Jornal de Anestesiologia e Pesquisa da Dor

Upon completion of twenty years or more of active military service, Roman legionnaires received financial benefits from the Roman State and free plots of land in Italy or Roman conquered lands. These outposts in Roman conquered territory served as a buffer between the Roman State and potential Roman enemies, helped to suppress insurrections in the territories they occupied and helped to Romanize these territories. The coloniae varied in size and population from a few hundred to several thousand people. Adequate medical care is indispensable to the survival and prosperity of any community of people. The larger coloniae had hospitals and health care professionals to support the colonists living there. Smaller colonies had a medical clinic with a smaller staff. Managing chronic pain suffered by ranchers and farmers was a major concern for the medici (physicians) who lived and worked in the coloniae. The veterans and their families sometimes required pain management for their functionality and quality of life.

Neurogenic pulmonary edema is an increase in pulmonary interstitial and alveolar fluid as a consequence of injury to central nervous system. It is an underdiagnosed condition. The main cause of its poor recognition is a lack of specific marker of its etiology in order to diagnose and treat it. It has been rarely reported in paediatric age group. We are presenting a case of neurogenic pulmonary edema in a fifteen year old female child.

Objective: Traditional spinal cord stimulation (SCS) relies on paresthesias to mask patients’ pain perception. This restricts the high-quality evaluation of SCS’s efficacy. 10-kHz high-frequency (HF10) therapy, however, is a paresthesia-free modality of SCS. As such, the introduction of this technology creates the opportunity to evaluate SCS’s efficacy with appropriate patient and provider blinding to treatment. We report a case of a patient with axial low back pain who, without her knowledge, underwent “blinded” testing of the device by her spouse.
Case: A 66 year-old female with four years of axial low back pain and a diagnosis of post-laminectomy syndrome presented for consultation after failing multiple medical and surgical treatments. HF10 SCS trial provided her with greater than 50% pain relief with reduction in her opioid consumption. As such, decision was made to pursue permanent implantation. Without her knowledge, the patient underwent ‘blinded’ testing of the devise’s efficacy by her spouse who repeatedly inactivated (and subsequently activated) the stimulator while she slept.
Discussion: This is the first report to evaluate the efficacy of HF10 in treating chronic axial low back pain where the patient was truly blinded to the SCS treatment (i.e., she did not know if the device was on or off). Future studies can lead to appropriately blinded randomized control studies to generate high-level evidence for HF10’s efficacy and harm in a variety of pain condition.

Anesthesia for pediatric cardiac surgery has special features and considerations regarding the patient, the pathophysiology and the surgical maneuver which will be done. When planning to do fast track anesthesia one should put this in mind from the start during induction of anesthesia. Good selection of the patient, proper management of anesthesia and co-operation with the surgeon together with follow up of the patient in the pediatric intensive care unit will ensure successful early extubation. Fast tracking has many advantages regarding safe recovery, less hospital stay, more free beds in the intensive care, early assessment of the results of the surgery and avoiding and diminishing the risks of prolonged mechanical ventilation. We recommend this technique as much as it is safe and beneficial to the patient.