Journal of clinical anesthesia
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Randomized Controlled Trial
Clinical analgesic efficacy and side effects of dexmedetomidine in the early postoperative period after arthroscopic knee surgery.
To determine the analgesic efficacy of dexmedetomidine in the early postoperative period. ⋯ Dexmedetomidine provides a modest analgesic effect after knee arthroscopy, but the side effects of this drug, such as hypertension and bradycardia, may restrict the use of large bolus doses.
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Randomized Controlled Trial Comparative Study
Comparison of sciatic psoas compartment block and sciatic femoral 3-in-1 block for knee arthroscopy.
To compare the clinical effectiveness of two peripheral nerve block techniques combined with sciatic nerve block: sciatic psoas compartment (SPC) and sciatic femoral 3-in-1 (SF 3-in-1) block. ⋯ Both SPC and SF 3-in-1 provided sufficient anesthetic efficacy for knee arthroscopy. However, SPC may be preferable to SF 3-in-1 block owing to better patient satisfaction and less requirement for opioid analgesics.
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Case Reports
Soft palate perforation during orotracheal intubation facilitated by the GlideScope videolaryngoscope.
We report a case in which a videolaryngoscope was used to facilitate endotracheal intubation in a patient with a large exophytic mass involving the right supraglottis. After intubation, it was noted that the soft palate had been perforated by the styletted endotracheal tube. The defect closed spontaneously postoperatively within 9 days.
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Case Reports
Occurrence of pneumothorax during noninvasive positive pressure ventilation through a helmet.
A 79-year-old woman presented with hypoxemic acute respiratory failure secondary to pneumonia and was started on continuous noninvasive positive pressure ventilation (NPPV) by helmet. Patient improved over first two days of NPPV, but worsened suddenly on the third day because of development of a pneumothorax. Pneumothorax may have been caused by barotrauma from desynchronization between patient and ventilator.
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A 61-year-old patient with severe stump pain required hospitalization and intravenous opioids for pain control. After evaluation by our anesthesia pain management service, we concluded that the patient had a neuroma at the site of sciatic nerve transection and that injection of a mixture of local anesthetic and corticosteroid at the site of the neuroma was the most appropriate management. Because the alternative methods of nerve localization (eg, motor stimulation, paresthesia) were unlikely to be successful, we felt that the most reliable way to accomplish this task was to use live ultrasound guidance. After a series of 4 ultrasound-guided blocks with bupivacaine and methylprednisolone acetate, the patient's pain was alleviated to the point at which it was managed with occasional doses of oral opioids.