Journal of clinical anesthesia
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To evaluate changes in cerebral tissue oxygen index (TOI) values under the beach chair position before and during general anesthesia in surgical patients with or without cardiovascular risk factors. ⋯ The beach chair position under general anesthesia did not alter cerebral oxygenation in patients with or without cardiovascular risk factors showing normal preoperative cerebral TOI values when the mean blood pressure was maintained above 60 mm Hg. The careful management using the cerebral oxygenation monitoring appears to maintain cerebral perfusion in the beach chair position during general anesthesia.
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Preemptive mapping of the airway is a useful adjunct to conventional clinical assessments when airway management planning for patients with complex head and neck pathology. Nasendoscopy is frequently used for this purpose but is also invasive and poorly tolerated in a subset of patients and, even in expert hands, may not allow complete visualization of the glottis and subglottic structures. ⋯ To highlight how well virtual endoscopy correlates to conventional fibreoscopy, we compare both of these assessment tools in 3 patients with glottic, subglottic, and multilevel airway pathologies. Virtual endoscopy represents a unique, noninvasive, safe, and accurate airway assessment and educational resource, which warrants further exploration.
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Randomized Controlled Trial
Effects of a 1:1 inspiratory to expiratory ratio on respiratory mechanics and oxygenation during one-lung ventilation in patients with low diffusion capacity of lung for carbon monoxide: a crossover study.
To investigate the effects of a 1:1 inspiratory-to-expiratory (I:E) ventilation ratio on oxygenation and respiratory mechanics during one-lung ventilation (OLV) in patients with low diffusion capacity of lung for carbon monoxide (DLCO). ⋯ Pressure-controlled ventilation with a 1:1 I:E ventilation ratio did not improve oxygenation in patients with low DLCO during OLV compared with a 1:2 I:E ventilation ratio. However, it did provide benefits in terms of respiratory mechanics and increased the efficiency of alveolar ventilation during OLV.
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In obese patients with unfavorable airways, awake fiberoptic intubations are sometimes performed to maintain spontaneous respiration and airway reflexes, until a secure airway is attained. Obese patients may be sensitive to the effects of sedation. ⋯ Adequate topical anesthesia minimizes airway stimulation, optimizes patient comfort and facilitates patient compliance. We report two cases of awake fiberoptic intubation in two morbidly obese patients, where a simple apparatus, made of an atomizer embedded in an oral airway, was used to effectively topicalize the airway and achieve excellent intubating condition with minimal sedation.
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The study objective is to describe our experience with placement and management of thoracic paravertebral block catheters in 2 neonates. The design is retrospective chart review of 2 consecutive newborns undergoing repair of tracheoesophageal fistula. ⋯ The main results are neither infant required continuous infusions of sedatives or narcotics. Thoracic paravertebral block catheter infusions for neonatal thoracotomy and chest tube placement may eliminate the need for continuous narcotic infusions and may avoid the need for narcotic and benzodiazepine taper or weaning.