Journal of clinical anesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
When should diclofenac be given in ambulatory surgery: preoperatively or postoperatively?
To determine the optimum time of administration of diclofenac in patients undergoing ambulatory knee arthroscopy: either preoperatively or postoperatively. ⋯ There is no difference in pain relief whether diclofenac is given preoperatively or postoperatively in patients undergoing unilateral ambulatory knee arthroscopy. Preoperative and postoperative treatment with diclofenac potassium is equally effective.
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The perioperative use of neuraxial techniques in the presence of anticoagulation is a controversial issue. There are significant pharmacokinetic differences between anticoagulants that will affect the timing of neuraxial needle insertion or catheter removal. The pharmacologic profiles of commonly used anticoagulants in the perioperative period are reviewed. Studies examining the use of neuraxial techniques in the presence of various anticoagulants are reviewed and evaluated in the context of the American Society of Regional Anesthesia consensus statements.
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Randomized Controlled Trial Clinical Trial
Pediatric caudal block with mepivacaine, bupivacaine or a mixture of both drugs: requirement for postoperative analgesia and plasma concentration of local anesthetics.
To assess the effects of pediatric caudal block using mepivacaine, bupivacaine, or a mixture of both drugs on postoperative analgesia, and to examine plasma concentrations of the local anesthetics after caudal injection. ⋯ Pediatric caudal block with a mixture of mepivacaine and bupivacaine is effective for intraoperative and postoperative analgesia.
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To quantify global coagulation and establish normal ranges for the celite-activated thrombelastograph (TEG) in healthy pediatric patients. ⋯ These data identify changes of small magnitude in three celite-TEG parameters in healthy children compared to adults, without implication of abnormal coagulation between groups. Changes do not seem to be consistently related to age and will be useful for clinicians using the TEG to monitor (ab) normal coagulation in pediatric patients.
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One-lung ventilation is a commonly used technique to facilitate surgical visualization during thoracic surgical procedures. New devices for one-lung ventilation have been introduced into clinical practice over the recent years. One such device is the Arndt Endobronchial Blocker which is a bronchial blocker with a central lumen through which a wire with a looped end has been passed. ⋯ The port for the bronchial blocker can be tightened down so as to hold the blocker in place during the procedure. However, patient issues such as size or airway alterations such as the presence of a tracheostomy may make necessary certain alterations in airway management. I describe four cases and provide suggestions for minor alterations in airway management that may be used to provide successful options for one-lung anesthesia.