Journal of clinical anesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Lidocaine plasma levels following two techniques of obturator nerve block.
To assess plasma levels and the potential toxicity of lidocaine following two different approaches to the obtruator nerve. ⋯ Despite a lower total dose of lidocaine administered (450 mg), higher mean and peak plasma levels were reached sooner with bilateral direct obturator nerve block compared with the indirect obturator nerve block (600 mg), indicating a faster blood absorption of lidocaine following direct block. Both types of obturator nerve block prevented adductor muscle contraction in a large percentage of cases.
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To test the hypothesis that morbid obesity implies increased difficulty of liver transplantation and increased risk of adverse outcome. ⋯ Morbid obesity alone does not predispose to increased complications or decreased survival after liver transplantation.
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Comparative Study
Automated ST-segment analysis during cesarean delivery: effects of ECG filtering modality.
To determine the effect of different electrocardiographic (ECG) filtering modalities on ST-segment changes during cesarean delivery. We compared the use of narrow and standard bandwidth ECG filtering modes in assessing ECG-detected ischemic changes in healthy patients undergoing routine, elective cesarean delivery. ⋯ In patients at low risk for myocardial ischemia, narrow bandwidth (monitor mode) ECG filtering reveals greater degrees of ST-segment depression than does standard (diagnostic mode) ECG filtering. Studies examining ST-segment phenomena would be facilitated by including a description of the ECG filtering-technique.
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Historical Article
A curious moment: the proposal to certify nurse anesthetists by the American Board of Anesthesiology.
During the 1930s, many different practitioners gave anesthetics to patients. Qualifications were not necessary, and economics often drove the choice of anesthetic administrator. Both physicians and nurse specialists in anesthesia understood the need for specialty certification. ⋯ For one curious moment, the ABS asked the ABA to certify nurse anesthetists. Neither the nurses nor the physician anesthetists were overwhelmingly in favor of the proposal. However, had the proposal succeeded, the face of American anesthesiology would have been quite different.
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Case Reports
Reexpansion pulmonary edema occurring after thoracoscopic drainage of a pleural effusion.
Video assisted thoracoscopic drainage and tale pleurodesis was used to treat a recurrent pleural effusion in a 60 year-old woman undergoing major gynecologic surgery. She developed reexpansion pulmonary edema immediately following surgery. Several important risk factors that were present in this patient are discussed. In addition to almost, complete collapse of the underlying lung for several weeks, thoracoscopy resulted in manipulations and rapid re-inflation of the underlying lung, which further increased the risk to the patient.