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Affichage des articles du 2012

The first intravenous anaesthetic: how well was it managed and its potential realized?

Our speciality commonly traces its origin to a demonstration of the inhalation of ether by a patient undergoing surgery in Boston in 1846. Less well known is the demonstration of the i.v. injection of opium with alcohol into a dog in Oxford in 1656, leading to anaesthesia followed by full long-term recovery. After gaining i.v. access, a mixture of opium and alcohol was injected, resulting in a brief period of anaesthesia. After a period during which the dog was kept moving to assist recovery, a full recovery was made. Details from this momentous experiment allow us to compare the technique used with modern management. It is important to consider why there was a failure to translate the results into clinical practice and nearly 200 yr of potentially pain-free surgery. Possible factors include lack of equipment for i.v. access, lack of understanding of dose–response effects, and a climate of scientific discovery rather than clinical application. Given the current interest in total i.v. a...

Efficacy of intravenous dexamethasone to reduce incidence of postoperative sore throat: A prospective randomized controlled trial

   Abstract   Background: Sore throat and hoarseness are common complications of endotracheal intubation. It may be very distressing for the patient and may lead to sleep disturbances and unpleasant memories. Materials and Methods: This prospective double-blinded randomized control trial was aimed to determine the efficacy of prophylactic intravenous dexamethasone to reduce the incidence of postoperative sore throat at 1 hour after tracheal extubation. Ninety six patients of either sex aged between 18 to 60 years scheduled for elective surgeries needing general anesthesia with endotracheal intubation, were randomly allocated into two groups A and B. The patients received either intravenous 0.2 mg/kg dexamethasone (group A, n = 48) or normal saline (group B, n = 47) just before induction. Trachea was intubated with appropriate size disposable endotracheal tubes for securing the airway. Follow up for the incidence of sore throat, cough and hoarseness ...

Brief Preoperative Smoking Abstinence: Is There a Dilemma?

Brief Preoperative Smoking Abstinence: Is There a Dilemma?  AuthorsYu Shi, MD, MPH andDavid O. Warner, MDFrom the Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota.Address correspondence to David O. Warner, MD, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905. Address e-mail to warner.david@mayo.edu. Abstract The concern that stopping smoking shortly ( 8 weeks) were necessary for pulmonary benefit, without commenting on differences in rates within abstinence durations of 8 weeks before surgery (18 of 153 patients experienced at least 1 complication, 15%) was significantly lower than that in smokers who continued to smoke (6 of 18 patients, 33%), and similar to that of nonsmokers (12%). Of the 21 smokers who had stopped for 20 years in textbooks (including recent texts), practice guidelines, and review articles, as noted in the examples provided in our introduction and others.2,7–12A detailed review of all the evidence concerning the effects of relatively br...

The Effect of Neuraxial Versus General Anesthesia Techniques on Postoperative Quality of Recovery and Analgesia After Abdominal Hysterectomy: A Prospective, Randomized, Controlled Trial

L ucas J. Santana Catro-Alves , MD * ,  Vera Lucia Fernandes De Azevedo , MD, MS * ,  Tania F. De Freitas Braga , MD * ,  Antonio C. Goncalves , MD * and  Gildasio S. De Oliveira Jr. , MD, MSCI † + Author Affiliations From the  * Department of Anesthesiology, Santo Antonio Hospital, Bahia, Brazil; and  † Department of Anesthesiology, Northwestern University, Chicago, Illinois. Address correspondence to Gildasio De Oliveira, Jr., MD, MSCI,  Department of Anesthesiology, Northwestern Memorial Hospital, 251 E. Huron St., F5–704, Chicago, IL 60611 . Address e-mail to  G-jr@northwestern.edu .   Next Section Abstract BACKGROUND:  Patients undergoing abdominal hysterectomy often have significant postoperative pain despite the use of concurrent multimodal pain strategies. Neuraxial anesthesia has opioid-sparing effects and may provide better postoperative recovery to patients when compared with general anesthesia. O...