivery|\n|US6966910||4 Apr 2003||22 Nov 2005||Stephen Ritland||Dynamic fixation device and method of use|\n|US6976955 *||31 Oct 2003||20 Dec 2005||Wilson-Cook Medical Inc.||Handle for medical devices, and medical device assemblies including a handle|\n|US6989004||14 May 2002||24 Jan 2006||Rex Medical, L.P.||Apparatus for delivering ablation fluid to treat lesions|\n|US7008431||30 Oct 2001||7 Mar 2006||Depuy Spine, Inc.||Configured and sized cannula|\n|US7087040||12 Feb 2002||8 Aug 2006||Rex Medical, L.P.||Apparatus for delivering ablation fluid to treat lesions|\n|US7166073||28 Mar 2005||23 Jan 2007||Stephen Ritland||Method and device for microsurgical intermuscular spinal surgery|\n|US7207992||30 Sep 2002||24 Apr 2007||Stephen Ritland||Connection rod for screw or hook polyaxial system and method of use|\n|US7214186||22 Dec 2003||8 May 2007||Stephen Ritland||Method and device for retractor for microsurgical intermuscular lumbar arthrodesis|\n|US7331947||13 Jan 2004||19 Feb 2008||Rex Medical, L.P.||Method for delivering ablation fluid to treat lesions|\n|US7344518||30 Apr 2004||18 Mar 2008||Rex Medical, L.P.||Apparatus for delivering ablation fluid to treat lesions|\n|US7455639||16 Sep 2005||25 Nov 2008||Stephen Ritland||Opposing parallel bladed retractor and method of use|\n|US7601138 *||18 Jun 2002||13 Oct 2009||B. Braun Melsungen Ag||Catheter|\n|US7655025||1 Mar 2005||2 Feb 2010||Stephen Ritland||Adjustable rod and connector device and method of use|\n|US7682375||8 May 2003||23 Mar 2010||Stephen Ritland||Dynamic fixation device and method of use|\n|US7695498||30 Jan 2007||13 Apr 2010||Stephen Ritland||Connection rod for screw or hook polyaxial system and method of use|\n|US7753939||10 Feb 2004||13 Jul 2010||Stephen Ritland||Polyaxial connection device and method|\n|US7763047||20 Feb 2003||27 Jul 2010||Stephen Ritland||Pedicle screw connector apparatus and method|\n|US7763196||19 Oct 2007||27 Jul 2010||B. Braun Melsungen Ag||Catheter|\n|US7815613||9 Feb 2004||19 Oct 2010||Medical Components, Inc.||Flexible conduit clamp|\n|US7824410||10 Aug 2004||2 Nov 2010||Depuy Spine, Inc.||Instruments and methods for minimally invasive spine surgery|\n|US7828793 *||21 Jan 2010||9 Nov 2010||Tyco Healthcare Group, Lp||Methods for treating a hollow anatomical structure|\n|US7837677 *||12 Jan 2010||23 Nov 2010||Tyco Healthcare Group, Lp||Systems for treating a hollow anatomical structure|\n|US7837678 *||24 Feb 2010||23 Nov 2010||Tyco Healthcare Group, Lp||Systems for treating a hollow anatomical structure|\n|US7909843||30 Jun 2004||22 Mar 2011||Thompson Surgical Instruments, Inc.||Elongateable surgical port and dilator|\n|US7914518||27 Dec 2006||29 Mar 2011||Medical Components, Inc.||Methods of implanting a dual catheter|\n|US7955369||8 Sep 2008||7 Jun 2011||Tyco Healthcare Group Lp||Systems and methods for treating a hollow anatomical structure|\n|US7959564||9 Jul 2007||14 Jun 2011||Stephen Ritland||Pedicle seeker and retractor, and methods of use|\n|US7963961 *||25 Oct 2010||21 Jun 2011||Tyco Healthcare Group Lp||Systems for treating a hollow anatomical structure|\n|US7963962 *||9 Nov 2010||21 Jun 2011||Tyco Healthcare Group Lp||Methods for treating a hollow anatomical structure|\n|US7985245||18 Nov 2005||26 Jul 2011||Stephen Ritland||Connection rod for screw or hook polyaxial system and method of use|\n|US8021399||19 Jul 2006||20 Sep 2011||Stephen Ritland||Rod extension for extending fusion construct|\n|US8043285 *||19 Nov 2010||25 Oct 2011||Tyco Healthcare Group Lp||Systems for treating a hollow anatomical structure|\n|US8088119||14 Aug 2007||3 Jan 2012||Laurimed, Llc||Methods and devices for treating tissue|\n|US8192437||5 Jun 2012||Depuy Spine, Inc.||Configured and sized cannula|\n|US8235999||10 May 2010||7 Aug 2012||Depuy Spine, Inc.||Configured and sized cannula|\n|US8262571||24 May 2004||11 Sep 2012||Stephen Ritland||Intermuscular guide for retractor insertion and method of use|\n|US8277437||2 Apr 2009||2 Oct 2012||Laurimed, Llc||Method of accessing two lateral recesses|\n|US8292909||16 Jul 2012||23 Oct 2012||Laurimed, Llc||Devices and methods for cutting tissue|\n|US8298254||30 Jun 2011||30 Oct 2012||Laurimed, Llc||Devices and methods for cutting and evacuating tissue|\n|US8321019||21 Jul 2006||27 Nov 2012||Covidien Lp||Apparatus and method for ensuring safe operation of a thermal treatment catheter|\n|US8361151||14 Jun 2012||29 Jan 2013||Depuy Spine, Inc.||Configured and sized cannula|\n|US8414587||31 Aug 2007||9 Apr 2013||Laurimed, Llc||Styli used to position device for carrying out selective discetomy|\n|US8444678||21 Oct 2010||21 May 2013||Depuy Spine, Inc.||Instruments and methods for minimally invasive spine surgery|\n|US8465451||22 Jun 2006||18 Jun 2013||Covidien Lp||Methods and apparatus for introducing tumescent fluid to body tissue|\n|US8556905||27 Dec 2012||15 Oct 2013||Depuy Spine, Inc.||Configured and sized cannula|\n|US8636729||21 Jul 2006||28 Jan 2014||Covidien Lp||Therapeutic system with energy application device and programmed power delivery|\n|US8696697 *||29 Aug 2012||15 Apr 2014||Helix Medical, Llc||Trocar and device for measuring a tracheoesophageal puncture|\n|US8721634||21 Jul 2006||13 May 2014||Covidien Lp||Apparatus and method for ensuring thermal treatment of a hollow anatomical structure|\n|US8852178 *||12 Sep 2011||7 Oct 2014||Covidien Lp||Systems for treating a hollow anatomical structure|\n|US8852244||13 Sep 2013||7 Oct 2014||DePuy Synthes Products, LLC||Configured and sized cannula|\n|US8932334||9 Sep 2005||13 Jan 2015||Stephen Ritland||Dynamic fixation device and method of use|\n|US9028551||2 Sep 2014||12 May 2015||DePuy Synthes Products, Inc.||Configured and sized cannula|\n|US9055956||10 Jun 2013||16 Jun 2015||Covidien Lp||Methods and apparatus for introducing tumescent fluid to body tissue|\n|US20040106853 *||21 Oct 2003||3 Jun 2004||Olympus Optical Co., Ltd.||Endoscope|\n|US20040106931 *||11 Jul 2003||3 Jun 2004||Percardia, Inc.||Left ventricular conduits and methods for delivery|\n|US20040147902 *||13 Jan 2004||29 Jul 2004||Mcguckin James F.||Method for delivering ablation fluid to treat lesions|\n|US20040162544 *||9 Feb 2004||19 Aug 2004||Raulerson J. Daniel||Flexible conduit clamp|\n|US20040172023 *||10 Feb 2004||2 Sep 2004||Stephen Ritland||Polyaxial connection device and method|\n|US20040204683 *||30 Apr 2004||14 Oct 2004||Mcguckin James F.||Apparatus for delivering ablation fluid to treat lesions|\n|US20040254428 *||24 May 2004||16 Dec 2004||Stephen Ritland||Intermuscular guide for retractor insertion and method of use|\n|US20040260274 *||31 Oct 2003||23 Dec 2004||Hardin David M.||Handle for medical devices, and medical device assemblies including a handle|\n|US20050004593 *||26 Jul 2004||6 Jan 2005||Depuy Spine, Inc.||Non cannulated dilators|\n|US20050080418 *||10 Aug 2004||14 Apr 2005||Simonson Robert E.||Instruments and methods for minimally invasive spine surgery|\n|US20050203490 *||10 May 2005||15 Sep 2005||Depuy Spine, Inc.||Apparatus and method for targeting for surgical procedures|\n|US20050228233 *||28 Mar 2005||13 Oct 2005||Stephen Ritland||Method and device for microsurgical intermuscular spinal surgery|\n|US20050228312 *||30 Mar 2005||13 Oct 2005||Vihar Surti||Biopsy needle system|\n|US20050256508 *||25 Jul 2005||17 Nov 2005||Cardiac Pacemakers, Inc.||Guide catheter system having relative markings|\n|US20060004401 *||30 Jun 2004||5 Jan 2006||Abernathie Dennis L||Elongateable surgical port and dilator|\n|US20120071873 *||12 Sep 2011||22 Mar 2012||Tyco Healthcare Group Lp||Systems for treating a hollow anatomical structure|\n|US20130281971 *||6 May 2011||24 Oct 2013||Carefusion 2200, Inc.||Catheter allowing variable dosing of an active agent|\n|USRE42525 *||10 Jun 2002||5 Jul 2011||Depuy Spine, Inc.||Cannula and sizing insertion method|\n|USRE45571||17 Dec 2010||23 Jun 2015||DePuy Synthes Products, Inc.||Cannula and sizing insertion method|\n|CN102389332B||21 Jul 2006||27 Aug 2014||泰科医疗集团有限合伙公司||Systems and methods for treating a hollow anatomical structure|\n|CN102389333B||21 Jul 2006||27 Aug 2014||泰科医疗集团有限合伙公司||Systems and methods for treating a hollow anatomical structure|\n|WO2001082837A2 *||3 May 2001||8 Nov 2001||Percardia Inc||Methods and devices for delivering a ventricular stent|\n|WO2011140449A2 *||6 May 2011||10 Nov 2011||Carefusion 2200, Inc.||Catheter allowing variable dosing of an active agent|\n|U.S. Classification||604/117, 604/158|\n|International Classification||A61B19/00, A61M25/01, A61M25/00|\n|Cooperative Classification||A61M25/01, A61M2025/0008, A61B2019/462|\n|10 Nov 1994||AS||Assignment|\nOwner name: VYGON, FRANCE\nFree format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:BRINON, THIERRY;REEL/FRAME:007336/0627\nEffective date: 19941104\n|21 Oct 1997||CC||Certificate of correction|\n|10 Oct 2000||REMI||Maintenance fee reminder mailed|\n|13 Feb 2001||FPAY||Fee payment|\nYear of fee payment: 4\n|13 Feb 2001||SULP||Surcharge for late payment|\n|23 Aug 2004||FPAY||Fee payment|\nYear of fee payment: 8\n|20 Aug 2008||FPAY||Fee payment|\nYear of fee payment: 12 |
Over the past two centuries, many people have used their knowledge, skills and experience in order to create a host of inventions that have made the world a much better place for us to live.\nHere are eight paramount discoveries and innovations that have improved our standard of living, and have given us the opportunity to pursue our personal and business endeavors in a more comfortable and prosperous fashion.\nBanknote (paper currency) - Tang Dynasty of China - 7 th Century\nChina is not only credited with having invented paper, but it is also generally recognized to have been the first country in the world to use paper money. The paper money system helped improve economies worldwide as it moved them from a barter economy of trade.\nVaccinations - Edward Jenner - 1796\nEdward Jenner's work is widely regarded as the foundation of immunology. Mr. Jenner is well renowned throughout the world for his innovative contribution to immunization and the ultimate eradication of the smallpox disease.\nLocal Anesthesia - William Morton - 1846\nWilliam Morton was the first to show how ether could be used to allay the pain of operations. His use of anesthesia was displayed at a public demonstration to the surgeons of the Massachusetts General Hospital in Boston on Oct. 16, 1846, where John Collins Warren excised a tumor from a patient's neck. William Morton was neither the inventor nor the discoverer of anesthetics, and for 20 years acrimony, vituperation and litigation surrounded the credit for the development of anesthesia.\nAntibiotics - Alexander Fleming - 1928\nAlexander Fleming discovered the active substance that he termed "penicillin" while working on the influenza virus. Fleming made this discover by observing that mold had developed accidentally on a staphylococcus culture plate and that the mold had created a bacteria-free circle around itself. He was inspired to further experiment and he found that a mold culture prevented the growth of staphylococci, which verified his discovery. To this day, penicillin is used to treat a host of bacterial infections.\nFood and Drink\nPasteurization - Louis Pasteur - 1862\nLouis Pasteur developed the process now known as "pasteurization," which is a process of heating a food to a specific temperature for a definite length of time and then cooling it immediately in order to reduce the number of viable pathogens that may cause disease. Dairy products, canned foods, juices, syrups, water and wines are the primary products that are pasteurized today.\nModern Automobile - Karl Benz - 1886\nKarl Benz patented all of the processes that made the internal combustion engine feasible for use in cars. Karl Benz and his wife Bertha Ringer Benz were the founders of the Mercedes Benz automobile manufacturing company.\nModern Alternating Current Electrical Supply System - Nikola Tesla - 1891\nNikola Tesla filed for seven U.S. patents in the field of polyphase alternating current motors and power transmission. Tesla's patents comprised a complete system of generators, transformers, transmission lines, motors and lighting. Tesla is also credited with the invention of the radio, although a patent dispute with the Marconi Company that was ultimately decided by the U.S. Supreme Court brings into question if he should receive the sole credit for the radio invention.\nElectronic Digital Computer - John Atanasoff and Clifford Berry - 1937\nJohn Atanasoff and Clifford Berry constructed the first electronic computer with vacuum tubes while working for Iowa State College. The Atanasoff-Berry computer w as the first digital computer, and introduced the concepts of binary arithmetic, regenerative memory and logic circuits. Th e Atanasoff-Berry m achine never reach ed the production stage and remain ed a prototype.\nWhile this list consists of well-known and distinguished inventors, it is important to note that their works were built upon the ideas and labor of many people in order to create the final product or service that we enjoy and use today. It is unfortunate that many of the contributors to a key invention or innovation will likely go unremembered and uncompensated, and hopefully governments throughout the world will strive to resolve this problem by putting in place a more equitable patent system. A recent step toward accomplishing this goal was the passage of the America Invents Act on Sept. 16, 2011. The passage of this Act has moved the U.S. patent system from a "first to invent" to a "first to file" system, which means that all parties know up front that if they have a good idea for an invention, they need to be the first to file a patent application with the United States Patent and Trademark Office in order to protect their intellectual property rights. Passage of this Act should also eliminate delays previously experienced through interference proceedings and allow a patented product to come to market in an expedited manner.\nThe Bottom Line\nFor current entrepreneurs, the recent change in U.S. patent law, in conjunction with the use of low-cost, powerful personal computers and the affordability of the ever expanding Internet should provide a much greater business environment for establishing a successful small business. We have already seen a number of relatively new and successful companies that have benefited from online intangible business models. Examples include Google, Amazon, E-Bay, YouTube, LinkedIn, Craigslist, Wikipedia and PayPal, to name a few. Now, with the change in U.S. patent law, a host of new online businesses should have an additional advantage for establishing a successful small business operation.\nMore From Investopedia |
Ketaset (Canada)This page contains information on Ketaset for veterinary use.\nThe information provided typically includes the following:\n- Ketaset Indications\n- Warnings and cautions for Ketaset\n- Direction and dosage information for Ketaset\nKetasetThis treatment applies to the following species:\n(ketamine Hydrochloride Injection Usp)\nFor Veterinary Use Only\nKETASET (ketamine hydrochloride) is a new rapid acting, nonbarbiturate general anesthetic for cats, chemically designated 2 - (o-chlorophenyl)-2-methylamino-cyclohexanone hydrochloride. It is supplied as a slightly acid (pH 3.5 - 5.5) solution for intramuscular injection in a concentration containing ketamine (as ketamine hydrochloride) 100 mg per mL and contains 0.10 mg/mL benzethonium chloride as a preservative.\nKETASET (ketamine hydrochloride) is a rapid acting anesthetic producing an anesthetic state characterized by profound analgesia; normal pharyngeal - laryngeal reflexes and skeletal muscle tone, mild cardiac stimulation and some respiratory depression. The anesthetic state produced by ketamine has been termed “dissociative anesthesia” in that it appears to selectively interrupt association of the brain before producing somesthetic sensory blockade.\nFollowing administration of the recommended doses of KETASET (ketamine hydrochloride), blood pressure and heart rate are usually moderately and transiently increased. Respiratory rate, on the other hand, is usually decreased in cats. The pharyngeal reflexes are maintained thus aiding in the maintenance of a patent airway. Although some salivation is occasionally noted, the persistence of the swallowing reflex effectively reduces the hazards of salivation.\nOther reflexes, e.g., corneal, pedal, etc., are maintained under KETASET (ketamine hydrochloride) anesthesia, and should not be used as criteria for depth of anesthesia. Moreover, the eyes normally remain open with the pupil dilated, making it prudent to apply a bland ointment if anesthesia is to be prolonged. By single intramuscular injection in cats KETASET (ketamine hydrochloride) has a wide margin of safety.\nFollowing administration of recommended doses of KETASET (ketamine hydrochloride) most cats become ataxic in about 5 minutes, and anesthesia will normally last 30-45 minutes. Recovery is generally smooth and uneventful, especially if animals are not stimulated by sound or handling during the recovery period. At the lower doses complete recovery usually occurs in 4-5 hours but with higher levels of KETASET (ketamine hydrochloride) recovery time is more prolonged and less predictable. With high levels complete recovery may take 24 hours or more in some selected cases, especially if the patient is in poor condition or suffering from nephritis.\nKETASET (ketamine hydrochloride) is recommended as the sole anesthetic agent for diagnostic and surgical procedures. Although best suited to short procedures, it can be used, with additional doses, in procedures requiring anesthesia for periods of six (6) hours or longer.\nFor use in cats only.\nThe use of KETASET (ketamine hydrochloride) is not indicated in kittens under 12 weeks of age as it is not unusual in immature cats for anesthesia to be of shorter duration. Ketamine hydrochloride is contraindicated for procedures in cats requiring complete skeletal muscle relaxation.\nBecause the drug is excreted in the urine by cats, largely unchanged, caution should be exercised in dosing subjects with severe renal impairment. Caution should also be exercised in administering the drug to animals with cardiovascular abnormalities due to its hypertensive effect in cats. Premedication with atropine may, to some degree, deepen and prolong anesthesia in the cat.\nAt high dosage, respiratory depression may occur. If at any time cyanosis occurs, or if respiration becomes excessively depressed, resuscitative measures should be instituted promptly, e.g., artificial respiration, oxygen administration, etc.\nAdministration And Dosage\nKETASET (ketamine hydrochloride) is well tolerated by cats when administered by intramuscular injection.\nFasting prior to induction of anesthesia by KETASET (ketamine hydrochloride) is not essential; however, when preparing for elective surgery it is prudent to withhold food for at least six (6) hours prior to induction of anesthesia.\nDosageAs with other general anesthetic agents, the individual response to KETASET (ketamine hydrochloride) is somewhat varied depending upon the dose, general condition and age of the subject so that the dosage recommendations cannot be absolutely fixed.\nThe Following Schedule Of Dosage Is Recommended11-22 mg/kg body weight; MINOR SURGERY, SUTURING, ETC., MINOR DENTAL PROCEDURES, SIMPLE DIAGNOSTIC X-RAY, RESTRAINT FOR EXAMINATION (INCLUDING INTERIOR OF EYE), DRESSING, GROOMING, ETC.\n22-33 mg/kg body weight: CASTRATION, CATHETERIZATION, DECLAWING.\n33-44 mg/kg body weight: GENERAL SURGERY, ABDOMINAL SURGERY (INCLUDING OVARIOHYSTERECTOMY), ORTHOPEDIC SURGERY, MAJOR DENTISTRY.\nStorageStore in a cool place, protect from light. Colour of solution may vary from colourless to very slightly yellowish and may darken upon prolonged exposure to light. Do not use if particulate material appears.\nKETASET (ketamine hydrochloride) is supplied in multidose 10 mL and 50 mL vials of a solution containing 100 mg/mL.\nTrademarks used under license\n© Wyeth 2006. All Rights Reserved.\nWyeth Animal Health, Division of Wyeth Canada, Guelph, Ontario N1K 1E4\n17,300 TRANS-CANADA HIGHWAY, KIRKLAND, QC, H9J 2M5\n|Technical Services Canada:||800-461-0917|\n|Technical Services USA:||800-366-5288|\n|Every effort has been made to ensure the accuracy of the Ketaset information published above. However, it remains the responsibility of the readers to familiarize themselves with the product information contained on the Canadian product label or package insert.|\nCopyright © 2013 North American Compendiums. Updated: 2013-05-17 |
