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Uncategorized Published - 15 August, 2014    By - Dr. Clemens
Pain management following myringotomy and tube placement: intranasal dexmedetomidine versus intranasal fentanyl

Published in Int J Pediatr Otorhinolaryngol. 2014 Jul;78(7):1090-4 Authors: Dewhirst E et al PURPOSE: Despite the brevity of the procedure, bilateral myringotomy and tympanostomy tube placement (BMT) can result in significant postoperative pain and discomfort. As the procedure is frequently performed without intravenous access, non-parenteral routes of administration are frequently used for analgesia. The current […]

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Uncategorized Published - 15 August, 2014    By - Dr. Clemens
Six steps to achieve your goals

I am often asked for a simple, effective, no-nonsense approach to goal setting that can be used by anyone, anywhere, anytime. What follows is what I affectionately call the Six Step Makeover. It’s a simple process that’s easy to learn, easy to apply, and easy to get results from. Follow it to the letter and […]

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Uncategorized Published - 15 August, 2014    By - Dr. Clemens
Efficacy and Safety of Remifentanil and Sulfentanyl in Painless Gastroscopic Examination: A Prospective Study

Published in Surg Laparosc Endosc Percutan Tech. 2014 Jun 6 Authors: Zhao YJ et al Abstract We aim to assess efficacy and safety of remifentanil or sulfentanyl combined with propofol during painless gastroscopic examination in patients. In this study, 270 patients were randomly divided into 3 groups: propofol was given only in group P; propofol […]

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Uncategorized Published - 15 August, 2014    By - Dr. Clemens
A randomized trial of epidural glucocorticoid injections for spinal stenosis

Published in N Engl J Med. 2014 Jul 3;371(1):11-21 Authors: Friedly JL1 et al BACKGROUND: Epidural glucocorticoid injections are widely used to treat symptoms of lumbar spinal stenosis, a common cause of pain and disability in older adults. However, rigorous data are lacking regarding the effectiveness and safety of these injections. METHODS: In a double-blind, […]

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Uncategorized Published - 14 August, 2014    By - Dr. Clemens
Early afferent activity from the facet joint after painful trauma to its capsule potentiates neuronal excitability and glutamate signaling in the spinal cord

Published in Pain. 2014 Jun 28. pii: S0304-3959(14)00308-X. doi: 10.1016/j.pain.2014.06.019 Authors: Crosby ND et al Abstract Cervical facet joint injury induces persistent pain and central sensitization. Preventing the peripheral neuronal signals that initiate sensitization attenuates neuropathic pain. Yet, there is no clear relationship among facet joint afferent activity, development of central sensitization, and pain, which […]

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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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