摘要:

Comment: Increases in myocardial oxygen demand, especially caused by tachycardia, are well documented to be associated with myocardial ischemic events in the postoperative period.

ISSN:0039-6206    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Comment: It is true that this and other studies have shown that patients require less epidural morphine when delivered in the thoracic region compared with the lumbar region for pain after a thoracotomy. However, in my mind, the significance of this is negligible when compared with the potential difficulties in performing a thoracic epidural vs. a high lumbar epidural. For example the difference between 12 mg during the first 24 hr in the thoracic group vs. 16 mg in the lumbar group thoracotomy in this study is far outweighed by the difficulty and possible complications of thoracic vs. lumbar epidural.

ISSN:0039-6206    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Comment: Use of intravenous local anesthetics as a means of controlling severe systemic pain is not new. Procaine was advocated decades ago for such difficult problems. It is fairly well established, therefore, that such treatment regimens can provide pain relief.The present article has two areas of weakness 1) it reinvents the wheel without a control group and 2) the small number of patients (n = 4) should have been better used via a cross-over study.

ISSN:0039-6206    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Comment: The presence of opioid receptors outside of the central nervous system is a well known fact, the significance of which is still being investigated. The endogenous opioid peptides (EOP) found in immune cells present in inflamed synovial tissue stress the EOP's role in inflammation. Most likely, up-regulation of peripheral opioid recepts during inflammation is counted by the delivery of EOP into the injured area by immune cells. The connection between immunological function and the intrinsic mechanism involved in pain inhibition merits future investigation. Another application of the “peripheral gate” pain control theory advocated by the authors could be the development of peripherally acting analgesic devoid of the adverse central effects exhibited by opioids.

ISSN:0039-6206    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Comment: For years patients with malignancies were under-treated insofar as pain was concerned. The reasons for this were legion but included reticence on the part of the physician to prescribe narcotics for fear of peer disapproval, the fear of “addiction” on the part of the patient, and the fact that prescribing large doses of narcotics placed the physician in the “caretaker” rather than the “active therapist” role. This later implied physicians had “given up” on any cure, something that is difficult to accept. Another real problem is the inability of medicine to quantify pain; unfortunately it cannot be objectively measured. This article implies in the discussion section that trained oncologists may manage cancer pain more adequately than those less well trained. Overall, however, this dismal picture is beginning to change. Patients should be given sufficient medication to reduce their pain. Cancer patients have nothing to lose except confidence in their doctors.

ISSN:0039-6206    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Comment: The data from this initial study of eltanolone for use of induction and maintenance of general anesthesia do not appear promising for this drug to become introduced into clinical medicine. First, this natural occurring metabolite of progesterone is insoluble in water requiring a special solvent. When used for short (6.0 min median; range 2–38 min), minor gynecological procedures it did not satisfactorily provide adequate analgesia to allow spontaneous mask respiration with 70% nitrous oxide in 8 of 50 women. Recovery was markedly prolonged as compared with that seen with propofol or even thiopental (see Table) making it unsuitable for outpatient surgery and causing potentially longer stays in the postanesthetic care unit. Its only virtues were a pleasant induction (available with thiopental) and a relatively stable cardiovascular system with no significant change in blood pressure and only a mild increase in heart rate. Respiratory data were not obtained. It seems to this clinician that the pulses offer very little to offset the disadvantages of the drug.

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

ISSN:0039-6206    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The following article is a description of the first use of halothane in the United States. Dr. C. Ronald Stephen was the principal investigator in this effort at Duke University (Dr. Stephen is the founding editor of Survey of Anesthesiology). The introduction of halothane constituted a quantum jump in the safety and advance of anesthesiology. However, the first use was certainly not without problems for the investigators! This is a fascinating tale.

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