-- Pandora, via the Internet\nIt happens, babe. Get a load of these horror stories from the medical journals:\n*One patient in the UK required an operation that involved cutting open his leg and drilling into the bone. He was anesthetized but awoke in the operating room with a tube down his throat, aware but unable to move. He tried to alert the doctors by wiggling his toes; a nurse noticed this but was told it was "just reflexes" and she should ignore it. Someone then grabbed the patient's leg and began applying a tourniquet to his groin, at which point he realized that (1) the operation was just beginning, (2) he was acutely sensitive to pain, and (3) he could do nothing about it. The patient had to lie there in helpless agony while his leg was sliced open and four holes were drilled into the bone. He felt sick and stopped breathing in another attempt to alert the OR staff, but the ventilator began "breathing for him." Afterward he sued and was awarded u15,000, pretty modest compensation under the circumstances.\n*A 31-year-old woman with Hodgkin's disease was due to have her spleen removed and other organs biopsied. She was anesthetized but awoke before the operation began, fully sensitive to pain but paralyzed except for some slight ability to move the eyelids. Two observers in the operating room, probably students, pointed out that the patient's pupils were not dilated, but the anesthesiologist lectured them on how anesthetics worked and shut the patient's eyes. The patient tried to flutter her eyelids later; the operating team eventually decided she was waking up and gave her more muscle relaxant, which made it impossible for her to signal further but did nothing for her pain. The patient suffered for 45 minutes while the surgeons cut her open, removed her spleen, explored the other organs, then stitched her back up. After the patient was wheeled out of the OR the muscle relaxant wore off, and she was able to shout, "I was awake in there!" The anesthesiologist rushed back to the operating room and discovered that the oxygen flush had been locked in the "on" position during the operation, diluting the anesthetic. The woman subsequently had recurring nightmares and panic attacks and required psychiatric help.\n*A woman having a cesarean section awoke on the operating table, alert but paralyzed. Initially she felt nothing, but eventually the painkiller wore off, and the rest of the operation was a nightmare. "The nearest comparison would be the pain of a tooth drilled without local anesthetic -- when the drill hits a nerve," she wrote later. "Multiply this pain so that the area involved would equal a thumbprint, then pour a steady stream of molten lead into it." Yikes.\nAwareness under anesthesia occurs in perhaps two cases per thousand in general surgery and at a substantially higher rate in cases involving trauma or cesarean section. (Not all incidents are as horrifying as the ones described; sometimes the patient knows he's being sliced open but feels no pain.) It's usually blamed on faulty equipment or technique, though a few people just seem to be immune to anesthesia, at least the part involving loss of awareness. The underlying problem is that nowadays anesthesia involves not one but several drugs. These include painkillers, sedatives, amnesia-inducing agents, and relaxants that allow the muscles to be pulled aside so the surgeons can do their work. Getting the right mix is tricky. Too much inhaled gas, for example, can cause cardiac instability and possibly snuff the patient; not enough and he suffers the tortures of the damned.\nOver the years doctors have used various methods to detect awareness under anesthesia, none entirely satisfactory. You can try keeping one arm unparalyzed so the patient can signal the doctors if he's not unconscious, but this approach is far from foolproof. A promising new technique involves something called a bispectral index monitor, which analyzes brain waves to determine the patient's depth of consciousness. I'm sure it works great. But I'd want my anesthetist to leave me with one good arm too, so if all else failed, I could strangle the son of a bitch.\nIs there something you need to get straight? Cecil Adams can deliver "The Straight Dope" on any topic. Write Cecil Adams at the Chicago Reader, 11 E. Illinois, Chicago, IL 60611; e-mail him at [email protected]; or visit "The Straight Dope" area at America Online, keyword: Straight Dope. |
Aaron BondsProject Manager\n- Customer Service\n- Project Management\n- Small Teams Leader\n- Hardware and Software Technical Support\n- Embry-Riddle Aeronautical University\n- B.S. Aerospace Engineering\n- Mathematics Minor\nAaron has almost 15 years’ experience in various positions throughout the software industry. He spent 6 years in the anesthesia software space, implementing solutions and directing a customer support team. His team was responsible for the continued operation of both proprietary hardware and software at numerous public and private hospitals across the country to ensure patient safety, profitability, and compliance.\n“Dorger Software Architects prides itself on building and maintaining customer relationships through reliable delivery of best-in-class software and value-added services.”-\nSince joining Dorger Software Architects, Inc., he is furthering his experience in the public sector, working with various state agencies to manage, deploy and support a range of solutions. These solutions are designed to streamline complicated business processes as required by ever-evolving legislation, while providing new tools for citizens to be more engaged with their state governments. |
A sagging jawline is one of the first telltale signs of aging. As you age, your skin naturally loses volume, causing tissue to collect near the jawline and underneath the chin. No matter how many medical-grade skin care products you use, it’s impossible to prevent skin laxity once it’s started. When researching treatments, you may think a permanent facelift or temporary PDO threads are your only options.\nFortunately, that is no longer the case thanks to MyEllevate®. This minimally-invasive procedure can lift a sagging jawline through a suture support system for long-lasting results that are visible right away.\nAs a double board-certified facial plastic surgeon with more than 30 years of experience, Dr. Philip J. Miller, MD, FACS, utilizes the latest advancements in facial plastic surgery to deliver exceptional results. Dr. Miller performs MyEllevate at his Manhattan, New York office for patients who are unhappy with the appearance of their jawline.\nWhat is MyEllevate?\nMyEllevate is a facial rejuvenation procedure that lifts and tightens saggy tissue around the jawline using the ICLED® light guided suture system. This patented suture system allows surgeons to perform procedures without incisions.\nRather than cutting deep into the skin, the LED light transillumination sends feedback to the illuminated Suturod® and suture that guides it through the correct depth and direction. This system enables Dr. Miller to perform the MyEllevate procedure without incisions, which reduces bruising, swelling, and scarring.\nWho should consider MyEllevate?\nMyEllevate is the ideal procedure for men and women who want to enhance their jawline definition, but aren’t interested in undergoing more invasive surgery. You may want to consider MyEllevate if you:\n- Have saggy jowls\n- Have skin laxity underneath the chin\n- Are in good overall health\n- Are in your 30s or 40s\n- Do not smoke or use tobacco products\nThe MyEllevate procedure is an excellent long-term solution for lax tissue around the jaw. Unlike PDO threads, the results from your treatment may last five years or more, particularly if you combine it with additional facial treatments.\nBenefits of MyEllevate\nMyEllevate offers many benefits for those considering jawline contouring, including:\n- Minimally invasive\n- Long-lasting results (3-5 years or more)\n- Outpatient procedure\n- Minimal downtime\n- No general anesthesia\nAnother important benefit about the MyEllevate procedure is that Dr. Miller can combine it with additional treatments, such as Kybella®, or Face-Tite™ to deliver optimal results.\nThe MyEllevate Procedure\nThe MyEllevate procedure takes just one hour to complete. During your initial consultation, you work with Dr. Miller through his proprietary NatraLook® process to discuss your concerns and aesthetic goals. This collaborative technique ensures that you and Dr. Miller are in alignment regarding your treatment.\nWhen you arrive for your procedure, Dr. Miller injects local anesthesia around the predetermined treatment zones to eliminate any pain and discomfort. Next, he uses the ICLED light guided suture system to perform the procedure without incisions.\nThe ICLED and suture rod allow Dr. Miller to interweave the underlying tissue and muscles in the upper neck with a suture thread. He then gently pulls the thread to lift and tighten the areas that are contributing to the neck and jawline’s sagging appearance.\nRecovery from the MyEllevate Procedure\nThe MyEllevate procedure has very minimal downtime. You can resume your normal activities almost immediately after treatment. Aside from minor swelling, bruising, and discomfort, you may experience some tightness or dimpling in your skin after the procedure. These minor side effects should subside within a few days.\nMost patients need about 4 days to recover from the MyEllevate procedure, during which time you may need to wear a chin strap.\nWhat is the difference between a facelift and MyEllevate?\nWhile a facelift is a surgical procedure that typically requires general anesthesia and 14 days of recovery time, MyEllevate is a nonsurgical treatment that only requires local anesthesia and minimal downtime.\nWhat is the difference between a thread lift and MyEllevate?\nMyEllevate is more precise than a thread lift. The treatment also delivers more permanent results. During a thread lift, your surgeon superficially places temporary sutures that your body absorbs over time.\nThanks to ICLED light guided technology, Dr. Miller can place your non-absorbable sutures in precise locations to lift and tighten your muscles and glands.\nIs MyEllevate right for me?\nMyEllevate is a safe and effective procedure for any healthy adult with sagging jowls and submental laxity. If you’re hoping for a defined, sculpted jawline, schedule a consultation with Dr. Miller in Manhattan, New York to find out if you’re a good candidate for MyEllevate.\nDoes the procedure hurt?\nDr. Miller performs MyEllevate using local anesthesia, so you shouldn’t feel pain during the procedure. However, slight discomfort and pressure are expected. Your skin may also feel sore and tender after the treatment.\nHow long is the recovery?\nWith very little downtime, most patients recover from the MyEllevate procedure within about 4 days.\nWhen will I see results?\nYou should notice results right away with MyEllevate, but it may take a few days for the swelling to subside around your jawline.\nHow long will my results last?\nResults from the MyEllevate procedure can last for up to five years or more. Even better, the procedure stimulates your body’s collagen production, which can result in firmer, tighter skin for years to come.\nContact New York City's Top Facial Plastic Surgeon Today\nDr. Miller is a highly reputable facial plastic surgeon with specialized training in facial aesthetics. To schedule a consultation with Dr. Miller, contact his Manhattan, New York office today.\nSettle for Nothing But the Best Facial Plastic Surgery\nFacial Plastic Surgery\nDr. Philip Miller and his team of New York's top rated facial plastic surgery experts provide custom cosmetic treatment plans that include a combination of minimally-invasive techniques and advanced procedures, to help each patient achieve the Aesthetic Confidence® they desire. Our unique NatraFace™ approach to facial rejuvenation includes the following effective procedures:\nEyelid Plastic Surgery\nDr. Miller provides patients with Manhattan's #1 customized care and treatment for smooth, supple skin that brightens the eyes and revitalizes the face. With our NatraFace™ approach, we utilize a combination of effective aesthetic techniques tailored to suit each patient’s needs. We offer:\nRhinoplasty (Nose Jobs)\nDr. Miller and his staff of NYC's best aesthetic specialists offer the NatraNose® process, which is a comprehensive range of minimally-invasive and advanced techniques to achieve natural-looking rhinoplasty results, improve nasal function, and meet the patient’s aesthetic goals. Dr. Miller specializes in nose jobs, nose reductions, non-surgical nose jobs, and more: Adjust the links in these sections as follows:\nSkin Care Treatments\nWidely acclaimed for our broad range of flawless skincare solutions, Philip J. Miller, MD, FACS and his team of aesthetic specialists offer customized skincare treatment plans to achieve healthy, natural-looking results. As part of our NatraLook™ process, the following procedures may be performed individually or in combination with more advanced surgical treatments for optimal rejuvenation.\nMale Plastic Surgery\nPhilip J. Miller, MD, FACS, is a double board-certified facial plastic surgeon with over 20 years of experience working with male and female patients. He specializes in facial plastic surgery and is recognized as an expert in facial rejuvenation procedures. Utilizing the most advanced surgical techniques, Dr. Miller can maintain or enhance masculine features while producing the most natural-looking results.\nThe Plastic Surgery Podcast with Dr. Philip Miller\nTune into The Plastic Surgery Podcast, hosted by facial plastic surgeon Dr. Philip Miller. Dr. Miller is here to answer your questions, de-mystify plastic surgery, and help you feel more knowledgeable and empowered about any procedure performed at our center.\nThe Plastic Surgery Podcast\nPlastic Surgery w/ Dr. Miller\nIf you're thinking about getting a lift, nip, or tuck, this app is for you. It's the most comprehensive pocket encyclopedia of plastic surgery terms, before and after photos, and visualization tools to help you really know what to expect from a procedure, including seeing potential results on your own photo. This app is only available on the App Store for iOS devices.View in App Store > |
View Before and After PhotosThe fact that people usually tend to show the first signs of aging in their necks often leads them to consider a lower facelift or a neck lift. This is a wonderful procedure for those desiring an improved neck contour without having a traditional facelift.\nNeck lift is ideally suited for people with a double chin that do not have jowling or sagging skin in the rest of the lower and mid-face. The procedure involves tightening the skin and muscles in the neck and jawline. Liposuction alone may help the problem if significant fat is present beneath the chin.\nThe procedure usually begins with liposuction in the neck and jowl regions. Then, operating through small hidden incisions behind the ear and under the chin, Dr. Bolourian lifts and tightens the neck muscle called (Platysma Muscle) to rejuvenate the neck contour. Any excess skin is removed from behind the ear. The result is a smoother and tighter jawline.\nNeck lift surgery is typically performed under local anesthesia or twilight anesthesia on an outpatient basis. The recovery time for an isolated neck lift is typically a short time. Bruising if it occurs resolves in 3 to 4 days. |
Up to 80% of pets develop some form of dental disease by 3 years of age. During regular physical exams, the veterinarian will take a look at your pet’s teeth and determine whether a dental cleaning is necessary. Dental disease can cause a number of medical issues including infection, loss of teeth, pain and inflammation, and can even affect the kidneys, liver, and heart. Here are some signs to look for that may help you identify if your pet has dental disease:\nGums are red, swollen, or inflamed\nGums bleed when they are brushed or touched\nPainful when chewing, won’t eat ice\nEats canned or soft food regularly instead of dry food\nIf you press a cotton swab to your pets gums, their teeth chatter or bleed\nHeavy tartar, green or black build up on teeth near gum line\nPus or discharge coming from the gums around the teeth\nPawing or scratching at face excessively\nSwelling on only one side of the face or eye discharge.\nTHE SCOTTSDALE VETERINARY CLINIC’S DENTAL CARE RECOMMENDATIONS\nGood teeth and gums are very important to the health of your pet. The average animal lives 2-3 years longer with healthy teeth than those with gingivitis and tartar. Bad teeth and gingivitis can lead to heart disease, kidney and liver failure, and many other diseases.\nWe recommend you try brushing your pet’s teeth 2 times weekly. You can buy toothpaste and toothbrushes here or at the local pet store. Some pets tolerate a finger brush very well. Do not use a human tooth paste as these cannot be swallowed. Dentacetic wipes may be used as an alternative to brushing. If you are unable to brush your pet's teeth on a regular basis, ask about our brushless dental cleaning plan option for maintaining your pet's teeth.\nYou can also use dental chews, and we recommend CET HEXTRA chews. A recent study in the Journal of Veterinary Dentistry noted a 46% reduction in gingivitis in dogs that were given rawhide chews. CET chews have enzymes that help eat the tartar off the teeth. The chews also have an antibacterial agent (Chlorhexidine gluconate) that acts like a mouth wash. These additions help to scrape tartar and plaque off the teeth and reduce bacteria in the mouth. If you purchase other chews from a local pet store, please keep in mind that they must be "enzymatic" to be really effective.\n*Most chews are safe and very beneficial to the teeth, however, if your pet swallows them whole they must be discontinued as they can cause a blockage and may require surgery. Other rawhides/chews tend to cause more problems with diarrhea or vomiting as they are cured with formaldehyde. The CET Chews are cured by a "bake-and-press" method, which make them safer to give to your pet, and easier to digest when swallowed.\nWe recommend starting your pet on Plaque Off. This product bonds to tartar, breaks tartar off the teeth, and helps prevent new tartar from forming. Simply add this powder to your pet's food daily. This product works well for dogs and cats that do not like to chew or are too sick for a sedated dental cleaning.\nGreenies can be beneficial to the teeth. Make sure your pet does not swallow them whole as they can cause a blockage which may require surgery.\nDental cleanings are recommended for all pets with tartar and gingivitis, or for those pets that may require tooth extractions. At The Scottsdale Veterinary Clinic we have great discounts on our Brushless Plan Option for Pet Dental Health. The brushless dental option includes dental cleanings every 6 months to keep the teeth in the best health. These dental cleanings are significantly discounted to make this procedure affordable and keep your pet in the best health. Most dogs and cats will require their first cleaning between 2-5 years of age.\nDental Steps Explained\nPre-Anesthesia Exam – Physical examination of the eyes, nose, ears, mouth, abdomen, legs, lymph nodes, skin, and coat, as well as listening to the heart, lungs, recording temperature and weight.\nPre-Operative Antibiotic Injection – To prevent infection due to the bacteria that is released from the plaque during the scaling of the teeth.\nPlace IV-Catheter – Allows for rapid and direct distribution of medications and fluids during the dental procedure.\nPre-Operative Blood Evaluation – Evaluate the liver, kidneys, electrolytes, and blood counts to ensure anesthesia is catered to your pet’s medical conditions.\nSedation & Pain Injection – Decreases pre-operative anxiety and pain during the procedure, and relaxes them in preparation for anesthesia induction.\nAnesthesia Induction – Injections are given to sedate, and an endotracheal tube is placed to administer inhalant anesthesia and maintain respiration during the procedure.\nPulse Oximetry & Anesthesia Monitoring – Assists in monitoring the heart rate and oxygen saturation while under anesthesia. A technician trained in anesthesia will also be with your pet at all times to monitor the temperature, heart rate, respiratory rate, blood pressure, and EKG.\nIV-Fluid Therapy – Helps maintain hydration and blood pressure during dental cleaning.\nTemperature Management System – The use of heating pads, warming tables, blankets, and warm water bottles to keep your pet warm and comfortable while under anesthesia, as anesthesia can cause a drop in body temperature.\nUltrasonic Scaling – High powered instrument supplying high frequency vibrations, used to remove plaque, bacteria, and calculus from the teeth.\nSub-gingival Cutterage – The removal of calculus and plaque found on the tooth below the gum line.\nProbing for Pockets & Gingival Recession – Measure pocket depths around a tooth and check for exposure of root surface to establish periodontitis and periodontal pockets, and determine if x-rays and extractions may be necessary.\nIrrigate – Flushing of the mouth to remove loosened plaque and bacteria from dental surfaces.\nDental X-ray – After probing, an x-ray may be taken to determine whether extractions are necessary due to bone loss and tooth decay, and to identify open root canals & infected tooth roots.\nPolish – To smooth the surface after the scaling of the teeth to decrease the adhesive ability of plaque in the future.\nFluoride – An anti-plaque treatment used to help strengthen and desensitize teeth and discourage the development of future plaque.\nRecovery – A technician will monitor your pet after anesthesia until they are awake with the ability to stand up and has recovered swallowing reflexes.\nRemove Catheter – The IV catheter remains in place until your pet is ready to be discharged. A pressure bandage is placed to prevent bleeding, and is usually ready to be removed 15-20 minutes after.\nDental Charting – The doctor and technician will complete a detailed medical chart after the procedure, along with home care instructions. The technician will call you to arrange a pick-up time after your pet is awake from anesthesia.\nHome Care & Dental Aftercare – The technician will go over any home care instructions and questions you may have, and we also send home a list of recommended preventative care techniques to help keep your pet’s teeth clean and plaque free.\nCall TSVC to schedule your dental appointment today! (480) 945-8484 |
