Journal of clinical anesthesia
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The local anesthetic systemic toxicity can be due to increased blood lignocaine levels or due to increased sensitivity to lignocaine. Several cases of lignocaine-induced central nervous system toxicity have been noted, but none have reported only loss of consciousness without any seizure-like activity. ⋯ However, majority of them were used in the treatment of cardiovascular manifestations of local anesthetic toxicity. We report a case of a 19-year-old man who had unconsciousness on 2 separate occasions after local lignocaine infiltration to undergo surgery for dental malocclusion and the use of lipid emulsion in its management.
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Observational Study
Factors associated with blood transfusion during intracranial aneurysm surgery.
The purpose of this study was to identify risk factors associated with intraoperative blood transfusions in patients presenting for intracranial aneurysm surgery in the current era of more restrictive transfusion guidelines. ⋯ The incidence of intraoperative red blood cell transfusion in intracranial aneurysm surgery in our patient cohort was 9.5%, and the most significant factors associated with transfusion were presenting hemoglobin level less than 11.7 g/dL and age greater than 52 years. It would seem advisable that these patients undergo routine type and cross-matching of red blood cells before intracranial aneurysm surgery.
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To evaluate the quality of postoperative pain relief during the first 3 days after surgery and to evaluate with the incidence of persistent pain at 6 months after surgery. ⋯ Poorly controlled acute postoperative pain correlated with persistent postsurgical pain at 6 months. In view of such a high incidence in thoracotomy patients, preventative strategies assume great significance.
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A 75-year-old man presented with dizziness and fatigue secondary to ventricular and supraventricular arrhythmias. He underwent an elective ablation but continued to suffer from ventricular tachycardia with cardiovascular instability despite antiarrhythmic therapy with multiple agents. The patient continued to develop episodes of ventricular tachycardia and an episode of ventricular fibrillation. ⋯ The patient demonstrated sinus rhythm with episodes of sinus tachycardia. Left stellate ganglion block has proven to be a successful mode of treatment for those patients with ventricular tachyarrhythmia resistant to medical management or those who fail atrioventricular node ablation. Ultrasound-guided left stellate ganglion block is a valuable and effective means to providing sympathectomy in the management of electrical storm or ventricular tachyarrhythmias.
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Observational Study
Airway management for glossopexy in infants with micrognathia and obstructive breathing.
To identify airway management and tracheal intubation techniques for glossopexy in infants with preexisting airway obstruction under general anesthesia. ⋯ There are severe cases of infants with difficult mask ventilation and difficult tracheal intubation in which a fiberscope is required because video laryngoscopy fails to improve the view of the larynx.