Journal of clinical anesthesia
-
A 62-year-old man with a left temporal lobe tumor was scheduled for a semiurgent craniotomy for tumor excision. Previously, the patient had a laryngeal carcinoma that was resected and treated with chemotherapy and radiotherapy and a history of laryngeal biopsy with awake fiberoptic intubation. ⋯ Based on these airway observations, we proceeded safely with intravenous induction and secured the airway in a controlled fashion, thereby minimizing the risk of increased intracranial pressure and catastrophic complications. Nasopharyngoscopy can be used safely to evaluate the upper airway to stratify airway management in patients with a history of head and neck cancer presenting for neurosurgical procedures in the setting of elevated intracranial pressure.
-
Randomized Controlled Trial
The influence of patient position on withdrawal force of lumbar epidural catheters after total knee arthroplasty: A randomized trial.
Elderly patients with degenerative knee disease may have accompanying degenerative spine conditions. There are no studies on lumbar epidural catheter withdrawal forces in these patients. The aim of this study was to investigate withdrawal forces and possible associated risk factors in patients undergoing total knee arthroplasty (TKA). ⋯ For ease of removal of catheters from the lumbar epidural space, the flexed lateral position is recommended for elderly patients undergoing TKA. When placing the epidural catheter, the physician should be careful not to insert a catheter that is excessively long.
-
Comparative Study
King Vision video laryngoscope versus Lightwand as an intubating device in adult patients with Mallampatti grade III and IV patients.
Anticipated and unanticipated difficult airways are often encountered by anesthesiologists in their clinical practice. There are various devices available in such situations. We aim to compare King Vision video laryngoscope and Lightwand for their performance as an intubating device in predicted difficult intubation. ⋯ Mean intubation time using King Vision video laryngoscope (19.50±6.73 seconds was lower than the intubation time using Lightwand 25.40±7.42 s, P=.00). The difference between number of attempts, success of intubation, numbers of adjustment maneuvers were comparable. There was a significant rise in heart rate within the groups from the pre-induction values. However inter group variations were similar. In addition, there was a significant rise in mean arterial pressure within the groups from the pre-induction values. Inter group variations show less increase in mean arterial pressure with Lightwand at immediate post intubation (P=.0234) and at 3 min and 5 min post intubation anesthesia.
-
Randomized Controlled Trial Comparative Study
Analgesic efficacy of pregabalin in acute postmastectomy pain: placebo controlled dose ranging study.
We hypothesized that oral administration of a single dose of pregabalin 2 hours before modified radical mastectomy (MRM) would produce dose-related reduction in postoperative opioid consumption. ⋯ A single preoperative oral dose of pregabalin 150 mg is an optimal dose for reducing postoperative pain and morphine consumption in patients undergoing MRM.
-
Case Reports
Real-time measurement of blood pressure with Nexfin in a patient with thalidomide-related phocomelia.
We report the novel application of photoplethysmographic technology with the Nexfin HD monitor for real-time measurement of blood pressure (BP) in a patient with tetraamelia. The patient was a 58-year-old man with tetraamelia secondary to thalidomide exposure in utero, who presented for surgical excision of a maxillary schwannoma. Because difficulty of cuff use on rudimentary limbs and failure to gain invasive arterial access due to abnormalities of limb vasculature, this population is known to pose some unique challenges for BP measurement. Nexfin may offer an alternative noninvasive method to detect BP in patients with phocomelia during the perioperative period.