AnaHana, Anesthesiologist Hana, Masui Kai Hana, Masuikai Hana, 麻酔科医ハナ\nOrigination: Manga Japanese\nStatus: 📖 Ongoing\nAs a young anesthesiologist who has been with her hospital for about three years, Hanaoka Hanako has just about had it with her job. The hours are grueling and there are never enough hands. Her coworkers are either obnoxious jerks who call her incompetent or sexist boors who try to cop a feel. She hardly ever sees the sky, has to eat cup ramen for most meals, and has no social life to speak of. Worst of all, her job is thankless. Everyone loves surgeons who perform lifesaving operations, paramedics who rush to the scenes of emergencies, or nurses who provide primary care - but anesthesiologists are only singled out if something goes wrong and a patient is lost. Still, someone's got to do it, and if not her, then who?\nSo even with crappy pay, terrible work hours, and sexual harassment...anesthesiologist Hana will cheerfully knock you out! |
Is fat transfer buttock augmentation the right choice for me ?\nYes, provided you want :\n- A buttock volume increase without buttock implants\n- A buttock augmentation with no scars\n- Lifted buttocks\n- Your flat or flabby buttocks to be rounder\n- To improve your whole figure\nAre there other ways to change the shape of the buttocks ?\nButtock implants can be used to that end for patients who do not qualify for fat grafting buttock augmentation. The fat grafting buttock augmentation, commonly called BBL (Brazilian Butt Lift), can be combined with buttock implants to achieve superior results. For more information about these procedures, visit the buttock augmentation Tunisia page of Dr.Balti’s website.\nAre BBL results definitive ?\nYes, all the fat cells that have survived over the 3 months mark are permanently engrafted. Note that weight fluctuations will have an impact on fat cells in the whole body and the fat cells transferred in the buttocks make no exception.\nWhat precautions to take after a buttock augmentation with implants ?\nFollowing surgery, surgeons typically instruct their patients to rest during 10 to 15 days and avoid sitting or laying on the back.\nWhat are my options if I am too skinny to qualify for fat grafting buttocks augmentation ?\nThe BBL is sometimes not an option for patients with a very low body fat percentage. The fat harvested has to come from your body. Patients who do not qualify for a BBL may benefit from buttock implants.\nIs buttock augmentation with implants painful ?\nThis procedure is performed under general anesthesia, therefore patients do not feel pain during the operation. Like other surgical procedures, mild pain can persist during 3 to 5 days following surgery. Standard painkillers are prescribed by the surgeon to alleviate pain and discomfort. |
Pediatric Rehabilitation Services at Norton Children’s\nNorton Children’s offers inpatient and outpatient physical, occupational and speech therapy to children needing rehabilitation services. Our licensed therapists evaluate and treat children of all ages, from infants through young adults, for a wide range of injuries and conditions.\nPhysical therapy services include evaluation and therapeutic activities for gross motor skills development, including posture, balance, coordination, strength, mobility, positioning and alignment (seating). Whether due to an injury, developmental delay or other medical condition, our pediatric-trained therapists can improve a child’s functional outcomes and abilities using evidence-based techniques and state-of-the-art equipment.\nPhysical therapy services include:\n- Balance and coordination training\n- Gait analysis and mobility training, including partial weight-bearing treadmill training\n- Gross motor skills development and strengthening\n- Neuromuscular education with the use of neuromuscular electrical stimulator and functional electrical stimulator\n- Wheelchair assessment\nOccupational therapy services include evaluation and therapeutic activities for development of fine, sensory and visual motor skills. Our pediatric-trained therapists incorporate strategies to improve a child’s functional and social behaviors in the home, school and community.\nOccupational therapy activities include:\n- Fine motor strengthening and coordination, including handwriting skills\n- Self-care, including dressing, feeding and grooming skills\n- Sensory processing and modulation\n- Visual-motor development\n- Motor planning\n- Adaptive play and equipment\n- Bracing and splinting\nOur pediatric speech therapists provide evaluation and therapeutic activities that enhance the development of feeding and communication skills. Formal standardized testing, interactive play, social interventions and other modalities allow our therapists to determine a child’s functional level of communication and swallowing abilities.\nSpeech therapy services include:\n- Articulation of speech sounds\n- Augmentative and alternative communication training\n- Cognitive development\n- Expressive language training (communicating thoughts through words and sentences)\n- X-ray swallow studies for feeding, chewing and swallowing disorders\n- Language comprehension, understanding concepts, following directions\n- Reading and phonics\n- Resonance, including the use of nasometry and X-ray speech studies\n- Social skills play and community interactions\n- Voice and vocal cord dysfunction training\nThe Norton Children’s difference\nWith a 125-year presence in Louisville, Norton Children’s is a leader in pediatric care across Kentucky and Southern Indiana, providing an expanded footprint that includes:\n- Norton Children’s Hospital– The hospital works closely with University of Louisville specialists and Frazier Rehab Institute’s Pediatric Program to provide rehabilitation services to our young patients. Norton Children’s Hospital is the region’s only full-service, free-standing pediatric hospital and Louisville’s only Level I Pediatric Trauma Center. It also has one of the largest Level IV (highest level) neonatal intensive care units in the country.\n- Numerous regional outpatient centers and extensive pediatrician and pediatric specialistoffices throughout the area.\n- Norton Women’s & Children’s Hospital– The only women’s hospital in Louisville, providing care dedicated to the needs of women and children.\n- Norton Children’s Medical Center– A unique regional outpatient facility designed “Just for Kids,” brings pediatric care to northeastern Jefferson County and the surrounding area.\nNorton Children’s offers specialized programs and services, including:\n- Norton Children’s Cancer Institute, affiliated with the University of Louisville, and the Addison Jo Blair Cancer Care Center, which is one of the oldest oncology programs in the U.S. and continuously accredited by the American College of Surgeons’ Commission on Cancer.\n- Norton Children’s Heart & Vascular Institute, affiliated with the University of Louisville, a pioneer in pediatric cardiothoracic surgery. Norton Children’s heart transplant surgeons performed Kentucky’s first heart transplant in a newborn in 1986, making the hospital the second site in the United States for infant transplants. Norton Children’s Hospital will be home to the Jennifer Lawrence Cardiac Intensive Care Unit (expected completion in 2019).\n- Pediatric neurology and neurosurgery, including a Level 3 epilepsy center\n- Orthopedic surgery and rehabilitation\n- The Wendy Novak Diabetes Center\nIf your child needs surgery that will involve general anesthesia, it’s important to know that pediatric patients have unique needs. Their brains and bodies are still developing, and administering anesthesia to pediatric patients is […]Read Full Story\nEar tubes and other ear, nose and throat (ENT) surgeries are among the most common requiring general anesthesia for children 1 to 3 years old and babies as young as 6 months. The procedure […]Read Full Story |
Ethan O Bryson, MD\nDr. Bryson is a Professor of Anesthesia and Psychiatry in the department of Anesthesiology, Perioperative and Pain Medicine in the Ichan School of Medicine at Mount SInai.\nDr. Bryson received his MD from the Mount Sinai School of Medicine in New York in 2001 where he received the Dr. Joseph R. Jagust Award for excellence in Anesthesiology. After completing an Internal Medicine internship at the University of Medicine and Dentistry of New Jersey, he returned to Mount Sinai Hospital for residency training in Anesthesiology. Upon graduation, Dr. Bryson received the Senior Resident Recognition Award for Outstanding Academic Accomplishments during residency. As a supplement to residency training, Dr. Bryson completed a one-year fellowship in simulation education at the Mount Sinai Human Simulation Center.\nDr. Bryson has published extensively on the utilization of simulation in medical education and the care and treatment of the addicted patient. He served as a guest editor for the special issue on simulation of the Journal of Critical Care published in June of 2008 and as a guest editor for the Winter 2011 issue of the International Anesthesia Clinics focused on the anesthetic management of the patient who is addicted, dependent, or acutely intoxicated by a wide range of illicit and prescription drugs.\nDr. Bryson is also the senior editor of the textbook of Perioperative Addiction (Springer Science). Considered an expert in the field of the potential for addiction among anesthesiologists and the addictive nature of anesthetic agents, he is frequently consulted by Physicians and members of the lay media for comment on such matters.\nHis current research involves addiction, depression and the use of novel anesthetic agents for in electroconvulsive therapy.\n- The Mount Sinai Hospital\n- Mount Sinai Morningside and Mount Sinai West |
I am apprehensive for breast augmentation surgery - although I am located very close to both Birmingham, AL surgeons and Atlanta, GA surgeons who are known to be very reputable. The money is not a problem and I have wanted to do this ever since I had my daughter (she is now 8), I am 27. But, I have severe concerns about waking up during surgery, or even not waking up at all. Let me preface this with the fact that I have been put under completely before with a C-section. Can anyone help?\nI'm Very Worried About Waking Up During Breast Augmentation Surgery\nDoctor Answers 12\nSouthrn princess: You should ask your surgeon and anesthesiologist about their experience with "intraop awareness". To circumvent this issue, our anesthesiologists always use the BIS monitor, which is a device which measures brain wave activity (electroencephalogram). Since implementing this additional monitoring device, I haven't had a single complaint of intraop awareness and the rapidity of emergence from anesthesia is excellent. This technique is gaining popularity, so it may be available at either Birmingham and/or Atlanta. Good luck.\nHave a question? Ask a doctor\nWaking up during breast augmentation surgery\nYou might want to consider having your breast augmentation procedure done under local anesthesia where you are not put to sleep (general anesthesia) and don't have to be awakened from the anesthesia. This is done with monitored IV sedation so that you likely won't have any memory of the procedure or putting in the local anesthetic.\nThe risk of general anesthesia is quite low but the risk of local anesthesia with IV sedation is even lower, plus the effects on your system are much less. Another advantage is pain control is not as much of an issue because the breast can remain asleep at the end of the operation under local anesthesia. There is also a huge cost difference.\nNot all plastic surgeons are trained in local anesthetic techniques as well as the IV sedation techniques required. They may not give you a choice for your anesthesia. Board certified plastic surgeons doing local anesthesia with IV sedation also require accreditation for their facility if done outside the hospital or outpatient facility.\nLiposuction, mastopexy, and reduction of the breast can also be done under local anesthesia with IV sedation.\nSelect a Board Certified Plastic Surgeon, Member of ASPS\nBoard Certified Plastic Surgeons who are members of the American Society of Plastic Surgeons are required to operate only in certified facilities (certification by AAAASF, JCAHO, State Organizations or Medicare). This will minimize the likelihood of any anesthetic practice that would make waking up during surgery.\nYou might also like...\nBreast augmentation surgery is very safe\nIt is not at all uncommon that young mothers having aesthetic surgery are fearful of leaving their babies. Rest assured, this is a very safe operation with low risks of anesthetic complication or we as surgeons would not be doing it. After all, breast surgery of this sort is completely elective and only done when risk is extremely low. In 12 years of practice, I have not had one patient wake up during surgery. There are many things that are done in the operating room to make sure that you stay asleep during the operation. You should be able to talk to your surgeon about your concerns and get an explantation of what anesthesia techniques will be used to ensure that you remain comfortably asleep. Please do make sure that your surgeon is certified by the American Board of Plastic Surgery and that he or she is working in a fully accredited surgical facility with anesthesiologists certified by the American Board of Anesthesiology.\nYou will wake up after breast augmentation surgery but not during!\nAlthough there are a few different ways to do the anesthesia for breast augmentation, all of them involve multiple systems of monitoring to keep you safe and comfortable. You should of course have the surgery in an accredited surgical facility. To put it in perspective, your drive to the facility will be the riskiest part of your day.\nWaking up during breast augmentation surgery\nAnesthesia services in today's world are extremely sophistocated as long as you're working with board certified plastic surgeons. Many board certified surgeons have their own operating room which allows them to be in complete control of there operations. Our choice of anesthesia services is based on proper training and first class equipment. Because we are doing primarily aesthetic, or cosmetic surgery, all of our attention is dedicated to the highest form of service for our patients. Hospitals do a very good job, however they have such a wide range of patients with different types of problems, that they may not have as much experience with this type of surgery. Privately owned surgery centers that are certified by at least two certifying groups are your best bet, as long as your surgeon is a board certified plastic surgeon.\nAnesthesia and surgery\nIt is extremely unlikely that you would wake up during breast augmentation surgery during the procedure. The anesthesiologists I use, and I am sure most of the lalstic surgeons, use are exceptional. The medications and technology available today, I think almost completely eliminates any such risk.\nAwakening during anesthesia for breast augmentation\nThis has occurred in the past, but, thanks to advances in anesthesia monitoring, is almost unheard of now. Most certified Anesthesiologists at certified facilities use a BIS Monitor. They place this device on your forehead to monitor your brain waves. This tells them how asleep you are. By using it, they can tell that you are not too deep (causing problems awakening) or too shallow (likely to awaken). Discuss with your surgeon who will provide your anesthesia. Make sure it is a certified Anesthesiologist and that the procedure will be done in a certified facility. Before surgery, discuss your fears with the Anesthesiologist. Most of the time you will have a chance to do this a week or so before surgery.\nNo one wakes up during surgery or doesn't wake up at all.\nIt's a fiction that people wake up during surgery when done in a JCAHO ceritifed facility and with a Board Certified Anethesiologist.\nPick the right doctors and you'll sleep like a baby and wake up when they want you to. You'll be fine and you won't die.\nCheck all the credentials and you'll have a great surgical experience.\nWaking Up during breast Augmentation\nWaking up, or worse feeling the surgery but being unable to move, are EXTREMELY RARE. The ONLY time they may be encountered is in massive injury surgery when the patient is actively bleeding and the anesthesia may be light to prevent losing blood pressure and the patient and even in such extreme cases they are rare. The likelihood of you being awake during cosmetic surgery done by a professional team is as close to zero as any event in Medicine can get.\nYou may want to speak with your Plastic surgeon's anesthesiologist to assure yourself. But I really would not worry about it. It is an irrational fear.\nThese answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship. |
We are open - safety is our top priority!\nDr. Nestor Guzman is a highly-respected and dedicated professional with over 20 years of dental experience. He is known for his thorough chairside manner and gentle approach. Patients appreciate his warm and caring demeanor and how he takes the time to explain every step of the treatment process.\nFrom general dentistry to more complex procedures such as implants, cosmetic dentistry, conscious sedation or extractions, Dr. Guzman delivers high quality care with a personal touch.\nDr. Cruz provides expert care in periodontal therapy, periodontal plastic surgery, dental implant therapy, pre-prosthetic surgery, as well as bone and periodontal regeneration therapies. She has a collaborative treatment approach, listening to her patients’ needs and concerns, answering any questions and explaining all treatment options available before deciding on a final treatment plan together.\nDr. Beverly Carr is a seasoned, highly-trained Orthodontist who’s been creating beautiful smiles for children, adolescents and adults for over 20 years. She is dedicated to providing comprehensive orthodontic treatment and helping her patients correct their bite or straighten their teeth. Known for her friendly and gentle demeanor, Dr. Carr builds strong relationships with her patients and makes them each feel at home when they come for a dental visit. |
