Biomedical subjects
Publications and source records attributed to G G DeVane.
Those who do not regularly participate in cardiac surgery are often anxious when faced with the patient with valvular dysfunction. The need for periodic review by anesthetists is critical for quality patient care. A review of the physiology and anesthetic management of aortic stenosis, mitral stenosis, aortic insufficiency, mitral regurgitation, and mitral valve prolapse is presented.
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Pulmonary edema developing after the relief of upper airway obstruction has been reported in association with a variety of factors including laryngospasm, foreign bodies, and tumors. However, as the phrase "negative pressure pulmonary edema" suggests, markedly negative intrapleural pressure is the dominant mechanism for the genesis of pulmonary edema associated with upper airway obstruction. A review for anesthesia providers of this poorly recognized and often perplexing syndrome may help to reduce the occurrence of this potential complication and facilitate its treatment.
OBJECTIVE: To compare postoperative analgesia and side effects of intramuscular ketorolac, intravenous fentanyl, and oral piroxicam on healthy women undergoing laparoscopic surgery. METHODS: The study was a randomized double-blind clinical trial of three analgesic drugs. An initial 100-micrograms dose of fentanyl was given at induction, with 25-micrograms boluses after 45 and 90 minutes of operating time. Piroxicam, 40 mg, and ketorolac, 60 mg, were administered 90 and 30 minutes before induction, respectively. RESULTS: Eighty-four subjects were included in the analysis. Ketorolac patients (N = 29) spent significantly less time in the recovery room (median 96 minutes) than those receiving fentanyl (N = 27) (median 121 minutes; P < .01) or piroxicam (N = 28) (median 124 minutes; P < .01) or a verbal descriptive scale, more fentanyl patients (38%) experienced moderate pain at discharge than ketorolac (11%; P < .05) or piroxicam (4%; P < .01) patients. The incidence of measured side effects did not differ significantly between groups. CONCLUSIONS: Intramuscular ketorolac was associated with shorter recovery room stays while providing analgesia equal to intravenous fentanyl or the oral nonsteroidal antiinflammatory drug piroxicam.