Management of acute postoperative pain is challenging, particularly in patients with preexisting narcotic dependency. Ketamine
has been used at subanesthetic doses as a N-methyl d-aspartate (NMDA) receptor antagonist to block the processing of nociceptive input in chronic pain syndromes. This prospective
randomized study was designed to assess the use of ketamine as an adjunct to acute pain management in narcotic tolerant patients
after spinal fusions. Twenty-six patients for 1–2 level posterior lumbar fusions with segmental instrumentation were randomly
assigned to receive ketamine or act as a control. Patients in the ketamine group received 0.2 mg/kg on induction of general
anesthesia and then 2 mcg kg−1 hour−1 for the next 24 hours. Patients were extubated in the operating room and within 15 minutes of arriving in the Post Anesthesia
Care Unit (PACU) were started on intravenous patient-controlled analgesia (PCA) hydromorphone without a basal infusion. Patients
were assessed for pain (numerical rating scale [NRS]), narcotic use, level of sedation, delirium, and physical therapy milestones
until discharge. The ketamine group had significantly less pain during their first postoperative hour in the PACU (NRS 4.8
vs 8.7) and continued to have less pain during the first postoperative day at rest (3.6 vs 5.5) and with physical therapy
(5.6 vs 8.0). Three patients in the control group failed PCA pain management and were converted to intravenous ketamine infusions
when their pain scores improved. Patients in the ketamine group required less hydromorphone than the control group, but the
differences were not significant. Subanesthetic doses of ketamine reduced postoperative pain in narcotic tolerant patients
undergoing posterior spine fusions.
This work was funded by the Department of Anesthesia, Hospital for Special Surgery.
This work was completed following IRB approval. 相似文献
BackgroundLittle is known about the practice, perceptions and experience of using traditional and complementary medicine (T/CM) for erection difficulties among Asian men.MethodsA total of 10,934 Asian men living in China (n = 2,055), Japan (n = 877), Korea (n = 2,000), Malaysia (n = 3,000) or Taiwan (n = 2,002) were recruited via random digit dialing, street interception and face-to-face interview in the Asian Men's Attitudes To Life Events and Sexuality (MALES) Phase I study. The Phase II study was comprised of a total of 1,286 men who experienced erection difficulties and who lived in China (n = 255), Japan (n = 228), Korea (n = 225), Malaysia (n = 380) or Taiwan (n = 228).ResultsUse of T/CM for erection difficulties (9.1%) was relatively low compared to conventional medicine (83.5%). Among those that seek help and treatment from T/CM, the majority were respondents from Malaysia, followed by respondents from China, whereas respondents from Japan and Korea ranked lowest. Use of a combination of alternative and conventional therapy was prevalent. Erection difficulty was amongst the highest in terms of preference of treatment seeking using traditional approaches after back pain, arthritis and gout. Overall outcome was expressed as ‘Partly satisfied’ with T/CM treatment for erection difficulties. The main reason that T/CM outweighs conventional medicine was because it was perceived that T/CM had fewer side effects than conventional medicine (56.1%). Users of T/CM were mostly middle-aged, married, employed, and perceived their health status and the severity of their erection dysfunction as moderate.ConclusionsThe findings help to identify the differences in practices and beliefs about T/CM among Asian countries and provide useful information to conventional practitioners about the alternative help- and treatment-seeking behaviors for erectile difficulties. 相似文献
PURPOSE. This study examined the experiences of postnatal depression between a group of Chinese and Caucasian women. DESIGN AND METHODS. This was a secondary analysis of two phenomenological studies. Thirty-five Chinese women and 12 Australian women were interviewed. FINDINGS. Women felt being trapped in the depression. The Hong Kong women attributed their depression to their mothers-in-law and husbands, and expressed much anger. The Australian women attributed their depression to not being able to live up to the ideal mother image, and felt guilty. PRACTICE IMPLICATIONS. Interventions were recommended with consideration for the cultural values that influenced women's experiences of postnatal depression. 相似文献
Background: Microscopic cerebral arterial air embolism (CAAE) occurs commonly during cardiac surgery and causes acute and chronic nonfocal neurologic dysfunction. Nevertheless, most neuroimaging studies do not detect brain injury after cardiac surgery. Using a rabbit model, the authors hypothesized they could detect and quantitate severe brain injury and infarction 24 h after microscopic CAAE using the vital stain triphenyltetrazolium chloride.
Methods: Experiments were conducted in methohexital anesthetized New Zealand white rabbits. Surgical shams (n = 5) underwent surgery but had no neurologic insult. Positive controls (n = 3) received 200 [micro sign]l/kg of intracarotid air. Other animals were randomized to receive either 50 [micro sign]l/kg intracarotid air, which produces microscopic CAAE (n = 18), or 300 [micro sign]l intracarotid saline (control, n = 18). Outcomes included somatosensory evoked potential amplitude at 90 min, neurologic impairment score at 4 and 24 h (0 [normal] to 99 [coma]), and percentage of nonstaining brain at 24 h using color-discrimination image analysis. Severely injured or infarcted brain does not stain with triphenyltetrazolium chloride.
Results: Surgical shams had little neurologic impairment and a small amount of nonstaining brain at 24 h (5.2 +/- 2.4%; mean +/- SD). Positive controls had profound neurologic impairment and large amounts of nonstaining brain (40-97%). Ninety-minute somatosensory evoked potential amplitude was less in animals receiving 50 [micro sign]l/kg air versus saline: 38 +/- 28% versus 102 +/- 32%, respectively, P < 1 x 10-7. Neurologic impairment scores were greater in animals receiving 50 [micro sign]l/kg air versus saline: at 4 h, 43 +/- 16 versus 23 +/- 9, P < 1 x 10-7; at 24 h, 24 +/- 12 versus 15 +/- 8, P = 0.013. Nevertheless, there was no difference between 50 [micro sign]l/kg air and saline in nonstaining brain: 5.5 +/- 2.9% versus 6.8 +/- 5.4%, P = 0.83. 相似文献