Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Case Reports
[Perioperative management of a patient with purpura fulminans syndrome due to protein C deficiency].
Protein C is a vitamin K-dependent anticoagulant and homozygous protein C deficiency is a rare fatal thrombotic disease. This report describes the perioperative management of homozygous protein C deficiency in a patient who underwent a total of three surgical procedures under general anesthesia and the successful use of activated protein C concentrate. ⋯ The perioperative management of homozygous protein C deficiency and purpura fulminans requires appropriate measures for thromboembolic prophylaxis. Sufficient iv fluid administration is necessary. Attention should be paid to decrease the risk of tissue compression such as that associated with positioning, blood pressure cuff, and endotracheal intubation, which may cause necrosis over pressure points. Replacement therapy with activated protein C concentrate appears safe and effective. The anesthetic management is reviewed and discussed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Continuous cardiac output measurements do not agree with conventional bolus thermodilution cardiac output determination.
To evaluate the performance of two different continuous cardiac output monitoring systems based on the thermodilution principle in critically ill patients. ⋯ There was no difference between the two systems regarding the agreement with conventional bolus thermodilution as the standard. A discrepancy between bolus and continuous thermodilution cardiac output measurement techniques above the clinically acceptable limits suggest that they are not interchangeable.
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Randomized Controlled Trial Comparative Study Clinical Trial
Lightwand intubation is associated with less hemodynamic changes than fibreoptic intubation in normotensive, but not in hypertensive patients over the age of 60.
To compare the effects of the lightwand and fibreoptic techniques for intubation, neither of which require laryngoscopy, on hemodynamic responses associated with tracheal intubation in normotensive and hypertensive elderly patients. ⋯ We conclude that the lightwand technique significantly attenuates hemodynamic changes following intubation in comparison with fibreoptic intubation in normotensive patients over the age of 60. Hemodynamic changes following intubation using the lightwand technique and the fibreoptic technique in hypertensive elderly patients are similar. However, both techniques are useful for intubation in hypertensive elderly patients in terms of RPP.
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This two-part review summarizes the current knowledge of physiological mechanisms, pharmacological modalities and controversial issues surrounding preemptive analgesia. ⋯ The variable patient characteristics and timing of preemptive analgesia in relation to surgical noxious input require individualization of the technique(s) chosen. Multi-modal analgesic techniques appear more effective.
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To report on the use of the laryngeal mask airway (LMA) for elective Cesarean section in 1067 consecutive ASA I-II patients preferring general anesthesia. ⋯ We conclude that the LMA is effective and probably safe for elective Cesarean section in healthy, selected patients when managed by experienced LMA users.