Journal of clinical anesthesia
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Comparative Study
Frequency and severity of desaturation events during general anesthesia in children with and without upper respiratory infections.
To determine whether anesthesia in the presence of a mild upper respiratory infection (URI) was associated with episodes of desaturation or reactive airway problems. ⋯ Children with a mild URI have an increased frequency of minor desaturation episodes, and intubated patients with a URI have an increased frequency of bronchospasm. It appears that children with a mild URI may be safely anesthetized, since the problems encountered are generally easily treated and without long-term sequelae.
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Randomized Controlled Trial Clinical Trial
Midazolam in combination with propofol for sedation during local anesthesia.
To compare the sedative, anxiolytic, and amnestic effects, as well as the recovery characteristics, when midazolam (vs. a placebo) is administered to patients receiving a propofol infusion for sedation during local anesthesia. ⋯ Premedication with midazolam 2 mg IV produced increased sedation, amnesia, and anxiolysis when administered immediately prior to the propofol infusion as part of a sedation technique for outpatient surgery. This combination did not prolong the recovery room stay when compared with propofol alone.
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Amniotic fluid embolism (AFE) is a rare obstetric problem characterized by sudden onset of hypotension, hypoxemia, and coagulopathy. This case represents the difficulty in differentiating AFE from other etiologies of cardiopulmonary compromise. The definitive diagnosis of AFE is made at autopsy with the demonstration of fetal cell elements in the pulmonary vasculature. ⋯ Predisposing factors for AFE include advanced maternal age, multiparity, large fetal size, and short tumultuous labor, especially if uterine stimulants are used. Cardiopulmonary resuscitation is the key to the treatment of parturients with AFE. A pulmonary artery catheter can be helpful in diagnosis and hemodynamic management of parturients with AFE.
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Case Reports
Management of a suspected and unsuspected difficult laryngoscopy with the laryngeal mask airway.
The laryngeal mask airway (LMA) is a new development in airway control. Presented here are two cases of difficult airway management--one anticipated, the other not anticipated--during which the LMA was used effectively.
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The laryngeal mask airway (LMA) is a new concept in airway management. A miniature inflatable mask is positioned in the hypopharynx, forming a low-pressure seal around the laryngeal inlet. The mask is attached via a tube to the breathing circuit. ⋯ It is now widely used in the United Kingdom; however, it is not yet available for sale in the U. S. It has already had a major effect on practice in Britain and has the potential to do the same in the United States.