Journal of clinical anesthesia
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Randomized Controlled Trial Clinical Trial
Total-body oxygen consumption after isoflurane anesthesia: effects of mild hypothermia and combined epidural-general anesthesia.
To determine the effects of epidural anesthesia and avoidance of intraoperative heat loss on the increase in total-body oxygen consumption in the immediate postoperative period after major intraabdominal surgery. ⋯ Total-body VO2 was increased in the immediate postoperative period. After general anesthesia, the magnitude of the increase in VO2 was significantly less in normothermic patients than in hypothermic patients. After combined epidural-general anesthesia, VO2 was increased in normothermic and in hypothermic patients.
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To evaluate current practice in preoperative testing of healthy children undergoing elective surgery that is not expected to result in significant blood loss. ⋯ The results indicate the present practice of routine preoperative laboratory testing for children undergoing elective outpatient surgery. In spite of the many studies that indicate no specific benefits of performing routine preoperative testing in healthy children undergoing scheduled surgery, many physicians continue to order these tests in all such children.
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One of the sources of error in pulse oximetry readings is associated with an abnormal signal-to-noise ratio. The pulse oximeter distinguishes the light absorbance of arterial blood from that of other absorbers by differentiating between a constant component and a pulsating component. The pulsating component is almost exclusively the result of arteriolar bed pulsations. ⋯ We report a case in which a low pulse oximetry reading was associated with concomitant use of a pulse oximeter and a peripheral nerve stimulator on the same arm. Further tests conducted using a nerve stimulator and a sensory evoked potential stimulator with different amplitudes and frequencies confirmed the association and delineated the relationship between frequency and amplitude of stimulation and the degree of artificial desaturation. A theoretical explanation for this phenomenon is presented.
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To examine contemporary practices and opinions regarding preoperative testing requirements, with special emphasis on perioperative pregnancy recognition and consequences thereof. ⋯ The desire to identify pregnancy using patient history was most prevalent among anesthesiologists, with less than one third using mandatory, departmentally imposed screening programs. Positive test results in minors are shared primarily with surgeons and patients, occasionally with parents and social services, but rarely with police, although a positive test almost universally signified child abuse, and mandatory reporting laws were acknowledged by anesthesiologists surveyed.
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In conclusion, providing anesthesia for a small child undergoing craniofacial reconstructive surgery is an enormous challenge. Even with the most experienced pediatric anesthesiologist and pediatric surgeons, problems can develop suddenly and lead, as they did in this case, to serious morbidity and even death. It is difficult to determine whether the anesthesiologists' "success" in this case in warding off a malpractice verdict was due to their lawyer's ability to convince the court they delivered a level of "care ordinarily supplied by physicians in their specialty," or, rather, due to the fact that defense experts were more convincing than those of the plaintiffs. Regardless, I do not think there were any "winners" in this situation.