Journal of clinical anesthesia
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Randomized Controlled Trial Clinical Trial
Altered reactivity to acetylcholine in the pulmonary circulation after cardiopulmonary bypass is part of reperfusion injury.
To investigate whether a time sequence of acetylcholine (ACH) reactivity indicative of endothelial reperfusion injury could be demonstrated in the pulmonary circulation in patients after cardiopulmonary bypass (CPB). ⋯ The maintained reactivity to ACH directly after CPB, followed by no reaction at 1 to 1.5 and 4 hours, was in agreement with experimental findings and indicates endothelial reperfusion injury caused by the period with no blood flow through the pulmonary artery during CPB and subsequent reperfusion.
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Clinical Trial
Pulmonary aspiration in pediatric patients during general anesthesia: incidence and outcome.
To determine the incidence of, outcome of, and risk factors for anesthesia-related pulmonary aspiration in the predominantly pediatric population receiving anesthesia care. ⋯ The overall incidence of anesthesia-related aspiration in our series (0.10%) was twice that reported in studies of adults, and four times (0.25%) higher for those at highest risk (ASA physical status III or IV vs. physical status I or II). Anesthesia-related pulmonary aspiration was proven to be a rare event in this tertiary pediatric center and its consequences relatively mild. Because of the very low frequency and the lack of serious outcome after aspiration in ASA physical status I and II pediatric patients, it appears that routine prophylactic administration of histamine blockers or propulsive drugs in healthy pediatric patients is unwarranted.
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To ascertain patients' recall of the risks of labor epidural analgesia from a discussion of informed consent during active labor. ⋯ Recall of risks by parturients is similar to the recall of risks by other patients, and it does not appear to be affected by parity or the reported level of pain.
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Muscle relaxant pharmacophysiology can be altered in various clinical situations. We report increased requirement of vecuronium in a patient diagnosed with testicular feminization. Increased level of endogenous testosterone and steroidal-core structure of vecuronium may explain the increased tolerance to vecuronium in this patient.
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We describe a case where massive air embolism occurred while infusing fluid under pressure with a pressurized infusion system, with fluid bags which contained volumes of air from the manufacturer. We suggest that anesthesiologists be meticulous in de-airing the infusion bag before connecting it to the intravenous infusion system. Also, if the manufacturers of crystalloid solutions would produce their product devoid of air, then this inherent risk would be substantially decreased.