Journal of clinical anesthesia
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Glucagon is well acknowledged as a sphincter of Oddi relaxant for both diagnostic and therapeutic uses in choledocholithiasis, and an empiric treatment for β-blocker overdose. Although it has been implicated in inducing cardiovascular crises in patients with asymptomatic pheochromocytoma, adverse effects in other patient populations have not been characterized. ⋯ The patient had no radiographic evidence of pheochromocytoma. As out-of-operating room and intraoperative uses of glucagon continue to increase, perioperative physicians should be aware of its potential hemodynamic effects even in healthy populations.
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A 69-year-old woman undergoing treatment for hypertension and epilepsy was scheduled to undergo cataract surgery. All preoperative examination results were within normal limits. Despite being tense, she walked to the operating room. ⋯ The respiratory depression and bradycardia were thought to be due to an inadvertent bolus of remifentanil. We surmised that the patient had received a slight amount of retained medication when the anesthesia resident established the intravenous line, which caused severe respiratory depression. It is important to note that adverse effects such as severe respiratory depression and bradycardia can be caused by even small doses of remifentanil.
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Evaluation of bacterial growth in atropine and glycopyrrolate. ⋯ Drawing up atropine or glycopyrrolate at the beginning of the operating list and use within 24 hours if needed are a safe practice and do not pose infection hazard. We can also reduce hospital costs if we do not throw away these unused syringes following each case.
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Ultrasound-guided Pecs block can provide perioperative analgesia for breast surgery. A single-injection technique (COMBIPECS) combines both Pecs 1 and Pecs 2 blocks in a single needle pass. ⋯ The block was administered before the surgery after induction of general anesthesia. The patients needed minimal intraoperative analgesics and remained pain free in the postoperative period up to 24 hours after surgery.
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Observational Study
Continuous ambulatory adductor canal catheters for patients undergoing knee arthroplasty surgery.
To determine after knee arthroplasty surgery the feasibility of discharging patients home on postoperative day 1 with continuous adductor canal blocks. ⋯ Ambulatory adductor canal catheters are a feasible analgesic modality after knee arthroplasty surgery as pain scores remained low and adverse events were minimal.