Journal of clinical anesthesia
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To assess the patient's understanding and knowledge of the anesthesiologist's role and responsibilities in the operating room and in other areas of hospital activity, and to delineate the effect of previous anesthetic experience on this knowledge. ⋯ If able to be extrapolated to all of Israel, our results show a high appreciation for the physician status of the anesthesia professional and role in safe recovery. Passive learning from a prior anesthetic experience did not appear to improve such appreciation.
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To investigate prospectively whether blood gas samples drawn from extracorporeal membrane oxygenation (ECMO) cannulae help to exclude at least clinically significant recirculation volumes in patients with acute respiratory failure. ⋯ The median arterial oxygen tension (PaO(2)) obtained from the arterial cannula was 537 mmHg (range, 366 to 625 mmHg), the median mixed venous oxygen tension (PvO(2)) drawn from the venous cannula was 42 mmHg (range, 25 to 54 mmHg), which was less than 10% of that observed in the arterial cannula, and also within the physiologic range of PvO(2). The ECMO flow necessary to maintain patients' oxygen saturation above 90% (4.1 L/min; range, 1.95 to 5.8 L/min) was significantly lower than the patients' cardiac output (CO; 6.2 L/min; range, 4.1 to 7.9 L/min; p < 0.001). CONSLUSIONS; We recommend obtaining blood gas samples-immediately after initiation of ECMO-from both cannulae. A PvO(2) within physiologic range and below 10% of PaO(2) rules out any clinically relevant recirculation volume.
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Case Reports
A two-person technique for fiberscope-aided tracheal extubation/reintubation in intensive care unit (ICU) patients.
The technique of fiberoptic-aided intubation for management of a difficult airway is often limited in the presence of blood or secretions and conditions in which the passage of a fiberoptic bronchoscope ("fiberscope") beneath the epiglottis and into the glottic opening may prove difficult. Direct laryngoscopy can be utilized in combination with the fiberscope as a two-person technique to overcome these challenges. We report the usefulness of a two-person technique using the flexible fiberscope in combination with direct laryngoscopy for extubation/reintubation in two intensive care unit patients with known difficult airways.
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Many anesthesiologists have called for the abandonment of the epidural test dose in the obstetric patient, citing its lack of sensitivity and specificity. A test dose of lidocaine 1.5% with epinephrine 1:200,000, in combination with aspiration, is highly effective in detecting incorrect placement of an epidural catheter. ⋯ It should not be administered during uterine contraction, as labor pain may trigger a tachycardic response. This test dose has been extensively studied and is safe both for both mother and fetus.