Journal of clinical anesthesia
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Observational Study
Fiberoptic-guided intubation after insertion of the i-gel airway device in spontaneously breathing patients with difficult airway predicted: a prospective observational study.
To assess the viability of performing fiberoptic-guided orotracheal intubation through the i-gel airway device previously inserted in spontaneously breathing patients with predicted difficult airway to achieve a patent airway. ⋯ i-gel insertion in spontaneously breathing patients avoids the "cannot ventilate" scenario. The subsequent fiberoptic-guided intubation through the i-gel is a safe and effective technique. More studies might be necessary to confirm the results presented, but we consider that the technique described is an adequate alternative to classic orotracheal intubation with fiberoptic bronchoscope in spontaneous ventilation for certain patients with predicted difficult airway.
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Comparative Study
Anesthesiology residents' perception of educational environment: comparison between different years of training.
To assess whether the year of residency in anesthesiology is associated with residents' overall perceptions of the learning environment and to evaluate the association between year of residency and each of the five domains of the Dundee Ready Education Environment Measure (DREEM) survey. ⋯ Resident's perception of the learning environment in the anesthesiology residency program of the Cleveland Clinic is on the positive side, as measured by the DREEM questionnaire. We found no association between the year of training and the DREEM questionnaire overall score. Furthermore, we found no association between year of residency and any of the subscores for the 5 DREEM domains. There is room for improvement, especially in the area of self-perception.
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Case Reports
Peroperative cardiogenic shock suggesting acute coronary syndrome as initial manifestation of Lyme carditis.
Carditis can complicate Lyme disease in an estimated <5% of cases, and cardiogenic shock and severe cardiac arrhythmias are described with electrocardiographic abnormalities that could be suggestive of coronary manifestations. We report a case of severe persistent biventricular heart failure complicated by cardiac arrhythmias as initial manifestation of a Lyme disease developing peroperatively electrocardiographic abnormalities suggesting acute transmural myocardial infarction.
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Comparative Study
Cost impact of unexpected disposition after orthopedic ambulatory surgery associated with category of anesthesia provider.
To provide estimates of the costs and health outcomes implications of the excess risk of unexpected disposition for nurse anesthetist (NA) procedures. ⋯ Provision of anesthesia for ambulatory knee and shoulder procedures by physician anesthesiologists results in better health outcomes, at a reasonable additional cost, compared with procedures with NA-administered anesthesia, at least when using updated cost-effectiveness willingness-to-pay benchmarks.
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The manipulation of an airway is always a critical moment in the anesthetic management of patients with pheochromocytoma due to the high incidence of undesirable hemodynamic events in relation with the stimulus represented by the laryngoscopy. A known difficult airway in which it is necessary to carry out an orotracheal intubation while preserving spontaneous ventilation subjects the patient to a stressful situation. The objective is to obtain an acceptable level of comfort and sedation avoiding respiratory depression (Anesthesiol Clin 2015;33:233-40). In this case, we describe the management of a known difficult airway in a patient with a pheochromocytoma and a personal history of arterial hypertension and chronic obstructive pulmonary disease who underwent orotracheal intubation with spontaneous ventilation with Airtraq and with dexmedetomidine as the only sedative agent.