Journal of clinical anesthesia
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Comparative Study
Anesthesia-controlled time and turnover time for ambulatory upper extremity surgery performed with regional versus general anesthesia.
To test the hypothesis that regional anesthesia (RA) employing a block room reduces anesthesia-controlled time for ambulatory upper extremity surgery compared with general anesthesia (GA). ⋯ Peripheral nerve block performed preoperatively in an induction area or LA injected in the OR significantly reduces anesthesia-controlled time for ambulatory upper extremity surgery compared with GA. Turnover time is unaffected by anesthetic technique. These results may increase acceptance of RA in the ambulatory surgery setting.
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Comparative Study
Interscalene block for postoperative analgesia using only ultrasound guidance: the outcome in 200 patients.
To report the results of single and continuous interscalene blocks (ISB) performed using ultrasound (US) guidance only. ⋯ In this group of 200 consecutive patients, the success rate for postoperative analgesia using US guidance only was 99%. Untoward events such as needle paresthesia and persistent neurologic deficits were lower than existing data on nerve stimulation and paresthesia techniques. Ultrasound can be successfully used as a "stand alone" method to perform ISB.
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Obstructive sleep apnea (OSA) is associated with postoperative airway obstruction, hypoxemia, cardiac arrhythmias, cardiorespiratory arrest, hypoxic encephalopathy, and death. Three cases highlighting important issues in patients with OSA are presented that occurred prior to and after implementation of an OSA protocol.
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A patient with advanced Chagas disease presented with symptoms attributable to dilated cardiomyopathy and mitral regurgitation. Although esophageal involvement is part of the constellation of findings in Chagas, transesophageal echocardiography was safely used to guide the mitral valve surgery.
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Following failed intubation attempts via conventional direct laryngoscopy, an Esophageal Tracheal Combitube was successfully placed in the esophagus of a 51-year-old man with a subdural hematoma and uncleared cervical spine. The decision was made to change the Combitube for an endotracheal tube (ETT). After deflation of the large oropharyngeal cuff of the Combitube, video laryngoscopy was performed with the Direct Coupled Interface (DCI) video intubation system, and the Combitube was exchanged for an ETT with the assistance of a gum elastic bougie.