Veterinary Surgery Experts for the Pets of Naperville\nSpringbrook Animal Care Center provides advanced veterinary surgical procedures for dogs and cats. We strive to offer the latest in diagnostic and surgical capabilities available in veterinary care, and our experienced veterinary team uses the latest tools and techniques to care for your pet.\nModern Surgical Suite\nThe advanced surgical suite at Springbrook Animal Care Center is designed for your pet’s safety and comfort. It’s equipped with:\n- CO2 surgical laser\n- Heated surgical table\n- Modern anesthesia equipment\n- Suction equipment\nThe unique surgical capability of the CO2 laser simplifies many procedures and reduces risks to your pet. The CO2 laser benefits veterinary surgical patients in the following areas:\nFaster recovery time\nLess bleeding, pain, and swelling, allowing for a far quicker recovery from surgery\nCauterizes small blood vessels, and allows surgical procedures that are not practical with conventional scalpel\nSeals nerve endings resulting in less pain and swelling and a more comfortable post-operative recovery\nReduced risk of infection\nEfficiently kills bacteria, sterilizing the incision site\nReduced surgery time\nEffective precision and control speeds the procedure and allows for less time under anesthesia for your pet.\nFor your pet’s safety, we conduct a thorough exam and bloodwork before any surgical procedure. Our experienced veterinary team carefully performs and monitors your pet before, during, and after the procedure. Our surgical experience is extensive, and a sample of our most common surgeries includes:\n- Dewclaw removal\n- Feline declawing\n- Foreign body removal\n- Bladder stone removal\n- Wound repair\n- ACL repairs\n- Mass removals\nVeterinary Orthopedic Surgery\nOur Veterinary Surgeons are committed to providing your pet with the highest level of orthopedic surgical care. If your dog has an obvious orthopedic injury, or you are concerned that they may be in pain, we have the expertise and state-of-the-art tools to put your dog back on the road to an active, pain-free, healthy lifestyle.\nFor your convenience, the Surgical Consent Form is available for download and completion prior to your pet’s surgical appointment. Please contact us to make an appointment or to discuss how our veterinary surgical services can benefit your pet.\nLighting fixtures utilize efficient LEDs and many of the rooms are equipped with motion-activated lighting, minimizing electric use.\nWe accept walk-ins during our Doctor’s Hours to meet your busy lifestyle. If you’d prefer to make an appointment, we offer those too!\nNews & Events\nNew Dog or Puppy? Time For Training!\nTraining is an important part of any dog's life. From providing mental stimulation to exercise and proper socialization, training will help in the development of a great canine companion. Enrollment is now open for Behavior Training Classes. The cost of a 6-week session is $120. Please call us at (630) 428-0500 to register your pet. For specific training questions only, please email: [email protected]. |
Physician / Anesthesiology\nCompany: Integrity Healthcare...\nPosted on: September 24, 2022\nThe position entails approximately 20% Peds and 80% Adult\nAnesthesia. The clinical practice includes L&D, neonatal and\ngeneral pediatric surgery, general surgery, robotic surgery,\nneurosurgery, ENT, plastics, burn, level I trauma, orthopedics,\npodiatric surgery, and special procedures outside the OR. TEE\nequipment is available to our anesthesiologists for perioperative\nand critical care patients. About 11,000 anesthesia encounters\ngenerated per year. In-house call is 4-5 times per month. Position\nrequires flexibility, excellent interpersonal skills, and ability\nto work with high acuity adult and pediatric patients while\nsupervising and teaching emergency medicine and surgery residents,\nCRNAs, student nurse anesthetist, and medical students. This\nteaching exposure creates opportunity for our physicians to apply\nto our university affiliations for academic appointment.\nAll qualified applicants are encouraged to apply.\nGroup is a large multi-specialty physician group offering great\nteaching and research opportunities, a great work environment,\ncompetitive salary, and comprehensive benefits package including\nprofessional liability coverage.\nContact Scott Scheinman at 561-413-9455 or\nKeywords: Integrity Healthcare..., Phoenix , Physician / Anesthesiology , Healthcare , Phoenix, Arizona\nDidn't find what you're looking for? Search again! |
There are several common problems found in dental anesthesia and I saw quite a few of these during my years of work in the dental field. Both general anesthesia and local anesthesia are used in dentistry. More complaints seem to stem from local anesthesia, though. Listed below are common problems found with both types of anesthesia.\nThe most common general anesthesia used in a dental office is Nitrous Oxide, also called laughing gas. The patient is not put into a sleeping state for as long a period of time or as deeply as that of a surgical patient in the hospital. A hospital surgical patient is kept NPO, without food and drink, after midnight for early morning surgery. This time is shortened for a dental patient to within two to three hours prior to the appointment. If the patient has a weak stomach, it is wise to extend the time frame. Some patients opt to receive only enough Nitrous Oxide to make them comfortable during the procedure without being totally sedated.\nA dentist applies a topical anesthic to numb the skin, followed by an injection containing Epinephrine to totally block the area of the tooth. The injection site, type of injection used, and your metabolism rate all play a part in the degree and duration of the numbness of the area.\nPatients with a slow metabolism rate will feel the effects of the injection for a longer period of time. If the patient does not normally drink coffee, they can speed the metabolism of the injection up by drinking strong coffee after the procedure. Likewise, patients who are heavy coffee drinkers, and particularly those with high metabolism rates, may never feel fully numb for the procedure. Therefore, it is best to avoid coffee prior to a dental procedure appointment.\nArticane HCl metabolizes slower than other local anesthetics. Therefore, if your dentist chooses to use Articane HCl you will feel the effects of the injection longer. The dentist may choose Articane HCl when performing a lengthy procedure. Dentists moved away from using Novacaine due to allergic reactions in many patients. They began using Lidocaine HCl. It is the active ingredient in Xylocaine HCl. The injections now used contained Epinephrine.\nThe human body varies in individuals and the art of dental anesthesia is not an exact science, measurable in increments from the tooth to be treated. It depends on how close to the sensory nerves the dentist actually was in injecting the area to be blocked. It is possible for your dentist to use the same injectable on different occasions and the patient to have varying results.\nPAIN FROM ROOF OF MOUTH INJECTIONS\nRoot canal work, crown preparation or any extensive work on the upper teeth requires a palatal injection of local anesthetic. The roof of the mouth has a much greater nerve supply than other areas of the mouth. Outside of asking for Nitrous Oxide or asking the dentist to use Articane HCl for less involved procedures, there is nothing the dentist can do to alleviate the pain.\nBLURRED VISION FOLLOW INJECTABLE ANESTHESIA\nThe fifth cranial nerve, the trigemenial nerve, splits in three branches after leaving the skull. These three divisions are opthalmic, maxillary, and mandibular. If the patient’s dentist hits the back portion of the fifth cranial nerve where the divisions split away from each other, you will experience blurred or double vision. The effect will subside as the injection is metabolized.\nMUSCLES HURT AFTER LOCAL ANESTHESIA\nAll oral local anesthetic injectables pierce one or more muscles as the needle enters while being administered. The patient may not notice any discomfort with muscles that are seldom used. However, if the muscle involved is one frequently used in chewing or the patient has Bruxism, the patient probably will notice pain. How long the pain persists depends upon how much work the muscle is subjected to.\nEpinephrine, the active ingredient in the local anesthetic injectables, can cause heart palpitations in patients with high blood pressure, diabetes, congenital heart defects, and other heart abnormalities.\nMany people have a fear of dentistry work. Though most combative patients are children, this problem can arise with adult patients. If the patient does not have medical issues preventing the use of Nitrous Oxide, it is the best for the patient and the dentist to use the general anesthesia. It can be far less traumatic to children to be admitted to the hospital to be fully sedated by an anesthesiologist specializing in pediatrics than to have the work done in the office. Many children have been known to bite or hit the dentist.\nDental procedures are not always painless but most of the common problems faced with anesthesia are temporary, minor, or can be alleviated. Good oral hygiene and health should be among a person’s top priorities. Good oral hygiene will lessen the need for dental procedures requiring anesthetics. When a procedure does need to be done, talk with your dentist about any past problems you may have experienced to make the new procedure more comfortable. |
Dr. Kevin Sadati is one of the most sought-after Orange County facial plastic surgeons. He is double board certified as both a facial plastic surgeon and as an ENT surgeon.\nDr. Kevin Sadati's unique balance of surgical expertise, as well as his artistic background as a painter and sculptor, drives his ability and passion to bring balanced, natural-looking results to his patients.\nDr. Sadati on The Doctors\nEmmy Award winning TV show The Doctors invited Dr. Kevin Sadati of Newport Beach to talk about a rhinoplasty surgery he performed on a twenty-seven year old woman who has dealt with an enormous, disfiguring tumor on her nose since she graduated from college.Watch the video\nDr. Kevin Sadati has performed well over 3,000 lower face and neck lift procedures utilizing his self-developed muscle tightening technique under (using) local anesthesia and twilight sedation, without the need for general anesthesia.Learn more\nThe neck and jowls are the first areas to show signs of aging with sagging, drooping and stretched skin, making an individual seem heavier and older than they really are. Dr. Kevin Sadati can perform this minimally invasive neck lift under local anesthesia and twilight sedation in his very own practice.Learn more\nAs a top nose job surgeon, Dr. Kevin Sadati utilizes various techniques to create harmonious rhinoplasty results that complement a patient’s facial features. This is why he has been said to give one of the best rhinoplasty surgeries around.Learn more\nEyelid surgery, also known as blepharoplasty, improves under eye bags and excess skin laxity around the eyes. Dr. Kevin Sadati specializes in minimally invasive facial surgery with the ability to perform it under local anesthesia and twilight sedation, while providing natural-looking results.Learn more\nDr. Kevin Sadati\nWhen searching for a facial plastic surgeon, choosing the right doctor who is both experienced and caring is extremely important. Dr. Kevin Sadati is a board certified facial plastic surgeon, as well as fellowship trained cosmetic surgeon. With over a decade of experience he has performed several thousand surgical procedures and remains active in medical community education. He has published his innovative techniques in peer review journals and been invited to present at several national plastic surgery conferences.\nDr. Sadati continues to set himself apart from other facial plastic surgeons with his unique blend of surgical finesse with his passion for the arts. As a trained sculptor and painter, he combines his surgical understanding of human anatomy with his artistic eye to create harmonious, natural-looking results for each patient. It is this unique blend of talents that has earned him a high level of respect and esteem among peers, and the love and admiration of his patients. In this way he has earned himself numerous titles, including: Voted Best Cosmetic Surgeon in Orange County by the OC Register and also an Awarded Top Doctor by RealSelf.com\n“Art has complemented my work as a facial plastic surgeon allowing me to see and express myself more profoundly. It allows the integration of heart, hand and science,” - Dr. Kevin Sadati.\nDR. KEVIN SADATI SURGERY AVERAGES COMPARED TO\nTHE AMERICAN SOCIETY FOR AESTHETIC PLASTIC SURGERY\n|Surgical Procedures||Number of procedures performed by the average board Certified Plastic Surgeon and Otolaryngologist per year||Dr. Kevin Sadati's average number of procedure performed per year|\nFat grafting is considered a permanent solution to facial volume loss, treating issues such as hollowness under the eyes, deep nasolabial folds and sagging, flat cheeks. Dr. Kevin Sadati removes unwanted body fat then mixes it with PRP (platelet rich plasma) to achieve permanent filler results. The procedure is performed under local anesthesia and twilight sedation.Learn more\nSome patients are not satisfied with the appearance of their nose after their initial rhinoplasty. While others suffer from structural or breathing issues that have occurred as a result of their first surgery. Dr. Kevin Sadati is familiar with all types of revision nose job techniques to help improve shape and function of the nose, allowing him to deliver truly stunning results in revision rhinoplasty.Learn more\nOngoing or recurring sinus infections, brought on by inflammation of the sinuses or a nasal obstruction, can negatively affect a person’s life, leading to headaches, facial pain, sinus pressure and a host of other complications. Dr. Kevin Sadati offers balloon sinuplasty as a minimally invasive procedure that provides instant relief to sinus problems. No general anesthesia is required for a comfortable experience.Learn more\nRevolutionary New Facelift Technique\nDr. Sadati has developed a less invasive facelift technique which is so effective it has been published in the American Journal of Cosmetic Surgery. Named the Double C Plication technique, it can be done using oral sedation with local anesthesia which eliminates surgical risk while producing a completely natural refreshed look. Men and women who are looking an elegant facelift can now achieve their goals with less risk and downtime.\nThe culmination of art and surgical skill\nDr. Sadati is among the few plastic surgeons in California who also has a Bachelor of Arts degree along with his double board certification in plastic and reconstructive surgery. As a result of his studies in sculpting and painting he is acclaimed as one of the top facial plastic surgeons in Orange County. Facial procedures demand an exceptionally high degree of skill and artistic perception since the result of the procedure is always visible. Dr. Sadati has performed thousands of facial procedures over the years, fine tuning his technique and sharing his discoveries with his colleagues.\nWhat is the Double C Plication technique?\nThe Double C Plication technique is a method of lifting underlying muscles using a folding and suturing technique. This method does not endanger facial nerves or create a stretched or windblown look, nor does it create dimples or ridges which look unnatural. The incisions are much smaller and there is very little swelling or bruising during the short recovery period. Returning to work and social activities is possible within a week to 10 days following surgery. Facelift patients are delighted with Dr. Sadati’s gentle method which turns back the clock 10 to 15 years without the risk of general anesthesia and with a shorter overall time commitment.\nRhinoplasty is One of the Top Five Cosmetic Procedures Performed Each Year\nRhinoplasty follows the national trend in popular facial plastic surgery procedures. It is among the top five plastic surgery procedures done in the United States each year. While it is among the most commonly done procedures, it is also considered to be among the most difficult facial procedures among plastic surgeons. Refinements to the size and shape of the nose must be done with extreme precision; the changes are measured in millimeters yet create a profound difference in appearance.\nThe nose is the most prominent feature of the face. When the nose is out of proportion or has a distracting feature, it is often a source of distress and lack of confidence. Rhinoplasty is a surgical procedure which focuses on restoring balance and harmony to the facial features as well as improving breathing function if this is an issue.\nAbout Dr. Sadati\nAs a double board certified facial plastic surgeon, Dr. Sadati has performed thousands of facial surgeries including highly complex facial reconstruction caused by birth defect or accident. He is highly respected by his peers and routinely publishes his innovative techniques in medical journals so as to elevate this surgical specialty and improve patient experience.\nChoose your facial surgeon carefully\nFor those seeking high quality rhinoplasty, Dr. Sadati cautions them to be very careful when choosing their plastic surgeon. He stresses that while there are many competent plastic surgeons available, rhinoplasty is a specialized procedure. Finding a plastic surgeon that does many rhinoplasty procedures each year is especially important for this procedure.\nThere are two components to successful rhinoplasty. One is the extreme surgical skill required when working with a three dimensional structure with a complex interior structure. Equally important to aesthetic results is the surgeon’s artistic perception and ability to correctly proportion the nose in relation to the rest of the features. This is particularly important when working with patients with distinct ethnic features. Dr. Sadati’s goal is always to create a functioning and aesthetic nose which complements rather than masks ethnic heritage.\nAt our office, patients are introduced to our practice by meeting with Dr. Kevin Sadati for an initial comprehensive consultation. During this appointment, Dr. Sadati invests time getting to know each individual patient, as well as his or her goals and expectations for surgery. Patients will meet all of the caring staff and receive top-notch customer service while experiencing Dr. Sadati's unrivaled patient care.Contact Us Today |
Q. I rescued an 11-year-old cavalier King Charles spaniel with dental issues. Her breath would melt glass…real bad. But more than that, I cannot brush her teeth or approach her mouth at all. Although her appetite remains good and she seems generally happy, when I go to touch her mouth to take care of her or get a look at her teeth, she cries out in pain (but never tries to bite me). I have tried all the over-the-counter remedies to no avail. Is there any alternative to get her mouth healthy again? I have taken Lady to two different veterinarians, and both said putting her under anesthesia for dental work is out of the question because she has an enlarged heart and progressive heart failure that is too far along to provide anesthesia safely. Any light you can shed on this would be greatly appreciated.\nMerritt Island, Florida\nDear Mr. Taylor,\nYou are an astute friend to your dog to observe that she seems to be in pain despite still having an appetite and eating well. According to Your Dog editorial board member and board-certified veterinary dentist Bonnie Shope, DVM, “people often mistakenly think that dogs must not be enduring pain if they are eating. This is not true. You and I would still be hungry and want to eat, even with a toothache!”\nDr. Shope also says that while you have taken your dog to see two veterinarians, you might want to consult a veterinary cardiologist. “Consulting with a cardiologist to evaluate the stage of heart disease informs us of the risk and guides us in developing the safest anesthesia protocols,” she notes. “It is rare that a cardiologist absolutely does not recommend using anesthesia to treat a pet suffering from advanced dental disease.”\nSeeing a veterinary dentist for surgery under anesthesia is the ideal solution.On the off chance that a board-certified veterinary cardiologist does rule out anesthesia for Lady, a veterinary dentist still has tools in her arsenal that can ratchet down pain far better than over-the-counter remedies. She may prescribe non-steroidal anti-inflammatory pain medication, a narcotic, or another medication based on the diagnosis, which could be anything from a cracked tooth or tooth abscess to an oral tumor.\nPlease keep us posted as you go forward. We feel confident that with the proper professional help, your dog can enjoy her life more comfortably. |
This map identifies and displays key features of city nuisance property ordinances across the 40 most populous cities in the United States in effect as of August 1, 2017.\nThis map identifies and displays key features of US state fair housing laws in effect as of August 1, 2017.\nThis map identifies and displays key features of state-level landlord-tenant laws across all 50 states and the District of Columbia in effect as of August 1, 2017.\nThis map shows laws that require facilities where abortions are performed to be regulated under a distinct abortion facility licensing (AFL) provision, and/or meet special requirements regulating abortion providers. This page identifies variation in states that have AFL requirements in effect as of August 1, 2016.\nThis study uses policy surveillance to compare the prevalence and characteristics of facility laws governing abortions specifically targeted regulation of abortion providers (TRAP) laws; office-based surgeries, procedures, sedation or anesthesia (office interventions) generally (OBS laws); and other procedures.\nThis map shows U.S. federal and state laws that regulate e-cigarettes.\nThis legal map shows laws that regulate various aspects of non-hospital facilities that provide office-based surgery, procedures and/or anesthesia/sedation. |
