Journal of clinical anesthesia
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To determine the utility of cerebral oximetry for monitoring the adequacy of cerebral blood flow (CBF) during carotid cross-clamp. ⋯ Cerebral SaO2 decreased significantly on carotid cross-clamp in patients undergoing awake CEA. Hemodynamically stable patients demonstrated no evidence of regional brain failure when SaO2 decreased to 63% (mean decrease of 7.2%). Two hemodynamically unstable patients had evidence of global brain failure when SaO2 was less than 48% (mean decrease of 36%). Our findings suggest that cerebral oximetry reflects CBF, and it may be an effective, noninvasive method of monitoring regional cerebral oxygenation changes during CEA. Significant reductions in regional SaO2 may be tolerated without evidence of brain failure. Further studies are needed to define an SaO2 threshold that reflects regional brain failure.
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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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Case Reports
Subcutaneous morphine is superior to intrathecal morphine for pain control in a patient with hypernephroma.
This case report illustrates differences in analgesia quality and morphine consumption between an intrathecal infusion and the subcutaneous instillation of morphine in a cancer patient with hypernephroma. Superior analgesia was obtained with a 450 mg dose of subcutaneous morphine [i.e., visual analog scale (VAS) score 0/10] than with 10 mg intrathecal morphine/day administered at the thoracolumbar (twelfth dorsal vertebra) level (VAS score 2/10). If the instillation occurs at the lumbosacral level (between the last lumbar and the first sacral vertebra), a dosage of 70 mg morphine/day cannot induce the same pain relief as 450 mg subcutaneous morphine (VAS score 5/10 vs. 0/10). In some cancer patients, subcutaneous morphine offers superior pain control than intrathecal morphine.
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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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Randomized Controlled Trial Comparative Study Clinical Trial
Remifentanil versus propofol as adjuncts to regional anesthesia. Remifentanil 3010 Study Group.
To compare the safety and efficacy of remifentanil and propofol as adjuncts to regional anesthesia in patients undergoing orthopedic or urogenital surgery. ⋯ At the doses studied, remifentanil was more effective than propofol in minimizing pain without producing excessive sedation. Remifentanil was associated with more transient respiratory depression and short-term nausea. Our findings indicate that the initial remifentanil rate should be 0.1 microg/kg/min (50% lower than the study's initial rate) and should be further decreased an additional 50% in the elderly to minimize adverse effects.