Journal of clinical anesthesia
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Lumbar chemical sympathectomy has been performed using fluoroscopic guidance for needle positioning. An 84 year old woman with atherosclerosis obliterans was referred to the pain clinic for intractable cold allodynia of her right foot. A thermogram showed decreased temperature of both feet compared with temperatures above both ankles. ⋯ Her blood pressure was 80/50 mmHg, and flank tenderness was noted. Retroperitoneal hemorrhage from the second right lumbar segmental artery was shown on computed tomography and angiography. Vital signs were stabilized immediately after embolization into the right lumbar segmental artery.
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A 65 year old man presented with fever, pancytopenia, hypoxemia, and cardiovascular collapse requiring intensive care unit admission. Computed tomographic pulmonary angiogram showed a right-sided mediastinal mass adjacent to the right atrium. ⋯ This shunt could be reversed with a norepinephrine infusion, resulting in improved oxygenation. Histopathology showed potentially curative diffuse large B cell lymphoma (DLBCL).
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Lambert-Eaton myasthenic syndrome (LEMS) is an autoimmune disorder of the neuromuscular junction that manifests with muscle weakness, autonomic and bulbar dysfunction, and increased sensitivity to neuromuscular blocking drugs. The objective of this study is to review perioperative outcomes on a series of patients with LEMS. ⋯ Patients with LEMS have increased sensitivity to neuromuscular blocking drugs. The risk for the development of prolonged muscle weakness or postoperative respiratory failure after being exposed to neuromuscular blocking drugs is increased in patients with undiagnosed or untreated LEMS.
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Review Meta Analysis
Postoperative complications in patients with obstructive sleep apnea: a meta-analysis.
To determine whether a diagnosis of obstructive sleep apnea (OSA) imparts an increased risk of postoperative respiratory failure, cardiac events, and intensive care unit (ICU) transfer than patients with no OSA diagnosis. ⋯ Surgical patients with OSA are at increased risk of postoperative respiratory failure, cardiac events, and ICU transfer.
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Randomized Controlled Trial Comparative Study
The effects of propofol-midazolam-ketamine co-induction on hemodynamic changes and catecholamine response.
To compare the clinical efficacy of co-induction with propofol-midazolam-ketamine with etomidate as the sole induction agent. ⋯ The higher norepinephrine/epinephrine ratio noted in the single-drug group may be implicated in lower adrenal sympathetic activity. Propofol-midazolam-ketamine co-induction may be used instead of etomidate for anesthesia induction in patients with hemodynamic instability.