When should diclofenac be given in ambulatory surgery: preoperatively or postoperatively?

Study Objective: To determine the optimum time of administration of diclofenac in patients undergoing ambulatory knee arthroscopy: either preoperatively or postoperatively. Design: Randomized, double-blind study. Setting: Ambulatory surgical unit in a tertiary referral hospital. Patients: 127 ASA physical status I and II patients undergoing ambulatory knee arthroscopy. Interventions: Patients were randomized into three groups. The Preop group received 50 mg of potassium diclofenac orally 1 hour preoperatively and a placebo 30 minutes postoperatively. The Pre+postop group received 25 mg of potassium diclofenac 1 hour preoperatively and 25 mg diclofenac 30 minutes postoperatively. The Postop group received a placebo 1 hour before surgery and 50 mg of potassium diclofenac 30 minutes postoperatively. Measurements and Main Results: The Postop group received a placebo 1 hour preoperatively and 50 mg of potassium diclofenac 30 min postoperatively. Postoperatively, patients used intravenous patient-controlled analgesia (PCA) with fentanyl. Total fentanyl consumption was recorded. During the recovery period, pain was assessed using a visual analog scale (VAS) at 30-minute intervals. Pain was assessed in both legs at rest, on flexion, and extension of the knee. There were no significant differences in pain scores either at rest or on movement of the operative knee among the Preop, Pre+postop, and Postop groups. The consumption of fentanyl via PCA showed no significant differences among the groups. Conclusions: There is no difference in pain relief whether diclofenac is given preoperatively or postoperatively in patients undergoing unilateral ambulatory knee arthroscopy. Preoperative and postoperative treatment with diclofenac potassium is equally effective. Author Keywords: Ambulatory anesthesia; ambulatory surgery; analgesia, postoperative; nonsteroidal antiinflammatory drug

Respiratory effects of intraoperative alfentanil infusion in post-abdominal hysterectomy patients: A comparison of high versus low dose

A number of reports have been published describing (recurrent) respiratory depression after the use of alfentanil intraoperatively. To evaluate the severity of respiratory depression after the administration of alfentanil, 49 patients undergoing general anaesthesia for abdominal hysterectomy were randomly allocated to one of three groups and studied in a double-blind manner. During surgery patients received no opioids (group 1), low dose (group 2) or high dose of alfentanil (group 3). Postoperatively patients were monitored with pulse oximetry and respiratory inductive plethysmography. Postoperative pain was managed with PCA morphine. Thirty-nine patients completed the study. Respiratory depressant effects were found in all three groups. A higher number of apnoeas (at 60 minutes in group 1: 3.3 ± 1.6; group 2: 3.5 ± 1.8; group 3: 12.2 ± 2.8) and a higher morphine consumption was found in group 2 when compared with group 1 and 3. No differences were found among the groups in the other respiratory parameters or in terms of the number of patients with respiratory depression at any one time. No cases of clear-cut recurrent respiratory depression were identified

Dependencies in language: On the causal ontology of linguistic systems

Dependency is a fundamental concept in the analysis of linguistic systems. The many if-then statements offered in typology and grammar-writing imply a causally real notion of dependency that is central to the claim being made—usually with reference to widely varying timescales and types of processes. But despite the importance of the concept of dependency in our work, its nature is seldom defined or made explicit. This book brings together experts on language, representing descriptive linguistics, language typology, functional/cognitive linguistics, cognitive science, research on gesture and other semiotic systems, developmental psychology, psycholinguistics, and linguistic anthropology to address the following question: What kinds of dependencies exist among language-related systems, and how do we define and explain them in natural, causal terms

Dependencies in language: On the causal ontology of linguistic systems

Dependency is a fundamental concept in the analysis of linguistic systems. The many if-then statements offered in typology and grammar-writing imply a causally real notion of dependency that is central to the claim being made—usually with reference to widely varying timescales and types of processes. But despite the importance of the concept of dependency in our work, its nature is seldom defined or made explicit. This book brings together experts on language, representing descriptive linguistics, language typology, functional/cognitive linguistics, cognitive science, research on gesture and other semiotic systems, developmental psychology, psycholinguistics, and linguistic anthropology to address the following question: What kinds of dependencies exist among language-related systems, and how do we define and explain them in natural, causal terms

