Journal of clinical anesthesia
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Clinical Trial Controlled Clinical Trial
Fluid resuscitation, nutritional support, and cholesterol in critically ill postsurgical patients.
To determine how and why cholesterol concentrations decrease after surgery, and the effect of the administration of nutritional support. ⋯ Serum cholesterol concentrations, like those of serum albumin and total protein, are markedly reduced immediately following major abdominal surgery, often to levels reported in malnutrition. Dilution by IV fluid and redistribution into an expanded extracellular fluid space are likely the major causes of these decreases. Serum cholesterol concentrations are therefore not useful in the nutritional assessment of patients in the immediate postoperative period.
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To measure the distances from the skin to the epidural space (DSES) of the lower cervical and upper thoracic intervertebral spaces. ⋯ In the cervical spine, DSES varies from space to space. In obese individuals, the fat pad may increase DSES at the lower cervical intervertebral spaces. The longest mean distances from the ligamentum flavum to the dural sac and to the spinal cord were found at the T1-2 and T2-3 levels, precisely where DSES is shorter. All things being equal, the upper thoracic intervertebral spaces appeared to provide a greater margin of safety for insertion of epidural catheters to treat cervicobrachial radiculopathies.
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Case Reports
Mucoid impaction following nasal intubation in a child with an upper respiratory infection.
We describe a case of mucoid impaction following nasotracheal intubation in a child with an upper respiratory infection that was successfully treated with a fiberoptic bronchoscope too large to pass through the endotracheal tube lumen. To the best of our knowledge, it is the first report in the anesthesia literature in which the placement of a nasal tracheal tube is implicated as the cause of the mucous obstruction. The physiologic changes that occur with anesthesia and that place patients at increased risk for this phenomenon, as well as the differential diagnosis, treatment, and prevention of this entity, are discussed.
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Review Case Reports
Aortic stenosis with end-stage liver disease: prioritizing surgical and anesthetic therapies.
A 48-year-old man with end-stage liver disease and aortic stenosis (AS), was being evaluated for liver transplantation. This report focuses on the question of which medical problem to correct first, the end-stage liver disease or the AS. Risk factors for surgical correction of AS and liver transplantation are reviewed and discussed, and the surgical and anesthetic management strategies for this patient are outlined.
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Randomized Controlled Trial Comparative Study Clinical Trial
Carbon dioxide dynamics during apneic oxygenation: the effects of preceding hypocapnia.
To compare the rate of increase of arterial carbon dioxide tension (PaCO2) during apneic oxygenation preceded by acute respiratory hypocapnia with that during apnea preceded by respiratory eucapnia. ⋯ Acute hypocapnia compared with eucapnia prior to apneic oxygenation is associated with a greater rise in PaCO2 in the anesthetized patient. This finding may be due in part to widening of the venoarterial gradient of pCO2.