Journal of clinical anesthesia
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To determine whether there has been any recent change in the mortality experience of American anesthesiologists. ⋯ We observed a significant increase in the average age at death and a decreased risk of death among anesthesiologists who died in the years 1992 to 2001. Parallel changes were observed in the control population of obstetricians.
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Case Reports
Anesthesia for cesarean section in a patient with placenta previa and methylenetetrahydrofolate reductase deficiency.
We describe the anesthetic management of a patient with placenta previa presenting for a cesarean section, who had methylenetetrahydrofolate reductase (MTHFR) deficiency. Methylenetetrahydrofolate reductase deficiency increases homocysteine levels in the body and, therefore, predisposes to thrombosis. After a cerebrovascular accident at 8 weeks of gestational age, the patient received anticoagulants throughout the course of her pregnancy. ⋯ Thus, we chose a subarachnoid block because the patient remained hemodynamically stable, and anticoagulation had been stopped 8 hours before surgery. To our knowledge, there is no reported case of a parturient with MTHFR deficiency complicated with a cerebrovascular accident and associated with placenta previa presenting for a cesarean section. Anesthetic considerations are discussed in patients presenting with placenta previa associated with MTHFR deficiency.
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Case Reports
An abnormal clinical course of an ultrasound-guided supraclavicular brachial plexus block using 0.375% bupivacaine.
We report on the case of a reappearance of a supraclavicular nerve block after the apparent initiation of its resolution in a 21-year-old athlete undergoing repair of a valgus impaction syndrome of his right elbow. The patient's anesthetic management consisted of a supraclavicular nerve block and general anesthesia. ⋯ His workup ultimately yielded negative results, and the block resolved at 23 hours. In addition to documenting an abnormal course of a supraclavicular block, this case report questions the appropriateness of placing long-acting nerve blocks in outpatients.
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Comment Letter
Assessment and management of airway obstruction with tumors.