ISSN:0039-6206    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Comment: The birth of a child is an extremely stressful time period for the mother. Not only is there the fear of pain and the anxiety of the unknown but also there is the excitement and the joy of the anticipated arrival. This stress may be further enhanced with the knowledge that a cesarean delivery must be performed. Each parturient reacts differently. Thorp et al. examined personality traits as a predictor of anxiety before cesarean section under regional anesthesia and determined whether this anxiety is a predictable entity.Some findings were not surprising. Anxious mothers tended to have higher anxiety scores pre-and intraoperatively. However, a previous cesarean section does not reduce a patient's level of anxiety. These women are equally as anxious as those parturients undergoing their first cesarean delivery. As such, women requiring a repeat cesarean section require the same support as those undergoing their first. Furthermore, a confounding variable in this study would be the fact that it is a study. Despite its noninvasiveness, the mention of studies and informed consent will heighten a patient's preoperative anxiety.Finally, the preoperative interview needs to be stressed. It has been shown that a carefully conducted preoperative visit reduces anxiety better than preoperative medication. It is this human factor that is important and will ultimately reduce a patient's anxiety.

ISSN:0039-6206    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Comment: This is an interesting study. I am perplexed by the minimal prolongation of the analgesia of sufentanil by the addition of morphine. Based on the results of this study I agree with the authors that there is little to recommend the addition of morphine, especially in view of the increased incidence of pruritus, nausea, and vomiting associated with its use.I am not surprised nor greatly concerned by the modest falls in blood pressure noted by the authors (not mentioned in the abstract). Epidural analgesia, with local anesthetics, has been shown to decrease circulating levels of epinephrine and norepinephrine in addition to decreasing the hyperventilation associated with painful contractions. Intrathecal fentanyl and sufentanil both quickly alleviate essentially all of the pain of labor and would be expected to result in the same effects minus the sympathetic block, associated with epidural local anesthetics. I doubt this modest fall in systolic blood pressure represents any significant threat to either the mother or the fetus.Lastly, I am somewhat at a loss to explain the enthusiasm of our colleagues for the use of sufentanil over fentanyl. The differences in onset time, intensity, and duration of analgesia between these two analgesics used intrathecally in equivalent doses (fentanyl 3.5:sufentanil 1) appears to be nil. Yet the cost differential is very great with 100 μg (2-ml ampule) of fentanyl costing $.23 compared with $10.18 for 50 μg (1-ml ampule) of sufentanil (the smallest dose available of each). Until this price differential decreases, this anesthesiologist can see little justification for the use of sufentanil for subarachnoid analgesia.

ISSN:0039-6206    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Comment: A simple method for assessing acute changes in the activity of the sympathetic nervous system would be useful for monitoring regional anesthesia or evaluating patients with sympathetically maintained pain. Galvanic skin response has been used in the past but has not been found to be completely satisfactory. Thermography is easily performed but designed for large areas of the body. Laser doppler flowmetry used to measure skin perfusion is a promising new technique. Previous studies have shown it can detect changes in skin perfusion in patients with regional anesthesia or autonomic dysfunction. The current study indicates that it can reliably detect changes in skin perfusion caused by known reproducible stimuli that provide a sympathetic response.

ISSN:0039-6206    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Comment: This study basically reviewed the experience in a particular institution of the usefulness of peripherally inserted venous catheters. Of interest to this reviewer was the fact that there were catheter-related problems in 21%. These included phlebitis, local infection, venous thrombosis, etc. However, despite the fact that 1 of 5 catheters failed to provide the long-term venous access that was desired, 4 of 5 did. In these very ill and, in some cases, terminal patients the overall efficacy rate was still high

ISSN:0039-6206    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Comment: The prognosis for long term outcomes in severely head-injured patients is grim. This study shows some promise when mild hypothermia (34AC) is combined with hyperventilation, fluid restriction, and high-dose barbiturates. Researchers were not blinded to the treatment groups although patients were randomized. No information is given regarding mean arterial blood pressure or central venous pressure; IV fluids were adjusted to maintain urine output. No rating scale other than death vs. a return to a productive life is used. More objective data may be useful in determining the degree of recovery in a larger group of patients.

ISSN:0039-6206    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Comment: This study, along with others, supports the fact that laparoscopic cholecystectomy results in better postoperative pulmonary functions than patients undergoing open cholecystectomy. The actual pulmonary functions showed figures such as a 56% decrease in forced vital capacity in the open group vs. 72% in the laparoscopic group. Differences in other pulmonary functions were of the same magnitude.All of patients studied were healthy and had undergone preoperative pulmonary function tests. The implications are perhaps more significant when one deals with a population of patients who have impaired pulmonary function.

ISSN:0039-6206    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Comment: This pilot study encourages further research, because there are many unanswered questions. No conclusions can be made until larger groups of patients are studied and postoperative neurophysiologic testing is done in addition to MRI scans. Of interest also would be an assessment of the effect of different anesthetic techniques, drugs, cardiopulmonary bypass length, and body temperature. The patients in this study group were maintained by Alphastat management, which does not correct blood gases for temperature. One wonders whether brain swelling would be worse if pH stat management had been used, in which there is gas correction for temperature.

ISSN:0039-6206    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Comment: Although this was a nonrandomized study, the authors studied patients who received post-bypass therapy in the ICU according to their cardiac index, which was either above or below 1.75 L/m2. No discussion of drugs given before the study period began is included, i.e., post-bypass and before arrival into the ICU. The criteria to determine whether sodium nitroprusside was used in addition to dobutamine are not stated. Also, a cardiac index of 1.75 L/m2may be an inappropriate threshold for instituting therapy; perhaps a lower threshold might be more informative. This study seems to indicate that splanchnic oxygen delivery is maintained at the expense of peripheral oxygen delivery, when cardiac function is marginal.

ISSN:0039-6206    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0039-6206    

出版商:OVID    

年代:1994

数据来源: OVID