General Cardiology, Echocardiography, Interventional Cardiology\nStem Cell Biology, Tissue Engineering, Regenerative Medicine, Vascular Interventional Radiology.\nResearch Interest: Atherosclerosis, Hypertension and Vasoactive Peptides\nResearch Interest: General anesthesia, Cardiac anesthesia, Cardiac surgery, Vascular surgery, Cardio-poulmonary pass, Anesthetic drugs, Critical care, Acute kidney injury, Respiratory failure, ECMO.\nResearch Interest: Thrombosis, Antithrombotic Therapy, Anticoagulant Therapy, Anti-Aggregating Agents, Aspirin, Fibrinolytic Drugs, New Oral Anticoagulants, Atrial Fibrillation, Cardioembolic Stroke, Ischemic Stroke, Peripheral Arterial Diseases, Carotid Stenosis, Deep Vein Thrombosis, Venous Ulcers, Venous Thromboembolism, D-Dimer, DVT Recurrences, Hemorheology.\nResearch Interest: Hemorheology, Red Cell, Blood Oxygen Transport\nBiomedical Physics the Faculty of Mathematics and Physics of the Comenius.\nResearch Interest: Cardiovascular Pharmacology-Arrhythmia And Hypertension, Neuroscience-Baroreflex Afferent Function, And Electrophysiology-Ion Channel Regulation\nResearch Interest: Biology: Histology, Cytology, Neurocytology and Endocrinology.\n1. Stem cell therapy for treatment of various neurological disorders, cardiac disorders and autoimmune diseases like type-1 diabetes mellitus, SLE\n2. Pediatrics, pediatric nephrology and transplantation and pediatric cardiology\n5. Autoimmune disorders and stem cell therapy\nSoutheastern University, China\nPeertechz Journal of Computer Science and Engineering\nMetaxas Memorial Anticancer Hospital , Greece\nAnnals of Bone Marrow Research\nPeter J Catalano\nTufts University, USA\nArchives of Otolaryngology and Rhinology\nOsmar Antonio Centurion\nAsuncion National University, Paraguay\nGlobal Journal of Medical and Clinical Case Reports\nDr. Pierre Guertin\nLaval University, Canada\nPeertechz Journal of Gerontology and Geriatric Research |
Year : 2014 | Volume\n| Issue : 4 | Page : 562-564\nAccidental intrathecal injection of magnesium sulfate for cesarean section\nMehryar Taghavi Gilani1, Nahid Zirak1, Majid Razavi2\n1 Department of Anesthesia, Cardiac Anesthesia Research Center, Imam-Reza Hospital, Mashhad, Iran\n2 Department of Anesthesia, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran\nDr. Majid Razavi\nDepartment of Anesthesia, Imam-Reza Hospital, Bahar Street, Mashhad\nSource of Support: None, Conflict of Interest: None\n|Date of Web Publication||16-Sep-2014|\nMagnesium sulfate is used frequently in the operation room and risks of wrong injection should be considered. A woman with history of pseudocholinesterase enzyme deficiency in the previous surgery was referred for cesarean operation. Magnesium sulfate of 700 mg (3.5 ml of 20% solution) was accidentally administered in the subarachnoid space. First, the patient had warm sensation and cutaneous anesthesia, but due to deep tissue pain, general anesthesia was induced by thiopental and atracurium. After the surgery, muscle relaxation and lethargy remained. At 8-10 h later, muscle strength improved and train of four (TOF) reached over 0.85, and then the endotracheal tube was removed. The patient was evaluated during the hospital stay and on the anesthesia clinic. No neurological symptoms, headache or backache were reported. Due to availability of magnesium sulfate, we should be careful for inadvertent intravenous, spinal and epidural injection; therefore before injection must be double checked.\nKeywords: Accidental, cesarean section, intrathecal, magnesium sulfate\n|How to cite this article:|\nGilani MT, Zirak N, Razavi M. Accidental intrathecal injection of magnesium sulfate for cesarean section. Saudi J Anaesth 2014;8:562-4\n|How to cite this URL:|\nGilani MT, Zirak N, Razavi M. Accidental intrathecal injection of magnesium sulfate for cesarean section. Saudi J Anaesth [serial online] 2014 [cited 2019 Dec 11];8:562-4. Available from: http://www.saudija.org/text.asp?2014/8/4/562/140906\n| Introduction|| |\nOne of the challenging problems in the operating room is accidental injection of drugs in epidural and subarachnoid spaces. It can be safe such as labetalol and atracurium , to even death following injection of vindesine or bortezomib. \nMagnesium sulfate is among the drugs, which is used in obstetrics department for prematurity and preeclampsia. Furthermore, this drug is used as an analgesic adjutant along with opioids and local anesthetics in spinal cavity. ,,, In the operation room, accessibility of magnesium sulfate has also caused certain problems. In this report, the complications caused by wrong intrathecal injection of magnesium sulfate were discussed.\n| Case Report|| |\nThe present case report is about the patient 26-year-old gravid 2 para 1 woman with a history of classic cesarean section (due to lack of the fetal head descent) and delayed emergence of anesthesia for pseudocholinesterase enzyme deficiency. She was transferred to the operation room at 3 am for emergency cesarean section. At first, the patient received 200 cc Ringer and then was placed in a sitting position. We decided to induce spinal anesthesia and for reducing neurologic complications, we used 3.5 ml of lidocaine 2%. Spinal anesthesia was done by a 25-gauge Whitacre needle in L4-L5 space; after confirmation of the subarachnoid space and cerebrospinal fluid, 3.5 ml of the lidocaine 2% was injected. The patient was immediately placed in the supine position. After 5 min with T5 block level by pinprick, the surgery was started. Skin incision was performed painless. However, the patient had complained of pain with deep incision. Then general anesthesia was induced by 4 mg/kg sodium thiopental and 0.5 mg/kg atracurium (instead of succinylcholine). Sellick maneuver was used and after about 2 min, the patient was intubated and ventilated mechanically and isoflurane was used for maintenance.\nCesarean operation was done and newborn was born with Apgar 8 in the 1 st min and Apgar 10 in the 5 th min. We administered 150 mg fentanyl and 30 units of oxytocin on serum. The surgery was performed with no special problem and lasted for 40 min. At the end of surgery, 0.04 mg/kg neostigmine and 0.02 mg/kg atropine were injected. Her shallow breathing and muscle movements confirmed that muscle relaxation was not adequately restored. Neostigmine and atropine (half of the initial administration) were again injected after 15 min. Meanwhile, a used magnesium sulfate 20% vial was found on the table beside lidocaine 2% (same color, size and volume) and a suspicion emerged about wrong injection of magnesium sulfate 20% instead of lidocaine 2%. Then 50 μg/kg/min propofol and 1 mg midazolam were infused. Spinal fluid on lateral position with Whitaker needle no = 27 in L3-L4 space was obtained and also blood tests were used to confirm the issue; magnesium was positive in spinal fluid and was reported as 5.5 mmol/L in blood. The patient was transferred to the intensive care unit (ICU). Her muscle relaxation was evaluated every half an hour using train of four (TOF). 6 and 8 h after intrathecal magnesium injection, 0.7 and 0.85 TOF were observed, respectively. At this moment, propofol injection was stopped and endotracheal tube was removed. Limbs movements were good but the patient was unable to speak yet. After about 10 h, the patient was in full consciousness, had good muscular strength with hand grip and biting test, then she started breast feeding. After 24 h, she was transferred to ward. During the hospital stay (72 h), the patient's motor and sensory evaluations showed no sign of neurological toxicity; she had no backache and she was discharged. The patient visited the anesthesia clinic twice in 2 week interval; she was evaluated and had no neuromuscular problems.\n| Discussion|| |\nAdministration of magnesium sulfate as a supplement for local anesthetic medications and opioids in intrathecal space has been studied in recent years. Numerous articles have used 50-100 mg of magnesium sulfate in combination with morphine and bupivacaine 0.05% in lower limb surgery, cesarean, hysterectomy and thoracotomy. \nMagnesium increases muscle relaxation performance and also prolongs clinical effects of succinylcholine and non-depolarizing muscle relaxants. It accelerates local anesthetics and is the non-competitive antagonist of N-methyl-D-aspartate (NMDA) receptors. It reduces central, peripheral and cardiac nerve conduction. It causes peripheral vasodilatation, mild tachycardia and bronchial dilatation.\nHypermagnesemia is usually induced due to iatrogenic reasons. Symptoms associated with increased magnesium depend on its blood levels. QRS complex widening, prolonged PR and QT are observed at 2-4 mmol/L levels. Hypoventilation, decreased tendon reflex and muscular weakness are seen at levels of 8-12 mmol/L. Hypotension, bradycardia and vasodilatation are also observed at level of 10-20 mmol/L and coma and apnea at 20-30 mmol/L levels.\nEpidural injection of 500 mg of magnesium sulfate with morphine and bupivacaine in Sun et al. study had better and long-lasting post-operative pain relief after cesarean section, reduced post-operative analgesics and improved patient satisfaction within 24 h in comparison to bupivacaine alone or morphine with bupivacaine. \nA systematic review in 2013 by Morrison et al. evaluated intrathecal magnesium sulfate in 15 clinical trials. Longer duration of anesthesia was observed in non-pregnant patients with no evident difference between pregnant and non-pregnant groups in prevalence of hypotension and pruritus. Another qualitative review by Albrecht et al. in the year 2013 reported earlier onset time in intrathecal and epidural magnesium sulfate groups with only one case of headache out of 140 patients. \nSo far there are no clear reports for neurological effects and no reports of high dose of intrthecal magnesium sulfate in humans. In the rats, was compared between single dose of 3 mg magnesium sulfate and seven consecutive daily doses of 3 mg magnesium sulfate in spinal cavity. Pathological studies reported effects of nerve damage (neurodegeneration) in both groups. Furthermore Saeki et al. showed that magnesium sulfate had no protective effects and increased risk of neural toxicity in rabbits. In contrast, in another study on rabbits, subarachnoid magnesium sulfate decreased and delayed ischemia-induced complications and had protective effects on the spinal cord due to reduction in acute neuronal degeneration. \nGoodman et al. in their study have reported two cases of inadvertent epidural administration of magnesium sulfate as much as about 9 g with intervals of several hours that was used to control pain in pregnant women. None of the patients showed any sign of local neurological toxicity. One patient complained about weakness and mild consciousness disorder with increased serum level. The second patient reported mild backache and mild non-postural headache on the 2 nd day after surgery which was improved on the 3 rd day. \nInitial thermal changes and numbness of the skin followed by intrathecal magnesium sulfate may be due to local semi-anesthetic or NMDA effects; but, deep tissue had no proper analgesic effects for surgery. Systemic effects of magnesium sulfate are because of its vascular adsorption which is induced with delay. Complications of increased blood levels of magnesium sulfate on central and peripheral nerves and also facilitation of muscular relaxation effects of atracurium are among the reasons mentioned for prolonged muscular relaxation.\nDue to availability of magnesium sulfate in the operation room, risks of wrong injection of medications should be considered. According to the instructions, the medication should be always checked twice before injection. In the reported patient, accidental intrathecal injection of 700 mg magnesium sulfate was accompanied by muscular relaxation for about 8-10 h, which was maintained by mechanical ventilation, patient transfer to ICU, intravenous sedation injection and supportive measures with no long-lasting adverse neurological or mobility disorders.\n| References|| |\n|1.||Balestrieri PJ, Hamza MS, Ting PH, Blank RS, Grubb CT. Inadvertent intrathecal injection of labetalol in a patient undergoing post-partum tubal ligation. Int J Obstet Anesth 2005;14:340-2. |\n|2.||Zirak N, Soltani G, Ghomian N, Hasanpour MR, Mashayekhi Z. Inadvertent intrathecal injection of atracurium. Saudi J Anaesth 2011;5:223-5. |\n|3.||Tournel G, Bécart-Robert A, Courtin P, Hédouin V, Gosset D. Fatal accidental intrathecal injection of vindesine. J Forensic Sci 2006;51:1166-8. |\n|4.||Gilbar P, Seger AC. Deaths reported from the accidental intrathecal administration of bortezomib. J Oncol Pharm Pract 2012;18:377-8. |\n|5.||Khalili G, Janghorbani M, Sajedi P, Ahmadi G. Effects of adjunct intrathecal magnesium sulfate to bupivacaine for spinal anesthesia: A randomized, double-blind trial in patients undergoing lower extremity surgery. J Anesth 2011;25:892-7. |\n|6.||Jabalameli M, Pakzadmoghadam SH. Adding different doses of intrathecal magnesium sulfate for spinal anesthesia in the cesarean section: A prospective double blind randomized trial. Adv Biomed Res 2012;1:7. |\n|7.||Nath MP, Garg R, Talukdar T, Choudhary D, Chakrabarty A. To evaluate the efficacy of intrathecal magnesium sulphate for hysterectomy under subarachnoid block with bupivacaine and fentanyl: A prospective randomized double blind clinical trial. Saudi J Anaesth 2012;6:254-8. |\n|8.||Ouerghi S, Fnaeich F, Frikha N, Mestiri T, Merghli A, Mebazaa MS, et al. The effect of adding intrathecal magnesium sulphate to morphine-fentanyl spinal analgesia after thoracic surgery. A prospective, double-blind, placebo-controlled research study. Ann Fr Anesth Reanim 2011;30:25-30. |\n|9.||Sun J, Wu X, Xu X, Jin L, Han N, Zhou R. A comparison of epidural magnesium and/or morphine with bupivacaine for postoperative analgesia after cesarean section. Int J Obstet Anesth 2012;21:310-6. |\n|10.||Morrison AP, Hunter JM, Halpern SH, Banerjee A. Effect of intrathecal magnesium in the presence or absence of local anaesthetic with and without lipophilic opioids: A systematic review and meta-analysis. Br J Anaesth 2013;110:702-12. |\n|11.||Albrecht E, Kirkham KR, Liu SS, Brull R. The analgesic efficacy and safety of neuraxial magnesium sulphate: A quantitative review. Anesthesia 2013;68:190-202. |\n|12.||Ozdogan L, Sastim H, Ornek D, Postaci A, Ayerden T, Dikmen B. Neurotoxic effects of intrathecal magnesium sulphate. Rev Bras Anestesiol 2013;63:139-43. |\n|13.||Saeki H, Matsumoto M, Kaneko S, Tsuruta S, Cui YJ, Ohtake K, et al. Is intrathecal magnesium sulfate safe and protective against ischemic spinal cord injury in rabbits? Anesth Analg 2004;99:1805-12. |\n|14.||Jellish WS, Zhang X, Langen KE, Spector MS, Scalfani MT, White FA. Intrathecal magnesium sulfate administration at the time of experimental ischemia improves neurological functioning by reducing acute and delayed loss of motor neurons in the spinal cord. Anesthesiology 2008;108:78-86. |\n|15.||Goodman EJ, Haas AJ, Kantor GS. Inadvertent administration of magnesium sulfate through the epidural catheter: Report and analysis of a drug error. Int J Obstet Anesth 2006;15:63-7. |\n|This article has been cited by|\n||J’Accuse! Failure to Prevent Epidural and Spinal Catheter Misconnections\n| ||David J. Birnbach,Sorin J. Brull,Richard C. Prielipp |\n| ||A & A Case Reports. 2016; 6(5): 107 |\n|[Pubmed] | [DOI]|\n||Obstetric Neuraxial Drug Administration Errors\n| ||Santosh Patel,Robert Loveridge |\n| ||Anesthesia & Analgesia. 2015; 121(6): 1570 |\n|[Pubmed] | [DOI]|\n| || |\n| ||Reactions Weekly. 2014; 1524(1): 131 |\n|[Pubmed] | [DOI]| |
The chin is an important part of the facial structure that defines the shape of your face. In some individuals, the chin may be smaller or set farther back beneath the mouth, creating an imbalance in the facial features. A chin implant or cheek enhancement can balance the face, giving a more appealing profile for both men and women.\nChin implants are inserted on top of the chin bone, becoming an extension of the structure already in place. When healed, the implant feels just like part of the chin, making it indistinguishable from the permanent bone. For many, this addition to the bottom portion of the face have a dramatic effect, creating symmetry and balance for all the facial features.\nChin Enhancement Surgery\nChin enhancement surgery or genioplasty is performed under anesthesia, usually with the implant inserted through a small incision under the chin. The normal crease in the area makes the incision easy to hide and virtually undetectable. Often chin implants are combined with neck or face lifts in older adults who are trying to improve their overall youthful appearance.\nBoth men and women can benefit from the addition of a chin enhancement. For men, it can add a more masculine appearance for those with a weak or less predominant chin or jaw line. For women, it can make them look less “bird-like”, balancing the top and bottom regions of their face.\nDr. Khosh is an experienced facial plastic surgeon who has focused his practice on the facial region exclusively. As a dual board certified surgeon, you can trust in his proven ability to create a beautiful new chin through artful genioplasty. Contact our office today to schedule your private consultation to learn more about chin implants.\nClick Here to See Chin and Cheek Implants Photo Gallery |
Flatten abdomen by removing excess fat and skin and tightening muscles of abdominal wall.\n2 to 5 hours.\nGeneral, or local with sedation.\nEither depending on individual circumstances and extent of surgery.\nTemporary pain. Swelling, soreness, numbness of abdominal skin, bruising, tiredness for several weeks or months.\nBlood clots. Infection. Bleeding under the skin flap. Poor healing resulting in conspicuous scarring or skin loss. Need for a second operation.\nBack to work: 2 to 4 weeks. More strenuous activity: 4 to 6 weeks or more. Fading and flattening of scars: 3 months to 2 years.\nSet prominent ears back closer to the head, or reduce the size of large ears. Most often done on children between the ages of 4 and 14 years. (Occasionally covered by insurance.)\n2 to 3 hours.\nYoung children: usually general. Older children or adults: general or local, with sedation.\nTemporary throbbing, aching, swelling, redness, numbness.\nInfection of cartilage. Excessive scarring. Blood clot that may need to be drained. Mismatched or artificial- looking ears. Recurrence of the protrusion, requiring repeat surgery.\nBack to work or school: 5 to 7 days.\nStrenuous activity, contact sports: 1 to 2 months.\nDuration of Results\nImprove body shape by removing exercise-resistant fat deposits with a tube and vacuum device. Can be performed using the tumescent technique, in which targeted fat cells are infused with saline containing solution with a local anesthetic before liposuction to reduce post-operative bruising and swelling. Common locations for liposuction include chin, cheeks, neck, upper arms, above breasts, abdomen, buttocks, hips, thighs, knees, calves, ankles.\nFor larger volumes of fat or for fibrous body areas, ultrasound-assisted lipoplasty (UAL) may be used. UAL is a new technique in which a ultrasound probe is inserted beneath the skin to “liquify” the fat before it is suctioned.\n1 to 2 hours or more. UAL: 20-40 percent longer than traditional liposuction.\nLocal, epidural, or general.\nUsually outpatient. Extensive procedures may require short inpatient stay.\nTemporary bruising, swelling, numbness, soreness, burning sensation. Tumescent: Temporary fluid drainage from incision sites. UAL: Larger incisions for cannula.\nAsymmetry. Rippling or bagginess of skin. Pigmentation changes. Skin injury. Fluid retention. Excessive fluid loss leading to shock. Infection. UAL: thermal burn injury caused by the heat from the ultrasound device.\nBack to work: 1 to 2 weeks. More strenuous activity: 2 to 4 weeks. Full recovery from swelling and bruising: 1 to 6 months or more. Use of tumescent technique or UAL may decrease post-operative bruising and swelling.\nDuration of Results\nPermanent, with sensible diet and exercise.\nThe Hague Center\nProgramming, Design and Hosting by PracticeDock, © 2017. |
Welcome to our dental office! Dentist @ Burlington. We are a dedicated team of experienced dentists and hygienists who strive to provide the highest quality care for our patients. Our mission is to ensure that each patient leaves our office feeling confident in their smile and overall oral health. We focus on preventive care and education, as well as providing a wide range of services from general dentistry to cosmetic procedures. With the latest technology, we can provide you with the best possible outcomes for your treatment. Our friendly staff will take the time to answer any questions you may have about your treatment plan and make sure you feel comfortable throughout your visit. We look forward to meeting you!\nDr. Yousef Abdelghaffar BDSc, MDSc, Ph.D.\nDr. Yousef has over 20 years of experience as a general dentist, his area of focus lies in Esthetic Dentistry such as Esthetic fillings, Esthetic Periodontal surgeries, crowns and bridges, Root Canal Treatment, and Surgery. Dr. Yousef Abdelghaffar prides himself on providing dental care to children and geriatric patients. He is Certified and experience in conscious sedation.\nDr. Alattar DDS\nDr. Alattar is well experienced dentist in Canada. He was born in Syria and then he moved to Canada with his family. |