Dependencies in language: On the causal ontology of linguistic systems

Dependency is a fundamental concept in the analysis of linguistic systems. The many if-then statements offered in typology and grammar-writing imply a causally real notion of dependency that is central to the claim being made—usually with reference to widely varying timescales and types of processes. But despite the importance of the concept of dependency in our work, its nature is seldom defined or made explicit. This book brings together experts on language, representing descriptive linguistics, language typology, functional/cognitive linguistics, cognitive science, research on gesture and other semiotic systems, developmental psychology, psycholinguistics, and linguistic anthropology to address the following question: What kinds of dependencies exist among language-related systems, and how do we define and explain them in natural, causal terms

Dependencies in language: On the causal ontology of linguistic systems

Dependency is a fundamental concept in the analysis of linguistic systems. The many if-then statements offered in typology and grammar-writing imply a causally real notion of dependency that is central to the claim being made—usually with reference to widely varying timescales and types of processes. But despite the importance of the concept of dependency in our work, its nature is seldom defined or made explicit. This book brings together experts on language, representing descriptive linguistics, language typology, functional/cognitive linguistics, cognitive science, research on gesture and other semiotic systems, developmental psychology, psycholinguistics, and linguistic anthropology to address the following question: What kinds of dependencies exist among language-related systems, and how do we define and explain them in natural, causal terms

Dependencies in language: On the causal ontology of linguistic systems

Dependency is a fundamental concept in the analysis of linguistic systems. The many if-then statements offered in typology and grammar-writing imply a causally real notion of dependency that is central to the claim being made—usually with reference to widely varying timescales and types of processes. But despite the importance of the concept of dependency in our work, its nature is seldom defined or made explicit. This book brings together experts on language, representing descriptive linguistics, language typology, functional/cognitive linguistics, cognitive science, research on gesture and other semiotic systems, developmental psychology, psycholinguistics, and linguistic anthropology to address the following question: What kinds of dependencies exist among language-related systems, and how do we define and explain them in natural, causal terms

Dependencies in language: On the causal ontology of linguistic systems

Dependency is a fundamental concept in the analysis of linguistic systems. The many if-then statements offered in typology and grammar-writing imply a causally real notion of dependency that is central to the claim being made—usually with reference to widely varying timescales and types of processes. But despite the importance of the concept of dependency in our work, its nature is seldom defined or made explicit. This book brings together experts on language, representing descriptive linguistics, language typology, functional/cognitive linguistics, cognitive science, research on gesture and other semiotic systems, developmental psychology, psycholinguistics, and linguistic anthropology to address the following question: What kinds of dependencies exist among language-related systems, and how do we define and explain them in natural, causal terms

Dependencies in language: On the causal ontology of linguistic systems

Dependency is a fundamental concept in the analysis of linguistic systems. The many if-then statements offered in typology and grammar-writing imply a causally real notion of dependency that is central to the claim being made—usually with reference to widely varying timescales and types of processes. But despite the importance of the concept of dependency in our work, its nature is seldom defined or made explicit. This book brings together experts on language, representing descriptive linguistics, language typology, functional/cognitive linguistics, cognitive science, research on gesture and other semiotic systems, developmental psychology, psycholinguistics, and linguistic anthropology to address the following question: What kinds of dependencies exist among language-related systems, and how do we define and explain them in natural, causal terms

Dependencies in language: On the causal ontology of linguistic systems

Dependency is a fundamental concept in the analysis of linguistic systems. The many if-then statements offered in typology and grammar-writing imply a causally real notion of dependency that is central to the claim being made—usually with reference to widely varying timescales and types of processes. But despite the importance of the concept of dependency in our work, its nature is seldom defined or made explicit. This book brings together experts on language, representing descriptive linguistics, language typology, functional/cognitive linguistics, cognitive science, research on gesture and other semiotic systems, developmental psychology, psycholinguistics, and linguistic anthropology to address the following question: What kinds of dependencies exist among language-related systems, and how do we define and explain them in natural, causal terms