Journal of clinical anesthesia
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Case Reports
Bilateral continuous 3-in-1 nerve blockade for postoperative pain relief after bilateral femoral shaft surgery.
We tested the effectiveness of bilateral continuous paravascular femoral nerve blocks in a patient following bilateral femoral shaft surgery in whom other analgesic regimens were considered contraindicated or of limited effectiveness. Bilateral continuous femoral paravascular nerve blocks were performed using a previously described technique. General anesthesia was subsequently used to facilitate surgery, which was a bilateral osteosynthesis using dynamic hip screws for osteolytic metastases of the proximal extremities of both femurs. ⋯ Plasma concentrations of lidocaine were consistently below toxic levels (1.35 to 1.65 micrograms/ml). Radiographic contrast studies failed to demonstrate movement of contrast to the level of the lumbar plexus. Bilateral continuous femoral paravascular nerve blocks can be used to provide effective and safe analgesia in patients requiring aggressive analgesia in whom other techniques may be contraindicated.
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We present a case of intramural hematoma initially misdiagnosed as angina, and requiring myocardial revascularization. Angiography failed to lead to the proper diagnosis and the original transesophageal echocardiogram was misinterpreted as showing an intimal flap that was actually an echocardiographic artifact. The echocardiographic characteristics and implications of this entity are reviewed.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of techniques for placement of double-lumen endobronchial tubes.
To compare two methods of double-lumen endobronchial tube placement for thoracic surgery and to identify factors that provide a rational basis for placement method selection. ⋯ Both the blind and directed approaches resulted in successful left mainstem placement of the endobronchial tube in the majority of patients but either method may fail when used alone. More time was required using the directed approach. Operator experience with both methods will increase the likelihood of success. The choice of the initial approach may be influenced by patient factors as well as available equipment and personnel.
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Randomized Controlled Trial Clinical Trial
Consideration of the optimal epidural fentanyl doses in abdominal surgery.
To determine an optimal dose of epidural fentanyl in open abdominal surgery by examining the effects of different doses of epidural fentanyl in combination with or without low concentration of lidocaine on hemodynamic and endocrine responses to surgical stress. ⋯ Epidural fentanyl 3 micrograms/kg with 0.5% lidocaine may be most adequate for laparotomy because these doses caused neither bradycardia nor increments of norepinephrine perioperatively.
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To identify indicators of prolonged length of stay (LOS) in the postanesthesia care unit (PACU) and to test the following hypotheses: (1) that patient age, pain medication administration at the time of PACU admission, length of surgery, and cardiovascular, pulmonary, and pain responses postoperatively predict prolonged PACU LOS and (2) that cardiovascular and pulmonary symptoms preoperatively predict cardiovascular and pulmonary symptoms postoperatively. ⋯ Patient history and postoperative symptoms predict only a small percentage of prolonged PACU stays. Organizational factors may be a more important predictor of prolonged PACU stay. Additionally, assessment of cardiovascular and pulmonary history needs refinement to improve prediction of patient responses postoperatively.