1/4. Improvement of postoperative analgesia during cancer surgery with Limoge's current: a personal experience.BACKGROUND: The anesthesiologist took advantage of a personal experience to determine whether transcutaneous cranial electrical stimulation using Limoge's current (TCES-LC) improved the level of postoperative analgesia by potentiating anesthetic agents used during the intra- and postoperative phases. Included were analgesics injected through an epidural thoracic catheter (T8-T9) positioned at the end of an esophagectomy. Another reason for a self-experimentation was to be able to evaluate the psycholeptic effects of TCES-LC to gain a better understanding of the problems linked with pain during treatment. methods: The Limoge' current is bidirectional and consists of a high-frequency biphasic asymmetrical wave composed of modulated, high-frequency (166-kHz) pulse trains with a repetition cycle of 100 Hz. TCES-LC was initiated 2 hours before anesthetic induction without any tranquilizer or other medication. TCES-LC was continuously applied during the entire surgical procedure and continued 48 hours postoperatively in the intensive care unit (ICU). As the objective was not to obtain electrical anesthesia, the usual anesthetic protocol was used during surgery. RESULTS: During the initial 48 postoperative hours with continuous application of TCES-LC (D0-D1), a decrease of the epidural anesthetic dose requirement was observed for ropivacaine, and sufentanil (-25% and -60% respectively). A similar decrease in these medications was also measured on day 2 (D2), while TCESLC was terminated. This decrease was amplified day 3 (D3) for both ropivacaine and sufentanil (-50% and -73% respectively). On day 4 (D4) the epidural anesthetics were totally suppressed (1 day before the normal conventional schedule planned for by the ICU physician with this type surgery). CONCLUSION: Future clinical trials need to be conducted to show the significant advantages of TCES-LC in alternative and complementary medicine.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/4. acute pain and substance abuse in surgical patients.Studies have determined that nurses and physicians undermedicate patients for postoperative pain as a result of inadequate knowledge and erroneous attitudes. fear of addiction seems to be the major reason for this undertreatment. A patient who abuses drugs requires larger than usual doses of narcotics postoperatively; however, larger doses are rarely given. This article emphasizes factors influencing the postoperative pain experience and presents 3 case studies to illustrate pain management in patients who abuse substances.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/4. Postoperative myocardial infarction after radical cystoprostatectomy masked by patient-controlled analgesia.We present a case report where improper patient use of patient-controlled analgesia (PCA) in the postoperative period resulted in a significant delay in diagnosis of a postoperative myocardial infarction. Despite its excellent safety record and documented efficacy in controlling pain, PCA does have its limitations and can present a danger to the patient if operator error, patient error, or mechanical errors occur. Although the latter is rarely of concern, the two former possibilities exist. Other reported complications of PCA are discussed. We recommended that physicians, when considering use of patient-controlled anesthesia, discuss the qualitative and quantitative aspects of pain associated with the particular type of surgery performed to avoid missed postoperative complications.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/4. Respiratory depression: an adverse outcome during patient controlled analgesia therapy.Patient-controlled analgesia (PCA) is one of the more popular means of controlling postoperative pain. However, there is very little in the literature concerning the adverse outcome of respiratory depression in PCA. This report is a prospective study of 4,000 patients on PCA postoperatively. Nine of these patients experienced respiratory problems while on PCA. The respiratory depressions were associated with drug interactions, continuous narcotic infusion, nurse- or physician-controlled analgesia and inappropriate use of PCA by patients. This report identified the common precipitating factors in PCA-associated respiratory depression and its prevention.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |