Professional membership is in decline, and professional survival is in ques- tion. Anesthesiologists can no longer claim to provide superior service, and hospital administrators are replacing them with nurses. The bene ts of CO2 supplementation were forgotten, and consequent CO2 confusion has derailed research, discouraged opioid treatment, damaged patient safety, and disrupted professional progress. Ralph Waters founded the anesthesiology profession on the basis of a practical new anesthetic tech- nique that introduced elective intubation and hyperventilation to eliminate CO2 toxicity, but mechanical hyperventilation dangerously depletes CO2 tissue reserves and exag- gerates morbidity and mortality. Previous anesthesia practitioners possessed a superior understanding of physiology and pharmacology, but overenthusiastic CO2 supplementation with inadequate monitors and machines caused asphyxiation disasters that were improperly attributed to CO2 toxicity. The anesthesiology profession may one day serve as a cautionary tale of how power, politics and privilege can perturb science and progress. Further research is required in the following areas: (a) dose-finding studies for ketamine as an adjunct to opioids and local anesthetics (b) efficacy and optimal route of administration (c) the role of S(+)-ketamine (d) the influence of ketamine on long-term outcome such as chronic pain (e) long-term physical and chemical stability of mixtures containing ketamine (f) spinal toxicity of ketamine and (g) effects of low-dose ketamine on cognitive and memory functioning after surgery. The evidence suggests that low-dose ketamine may play an important role in postoperative pain management when used as an adjunct to local anesthetics, opioids, or other analgesic agents. We conclude that ketamine may provide clinicians with a tool to improve postoperative pain management and to reduce opioid related adverse effects. administration low-dose ketamine is defined as a rate of < or =20 microg/kg per min. Low-dose ketamine is defined as a bolus dose of less than 2 mg/g when given intramuscularly or less than 1 mg/kg when administered via the intravenous or epidural route. We evaluate the clinical literature and discuss the efficacy of low-dose ketamine in the management of acute postoperative pain when administered alone or in conjunction with other agents via the oral, intramuscular, subcutaneous, intravenous and intraspinal routes. Studies were included for review if they were randomized, prospective, controlled, double-blind and reported pain scores. The literature was obtained from a computer search of the MEDLINE database from 1966 through December 1998. This paper reviews the use and efficacy of low-dose ketamine in the management of acute postoperative pain. The role of the NMDA receptor in the processing of nociceptive input has led naturally to renewed clinical interest in N-methyl-D-aspartate (NMDA) receptor antagonists such as ketamine. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices, in addition to accessing regular updates, related websites, and an expanded collection of procedural videos.Ketamine hydrochloride is a well known general anesthetic and short acting analgesic in use for almost 3 decades. Enhanced eBook version included with purchase.Provides state-of-the-art coverage of anesthetic drugs, guidelines for anesthetic practice and patient safety, new techniques, step-by-step instructions for patient management, the unique needs of pediatric patients, and much more – all highlighted by more than 1,500 full-color illustrations for enhanced visual clarity.Kate Leslie of the University of Melbourne and Royal Melbourne Hospital. Features the knowledge and expertise of former lead editor Dr.Streamlines several topics into single chapters with fresh perspectives from new authors, making the material more readable and actionable.Addresses timely topics such as neurotoxicity, palliation, and sleep/wake disorders.Includes four new chapters: Clinical Care in Extreme Environments: High Pressure, Immersion, and Hypo- and Hyperthermia Immediate and Long-Term Complications Clinical Research and Interpreting the Medical Literature.Contains fully revised and updated content throughout, including numerous new videos online.Michael Gropper leads a team of global experts who bring you the most up-to-date information available on the technical, scientific, and clinical issues you face each day – whether you’re preparing for the boards, studying for recertification, or managing a challenging patient care situation in your practice. Covering everything from historical and international perspectives to basic science and current clinical practice, Miller’s Anesthesia, 9th Edition, remains the preeminent reference in the field.
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