Medical Malpractice and Medical Negligence in the United States\nSummary: Medical malpractice and medical negligence includes: Medical misdiagnosis, failure to treat a medical condition in a reasonable period of time, surgical mistakes, anesthesia mistakes, and medication mistakes.\nEach year, nearly 225,000 people in the United States die because of medical malpractice. This places medical malpractice deaths as the third leading cause of death in the U.S. after heart attacks and cancer. Countless others are injured as well from medical malpractice and many cases are never reported or legally pursued by patients.\nWhen doctors are given their medical license, they take the Hippocratic Oath which is a promise to treat their patients to the best of their ability and avoid causing them harm. When a doctor or any other medical professional violates this oath, they are considered negligent in legal terms. A medical malpractice lawyer will attempt to determine if a medical professional acted negligently by comparing their performance to the accepted medical standard of care. Medical malpractice defines negligence in which a medical professional or a medical facility did not take the proper action required in a reasonable amount of time and this negligence caused injuries to the patient.\nWhat is medical malpractice and negligence:\nMedical misdiagnosis - A misdiagnosis of the symptoms could cause a patient to receive incorrect treatment. An example of misdiagnosis would be a patient who is displaying the warning signs of a heart attack but is misdiagnosed with strained muscles, and ends up having a heart attack.\nFailure to treat the medical condition within a reasonable amount of time - If the patient is injured as a result of not being diagnosed or treated within a reasonable amount of time or if the doctor does not follow up with treatment after the initial appointment in a timely manner and the patient is injured as a result.\nSurgical mistakes - Surgical errors are a common form of medical negligence. Because of the complications of surgery and the precision required, if a surgeon accidentally cuts or cauterizes a vital organ, foreign fluids can enter the organ and cause severe infections, sepsis, or septic shock which can lead to a patient’s death. Other surgical mistakes include removing the appendage from the wrong side of the body.\nAnesthesia mistakes: Administering anesthesia poses a high risk during surgery. Anesthesia mistakes can cause serious and permanent brain injuries to the patient and even death. Even if the operation was successful, the patient can still be seriously injured or die from an anesthesia mistake made after the operation on the surgical floor or in the post anesthesia recovery room.\nMedication mistakes: A medication mistake can occur if the doctor or nurse prescribes the incorrect dosage of a medication, the wrong medication, or does not thoroughly screen a patient for other medications they may be taking, or allergies they may have to certain medications. A common occurrence with medication mistakes involves a doctor or nurse administering a medication to a patient as they are exiting their shift but failing to communicate this to the next shift’s doctor or nurse, causing twice the dosage of a drug to be administered to the patient. This can result in an overdose.\nIf you or someone you love was seriously injured or died as the result of medical malpractice or medical negligence, you should contact the best medical malpractice lawyer possible. Call the Law Offices of Dr. Bruce G. Fagel & Associates at (800) 541-9376 for a free consultation. Dr. Bruce Fagel is a leading medical malpractice attorney and a licensed medical doctor.\nVisit us on Facebook and Twitter:\nArticle posted with keywords: best medical negligence lawyer, best medical negligence attorney, best medical malpractice lawyer, best medical malpractice attorney, how do I sue for medical malpractice\nLawyer website: www.fagellaw.com |
Facts About Sedation dentist Spokane RevealedThis consumer has arrived from Qype, a corporation acquired by Yelp in 2012. We now have built-in the two web-sites to provide you 1 good regional experience.\nProtection and compliance are two essential components of remedies, so sedation dentistry offers both of those the person plus the dentist the most effective alternative.\nDr. Nathan Johnson, a lover from the Workplace surgically placed a graft in my decrease remaining quadrant exactly where I'd main economic downturn. Dr. Johnson took the graft within the roof of my mouth. I believed It will be quite agonizing. To my shock I didn't experience any actual agony, only mild dis...morecomfort.\nI wasn't inside the Workplace a long timeframe, but for the duration of that time I seasoned a pleasant employees, a delicate one that did my x rays (sorry, I am horrible with names), a clean Workplace and all in all a positive working experience. Sadly the dentist who examined me and checked out my overall health information was not able to perform any sleeping anesthesia mainly because he felt I used to be way too medically complex to obtain my dental do the job performed in his Place of work.\n“It’s sad to begin to see the state they set by themselves into by averting that regime dental treatment. But If you're able to eliminate that aspect, and they know they’re destined to be far more calm and … they're able to receive the get the job done accomplished, it alterations their everyday living.”\nMy daughter experienced alot of dental do the job and was so happy Along with the dentist and his team. She smiles constantly and we've been loving it, pretty proud of…\nCan it be safe? At Northwest Implants and Sleep Dentistry, we only use sedation types and procedures that have been approved from the American Dental Affiliation. Now we have quite a lot of know-how in the area of general anesthesia and need your practical experience with us to generally be as pleasurable as possible.\nHe advised my dental perform be done in the medical center for security factors. I recognize that and value it that he opted for me to be in a hospital surroundings for my dental work. Too lousy for me, mainly because I couldn't locate a clinic to do it but I am even now studying my Problem. I wish I might have experienced it all completed there simply because I comprehend it might have been a fantastic knowledge and end result. • • •\n"We experienced a regular Test up and cleaning nowadays for my little one. The nurses have been extremely welcoming and cheering him up, described all the things that youngster would understand.\nSedation dentistry is frequently mistakenly assumed to induce sleep. In fact, most sedatives enable the affected person to stay awake in the course of the course of action. read more Sleepiness is a aspect outcome of some medicines, but nitrous oxide, oral aware sedation and IV sedation only get the job done to quiet stress all through the dental visit.\nWe offer Highly developed spinal correction and chiropractic adjustments utilizing "state on the artwork" chiropractic techniques. In no way while in the historical past of chiropractic treatment have chiropractors been equipped to provide the level of assist… go through extra\nThe American Academy of Dental Sleep Drugs is the only real non-profit national Skilled Modern society dedicated exclusively on the exercise of dental sleep drugs. The AADSM encourages the use of oral appliance therapy for that procedure of sleep-disordered breathing, including snoring and obstructive sleep apnea.\nMaking contact with a pediatric dentist is the first step to safeguarding your son or daughter's smile. Find more about pediatric dentistry and at-…\nOther sedation-similar dangers include things like vomiting and respiratory problems, together with aspiration, by which the client takes foreign subject into his / her lungs. |
Our Anesthesiology Department deals with wide range of surgical sub-specialties. Acute pain service management is a core issue in patient’s care following surgery. The anesthesia department is fully equipped with the latest technology to enable the physicians to provide the highest quality of service. The recovery room is highly prepared and staffed with qualified & trained nursing staff. As well as assisting pre-operative assessment, they are also involved in critical care management and pain medicine.\nAnesthesiology is the practice of medicine which involves the perioperative care of patients and the treatment of pain It also involves the treatment of acute and chronic pain as one of its major subspecialties. The practice of anesthesiology includes a wide spectrum of patients: all ages, all degrees of illnesses and both sexes. The subspecialties include: pediatric, cardiac, neuro, obstetrical, ambulatory anesthesia as well as critical care medicine and pain management\nBurjeel Specialty Hospital reputation is built on the quality of medical care provided. Hence, stringent standards are in place to recruit world-class medical professionals. Our panel of highly qualified expertise have trained extensively in leading hospitals around the world and possess internationally recognized degrees from Europe and other continents. Combined with state-of-the-art technology, the team delivers exemplary care and treatment following the highest international standards and protocols.\n2021. burjeel speciality hospital. all rights reserved. MOH Approval No - VN65972 |
Perioperative medicine is a newly emerging field of medicine that focuses on optimizing the health of patients who are planning to undergo surgery and providing medical care for those patients following surgery. As part of an institution-wide commitment to ensuring the best possible outcomes for surgical patients, the Perioperative Medicine Division was created within the HSS Department of Medicine.\nThe Division has responded to the extraordinary growth in orthopedic surgery procedures at HSS by establishing a coordinated approach to individualized assessment of surgical patients. Medical conditions that require optimization are identified prior to surgery by our team of internists who collaborate with our surgeon colleagues, cardiologists and anesthesiologists to assure an optimal outcome of surgery. The goal of the Division is to focus on patient care, education, and research.\nPhysicians in the Division of Perioperative Medicine oversee a teaching program in which daily meetings are held with house officers (doctors in the residency stage of their training), nurses, physician assistants, and nurse practitioners who share information about patient care. These meetings, also called teaching rounds provide a forum for all participants to ask questions and learn how to provide consistent, high quality care to their HSS patients.\nIn addition to these members of the perioperative medical team, during their hospitalization patients at HSS may also receive care from other medical professionals including consulting physicians in specialties including anesthesiology, cardiology, pulmonology, endocrinology and neurology, as well as respiratory and physical therapists.\nThe Perioperative Medicine Division at HSS evaluates every patient scheduled for surgery and creates an individualized “Risk Assessment” plan based on his or her health issues. A comprehensive plan is then constructed to optimize the health of the patient before, during, and after surgery including a safe and smooth discharge from the hospital. Guidelines have been developed to ensure all physicians have access to up to date information on patient care recommendations.\nUnderstanding Perioperative Care\nDiet and Nutrition\nMaintaining a healthy weight and diet before and after surgery helps reduce the risk of complications and ensure a speedy recovery. Our HSS Weight Management team is available for consultation, and the below resources can help you prepare:\nCase Management - Discharge Planning\nHSS case managers are dedicated to addressing the needs of adult and pediatric patients.\nPatients at HSS have access to a wide range of materials to help them understand the role of perioperative medicine in their care and help them prepare for their hospitalization. The following resources address many of the frequently asked questions and concerns related to surgery at HSS.\nPre-Operative Education Classes\nPatients undergoing surgery at HSS can benefit from pre-operative classes that explain what to expect and how to adapt during recovery.\nPediatric Perioperative Medicine\nThe Lerner Children's Pavilion provides information to pediatric patients undergoing surgery and their families.\nInformation about Surgery at HSS\nHSS is currently a site for the Perioperative Ischemic Evaluation-2 Trial (POISE-2), which is an international study evaluating medication use perioperatively and the risk of cardiovascular outcomes postoperatively.\nMany studies have been completed on the outcomes of patients with inflammatory diseases. The large volume of surgery done at HSS provides an excellent environment for research and to help answer questions about the best ways to care for patients perioperatively. |
Fibroids, commonly known as fibroid tumors or uterine fibroids, are benign tumors that grow either in or on the uterus. Heavy menstrual bleeding, extremely painful menstrual periods, and pressure in the pelvic area are some typical symptoms of fibroids. Women experiencing symptoms that interfere with daily activities may need to seek fibroid treatment, such as fibroid surgery to shrink or remove the fibroids. Some general types of surgery for fibroids include fibroid embolization, a myomectomy, and a hysterectomy. Expectations from fibroid surgery will vary according to the type of surgery performed.\nA fibroid embolization is one common procedure used as a treatment method. The purpose of this procedure is not to remove the fibroids, but to shrink them. Fibroids have a direct blood supply which enables growth. Embolization of fibroids are successful by cutting off this blood supply. During this procedure, arteries that are feeding the fibroids with blood are injected with small particles, resulting in a blockage of the blood flow and causing the fibroids to shrink.\nPatients undergoing this procedure can typically expect to be admitted to the hospital as an outpatient. Some form of anesthesia is commonly used to sedate the individual. The expected recovery time for a fibroid embolization is generally short because there are no large surgical incisions made. After the procedure, pain and cramping – similar to that which can take place during a menstrual period – may be expected. Additional expectations may be identified by the doctor performing the procedure.\nAnother common type of fibroid surgery is a myomectomy. In this surgical procedure, only the fibroids are removed from the uterus while the uterus remains in place. There are three different common ways a myomectomy may be performed. These alternatives include a hysteroscopic myomectomy, an abdominal myomectomy, and a laparoscopic myomectomy. Each of these alternatives will have different expectations.\nHysteroscopic myomectomies may be an option for women who have fibroids inside of the uterus. A patient undergoing this procedure can expect the fibroids to be removed by an instrument called a hysteroscope that is passed through the cervix and into the uterus. An abdominal myomectomy is an open-abdomen surgery to remove fibroids. The patient can expect general anesthesia, an extended hospital stay, and a typical recovery expectation of six to eight weeks following this fibroid surgery. In a laparoscopic myomectomy, the fibroids will be removed through small incisions made in the abdomen and the patient can expect a shorter recovery time than an abdominal myomectomy, but generally a longer recovery than a hysteroscopic myomectomy, which typically requires no incisions\nHysterectomies may also be used as a surgical treatment for fibroids. A hysterectomy involves the removal of the entire uterus. Other female reproductive organs such as the fallopian tubes and ovaries may also be removed during a hysterectomy. As with many abdominal surgeries, the expected recovery period is from six to eight weeks. Women undergoing a hysterectomy should expect to no longer be able to become pregnant once the uterus is removed.\nIt is important for the patient to understand the type of fibroid surgery to be performed. Of the different types of surgeries, each one will have different expectations. Generally, non invasive procedures such as a fibroid embolization will be a shorter procedure with a shorter recovery period. Open abdominal surgeries such as an abdominal myomectomy will typically include a longer hospital stay and a longer recovery. The physician advising the patient on the best surgery option for fibroid treatment typically will be able to adequately discuss what should be expected from each type of surgery. |
Non Surgical Treatment for Pain\nTypically when we injure ourselves, we think to visit a doctor or surgeon to remedy our pain. However, with chronic pain, the same decisions are usually made which might not be best. When it comes to chronic pain it might be best to visit a pain management specialist.\nWhat is a pain management specialist? Pain management specialists are Physicians that are specifically trained in the functional human anatomy as well as specially trained in how our bodies cause and interpret pain signals. Understanding how pain is perceived and where it is located can tell a Pain management specialist a great deal about the root cause of the problem as well as the most effective diagnosis and course of treatment.\nMany courses of treatment include: nerve blocks, injections, spinal cord stimulators, and rehabilitation. Which treatment method you require will depend solely on your condition and functional ability.\nIf you’ve been experiencing pain for an injury that’s lasted longer than a few weeks, contact a pain management specialist today! We’re here to help and would gladly answer any questions you might have.\nSource: AAOS – PRP |
The IntraFlow Intraosseous Anesthesia Delivery System now features new IntraFlow Disposables\nThese disposbles result in a product that is easier to assemble and to use clinically.\nIntraFlow effectively achieves profound and reliable anesthesia and can be used for cosmetic and restorative procedures, endodontic therapy, oral surgery and implantology.\nThe IntraFlow System utilizes a simple, one-step technique to deliver focused anesthesia while minimizing facial numbness and patient discomfort without distortion to the lip line. The System is especially useful for fear management in anxious dental patients.\nPain relief and profound pulpal anesthesia are achieved in approximately one minute. This saves valuable chair time and allows practitioners to work in multiple quadrants during a single visit.\nFor additional information about the IntraFlow System contact Pro-Dex, Inc. at (800) 562-6204 or visit Pro-Dex.\nTo read more about the IntraFlow System, go to IntraFlow.\nTo comment on this product, go to PennWell Dental Community site. |
