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Authors: Friedman BW et al. JAMA 2015 Oct 20. Neither cyclobenzaprine nor opioids are helpful as adjuncts to naproxen therapy for low back pain. Cyclobenzaprine (Flexeril) is a tricyclic antidepressant that is viewed as having “muscle relaxant” properties, even though it has no effect on motor neurons or skeletal muscle. Opioids act at the mu receptor […]
Read MoreAnesthesia & Analgesia: October 26, 2015 Tusman, Gerardo MD et al BACKGROUND: We sought to determine whether the response of pulmonary elimination of CO2 (VCO2) to a sudden increase in positive end-expiratory pressure (PEEP) could predict fluid responsiveness and serve as a noninvasive surrogate for cardiac index (CI). METHODS: Fifty-two patients undergoing cardiovascular surgery were […]
Read MoreAnesthesia & Analgesia: October 26, 2015 Brown, Rebecca BS et al BACKGROUND: It has been established that pain is frequently undertreated in children following outpatient surgery. Very few studies, however, have investigated this phenomenon in ethnically diverse populations. METHODS: This study included 105 families of children aged 2 to 15 years of Hispanic origin and […]
Read MoreAnesthesia & Analgesia: October 26, 2015 Miu Mihaela MD et al BACKGROUND: Surgical site infiltration with local anesthetic reduces analgesic requests in various types of surgeries. Because thyroid surgery may induce severe postoperative pain, we tested the hypothesis that ropivacaine surgical site infiltration would significantly decrease postoperative administration of morphine in patients undergoing thyroid surgery. […]
Read MoreThe American College of Chest Physicians has issued new guidelines on antithrombotic therapy for venous thromboembolism (VTE), including guidance on use of non-vitamin K antagonist oral anticoagulants. Among the recently changed or added recommendations, published in Chest: For patients without cancer who have deep vein thrombosis (DVT) of the leg or pulmonary embolism (PE), the guidelines […]
Read MoreCarol Peckham. Malpractice and Medicine: Who Gets Sued and Why? Medscape. Dec 08, The Scope of the Malpractice Problem Medscape surveyed almost 4000 primary care physicians and selected specialists to find out if and why they were sued and how the lawsuit affected their career and patient care decisions. Fifty-nine percent of respondents to the Medscape survey have been named in […]
Read MoreTzimas et al Br J Anaesth. 2015;115(2):194-202. Abstract Clinicians inevitably encounter patients who meet the diagnostic criteria for the metabolic syndrome (MetS); these criteria include central obesity, hypertension, atherogenic dyslipidaemia, and hyperglycaemia. Regardless of the variations in its definition, MetS may be associated with adverse outcomes in patients undergoing both cardiac and non-cardiac surgery. There is […]
Read MoreAnesthesia & Analgesia: December 2015 Sitsen, Elske MD et al BACKGROUND: Neuraxial blockade reduces the dose requirements of sedative agents. It is unclear whether neuraxial blockade affects the pharmacokinetics and/or the pharmacodynamics of IV hypnotics. We therefore studied the influence of epidural blockade on the pharmacokinetics of propofol in patients scheduled for general surgery. METHODS: […]
Read MoreAnesthesia & Analgesia: December 2015 Blanié, Antonia MD et al BACKGROUND: In this prospective observational study, we compared changes in cardiac index (CI) during fluid challenge using photoplethysmography (PPG; Nexfin(TM)) (CIPPG) versus esophageal Doppler (ED) (CIED) in major noncardiac surgery patients. METHODS: Measurements were obtained when the attending anesthesiologist decided to perform a fluid challenge. […]
Read MoreAnesthesia & Analgesia: December 2015 Whitener, George MD et al BACKGROUND: Current guidelines define severe aortic valve stenosis (AS) as an aortic valve area (AVA) <=1.0 cm2 by the continuity equation and mean gradient ([DELTA]Pm) >= 40 mm Hg. However, these measurements can be discordant when classifying AS severity. Approximately one-third of patients with normal […]
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