Journal of clinical anesthesia
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As a result of the aging US population and the subsequent increase in the prevalence of coronary disease and atrial fibrillation, therapeutic use of anticoagulants has increased. Perioperative and periprocedural management of anticoagulated patients has become routine for anesthesiologists, who frequently mediate communication between the prescribing physician and the surgeon and assess the risks of both thromboembolic complications and hemorrhage. ⋯ In this review, we will discuss the most commonly used anticoagulants used in outpatient settings and discuss their management in the perioperative period. Special considerations for regional anesthesia and interventional pain procedures will also be reviewed.
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Randomized Controlled Trial
The optimal combination of mechanical ventilator parameters under general anesthesia in obese patients undergoing laparoscopic surgery.
Pulmonary dysfunction after laparoscopic surgery is commonly seen in the high-risk group of obese patients. To reduce or avoid this complication caused by an improper combination of mechanical ventilation parameters, we conducted the following trial of 3 factors with 3 levels of mechanical ventilation, aimed to obtain the low airway pressure with good ventilator effects. ⋯ The best combination of respiratory parameters is A3B1C2, that is, f=9beats per minute, VT=8mL/kg, and I:E=1:2.0. That is, neither small tidal volume and faster frequency nor slow frequency large tidal volume is a good choice. To let obese patients under general anesthesia can obtain a lung protective effect of low airway pressure with good ventilation; it is noteworthy that (1) I:E of airway pressure (PIP, Pmean) is the important impact factor for the protection of the lung and (2) I:E of airway pressure (PIP, Pmean) is the factor with opposite properties.
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Randomized Controlled Trial
A comparison of the effectiveness of the streamlined liner of pharyngeal airway in paralyzed and nonparalyzed patients undergoing gynecological surgery: a randomized trial.
To compare the effectiveness of streamlined liner of pharyngeal airway (SLIPA) in paralyzed and nonparalyzed, anesthetized patients undergoing gynecological surgery. ⋯ SLIPA had good performance in both paralyzed and nonparalyzed patients. There was no difference in SLIPA performance or complications irrespective of muscle relaxant use, except decrease in PIP and prolong recovery time in paralyzed patients.
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Randomized Controlled Trial Comparative Study
LMA-ProSeal insertion by novice doctors as affected by a 90° bend created by an intubating stylet: a randomized clinical trial.
This study aimed to test the hypothesis that insertion of the supraglottic device LMA-ProSeal (ProSeal) by novice doctors in anesthetized patients can be improved by using an intubating stylet to create a 90° bend and that better sealing pressure is achieved. ⋯ Our results suggest that creating a 90° bend using an intubating stylet facilitates ProSeal insertion by novice doctors, as reflected by higher successful insertion rates, higher sealing pressure, and lower subjective difficulty of insertion in anesthetized patients.
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Randomized Controlled Trial Comparative Study
Pectoralis-serratus interfascial plane block vs thoracic paravertebral block for unilateral radical mastectomy with axillary evacuation.
The aim of this study was to evaluate the analgesic efficacy and safety of pectoralis-serratus interfascial plane block in comparison with thoracic paravertebral block for postmastectomy pain. ⋯ Pectoralis-serratus interfascial plane block was safe and easy to perform and decreased intensity of postmastectomy pain, but it was inferior to thoracic paravertebral block.