Journal of clinical anesthesia
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Clinical Trial Controlled Clinical Trial
Variability of onset times within and among relaxant regimens.
To evaluate the consistency of times to 95% twitch height depression (T95%) in groups of patients receiving identical induction and relaxant regimens. ⋯ The wide variability in onset times among subjects receiving the same regimen indicates that monitoring of neuromuscular response, preferably to a relatively slow rate of neurostimulation, is essential if one elects to use moderate to high doses of atracurium and/or vecuronium for rapid-sequence induction in a patient in whom movement or coughing is unacceptable. Since onset times were not symmetrical about the mean, the magnitude and frequency of unacceptable onset times would not be fully appreciated unless the individual data points were displayed. Such information may be critical when reporting the suitability of a neuromuscular blocking drug for rapid intubation.
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Much has been written about Canada's health care system as all countries wrestle with rising health costs. Few, however, have attempted to describe the influence of a system of health care on a nonprimary care specialty such as anesthesia. The purpose of this review is to describe the Canadian system, contrast it with that of the United States, and outline the impact that Canadian Medicare has had on anesthetic practice. ⋯ Each provincial medical association is responsible for negotiating the fee schedules with the provinces on behalf of its members. Since these associations must respond to the majority of their members, it has been the perception of specialty groups such as anesthesia that the emphasis of allocations in recent years has been on primary care fields. Anesthetists have therefore found themselves increasingly involved with the collective negotiation process as an unwanted necessity of practice.(ABSTRACT TRUNCATED AT 400 WORDS)
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A jet stylet is a small internal diameter (ID), semirigid hollow catheter that is inserted into an in situ tracheal tube prior to extubation of a patient who may be difficult to reintubate. After the tracheal tube is withdrawn over the jet stylet, the hollow catheter can be used for jet ventilation or as an intratracheal stylet for reintubation with a new tracheal tube. It was previously thought that after the new tracheal tube was inserted over the jet stylet, the stylet would have to be removed to allow connection of the new tube to the breathing circuit and confirmation of intratracheal placement of the tube. We describe a method for preserving the intratracheal location of the jet stylet while confirming intratracheal placement of the new tracheal tube.
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We describe the first case report of an epidural autologous blood patch used for the treatment of a durocutaneous fistula caused by a surgical dural tear. The epidural blood patch cured the patient's headache and was followed by a sequelae of back pain that responded to conservative therapy.
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To establish the frequency of large visible bubbles or collections of bubbles in the jugular vein during radical neck dissection in the supine position. ⋯ We theorize that some unexplained, undesirable intraoperative events (hypotension, arrhythmia, and hypoxemia) during radical neck dissection could be a result of venous air embolus or paradoxical air embolus. The anesthesia community should be aware of the high frequency of these visible bubbles in the jugular veins during radical neck surgery, even in the supine position. At minimum, this phenomenon is a frequent event of intellectual interest. At worst, these bubbles may be harbingers of significant central air embolism.