The development of an acute pain service has enabled hospital staff to improve postoperative analgesia. Patient protocols have been coordinated to ensure consistent and safe management throughout the hospital. Patient satisfaction has been very high with consistently over 90% of patients having good pain relief. High quality analgesia highlights side effects especially urinary retention with extradural opioids. Further research is needed to diminish the incidence of these complications. 相似文献
Background: The authors hypothesized that patients with Duchenne's muscular dystrophy (DMD) are more sensitive to nondepolarizing muscle relaxants.
Methods: Eight children with DMD and eight healthy children having orthopedic procedures were studied. Anesthesia consisted of thiopental, 60% nitrous oxide in 40% oxygen, and intravenous fentanyl and midazolam. Using electromyography, the ulnar nerve was stimulated and the electromyographic train-of-four ratio (TOFr) of the first dorsal interosseous muscle was recorded every 60 s. After baseline TOFr recording, all patients received 50 micro gram/kg vecuronium and the TOFr at 3 min was compared. Vecuronium (10 micro gram/kg) was then administered every minute until TOFr was or= to 0.01. Then 10 micro gram/kg of vecuronium were administered to maintain TOFr Results: The initial dose of vecuronium resulted in greater TOFr depression in patients with DMD than in controls (0.14 vs. 0.86). Less vecuronium was needed to produce TOFr or= to 0.1 after the initial dose was longer in the patients with DMD than in the controls (28 vs. 20 min; P = 0.03), and the maintenance dose of vecuronium was less in patients with DMD (0.6 vs. 1.3 micro gram [center dot] kg sup -1 [center dot] min sup -1; P < 0.01). The time for TOFr recovery from 0.1 to 0.25 was 36 min in the patients with DMD and 6 min in the controls (P <0.01). After neostigmine, the TOFr was 1.0 in the controls and 0.91 (P = 0.03) in the patients with DMD. 相似文献
This study was conducted to examine the interpatient variability in steady–state plasma concentrations of fluphenazine by repeat depot intramuscular administration, and to determine the relationship between these concentrations and clinical state. Steady–state pre–dose concentrations of fluphenazine in plasma were measured using a sensitive and specific gas chromatography/mass spectrometry (GC/MS) assay in 24 patients with schizophrenia who were receiving continuous treatment with depot intramuscular fluphenazine decanoate. Clinical response was measured using the Andreasen Scale for positive and negative symptoms. Steady–state plasma concentrations of fluphenazine ranged from undetectable (< 0–l ng/ml) to 27-9 ng/ml, with a median of 0–5 ng/ml. No significant associations were found between plasma concentration and dosage, or age and sex of the patient. Steady–state plasma concentrations in patients taking anticholinergic agents were significantly higher than in patients not receiving such drugs (P < 0–05 by MannWhitney U–test). Poorer control, expressed as the sum of the negative symptom scores or the sum of the positive and negative symptom scores, was related to higher log transformed plasma concentrations of fluphenazine and higher fluphenazine decanoate dosage. The log transformed plasma concentrations of fluphenazine and the fluphenazine decanoate dosages were weakly related. Patients receiving another antipsychotic drug in addition to fluphenazine decanoate tended to have poorer clinical control and higher dosages of fluphenazine decanoate. These results indicate the useful role that plasma level monitoring can fulfil in identifying patients who are therapy–resistant despite high plasma levels. 相似文献
The peri-operative anaesthetic management of 61 children undergoing leg lengthening procedures on 72 occasions has been analysed retrospectively. The findings are discussed and the operations performed are described. Twenty-one anaesthetics were administered to 14 achondroplastic children with no major problems. The main challenge for the anaesthetist is the management of postoperative pain to gain the confidence of the patient whose co-operation is vital during a protracted leg lengthening programme. 相似文献
An etomidate infusion was used in the place of nitrous oxide during one lung anaesthesia for 40 patients undergoing thoracic surgery. Analgesia was provided by fentanyl. A mixture of oxygen and air was used to maintain arterial oxygen tension within normal limits despite one lung anaesthesia and enabled the use of nitrous oxide to be avoided in several patients who had lung cysts. Recovery was fairly rapid (mean (SEM) 11.5 (1.4) minutes). There was no incidence of awareness or dreams. This technique provides satisfactory anaesthesia and oxygenation during thoracic surgery when one lung only is being ventilated. 相似文献
A 60-year-old man presented with ureteric obstruction secondary to a mycotic right common iliac artery aneurysm complicating
methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. The diagnosis of MRSA was not known at the time of surgery, and in situ replacement of the aneurysm using
a rifampicin-bonded prosthesis was performed. The patient made a full recovery, and to date there is no evidence of residual
or recurrent infection. To our knowledge, this is the first reported case of mycotic iliac aneurysm infected with MRSA in
the literature. We discuss the consequences and the considerable diagnostic and therapeutic problems that arise.
Presented at the Fifty-third International Congress of the European Society for Cardiovascular Surgery, Ljubljana, Slovenia,
June 2-5, 2004. 相似文献
Thirty cases of femoral sub-capital fractures, Garden grades 1-4, were reduced and internally fixed with crossed Garden screws using femoral nerve block. In addition, sedation and analgesia was provided by low dose ketamine and diazepam. No deaths or other complications occurred in these patients. In a similar group of patients who received spinal analgesia in the same unit under similar conditions there was one death and two cerebrovascular accidents. 相似文献
Classification of all relevant factors is a prerequisite to the formulation of specific objectives to attain goals of prevention of retinal dystrophy (RD) and effective provision of services. National and international agreement on a classification is sought. This outline stresses the importance of a sound conceptual basis. The root meaning of dystrophy (difficult nourishment), and the concepts given in the World Organization's International Classification of Impairments, Disabilities and Handicaps are emphasized. The proposed classification is designed to be statistical as well as assisting diagnosis and case management. The scheme for RD entities takes into account special features, in contrast to most treatable eye diseases. Genetics is stressed because of the importance of genetic counselling and rapid research advances. Three appendices illustrate portions of a comprehensive classification already in operation at the Retinal Dystrophy Service of NSW. 相似文献