Journal of clinical anesthesia
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To determine the incidence and severity of vomiting in pediatric patients who have had inhalation anesthesia for magnetic resonance imaging (MRI). ⋯ Protracted post-procedure vomiting is an infrequent complication of inhalation anesthesia for MRI. Inhalation anesthesia may be a less important cause of postoperative vomiting than factors such as the type of operative procedure, use of opioids, or presence of postoperative pain.
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Comparative Study
A re-evaluation of the ability of thiopental to identify cerebrospinal fluid in epidural catheter aspirate.
Sodium thiopental has been used to determine whether fluid aspirated from an epidural catheter is previously injected local anesthetic or cerebrospinal fluid (CSF). The purpose of this study was to test the efficacy of this test in distinguishing opioids from CSF. ⋯ Use of thiopental to differentiate opioids from cerebrospinal fluid is unreliable. In addition, in some simulated situations, opioids may mask the presence of local anesthetic.
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With improvements in the surgical technique for orthotopic liver transplantation, patients with significant underlying systemic disease are considered candidates for transplantation, thus increasing the complexity of the medical management of these patients and necessitating additional monitoring in order to minimize the anesthetic risk. We describe the anesthetic management of orthotopic liver transplantation for a patient with severe hypertrophic cardiomyopathy and mitral insufficiency. In this case, transesophageal echocardiography proved useful in the management of the postreperfusion period of the surgical procedure.
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The anesthetic challenge of managing a difficult airway is demanding under the best of conditions. An emergency operation compounds the difficulty. Seldom do we have the opportunity to truly plan for a possible emergency. This report presents a solution to the problem of knowing of a difficult airway but having no control over the timing or possible emergent state of the operation.
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Sudden cardiac arrest, a rare and often fatal complication of total joint replacement, usually occurs during the insertion of polymethyl methacrylate cement and a prosthesis. We describe a cardiac arrest during insertion of a customized long-stem prosthesis (without the use of a tourniquet) for revision of an earlier total knee replacement. We attribute this complication to the "fat embolism syndrome" (FES)--hypoxemia from an acute pulmonary embolism composed of fat and marrow elements extruded into the venous circulation--coupled with systemic hypotension from absorption of the cement monomer. ⋯ Intraoperative increases in pulmonary artery and pulmonary artery occlusion pressures and pulmonary vascular resistance during unexplained hypoxemia should alert the clinician to the possibility of FES. Proper diagnosis relies on recognizing the three most common clinical manifestations: hypoxemia, neurologic derangements, and fever. Other manifestations of FES are petechiae, thrombocytopenia, anemia, lipuria, changes on ECG, tachycardia, and dyspnea.