Journal of clinical anesthesia
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Venous air embolism (VAE) can be a lethal complication of surgical procedures, during which (1) venous pressure at the site of surgery is subatmospheric or (2) gas is forced under pressure into a body cavity. Though classically associated with neurosurgery, VAE is also a potential complication of laparoscopic, pelvic, and orthopedic procedures. It is, therefore, essential for the practicing anesthesiologist to recognize and treat venous air entrainment. An in-depth review of the pathophysiology, clinical presentation, detection, prevention, and treatment of VAE is presented.
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To determine the volume of air in 1000-ml crystalloid bags before and after connection to an infusion set; and to determine the volume of air that is not eliminated by the air eliminator in the Level 1 fluid warming device (Level 1 Technologies, Inc., Rockland, MA) when air boluses of different volumes enter into the fluid warming set. ⋯ Air must be rigorously eliminated from all fluid containers because of the limited air elimination capability of the Level 1 air eliminator.
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Comparative Study
Effects of gas flow management on postintubation end-tidal anesthetic concentration and operating room pollution.
To study how different anesthetic practices during the transition from anesthetic delivery by mask to endotracheal intubation affect end-tidal postintubation anesthetic concentration and operating room (OR) pollution. ⋯ In a mechanical model of anesthetic induction, turning the gas flows off before "intubation" and leaving the vaporizer on (the gas off practice) maintained "postintubation" end-tidal drug concentrations close to "preintubation" equilibrium and minimized OR pollution.
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To determine the cause and timing of case cancellation in a pediatric outpatient surgical population, and to examine the economic and emotional impact of such cancellations on patients and their families. ⋯ This study suggests that last-minute cancellation of surgery has an important impact on patients and their families and suggests a need to review present protocols for screening patients prior to surgery.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Outpatient general anesthesia: a comparison of a combination of midazolam plus propofol and propofol alone.
To compare the hemodynamics, efficacy, safety, and postoperative recovery of patients following the use of either midazolam plus propofol or placebo plus propofol for induction and maintenance of general anesthesia for outpatient surgical procedures of less than two hours' duration. ⋯ Concomitantly administered midazolam and reduction-concentration propofol did not exacerbate the well-described hypotensive effects of full-strength propofol during induction of anesthesia. The time to intubation was equivalent with the combination of midazolam/propofol as compared with propofol alone. Recovery from the two regimens was not significantly different. However, reduced recall of perioperative events was observed more often in the midazolam/propofol regimen compared with propofol alone.