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 case of a 17-month-old boy with dissegmental dysplasia of the Rolland-Desbuquois type, who was scheduled for bilateral inguinal herniotomy, is presented. Preoperative assessment showed limited mouth opening, head extension, and kyphosis. ⋯ Copious airway secretions required frequent suctioning. On the second postoperative day, respiratory status stabilized, and the patient was discharged home.
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To confirm the relationship between bevel orientation, catheter direction, and radiopaque contrast spread in the lumbar region. ⋯ A strong relationship exists between bevel orientation and catheter direction; however, catheter position does not reliably predict the direction in which the injected fluid spreads in all cadavers.
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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.
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To validate intraoperative pulse hemoglobin (SpHb) measurements in anesthetized patients with large forearm temperature - fingertip temperature gradients. ⋯ SpHb measured at fingertip was significantly affected by the perfusion state, with lower perfusion associated with lower SpHb. Thermoregulatory vasoconstriction affects measurement of SpHb.