January 24, 2014, was a typical day for me, spent hurrying up and down the halls outside the operating rooms at the hospital where I was an attending anesthesiologist. I often “ran the board” or was the charge person, and I enjoyed being the facilitator. Each operation was written on a magnetic strip and we moved them around like pieces of a puzzle to get the surgeries done efficiently. I loved taking the strips down and wiping the marker off — it was neat, tidy, and methodical. For the last five years, I had spent 98 percent of my time learning and honing the trade of anesthesiology. I was a female doctor working in a primarily male-dominated field, and I was proud of fitting in as “one of the boys.”\nOn January 25, 2014, my life trajectory forever changed. I gave birth to our first child and as they cleaned her up on the warming table, the delivery room went silent. Rather than the cheerful congratulations I had pictured in my mind, we were told with heavy sadness that she had characteristics of Down syndrome. Devastation is as close as one word can come to describe the heart-wrenching, knife-like stabbing pain that cut through my chest. As time stood still on that delivery bed and with immense grief overwhelming my senses, I requested out loud to go back to work. I will never forget those words coming out of my mouth.\nSeven weeks later, this is exactly what I did. I was a fully functioning and capable anesthesiologist at the hospital and a lost woman in all other aspects of my life. I was terrified to face my fear and the unknown of parenting a child with Down syndrome. My husband, a surgeon, grieved for a day and came back after speaking to a family with a child with Down syndrome and accepted the diagnosis and her.\nOn the other hand, I adamantly refused to believe this could be our truth. For over a year, I found my only comfort at work, where thanks to the intense focus required and high-paced environment, I could forget about my reality at home and lessen the pain I felt inside.\nMy spirit was broken. I knew that something needed to change, but I only observed and knew one path, and I had large student loans to pay back. When my group lost the contract to provide anesthesia services, I was ecstatic to find that the new group taking over had part-time options. I had no clue what I would do with it, but I was given the gift of time.\nAfter 15 months of working full-time, I had a new three-day-a-week schedule. I began to explore and process what I had been through with Sidney’s delivery. I started seeing a therapist, working through my grief, and envisioning our future with more children. I went to work on myself — for me, for my spouse, and for our family. I also connected with another part-time female anesthesiologist, who changed my life by being a mentor and friend to me. I was no longer alone in medicine, and I felt supported in designing a career that worked for my family.\nIt has been a little over eight years since Sidney’s birthday. I look back at that day with gratitude. The gifts of reflection and intentional living continue to fill our life with abundance and have long replaced any sorrow.\nI prioritize my mental health, and I am a vocal advocate for other physicians (and non-physicians) to do the same. In t-shirt size and in work-life balance, my motto is: “One size fits none.” I have continued to tweak my practice of anesthesiology as my family’s needs have changed, and it has undoubtedly prolonged my career. It is not a traditional path that I am on (in many aspects), and I am grateful for it every day.\nOn World Down Syndrome Day, I celebrate our daughter and all of the amazing people who inhabit this earth who also happen to rock an extra 21st chromosome.\nI see you, and I will continue to go to work so that you can be seen.\nAshley Prince is an anesthesiologist.\nImage credit: Shutterstock.com |
Functional Implications of an Early Exposure to General Anesthesia: Are We Changing the Behavior of Our Children?\n- First Online:\n- Cite this article as:\n- Jevtovic-Todorovic, V. Mol Neurobiol (2013) 48: 288. doi:10.1007/s12035-013-8488-5\n- 513 Views\nThere is a rapidly growing body of animal and clinical evidence suggesting that the exposure to anesthetics and sedatives during the critical stages of brain development results in long-lasting (perhaps permanent) impairment in cognitive development in a variety of mammalian species. With improved understanding of the mechanisms responsible for behavioral outcomes of anesthesia-induced developmental neurotoxicity, there is hope for development of protective strategies that will enable safe use of anesthesia in the youngest members of our society. Here, I review presently available evidence regarding anesthesia-induced neurocognitive and social behavioral impairments and possible strategies for preventing them. I also review limited and somewhat controversial evidence that examines the effects of nociception and surgical stimulation on anesthesia-induced developmental neurotoxicity.\nKeywordsLearning and memorySocial behaviorAnestheticsNeurotoxicityNeurodevelopmentImmature brain\nOver the last decade, mounting animal data and rapidly emerging clinical evidence suggest that the exposure to anesthetics and sedatives during critical stages of brain development (often referred to as synaptogenesis) results in long-lasting (perhaps permanent) impairment in cognitive development. These new findings are likely to have lasting impact on anesthesia and sedation practices in pediatrics. Although it is indisputable that a child’s comfort during painful interventions is critically important, we now are focusing more on how to achieve a fine balance between providing anesthetic conditions that permit critical surgeries and procedures while avoiding serious, previously unknown neurotoxicities.\nThere is no controversy about the animal evidence showing that early exposure to clinically used general anesthetics leads to substantial neuronal injury and impairment in synaptogenesis in the neonatal brain, or about the fact that such injury is associated with long-term behavioral impairments [1–11]. However, the mechanisms for these effects and potential causality between morphological and functional outcomes remain to be established. The quest to understand the mechanisms responsible for neuronal damage has led to a flurry of studies and implication of a variety of cellular processes, such as extensive apoptotic activation [1–7], disturbances in organelle homeostasis (mitochondrial and endoplasmic reticuli in particular) [12–14], and alterations in cytoskeletal formation and function . The hope is that better understanding of the key factors that trigger widespread injury to the immature neurons and synapses will aid in devising protective strategies that can enable safe use of anesthesia in the youngest members of our society, with special emphasis on ameliorating anesthesia-induced impairments of behavioral development. Here, I review presently available evidence regarding anesthesia-induced functional impairments and possible strategies for preventing them.\nEarly Exposure to Anesthesia and Behavioral Development in Rodents\nInitial work with rats exposed to general anesthesia (a cocktail containing a sedative dose of midazolam with nitrous oxide and isoflurane) at the peak of their brain development showed that their cognitive abilities in young adulthood lagged behind those of controls; the gap in learning abilities widened later in adulthood, as demonstrated by an inability to master more complicated learning paradigms . Although isoflurane seems to be most detrimental , other volatile anesthetics such as desflurane and sevoflurane also have been shown to compromise the cognitive development in rodents. In addition, there is mounting evidence that early exposure to the most commonly used intravenous anesthetics, propofol and ketamine , leads to persistent learning deficits when animals are examined in young adulthood. For example, ketamine was shown to cause significant deficits in habituation, marked deficits in acquisition and retention of memory in the radial arm maze-learning task, as well as decreased shift learning in a circular swim maze-learning task . Propofol was shown to impair explorative learning, as tested in the hole board test, more than spatial navigation, as estimated using the Morris water maze test .\nIn addition to the evidence of significant impairment in cognitive development, there is concern that early exposure to anesthesia may harm the development of social behavior. For example, studies of mice have shown that early exposure to intravenously administered general anesthetics in combination, but not singly, significantly alters the social behavior of the mice during young adulthood (postnatal days 55 to 70). Fredriksson et al. have shown that mice exposed at postnatal day 10 to propofol or thiopental in combination with ketamine exhibited hypoactivity followed by distinct hyperactivity behavior and complete lack of habituation to the activity test chambers during a 60-min test period. More recent study by Satomoto et al. has shown that exposure of neonatal mice (at postnatal day 6) to inhaled sevoflurane causes abnormal social behavior suggestive of autism spectrum disorder. For instance, they report that exposure of neonatal mice to clinically relevant concentration of sevoflurane caused impaired social memory and decreased interaction with a social target despite normal general interest in novelty or in olfactory sensation.\nWhen anesthetic agents with γ-amino-butyric acid-ergic and N-methyl-D-aspartate antagonist properties are combined, which is done frequently in the clinical setting (for example, nitrous oxide and volatile anesthetics or propofol and ketamine), behavioral deficits, including cognitive ones, appear to be even more profound [1, 6, 7]. Coincidentally, the severity of behavioral deficits seems to correlate with the severity of neuronal damage since combined anesthetics have been shown to induce more profound neurotoxicity than the individual agents [1, 6, 7].\nIt is noteworthy that the initial study and numerous others that followed over the ensuing decade [2, 6, 7, 9–11, 13] were focused mainly on the effects of anesthesia in the absence of painful and/or surgical stimulation on subsequent development of behavioral responses. Although there are many instances in clinical practice when anesthesia is administered in the absence of a painful stimulus (e.g., imaging studies such as MRI and CT scanning), substantially more anesthesia exposures during early stages of human brain development are performed to permit painful interventions. Thus, anesthesia-induced impairment of subsequent behavioral responses also must be examined under surgical conditions. Based on a recent report by Shu et al. , it appears that surgical incision and nociception induced by formalin injection worsen cognitive impairment caused by combined nitrous oxide/isoflurane anesthesia when examined in 7-day-old rat pups and compared to anesthesia without painful stimuli. When pathomorphological outcomes were assessed, it was discovered that nociceptive stimulation with formalin or surgical incision increased the injury in the brain cortex. In contrast, Liu et al. reported that noxious peripheral stimulation with complete Freund’s adjuvant resulted in an attenuated neurotoxic response to ketamine in postnatal day 7 rat pups. However, the functional implications of this finding were not investigated.\nA third study which assessed the role of nociception in anesthesia-induced cognitive development reported that sevoflurane anesthesia produced comparable impairment in neurocognitive functioning whether administered with or without a painful stimulus and tissue injury (tail pinch) . These conflicting studies indicate a need for additional investigation into the conditions under which painful stimuli may or may not exacerbate impairments caused by application of anesthesia during synaptogenesis.\nConsidering that general anesthetics are often a necessity when a child’s well being is in jeopardy, protection from anesthesia-induced developmental neurotoxicity is an important issue. Several protocols have been described in which concomitant administration of protective agents such as melatonin , L-carnitine , β estradiol , and dexmedetomidine was noted to offer protection against neuronal injury. Although the reports regarding the beneficial effects of these protective agents on cognitive behavior are scarce, some promising clues are beginning to emerge. Recently published evidence indicates that anesthesia impairs morphogenesis and function of mitochondria in developing neurons, suggesting that strategies aimed at protecting mitochondria and curtailing oxygen free radical production may offer beneficial effects . For example, oxygen free radical up-regulation was curtailed, and outcomes of acute oxidative stress such as lipid peroxidation and neuronal deletion were abated when anesthesia administration was accompanied by administration of EUK-134, a synthetic oxygen free radical scavenger having both Mn-superoxide dismutase and catalase activity [24, 25], or R(+) pramipexole, a synthetic aminobenzothiazole derivative that blocks permeability transition pores, restores the integrity of mitochondrial membranes , and limits the production of reactive oxygen species [27–29]. Most importantly, these preventive strategies led to complete abolishment of anesthesia-induced cognitive impairments . These results suggest that protection of mitochondria may be a strategy for the prevention of developmental neurotoxicity when anesthesia is used during critical stages of brain development.\nAnother interesting possibility for treatment rather than prevention of anesthesia-induced cognitive decline involves the behavioral strategies referred to as “delayed environmental enrichment.” Stratmann and colleagues examined the value of nonspecific but powerful environmental enrichment in young adolescent animals (4 weeks of age) that previously were exposed to general anesthesia during a critical period of their brain development (7 days of age). They discovered that the anesthesia-treated rats that were exposed to a home environment that provided voluntary exercise, environmental complexity, and social interaction with a group of rats showed clear signs of rescued memory function when compared to anesthesia-treated rats that were exposed to a standard home cage environment. They suggest that “environmental enrichment, including voluntary exercise, might be a potential therapeutic strategy, in case long-term cognitive impairment caused by anesthesia in infancy occurs in humans.”\nEarly Exposure to Anesthesia and Behavioral Consequences in Non-human Primates\nBehavioral studies in rodents have provided important support for the effects of anesthesia on cognitive development; however, the relevance of rodent behavioral findings to human clinical settings remains to be determined. Due to the numerous ethical and medical considerations that limit randomized prospective trials in very young children, the importance of well-designed behavioral studies with non-human primates cannot be overemphasized. Recently, Paule and colleagues have addressed long-standing questions regarding the effects of anesthesia during the early period of brain development on the cognitive development of non-human primates. They demonstrated that the use of continuous low-dose ketamine infusion to maintain a light surgical plane of general anesthesia during a critical period of brain development in rhesus monkeys (120 to 123 days in utero), resulted in significant and long-lasting cognitive impairment compared with unexposed monkeys. They used the Operant Test Battery designed to assess learning, motivation, color discrimination, and short-term memory, and found that ketamine-treated monkeys demonstrate lower training scores starting at about 10 months of postnatal age and lasting beyond 3 years of age. The impairments were noted not only in accuracy of task performance but also in response speed as well. The authors report lower motivation in the ketamine-treated group, which could account for some aspects of the impaired cognitive performance. However, this qualification does not lessen apprehension regarding the long-term and possibly permanent effects of anesthesia on cognitive development and normal functioning after only a single exposure during the critical period of synaptogenesis. Of particular concern is the fact that concept formation, one of the most important cognitive functions, was most vulnerable. In view of the fact that monkey performance on the Operant Test Battery is quite similar to that of humans , it is reasonable to propose that early exposure to general anesthesia also may cause long-lasting impairment in children’s cognitive development. Careful randomized prospective clinical trials are warranted.\nEarly Exposure to Anesthesia and Behavioral Consequences in Humans\nAlthough some earlier studies suggested the possibility that early exposure to anesthesia may have lasting effects on psychological and emotional development of children, the major impetus for methodical investigations into the possibility of anesthesia-induced neurotoxicity in newborns and infants came from several early preclinical studies [1, 6, 7] that clearly implicated anesthetic agents in a variety of behavioral disturbances indicative of impaired neurocognitive development. Previous assumptions had held that the main factors in children’s regressive behavioral changes after surgery were the emotional shocks of hospitalization and separation from family, and the physical traumas of surgical intervention, such as pain, fluid imbalance, nutritional changes, and blood loss. These assumptions now are being challenged.\nAlthough investigations are still at an early stage, the clinical evidence that has emerged over the last few years has begun to point to potentially detrimental effects of anesthetic agents on cognitive development. In a population-based retrospective birth–cohort study of 5,357 children, Wilder et al. found that although a single exposure to general anesthesia was not associated with a greater risk of learning disabilities, children who were exposed to general anesthesia two or more times before the age of 4 years were at significantly increased risk of learning disabilities compared with unexposed children. Moreover, that risk increased with longer cumulative duration (more than 2 h) of anesthesia exposure. Of particular concern is their finding that the cohort exposed to anesthesia before the age of 4 years had cognitive scores over their years of schooling that were, on average, two standard deviations below the predicted ones based on the individual assessment of their cognitive ability, i.e., IQ scores. This result suggests that early exposure to general anesthesia prevented these individuals from reaching their full cognitive potential.\nIn an even larger population study, Sun et al. focused on assessing learning disabilities in 228,961 patients. They reported that children who had received anesthesia before the age of 3 years required higher use of Medicaid services to deal with learning deficits than did children who had not been exposed to anesthesia. Several studies of premature infants have suggested that behavioral disabilities later in life are more prevalent among those who were exposed to surgery and general anesthesia during the neonatal period than they are among premature infants who were treated medically. For example, surgically treated premature infants with patent ductus arteriosus or necrotizing enterocolitis had worse neurological outcomes than did premature infants who were treated medically. Although a possible causal link between early exposure to general anesthesia and neurocognitive deficits could be suggested on the basis of these studies, a measure of caution is advisable since the effects of surgery cannot be separated clearly from the effects of anesthesia.\nSome newer retrospective evidence points toward a clear negative correlation between the duration of anesthesia exposure and scores on academic achievement tests, i.e., the longer the duration of anesthesia, the lower the scores . Although the authors caution that there may be other explanations, it is of concern that they report a significantly higher percentage of otherwise healthy Iowa children performing below the fifth percentile on academic achievement tests in the groups exposed to anesthesia at a very young age (about 12–14 %) when compared to the Iowa population as a whole (about 5 %).\nAnother recent report from the Mayo clinic suggests that early exposure to anesthesia may result in higher incidence of attention deficit/hyperactivity disorder. Sprung and colleagues report that, after adjustment for co-morbidities, children who underwent multiple (two or more), but not a single exposure to anesthesia, had a significantly higher risk of developing hyperactivity problems when anesthesia exposure occurred before the age of 2 years.\nPresently available information that stratifies children based on a mode of delivery (Cesarean section vs. vaginal) suggests that the risk for learning disabilities were higher among children born vaginally compared to the ones born by Cesarean section under regional anesthesia. Interestingly, there was no significant difference in the risk for cognitive impairments between children born by Cesarean section under general or regional (neuroaxial) anesthesia, suggesting that brief perinatal exposure to general anesthetics may not have adverse effect on cognitive development .\nAlthough, to date, these few clinical studies suggest that the exposure of infants and neonates to surgery and general anesthetics may cause significant neurocognitive deficits and a variety of behavioral sequellae, all of these studies were done retrospectively and therefore could not control for the many variables that come into play during the perioperative period. The complex issues associated with the design of randomized, double-blinded prospective clinical studies of very young patients cannot be underestimated. These issues include, but are not limited to, ethical considerations; the lack of biomarkers of apoptosis that can be used safely in a living organism; the complexity and meaningfulness of various clinical outcomes, especially neurocognitive ones; and the lack of appropriate controls.\nBased on presently available evidence, it is becoming clear that regressive behavioral changes in children exposed to general anesthesia are most common in those exposed before the age of 4 years, which coincides with the time period of rapid brain development in humans. A causal relationship between a specific anesthesia protocol and specific cognitive disturbances has not been reported, suggesting that the majority of commonly used general anesthetics could be detrimental.\nIn view of this rapidly emerging information, it is of paramount importance to better understand the etiology of poor neurocognitive outcomes that may be anesthesia induced so that prevention strategies can be developed. Only then can we feel confident that existing anesthetics can be used to their full advantage for therapeutic benefits without the risk of neurotoxic side effects, especially in cases when life-threatening conditions make frequent surgical interventions and prolonged stays in intensive units necessary for a child’s survival.\nThis work was supported by NIH/NICHD HD 44517, John E. Fogarty Award TW007423-128322, ARRA supplement NIH/NICHD HD 44517, March of Dimes National Award,. and Harold Carron endowment. VJT was an Established Investigator of the American Heart Association. |
