Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2008
Case ReportsAwake insertion of the Bonfils Retromolar Intubation Fiberscope in five patients with anticipated difficult airways.
Traditionally, an awake intubation is performed by flexible fiberoptic laryngoscopy. However, many new devices have been developed to assist anesthesiologists with both routine and difficult airway management, one of which is the Bonfils Retromolar Intubation Fiberscope. This device may be more beneficial than the flexible fiberoptic laryngoscope since it can readily navigate through soft tissue and physically lift airway structures, is more affordable, durable, and easier to clean. This case series demonstrates successful use of the Bonfils Scope in five patients for awake orotracheal intubation with anticipated difficult airways.
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Anesthesia and analgesia · Apr 2008
Systematic review of general thoracic surgery articles to identify predictors of operating room case durations.
Previous studies of operating room (OR) information systems data over the past two decades have shown how to predict case durations using the combination of scheduled procedure(s), individual surgeon and assistant(s), and type of anesthetic(s). We hypothesized that the accuracy of case duration prediction could be improved by the use of other electronic medical record data (e.g., patient weight or surgeon notes using standardized vocabularies). ⋯ Matching findings of prior studies using OR information system data, multiple case series show that it is important to rely on the precise procedure(s), surgical team, and type of anesthetic when estimating case durations. OR information systems need to incorporate the statistical methods designed for small numbers of prior surgical cases. Future research should focus on the most effective methods to update the prediction of each case's duration as these data become available. The case series did not reveal additional data which could be cost-effectively integrated with OR information systems data to improve the accuracy of predicted durations for general thoracic surgery cases.
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Anesthesia and analgesia · Apr 2008
Case ReportsBilateral ultrasound-guided continuous ilioinguinal-iliohypogastric block for pain relief after cesarean delivery.
We present three cases in which continuous ilioinguinal-iliohypogastric nerve block with 0.2% ropivacaine, together with oral ibuprofen, was used to provide analgesia after cesarean delivery. The catheters were placed under ultrasound guidance in the plane between the internal oblique and transversus abdominis muscles on both sides of the abdomen. Numeric pain rating was used for the assessment of postoperative pain. Low pain scores, minimal use of supplemental opioid, and the absence of nausea and vomiting suggests that continuous ilioinguinal-iliohypogastric nerve blockade deserves further study as a possible component of multimodal analgesia after cesarean delivery.
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Anesthesia and analgesia · Apr 2008
One-year experience with day-of-surgery pregnancy testing before elective orthopedic procedures.
Elective surgery is generally postponed in pregnancy. A policy of testing for urine human chorionic gonadotropin (hCG) in all women of childbearing age on the day of surgery was initiated at an elective orthopedic surgery facility. This is a retrospective report of our 1 yr experience and the associated costs. ⋯ A policy of routinely performing urine hCG pregnancy tests in women of childbearing age on the day of surgery was effective in detecting unrecognized pregnancy. This resulted in a postponement of elective surgery in all cases. Of 2588 women tested, one had surgery postponed because of a false-positive result. The cost of $3273 per true positive test must be compared with the benefit.
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Anesthesia and analgesia · Apr 2008
Case ReportsExtracorporeal membrane oxygenation with danaparoid sodium after massive pulmonary embolism.
During extracorporeal membrane oxygenation, anticoagulation therapy is usually achieved with unfractionated heparin. We report on an extracorporeal membrane oxygenation with danaparoid sodium for a patient with severe respiratory failure due to massive pulmonary embolism and suspected type 2 heparin-induced thrombocytopenia. ⋯ No excessive bleeding or clotting of the circuit was noted. The patient was weaned from extracorporeal membrane oxygenation after 9 days of treatment.