Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2010
Comparative StudyOral contrast for abdominal computed tomography in children: the effects on gastric fluid volume.
Oral enteric contrast medium (ECM) is frequently administered to achieve visualization of the gastrointestinal tract during abdominal evaluation with computed tomography (CT). Administering oral ECM less than 2 hours before sedation/anesthesia violates the nothing-by-mouth guidelines and in theory may increase the risk of aspiration pneumonia. In this study we measured the residual gastric fluid when using a protocol in which ECM is administered up to 1 hour before anesthesia/sedation. We hypothesized that patients receiving ECM 1 hour before anesthesia/sedation would have residual gastric fluid volume (GFV) >0.4 mL/kg. ⋯ For children receiving an abdominal CT, the residual GFV exceeded 0.4 mL/kg in 49% (178/365) of those who received oral ECM up to 1 hour before anesthesia/sedation in comparison with 23% (11/47) of those who received IV-only contrast.
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Anesthesia and analgesia · Nov 2010
Case ReportsCase report: intraoperative management of extreme hemodilution in a patient with a severed axillary artery.
We present a case of extreme hemodilution in which appropriately crossmatched blood was not available. A 53-year-old man was admitted to our hospital because of hemorrhagic shock due to multiple stab wounds. ⋯ No evidence of cardiac ischemia was noted and he was discharged in good condition. Extreme hemodilution can be successfully managed by maintaining a normal blood volume, 100% oxygen, and the use of plasma substitutes.
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Anesthesia and analgesia · Nov 2010
Comparative StudyThe pharmacokinetics of ropivacaine after intraperitoneal administration: instillation versus nebulization.
Intraperitoneal local anesthetic administration provides perioperative analgesia during laparoscopic procedures. We compared the pharmacokinetics of intraperitoneal ropivacaine administered by instillation or nebulization. ⋯ The pharmacokinetic profile of ropivacaine nebulization is similar to direct intraperitoneal instillation, but with a lower absorption rate.
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Anesthesia and analgesia · Nov 2010
Case ReportsCase report: pediatric liver retransplantation on an extracorporeal membrane oxygenation-dependent child.
We describe the perioperative management of a venovenous extracorporeal membrane oxygenator-dependent child requiring liver retransplantation after emergent hepatectomy because of an ischemic liver graft. This child required renal replacement and inotropic support as well as treatment for heparin-induced thrombocytopenia (HIT). We describe each step in this child's perioperative management leading to the successful liver retransplantation. This is the first description, to our knowledge, of a pediatric patient undergoing liver transplantation while supported by extracorporeal membrane oxygenation (ECMO).