Best Cosmetic Dentist Kennesaw\nAlice Canady | 05/22/15\nInfected baby teeth can cause permanent teeth to develop incorrectly and result in stains, pits and weaker teeth.\nGina Balta | 05/21/15\nThe smaller the cavity when it is treated, the less painful it will be. If a cavity is deep it may expose the nerves inside the pulp.\nDawn Mcdonald | 05/20/15\nThe taste that brushing your teeth leaves in your mouth should break the desire for you to eat something sweet.\nBarbara Garney | 05/19/15\nCareful brushing and flossing of the teeth are a necessity and frequent dental visits may be needed to keep good oral health.\nDenise Carver | 05/19/15\nCosmetic dentistry is the procedure to improve the appearance of teeth.\nEmily Bennett | 05/18/15\nIf you want to make teething easier on your child, trying adding chunks of sour pickle, cucumber or sweet carrot to their mesh teething ring.\nBecky Boyer | 05/18/15\nCrooked and gapped teeth are not only a cosmetic blemish, but a social stigma.\nDiane Connolly | 05/16/15\nJuices from items such as carrots or beets are likely to stain your teeth, so brush immediately after drinking them.\nCarol Burns | 05/14/15\nIf you have gum disease or cavities that have not been filled yet, you should avoid teeth whitening treatments.\nDonna Allgood | 05/12/15\nYour children's teeth are what help them speak and chew.\nCynthia Goldman | 05/10/15\nIt's very important to have strong, healthy teeth throughout your life.\nDebra Dunlap | 05/10/15\nAt the heart of your teeth, decay can gradually destroy the inner layer, or dentin, the pulp which contains blood vessels, nerves and other tissues, and roots.\nDave Castillo | 05/10/15\nOne of the biggest problems with gum disease is that you don't know it is there until it causes you pain.\nCathy Breckenridge | 05/08/15\nSome people really hate the gaps in their teeth but never do anything about them.\nCynthia Sohn | 05/06/15\nSome dentists have access to different forms of sedation to help patients feel comfortable before, during and after the treatment. Vitamin D is an important part of a healthy diet that builds strong bones and teeth.\nAdriana Dancea | 05/04/15\nThese procedures use a combination of a bleaching agent, hydrogen peroxide and blue light technology.\nCathy Bainb | 05/03/15\nThe process of installing veneers can take as little as three appointments. Porcelain is generally the material used to make a crown for your teeth.\nConnie Haase | 05/02/15\nIf you have missing teeth, then you can consider implants.\nCynthia Frank | 05/01/15\nDo not neglect your teeth if you want to stay beautiful.\nDonna Bartle | 04/29/15\nThere are three main types of bridges, the bridges include the development of the traditional crown of the tooth or implant on either side of missing teeth.\nCecilia Welch | 04/28/15\nYour dentist will take a cast of your mouth and send it to the lab to have dentures made.\nBill Markiewicz | 04/26/15\nMany times, people pay ridiculous amounts of money for a product that promises to whiten their teeth. Once you lose the enamel on your teeth, it does not grow back.\nDavid Christensen | 04/26/15\nDo not share utensils with your baby as it can introduce bacteria into their mouth.\nDerek Drawhorn | 04/24/15\nSome women may experience dry mouth during menopause.\nDomenic Cornacchioli | 04/22/15\nYou may be the kind of person who will do better with conventional dentures.\nCarl Landauer | 04/20/15\nPatients are put into a light sleep with oral sedation so that breathing and swallowing remain under their control while they are in the dental chair.\nTags | implants teeth Ball Ground custom dental 31126 how to whiten teeth Adairsville professional teeth whitening kits 30102\nCategories | periodontal surgery 30102 dental braces GA Belvedere 30032 tooth extraction pain Avondale Estates sitemap |
Going to the dentist is rarely a good experience. Some people are very unlucky, though, and end up getting care from someone who traumatizes them so badly that they refuse to go back. There are many adults who don’t seek care for their teeth for years on end, and this can lead to tooth decay and even loss. If this is similar to your situation, though, you don’t have to just live without your teeth. You can go to an Implant Dentist Suffolk County to get an implant put in that will act as a root for an artificial tooth, so that your smile can be restored.\nThis might sound like a very frightening prospect, but it is really not that bad. Because this is a surgical procedure, people are routinely sedated for it and you won’t have any memory of what was done. Of course, you will be sore during the healing process. Still, that is a temporary problem that will give you the lasting benefit of being able to repair a gap in your teeth. If you feel like your romantic or career prospects have been held back by the way that you look, this can be a way to improve your life.\nOnce you’ve found a good dentist, you can also get more general care. At Dentist-Smile.com, you can get access to a provider who goes out of his way to create a very relaxing environment for his patients. He also has the skills needed to provide sedation for those patients who truly need it to get through normal procedures. These are his way of trying to make sure that good dental care is available to everyone who needs it. Everything about the environment and his approach to treatment is designed to maximize your comfort and confidence.\nYou don’t have to be afraid of going to an Implant Dentist Suffolk County. They are able to do remarkable things these days, and you could have a new tooth in place in a very short time. If the damage to your smile has been holding you back, it is an investment worth making. |
- Our Hospital\n- Centres of Excellence\n- Services & Facilities\n- Patient Guide\n- Promotions & Discounts\nWide awake hand surgery\nWide awake hand surgery represents a breakthrough in surgery of the hand and upper extremity. It can be performed with no preoperative testing, no intravenous insertion, and no monitoring. Like a dental procedure, the patient simply gets up and goes home after the procedure.\nWide awake hand surgery means no sedation, no tourniquet, and no general anesthesia for hand surgery. The only medications given to the patient are lidocaine with epinephrine. Lidocaine is for anesthesia, and epinephrine provides hemostasis, which deletes the need for a tourniquet. The advantages are:\nThe ability of the comfortable unsedated tourniquet-free patient to perform active movement of the reconstructed structures during surgery so the surgeon can make alterations to the reconstruction before the skin is closed to improve the outcome of many surgeries;\nThe deletion of all risks, costs, and inconveniences of sedation and general anesthesia.\nWith this, patients can voluntarily move their fingers intra-operatively, thereby enabling this surgeon to make fine adjustments to repaired tendon, joints and bones before closing the skin.\nSome painful hand problematic cases may originate from the neck and other upper extremities.\nIf the patient is suffering from diabetics, this kind of surgery is not that very effective. So take precautions for clients that have any of this disease.\nBy Dr Ruban Sivanoli, Consultant Orthopaedic, Hand & Microsurgeon (Daily Express, Your local Voice) |
Dr. Ira Goldberg is a general and restorative dentist in Succasunna, NJ offering experienced care for tooth extractions to patients. If you have severe or sudden tooth pain it is important to seek an appointment so that Dr. Goldberg can evaluate the condition of your affected tooth and recommend appropriate care.\nTooth extraction is always a treatment of last resort when all other restorative options are not considered viable. If you have impacted wisdom teeth or extensive tooth damage one of the best options for you is often tooth removal. This general dentistry treatment helps ensure that all teeth are healthy and we can offer restorative solutions to replace your extracted tooth.\nWhy Do I Need a Tooth Extraction?\nPatients may require a tooth extraction for several reasons, including:\n- Wisdom teeth extraction\n- Remove extra teeth\n- Overcrowding of teeth\n- Teeth damaged from gum disease\n- Tooth infection\n- Extensive tooth damage\n- To create more space in the mouth to accommodate orthodontics\n- Baby teeth that prevent permanent teeth from developing correctly\nIf you have any of these conditions, call 973-298-5893 to schedule an appointment with Dr. Goldberg and discuss your concerns and treatment options.\nThe Tooth Extraction Procedure\nDr. Goldberg will administer a local anesthetic to numb the area of the tooth that is being extracted. He will then gently remove the tooth by rocking it back and forth in the socket. When the tooth is out of the socket a blood clot will form. It’s important to try to maintain the clot in place.\nDr. Goldberg will pack a gauze pad into the socket and will have you bite down on it to stop the bleeding. If the gums were opened, they may be closed with a few self-dissolving stitches. If you will be replacing the tooth with a dental implant, a bone graft will be placed into the socket.\nTooth Extraction Recovery\nHaving a tooth extracted is often considered oral surgery, and you can expect some pain. However, it is usually mild and manageable with over-the-counter pain medications. Ice and saltwater rinses may also be needed. Dr. Goldberg will review your customized post-treatment instructions with you before you leave our office. You can continue to brush and floss, but you need to avoid the extraction site.\nThe initial healing period after a tooth extraction usually takes from one to two weeks. New bone and gum tissue will start to grow into the gap. However, you may need to replace the missing tooth. When a tooth or teeth are gone, the adjacent teeth tend to slide into the gap, which is a problem for the person’s bite and alignment. The best replacement for a missing tooth is often a dental implant.\nTooth Extraction FAQs\nThe following are common questions and concerns regarding tooth extractions. Whether you’re preparing for a dental extraction or seeking information on the recovery process, we aim to address your concerns. Understanding the reasons for extractions, aftercare measures, and what to expect during the procedure can empower you with knowledge for a smoother dental experience. If you have additional questions or concerns about your upcoming tooth extraction, please contact us.\nWill I feel pain during the tooth extraction procedure?\nWhile you shouldn’t feel pain during a tooth extraction, you may experience some discomfort or pressure. Dr. Goldberg uses local anesthesia to numb the area around the tooth, ensuring you don’t feel pain during the procedure. You will feel some tugging or pressure as he works, but it should not be painful. If you’re anxious or concerned about potential discomfort, discussing your worries with your dentist beforehand can help them tailor their approach to ensure your comfort during the extraction.\nCan I use sedation dentistry to get my tooth pulled?\nYes, we offer dental sedation for patients who suffer from dental anxiety. Sedation dentistry is available for tooth extractions. Dr. Goldberg will review the various sedation techniques with you, which include oral sedatives, nitrous oxide, or intravenous (IV) sedation. He will decide which option is best for you after review your medical history.\nHow long should I rest after tooth extraction?\nAfter a tooth extraction, it is complete, patients will need to rest for at least one day or 24 hours. Most patients limit their physical activity for a couple of days following the procedure to give their bodies time to heal.\nHow long will it hurt after tooth extraction?\nMost patients report feeling pain for 1-3 days following their tooth extraction. The area may be tender and swollen for a week or two following the procedure. Icing and OTC pain relievers can help regulate any pain.\nWhat is the best OTC painkiller after tooth extraction?\nThe best OTC painkiller following a tooth extraction is ibuprofen. It will lessen the swelling and relieve pain temporarily while you heal. Follow instructions and do not overdo it because painkillers can sometimes elongate recovery and healing time.\nDo and don’ts after tooth extraction?\nAfter tooth extraction patients should avoid eating and chewing hard or sticky foods. It is recommended to stick to a soft diet for the first few days following the extraction. Patients should also avoid smoking following their tooth extraction to avoid dry socket.\nHow can I make my tooth extraction heal faster?\nPatients can help speed up their recovery from a tooth extraction by holding gauze over the extraction site, being careful while eating and drinking, avoiding smoking, rinsing with a warm salt water solution, and resting.\nHow long should I use salt water after tooth extraction?\nAfter a tooth extraction patients may rinse with a warm salt water solution to soothe their gums and remove bacteria. Most patients rinse with saltwater twice a day until the area feels like it is healing.\nDoes a cracked tooth require an extraction?\nNot all cracked teeth require extraction. Treatment depends on the severity and location of the crack. Minor cracks may be repaired with bonding or a crown, while more severe cases may necessitate extraction. Dr. Goldberg will assess the extent of the damage and determine the most appropriate course of action.\nDoes an infected tooth require an extraction?\nNot necessarily. Infected teeth are often treated with a root canal to remove the infection and preserve the tooth. A tooth extraction is only considered if the infection is severe, irreparable damage exists, or if the tooth poses a risk to overall oral health. Dr. Goldberg will examine your tooth and take X-rays to determine which treatment is best for your infected tooth.\nDr. Goldberg can provide you with a tooth extraction in Succasunna, NJ if you require one. Call 973-298-5893 or request an appointment at Morris County Dental Associates online. |
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.\nMonday, February 20, 2017\nConscious sedation for multiple extractions\nHello, My 28 year old son recently was examined by a dentist. He needs a great deal of dental work. His upper teeth are beyond repair (lots of antibiotics before the age of 2). The dentist has recommended upper full extraction as well as removal of impacted wisdom teeth x4; He has recommended utilization of Demerol, Valium, and NO2; I am an RN; This seems to be a good deal of dental work for this level of conscious sedation... I am particularly concerned regarding the wisdom teeth and anesthesia safety. Your thoughts would be appreciated.\nThank you for your question. This case is usually done under moderate (conscious) sedation, if sedation is needed at all. The issue is only partially the procedure and more the patient. If your son is not terribly anxious about this treatment, this is a great option, particularly if the sedation is well-maintained during the procedure (i.e. additional medication is given as needed during the procedure).\nThe other option that oral surgeons, who are also licensed to do deep sedation, might consider is just that - deep sedation. This is a hybrid state where the patient is sometimes in a light general anesthetic and sometimes in a moderate sedation state. Most would probably choose moderate sedation since there can be a fair amount of residual bleeding as the procedure continues and the risk of airway complications is more likely with deep vs. moderate sedation.\nTrue general anesthesia with an independent anesthesia provider, like a dentist anesthesiologist, is another option, and now you would have the most qualified dentist providing the anesthesia and independently watching over your son while the dentist does the procedure. If your son is very anxious about this surgery, this may be the best option.\nI think the plan of moderate sedation is a good one. If an oral surgeon is comfortable with deep sedation for this case, that is another option. A much smaller number of oral surgeons are comfortable with true general anesthesia for this type of case, and they will be administering the anesthesia and doing the surgery at the same time. Or you can find a dentist anesthesiologist in your area by going to http://www.asdahq.org/.\nSteven I Ganzberg, SB, DMD, MS\nFormerly, Clinical Professor of Dentistry\nCollege of Dentistry\nThe Ohio State University |
All pet owners dread hearing their vet say cancer.\nBut a cancer treatment for dog is something that, unfortunately, many of us will have to think about.\nDog cancer treatment is considered in this article from the expert vets at Drs Foster and Smith.\nAfter working with hundreds of pets with cancer, and their owners, Dr. Kathy Mitchener, a veterinary oncologist, has identified three commandments of Cancer Care (A cancer treatment for dog) that are essential in maintaining the quality of life and human-animal bond.\nDr. Mitchener has found these commandments will help build an atmosphere of hope for both the pet and pet owner.\nDo Not Let Them Hurt\nComprehensive pain management is critical to the quality and longevity of life for cancer patients. Research has shown that once an animal is in pain, there is magnification of the pain response. The goal then is to prevent pain, not try to alleviate it once it occurs.\nLocal anesthesia may be helpful in those animals that have localized pain. Pain-relieving medications can be used, including fentanyl patches, which are applied to the skin and slowly release the active ingredient.\nOral pain relievers can be of benefit, especially if the pain is mild. If an animal is undergoing surgery, the pain medication should start while the animal is still anesthetized, so as the animal wakes up, the pain reliever is already working.\nProper care of the animal also helps in pain management. The animal should be handled gently. Use orthopedic beds and other devices to make the animal more comfortable and decrease the risk of painful secondary problems such as "bed sores."\nDo Not Let Them Vomit\nNausea and vomiting are actually uncommon problems for animals undergoing chemotherapy. If either one becomes a problem, however, it needs to be managed swiftly.\nVomiting animals can quickly become dehydrated and develop electrolyte imbalances. Nauseated and vomiting animals will generally not eat, which brings us to the Third Commandment.\nDo Not Let Them Starve\nThis is perhaps the most vital of the three.\nIf an animal will not eat, but has a functioning digestive tract, enteral dietary therapy should be used. The first step is to increase the appetite.\nThis may be accomplished by warming the food: serving palatable, aromatic foods; and feeding in a stress-free environment. Medications that stimulate the appetite, such as diazepam (Valium) and cyproheptadine may be used.\nIf the animal will not eat on his own, a "stomach tube" may be used. Depending upon the animal, the tube may be inserted through the nose and then into the stomach or intestine; or the tube may be placed through an incision in the skin into the esophagus or stomach.\nThe diet of the animal will need to be tailored individually. The correct diet may not only limit weight loss, but also improve the response to chemotherapy, and decrease the adverse effects of radiation therapy. In general, the diet should:\nIn providing care for pets with cancer, the medical management of the cancer treatment for dog is only one part of the goal. Other needs of the pet and owner need to be met to achieve the quality of life they want and deserve.\n© 2008 Drs. Foster and Smith, Inc.\nReprinted as a courtesy and with permission from PetEducation.com\nSubscribe to Our Free Dog Health Newsletter and Get the eBook Pamper Your Dog for Free! |
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