Journal of clinical anesthesia
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Recent pharmacologic and technologic advances in anesthesia and surgery allow outpatients with complex medical problems to undergo a wide variety of diagnostic and surgical procedures on an ambulatory basis. Increasingly, however, anesthesia practitioners, as well as pharmacy and therapeutic committees, are demanding proof that a new, more costly drug or medical device is superior to existing products in achieving its desired effect, is associated with fewer adverse effects, enhances efficiency, and reduces health care costs. The new field of pharmacoeconomics has emphasized the importance of cost-effectiveness analyses that consider both direct and indirect costs of newer drugs and therapeutic modalities. ⋯ Ambulatory anesthesia and surgery will continue to increase because of the potential cost savings for patients undergoing elective operations on an outpatient basis. However, the challenge we face will be to continue to provide high-quality anesthesia care at a reduced cost. A careful examination of commonly accepted (but unproven) clinical practice patterns will be necessary to meet this challenge.
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To evaluate the ability of arterial waveform contour analysis to measure cardiac output (CO) continuously in postoperative critically ill patients. ⋯ The PCCO method appears to be able to estimate changes in CO under the conditions tested, in which PCCO was recalibrated after each TDCO measurement. However, limitations of this method in the immediate postoperative period following aortic aneurysm surgery were identified.
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Case Reports
Diagnosis of a left-sided superior vena cava during placement of a pulmonary artery catheter.
We report a case of a left sided superior vena cava (SVC) that was diagnosed during placement of a pulmonary artery (PA) catheter. After entering the left internal jugular, the PA catheter passed into the left side of the heart, through the aortic valve, and into the aorta. ⋯ The embryology and physiology of a left sided SVC is reviewed, including an historical perspective. A discussion of the variants of the syndrome is included, as is a review of aberrant placement of central venous catheters.
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To describe a method of the authors' design for estimating gastric volume quantitatively using ultrasound and to evaluate the usefulness of this method in the clinical setting. ⋯ This method would be useful to estimate gastric contents quantitatively, and a CSA of 8.0 cm2 might be a valid indicator of an empty stomach.