Journal of clinical anesthesia
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Observational Study
Confirmation of optimal guidewire length for central venous catheter placement using transesophageal echocardiography.
Several authors have reported rare, but severe, complications associated with the length of the intravascular guidewire during central venous catheter placement, as the wire tip can cause cardiac arrhythmia or perforation or become trapped within the vessel. Although one report investigated the optimal guidewire length using fluoroscopy, few reports have precisely measured guidewire position using transesophageal echocardiography (TEE). Here, we investigated the appropriate intravascular length of a guidewire for right internal jugular vein approach using TEE during cardiac surgery. ⋯ We confirmed the wire tips at all cases by ultrasonography. The distance using TEE was similar to that by fluoroscopy, but TEE was more precise. Guidewire length was weakly correlated to height. About 15 cm as minimum length should be considered the limit for guidewire length in an adult, in consideration of height, to ensure patient safety during central catheter placement for right internal jugular vein approach.
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Comparative Study
Carbetocin for prevention of postcesarean hemorrhage in women with severe preeclampsia: a before-after cohort comparison with oxytocin.
The aim of the study was to compare the incidence of the use of additional uterotonics before and after the change of carbetocin to oxytocin for the prevention of postpartum hemorrhage after cesarean delivery in women with severe preeclampsia. ⋯ As carbetocin appears to be as effective and safe as oxytocin in preeclamptic women, its advantages make it a good uterotonic option in this particular setting.
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Observational Study
Anesthetic implications for patients with Segawa syndrome.
To characterize the perioperative course of patients with Segawa syndrome undergoing anesthetic management. ⋯ In this cohort, patients with Segawa syndrome tolerated the anesthetic management, including neuromuscular blocker administration. Although these patients are frequently receiving levodopa therapy, no associated complications were noted.
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Comparative Study
Does dexmedetomidine cause less airway collapse than propofol when used for deep sedation?
The risk of airway collapse in patients undergoing deep sedation is a major concern. In this study, we compared the airway patency of deep sedation provided by propofol with the airway patency of deep sedation provided by dexmedetomidine in magnetic resonance imaging (MRI) procedures. This comparison was done using MRI static and dynamic images and comparing these images to baseline after sevoflurane induction. ⋯ In deep sedation, which is commonly associated with a loss of airway tone, it may not matter which of these intravenous study agents are used. Intravenous sedation with propofol or dexmedetomidine appears to produce the same effect on the pediatric airway.
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Case Reports
Intraoperative mandibular nerve block with peripheral nerve stimulator for temporomandibular joint ankylosis.
We describe the use of peripheral nerve stimulator for mandibular nerve block intraoperatively in a 4.5year old child with complete temporomandibular joint ankyloses. The block was not possible preoperatively, therefore, it was administered after release of ankyloses. ⋯ Postoperative pain relief was excellent. Peripheral nerve stimulator is an easy way of for accurate needle tip placement for mandibular nerve block in patients with distorted anatomy.