Journal of clinical anesthesia
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Characterize the incidence of elevated aPTT results in patients treated with prophylactic, subcutaneous unfractionated heparin (UFH). ⋯ Treatment with UFH resulted in a small, but significant, increase in aPTT.
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Observational Study
Association between preoperative maternal anxiety and neonatal outcomes: a prospective observational study.
Preoperative anxiety can be associated with poor postoperative clinical outcomes. We aimed to assess whether preoperative maternal anxiety level of obstetric patients scheduled for elective cesarean surgery has an effect on clinical outcome of the newborn. ⋯ We concluded that there was no relationship between preoperative maternal anxiety scores and Apgar scores at the first and fifth minute.
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The purpose of this study was to analyze previously reported airway risk factors in the performance of Miller laryngoscopy and orotracheal intubation. ⋯ The Miller blade is highly successful in the performance of direct laryngoscopy for orotracheal intubation. These findings suggest that different sets of airway risk factors affect the process of laryngoscopy and orotracheal intubation.
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Case Reports
Reversal of profound neuromuscular blockade with sugammadex in an infant after bronchial foreign body removal.
Sugammadex is a selective chemical agent that can reverse neuromuscular blockade induced by vecuronium and rocuronium. The aim of this report is to discuss the effectiveness of sugammadex in the reversal of neuromuscular blockade in children younger than 2 years. A 16-month-old boy, weighing 10 kg, was admitted to the pediatric emergency department due to choking, cyanosis, and severe respiratory distress that occurred while he was eating peanuts. ⋯ Clinical use of sugammadex in children younger than 2 years is not recommended because of the lack of clinical studies. In this case report, the profound neuromuscular blockade was successfully reversed with a dose of 2 mg/kg sugammadex in a 16-month-old boy. However, more prospective clinical studies are required for the safe use of this agent in children.
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Historically, the placement of internal jugular central venous lines has been accomplished by using external landmarks to help identify target-rich locations in order to steer clear of dangerous structures. This paradigm is largely being displaced, as ultrasound has become routine practice, raising new considerations regarding target locations and risk mitigation. Most human anatomy texts depict the internal jugular vein as a straight columnar structure that exits the cranial vault the same size that it enters the thoracic cavity. We dispute the notion that the internal jugulars are cylindrical columns that symmetrically descend into the thoracic cavity, and purport that they are asymmetric conical structures. ⋯ Understanding that the largest target area for central venous line placement is the lower portion of the right internal jugular vein will help to better target vascular access for central line placement. This is the first study the authors are aware of that depicts the internal jugular as a conical structure as opposed to the commonly depicted symmetrical columnar structure frequently illustrated in anatomy textbooks. This target area does come with additional risk, as the closer you get to the thoracic cavity, the greater the chances for lung injury.