Journal of clinical anesthesia
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Comparative Study Observational Study
Sedation or general anesthesia for patients undergoing transcatheter aortic valve implantation-does it affect outcome? An observational single-center study.
Aortic stenosis is one of the most common valvular lesions. Nowadays, a new treatment is emerging: the transcatheter aortic valve implantation (TAVI). It is considered a suitable alternative for the surgical approach in selected high-risk patients. This procedure may be performed under sedation (SED) or under general anesthesia (GEA). ⋯ The results of the current study, which included a relatively large number of patients, suggest that both anesthetic modalities are safe for patients undergoing TAVI. The anesthesiologist should thus tailor the anesthetic approach to the patient, taking into account the team's experience as well as the hemodynamic status of the patient. With growing experience, our team recommends performing TAVI under SED and in selected cases under GEA.
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Case Reports
Dystonic reaction associated with ondansetron administration in a patient with normal pressure hydrocephalus.
A 77-year-old female with normal pressure hydrocephalus underwent urgent revision of the abdominal component of a ventriculoperitoneal shunt. Upon emergence from an uneventful general anesthetic, the patient exhibited cogwheel rigidity with decerebrate posturing and a markedly irregular respiratory rate. ⋯ In a previous procedure, the patient had been given ondansetron without a similar reaction. This presentation may have been provoked by existing pathology such as her underlying normal pressure hydrocephalus and small increases in intracranial pressure.
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The anesthetic management of patients with morbid obesity is challenging. There is no consensus on the routine use of aspiration prophylaxis in morbidly obese patients undergoing elective surgery. ⋯ Morbidly obese patients undergoing elective surgery are at a higher risk for regurgitation and pulmonary aspiration when compared with lean patients. Preoperative aspiration prophylaxis decreases gastric volume and increases gastric pH and thus should be routinely prescribed.
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Ankle surgery is often done using a tourniquet. Ischemia/reperfusion injury caused by the tourniquet may increase postoperative pain. The study objective was to investigate the amount of opioids given to patients after ankle surgery with and without tourniquet. ⋯ We found an increase in postoperative opioid consumption correlated to tourniquet use. Possible preventive measures with antioxidant treatment to prevent ischemia/reperfusion injury should be investigated.
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Severe bleeding from injury to abdominal wall blood vessels during minor laparoscopic procedures can occur. Two cases of shock presenting several hours after surgery are presented.