Journal of clinical anesthesia
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Anesthetic management of the child with an anterior mediastinal mass is challenging. The surgical/procedural goal typically is to obtain a definitive tissue diagnosis to guide treatment; the safest approach to anesthesia is often one that alters cardiorespiratory physiology the least. ⋯ Distraction techniques, designed to shift attention away from procedure-related pain (such as counting, listening to music, non-procedure-related talk), may be of great benefit, allowing for avoidance of pharmaceuticals. In this report, we present an approach in children where the anesthetic risk is deemed excessive.
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Comparative Study
Functional outcome and cost-effectiveness of outpatient vs inpatient care for complex hind-foot and ankle surgery. A retrospective cohort study.
To compare the postoperative functional outcome and the total cost associated with outpatient vs inpatient care following complex hind-foot and ankle surgery. ⋯ This retrospective study suggests that outpatient care including an ambulatory perineural infusion of local anesthetic may be a cost-effective alternative to inpatient care after complex foot and ankle surgery.
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The aim of this study was to compare the effectiveness of epsilon-aminocaproic acid (εACA) and tranexamic acid (TXA) in contemporary clinical practice during a national medication shortage. ⋯ Substitution of εACA with TXA during a national medication shortage produced equivalent postoperative bleeding and red cell transfusions, although patients receiving εACA were more likely to require supplemental hemostatic agents.
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Case Reports
Undiagnosed pulmonary sequestration results in an unexplained hemorrhagic shock in thoracoscopic pulmonary lobectomy.
We report the first case of pulmonary sequestration which was not detected in the preoperative evaluation, resulting in a life-threatening hemorrhagic shock rapidly during the procedure of thoracoscopic pulmonary lobectomy. The anesthesiologists could not figure out the reason for the hemorrhagic shock in the surgery until an emergent laparotomy was performed. The aim of presenting this clinical case is to highlight the vigilance for undiagnosed pulmonary sequestration which lacks any specific clinical feature but has the potential to become an anesthetic disaster.
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Comparative Study Observational Study
Disagreement between fourth generation FloTrac and LiDCOrapid measurements of cardiac output and stroke volume variation during laparoscopic colectomy.
To determine the agreement between cardiac output (CO) and stroke volume variation (SVV) measured simultaneously by the fourth generation FloTrac/Vigileo system and LiDCOrapid system during pneumoperitoneum in patients undergoing laparoscopic colectomy. ⋯ Our study showed disagreement between the 2 methods and the hemodynamic parameters measured by one of the two devices should be interpreted with caution before therapeutic interventions.