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Uncategorized Published - 14 August, 2014    By - Dr. Clemens
4 tips to make that ‘difficult chat’ easier

Talking to employees about performance problems, attendance issues or an upcoming layoff can be awkward and difficult. But there are steps you can take to make those types of conversations easier for you—and your employees. Leaders are often placed in situations that require difficult conversations.  It’s quite common to put off these painful encounters because […]

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Uncategorized Published - 14 August, 2014    By - Dr. Clemens
Aspiration induced by remifentanil: a double-blind, randomized, crossover study in healthy volunteers

Published in Anesthesiology. 2014 Jul;121(1):52-8 Authors: Savilampi J et al BACKGROUND: Remifentanil is widely used for monitored anesthesia care in spontaneously breathing patients. However, the authors’ previous studies have shown that remifentanil induces subjective swallowing difficulties, which may increase the risk of aspiration. METHODS: Twenty-five healthy volunteers participated in a double-blind, randomized, crossover trial at […]

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Uncategorized Published - 14 August, 2014    By - Dr. Clemens
Topical and peripheral ketamine as an analgesic

Published in Anesth Analg. 2014 Jul;119(1):170-8 Authors: Sawynok J. et al Abstract Ketamine, in subanesthetic doses, produces systemic analgesia in chronic pain settings, an action largely attributed to block of N-methyl-D-aspartate receptors in the spinal cord and inhibition of central sensitization processes. N-methyl-D-aspartate receptors also are located peripherally on sensory afferent nerve endings, and this […]

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Uncategorized Published - 14 August, 2014    By - Dr. Clemens
Study Elucidates Spike in 1997-2009 Opioid Prescribing; Trend May Be Reversing

The multifaceted problem of sharply rising opioid prescribing and related overdose deaths, which peaked in 2009, has been further analyzed by a research group in a recently published paper PM R 2014 Jan 9. The Stanford University team used 1997-2009 data from the large National Ambulatory and National Health Ambulatory Medical Care Surveys from the […]

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Uncategorized Published - 13 August, 2014    By - Dr. Clemens
Case discussion and root cause analysis: bupivacaine overdose in an infant leading to ventricular tachycardia

Published in Anesth Analg. 2014 Jul;119(1):137-40. Authors: Buck D et al Abstract An otherwise healthy 11-month-old, 8-kg infant presented for an elective circumcision. After a penile block with an excessive dose of 0.5% bupivacaine, the patient progressed to ventricular tachycardia. He was resuscitated with intralipid and had an uneventful recovery. The case was classified as […]

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