A survey of acute pain service in Canadian teaching hospitals.

Background: The first national survey to ascertain the prevalence, structure, and functioning of the APS in Canadian university affiliated hospitals was conducted in 1991. This is a follow-up survey to assess the current status of the APS in Canada.

Methods: We requested completion of a 26-question survey from lead personnel of the APS teams or Anesthesia departments of Canadian teaching hospitals.

Methadone for Pain Management: A Pharmacotherapeutic Review.

Methadone is increasingly being used for its analgesic properties. Despite the increasing popularity, many healthcare providers are not familiar with methadone's complex pharmacology and best practices surrounding its use. The purpose of this narrative review article is to discuss the pharmacology of methadone, the evidence surrounding methadone's use in acute pain management and both chronic cancer and non-cancer pain settings, as well as highlight pertinent safety, monitoring, and opioid rotation considerations.

Expanding Role of NMDA Receptor Antagonists in the Management of Pain.

Pain management is complex regardless of whether the pain is acute or chronic in nature or non-cancer or cancer related. In addition, relatively few pain pharmacotherapy options with adequate efficacy and safety data currently exist. Consequently, interest in the role of NMDA receptor antagonists as a pharmacological pain management strategy has surfaced.

Pain and Surgical Outcomes Reporting After Laparoscopic Ventral Hernia Repair in Relation to Mesh Fixation Technique: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Objectives: The aim of this meta-analysis was to examine postoperative pain and surgical outcomes (operative time, hospital stay, the incidence of seroma and recurrence) with different mesh fixation methods following laparoscopic ventral hernia repair (LVHR).

Methods: Randomized clinical trials compared different methods of mesh fixation in LVHR and reported on pain outcome measures analyzed. The results were expressed as odds ratio (OR) for combined dichotomous and mean difference (MD) for continuous data.

Postoperative pain management in patients with chronic kidney disease.

Chronic kidney disease (CKD) is a health care problem with increasing prevalence worldwide. Pain management represents one of the challenges in providing perioperative care for this group of patients. Physicians from different specialties may be involved in pain management of CKD patients, especially in advanced stages.

Acute pain service: past, present and future.

Post surgical pain is a continuing major medical challenge despite all the advances in understanding acute pain and the development of new modalities of pain management. Since 1985 when the first acute pain service (APS) was started, many organizations initiated APS protocols and guidelines and it became mandatory to have an APS in all major acute care centers. This review focuses on the stages of development of APS and the challenges of postoperative pain management to provide optimal analgesia.

Obstetric anesthesia considerations in Kearns-Sayre syndrome: a case report.

Kearns-Sayre syndrome (KSS) is a rare mitochondrial myopathy that usually develops before 20 years of age. It demonstrates multisystemic involvement with a triad of cardinal features: progressive ophthalmoplegia, pigmentary retinopathy, and cardiac conduction abnormalities. In addition, patients might have cerebellar ataxia, a high content of protein in the cerebrospinal fluid, proximal myopathy, multiple endocrinopathies, and renal tubular acidosis.

A review of the use of ketamine in pain management.

Ketamine is a noncompetitive antagonist of N-methyl-d-aspartate receptor. It has been widely used in anesthesia and pain management. Ketamine has been administered via the intravenous, intramuscular, subcutaneous, oral, rectal, topical, intranasal, sublingual, epidural, and caudal routes.

The role of a low-dose ketamine-midazolam regimen in the management of severe painful crisis in patients with sickle cell disease.

Context: Acute pain is one of the main causes of hospital admission in sickle cell disease, with variable intensity and unpredictable onset and duration.

Objectives: We studied the role of a low-dose intravenous (IV) ketamine-midazolam combination in the management of severe painful sickle cell crisis.

Methods: A retrospective analysis was performed with data from nine adult patients who were admitted to the intensive care unit with severe painful sickle cell crises not responding to high doses of IV morphine and other adjuvant analgesics.

Esophageal bezoar formation due to solidification of enteral feed administered through a malpositioned nasogastric tube: case report and review of the literature.

Enteral feeding is now standard and routine practice in intensive care. The use of a nasogastric tube for enteral feeding is generally considered to be safe, but tubes with small bores can sometimes lead to aspiration or passage clogging when malpositioned in sedated patients who are on long-term mechanical ventilation. Thus, accurate confirmation of correct placement is mandatory in such patients.

Speechless after general anaesthesia for caesarean section.

'Speechless' patient after general anesthesia may be a real horror for the anaesthetist as well as the patient and his relatives. Whatever the cause "functional or organic" the anaesthetist will be under pressure as his patient is not able to talk. Here we report a 40 years old patient who has no history of medical problems and developed aphemia after general anaesthesia for emergency caesarean section with an uneventful intra-operative course.

Prevention of Intra-operative Cerebral Ischemia during Carotid Endarterectomy, Loco-regional versus General Anesthesia.

Carotid endarterectomy (CEA), as a prophylactic operation is becoming more popular. It is performed in patients who are at risk of stroke from dislodged atheromatous plaque at the carotid bifurcation. The major concern during CEA is the detection of cerebral hypoperfusion or ischemia during carotid cross clamping.

Adult Sickle Cell Disease: A Five-year Experience of Intensive Care Management in a University Hospital in Oman.

Objectives: Sickle cell disease (SCD) is an inherited disease caused by an abnormal type of haemoglobin. It is one of the most common genetic blood disorders in the Gulf area, including Oman. It may be associated with complications requiring intensive care unit (ICU) admission.

Complications of Central Venous Catheterisation: Breakage of guidewire-a disaster averted.

Central venous catheterisation (CVC) is a common bedside invasive procedure done in medical practice. Even though it is a safe procedure when done with ultrasound guidance, difficulties and complications do occur even in experienced hands. Here, we describe the difficulties encountered in the form of the breakage of the guidewire while inserting a CVC in a patient with sickle cell disease.

Liquid ventilation.

Mammals have lungs to breathe air and they have no gills to breath liquids. When the surface tension at the air-liquid interface of the lung increases, as in acute lung injury, scientists started to think about filling the lung with fluid instead of air to reduce the surface tension and facilitate ventilation. Liquid ventilation (LV) is a technique of mechanical ventilation in which the lungs are insufflated with an oxygenated perfluorochemical liquid rather than an oxygen-containing gas mixture.

Subclavian vein injury and massive hemothorax requiring thoracotomy following insertion of tunneled dialysis catheter--a case report and review of literature.

Tunneled dialysis catheters are widely used for hemodialysis. Large caliber dilator is used for insertion of such catheter which can result in serious vascular injury leading to haemothorax. Here we report such an inadvertent central venous injury requiring thoracotomy following blind dilator advancement along with review of literature and recommendation to prevent such complication.

Psycho-mimetic manifestations following propofol in day care surgery--case reports.

Objectives: Propofol has virtually replaced other agents for induction of anesthesia in the ambulatory setting because of its favorable recovery profile. Psycho-mimetic effects, common after use of ketamine, are not so well known for propofol. We present two case reports where patients had two spectrum of abnormal psychological outbreaks after propofol anesthesia.