Journal of clinical anesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Differential effects of serial hemodilution with hydroxyethyl starch, albumin, and 0.9% saline on whole blood coagulation.
To determine by thrombelastography assessed coagulation, the effects of progressive hemodilution with three intravascular volume expanders. ⋯ No differences were found after 11% hemodilution with any volume expanders. Hemodilution with up to 50% saline maintained thrombelastographic indices. Albumin produced early and profound hypocoagulable effects. Significant hypocoagulability occurred for all three diluents at 75% hemodilution. The study supports the use of albumin in patients at risk for thrombosis, and saline in patients with a need for normal hemostasis.
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Comparative Study
The impact of price labeling of muscle relaxants on cost consciousness among anesthesiologists.
To determine whether placing price labels on the vial caps of muscle relaxants increases cost consciousness among anesthesiologists. ⋯ Expenditures for the less costly pancuronium increased while expenditures for vecuronium and atracurium decreased. Price labeling of muscle relaxants in conjunction with education reduces total pharmacy expenditure on muscle relaxants.
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To investigate, in a group practice setting, the effects of combining information about drug costs with adoption of a voluntary low-cost protocol. ⋯ A private practice anesthesia group that followed a voluntary protocol could significantly reduce drug cost with little change in clinical outcome. However, the savings may not be completely maintained after the monitoring period.
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Comparative Study
Procaine spinal anesthesia: a pilot study of the incidence of transient neurologic symptoms.
To determine the approximate incidence of transient neurologic symptoms (TNS) [formerly known as transient radicular irritation (TRI)] associated with procaine spinal anesthesia, and whether fentanyl prolongs the duration of procaine spinal anesthesia. ⋯ Procaine may be a useful alternative to lidocaine for short procedures, and it is less likely to produce TNS. Fentanyl prolongs motor block when added to procaine.
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We report a case of interpleural misplacement of an epidural catheter possibly caused by inappropriate angle of the Tuohy needle. A 71-year-old man was scheduled for left lower lobectomy of the lung with general and epidural anesthesia. A 18-gauge Tuohy needle was introduced into the Th5-Th6 interspace with a right paramedian approach. ⋯ The surgeon then found the epidural catheter to be in the left pleural cavity. The catheter was immediately withdrawn. It is, therefore, necessary to employ the appropriate angle of the Tuohy needle on attempting epidural anesthesia to avoid the complication that we experienced.