Journal of clinical anesthesia
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Clonidine has both analgesic and sedative actions, and it has been used in a variety of settings as a sedative, or both. We administered oral clonidine with intravenous ketamine to a burn patient to control severe pain. ⋯ In addition, clonidine counterbalanced the sympathetic stimulation of ketamine by virtue of its action in reducing sympathetic outflow. The combination of these two drugs may be useful for burn patients with hypertension or myocardial ischemia.
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To determine the incidence of and reasons for prolonged length of stay in the postanesthesia care unit and unplanned hospital admissions of children scheduled for outpatient surgery. ⋯ Prolonged length of stay and unplanned hospital admissions were uncommon outcomes following pediatric outpatient surgery. However, the impact of such outcomes on hospital staffing and family convenience may have implications related to cost containment and patient satisfaction.
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To evaluate whether a hospital's profitability for a surgeon's common procedures predicts the surgeon's overall profitability for the hospital. ⋯ Even though most surgical cases were for uncommon procedures, a surgeon's hospital profitability on common procedures predicted the surgeon's overall financial performance. Perioperative incentive programs based on common surgical procedures (clinical pathways) are likely to accurately reflect a surgeon's financial performance on their other surgeries.
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Case Reports
Occlusion of the pilot tube in a Laser-Shield II endotracheal tube caused by methylene blue crystals: a case report.
The Laser-Shield II (Xomed-Treace, Jacksonville, FL) endotracheal tube is equipped with methylene blue crystals to aid in the prompt detection of tube cuff rupture. As the tube cuff is being inflated with saline, the crystals are supposed to dissolve fully in the saline, forming a solution that is readily visible in the event of cuff rupture. We describe a case of occlusion of the pilot balloon tube caused by undissolved methylene blue crystals, a situation that made it impossible to deflate the Laser-Shield II tube cuff. Our experience may aid in future modification of endotracheal tube design.
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Case Reports
Continuous spinal anesthesia for cesarean section in a parturient with severe preeclampsia.
Epidural anesthesia is a widely accepted technique for cesarean section in the preeclamptic patient with normal coagulation. Regional anesthetic techniques avoid the hazards associated with tracheal intubation in the preeclamptic or eclamptic patient. ⋯ Continuous spinal anesthesia was successfully administered without significant hemodynamic consequences or maternal or fetal morbidity. This case suggests that continuous spinal anesthesia may be a viable alternative anesthetic technique for operative delivery in the preeclamptic parturient when epidural anesthesia cannot be established.