Journal of clinical anesthesia
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To investigate the pharmacokinetics after an intramuscular (IM) injection of sufentanil in thin vegetable oil in postsurgical patients and to determine whether sustained-release IM sufentanil can provide safe and sufficient analgesia of long duration in these patients. ⋯ Although an IM injection of sufentanil in thin vegetable oil is effective for postoperative pain relief, it is associated with wide interindividual variability in plasma concentration of sufentanil and long duration of action.
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A case of a hemothorax that occurred after thoracic epidural anesthesia is described. This situation might have been caused by accidental puncture of the intercostal vessel and visceral pleura by a Tuohy needle. The risk of causing a pneumothorax and/or hemothorax must be kept in mind when attempting thoracic epidural anesthesia.
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Case Reports
Pneumocephalus following the treatment of a postdural puncture headache with an epidural saline infusion.
We report a case of pneumocephalus following the attempted treatment of a postdural puncture headache by a continuous epidural saline infusion. Within 1 hour of infusion, symptoms of a severe headache, nausea, and vomiting prompted a computerized tomographic scan of the head that showed 12 to 15 ml of air in the cranium. ⋯ A saline bolus and infusion were initiated after confirmation of correct placement of the epidural catheter. We suggest that air passed from the negative-pressure epidural space through the dural puncture created by the diagnostic spinal tap, producing a pneumocephalus.
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To determine the types of discrepant data during intraoperative pulse oximetry and their frequency and duration. ⋯ Pulse oximeters frequently report discrepant data intraoperatively, most frequently during emergence from anesthesia. An alarm delay triggered by discrepant data and lasting 12 to 30 seconds would keep most discrepant data from becoming false alarms and, thus, may reduce distracting sound pollution in the operating room.
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During palatoplasty on a 9-year-old girl with no personal or familial history of malignant hyperthermia, the temperature monitor reported an increase in temperature. Additionally, the surgeon thought the patient's jaw muscle was in spasm. While preparations were made for treatment of malignant hyperthermia, the temperature probe was tested and found to be defective. ⋯ When the temperature probe was tested 6 days later, it was working properly. The cause of the problem may have been moisture in the connection between the probe and the exterior cable, which eventually evaporated. Decision algorithms can assist in such situations to distinguish between a medical problem and a mechanical problem with the monitor.