Journal of clinical anesthesia
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To evaluate intra-abdominal needle trajectories of the classic transcrural celiac plexus block (tCPB) with a simulation technique. ⋯ Despite uncommon clinical complications, classic tCPB needle placement frequently traversed through several key organs in this simulation series. Organ penetrations could be avoided by needle trajectory adjustment.
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Case Reports
Increased airway pressure due to superior mediastinal hematoma during endovascular coiling by transcarotid approach.
An elderly woman with subarachanoid hemorrhage presented to our interventional neuroradiology suite for coil embolization of multiple intracranial aneurysms. The patient had difficult vascular access for the passage of microcatheter; hence, the embolization procedure was carried out with direct puncture of the left common carotid artery. ⋯ At the end of procedure, she developed airway compromise due to extension of a local neck hematoma into the superior mediastinum. The management issues in such a scenario have been discussed.
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Despite the fact that anesthesia was discovered in the United States, we believe that both physicians and nurses are largely unaware of many aspects of the development of the nurse anesthetist profession. A shortage of suitable anesthetists and the reluctance of physicians to provide anesthetics in the second half of the 19th century encouraged nurses to take on this role. We trace the origins of the nurse anesthetist profession and provide biographical information about its pioneers, including Catherine Lawrence, Sister Mary Bernard Sheridan, Alice Magaw, Agatha Cobourg Hodgins, and Helen Lamb. ⋯ We provide information on difficulties faced by nurse anesthetists and how these were overcome. Next, we examine how members of the profession organized, developed training programs, and formalized credentialing and licensing procedures. We conclude by examining the current state of nurse anesthesia practice in the United States.
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Randomized Controlled Trial Comparative Study
Is the Ambu aScope 3 Slim single-use fiberscope equally efficient compared with a conventional bronchoscope for management of the difficult airway?
The study objective was to evaluate whether the single-use fiberoptic bronchoscope (FOB), Ambu aScope 3 Slim, was equally efficient compared with the conventional reusable FOB, Olympus LF-GP, for nasal fiberoptic intubation in a manikin. ⋯ The Ambu aScope 3 Slim required more time to intubate than the conventional reusable FOB. It requires more rigidity, similar to the conventional FOB for management of the difficult airway.
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The prevalence of medical conditions representing a risk for thromboembolic complications and requiring antithrombotic therapy increases gradually with age. Two cases of fatal noncritical organ bleeding complication that occurred during the conversion period from initial fondaparinux to vitamin K antagonist are presented. An 81-year-old obese female patient (body mass index 43 kg/m(2)) with previous postoperative thrombosis underwent uneventful total knee replacement under spinal anesthesia. ⋯ A 92-year-old female patient (body mass index 33 kg/m(2)) with left lower limb thrombosis was referred to our orthopedics department from her senior citizens' home for right lower limb hematoma and ischemia that occurred during conversion to oral anticoagulant. Thromboembolic and bleeding events in the elderly are real public health problems. Specific guidelines dedicated to this particular population are needed, which will improve the management of anticoagulation and decrease risk of complications.