Journal of clinical anesthesia
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To investigate the pharmacokinetics after an intramuscular (IM) injection of sufentanil in thin vegetable oil in postsurgical patients and to determine whether sustained-release IM sufentanil can provide safe and sufficient analgesia of long duration in these patients. ⋯ Although an IM injection of sufentanil in thin vegetable oil is effective for postoperative pain relief, it is associated with wide interindividual variability in plasma concentration of sufentanil and long duration of action.
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Case Reports
Pneumocephalus following the treatment of a postdural puncture headache with an epidural saline infusion.
We report a case of pneumocephalus following the attempted treatment of a postdural puncture headache by a continuous epidural saline infusion. Within 1 hour of infusion, symptoms of a severe headache, nausea, and vomiting prompted a computerized tomographic scan of the head that showed 12 to 15 ml of air in the cranium. ⋯ A saline bolus and infusion were initiated after confirmation of correct placement of the epidural catheter. We suggest that air passed from the negative-pressure epidural space through the dural puncture created by the diagnostic spinal tap, producing a pneumocephalus.
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To determine the types of discrepant data during intraoperative pulse oximetry and their frequency and duration. ⋯ Pulse oximeters frequently report discrepant data intraoperatively, most frequently during emergence from anesthesia. An alarm delay triggered by discrepant data and lasting 12 to 30 seconds would keep most discrepant data from becoming false alarms and, thus, may reduce distracting sound pollution in the operating room.
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Case Reports
Hypoplastic left heart syndrome: anesthetic care prior to transplantation or surgical palliation.
Hypoplastic left heart syndrome is the most common lethal cardiac defect in neonates. Options for treatment include cardiac transplantation and surgical palliation. ⋯ During this time, anesthetic care may be required for various surgical procedures. Associated anomalies seen in these infants and the anesthetic implications imposed by the abnormal cardiac anatomy are discussed.
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To measure the start time for the first case of the day and the turnover times for subsequent cases in the operating rooms (ORs) at an academic hospital. ⋯ The scheduled start time for the first case of the day was generally the time the patient was brought into the OR. Because of the variable amount of time required for anesthesia induction and surgical preparation and draping, incision occurred 21 to 49 minutes later. The time between cases when no surgery was occurring was significantly longer than room turnover time because of the need to wake up one patient and induce the following patient. Because of a lack of standardized definitions, there is probably a strong perceptual difference among anesthesiologists, OR nurses, and surgeons when viewing start and turnover times. At our own teaching institution, shortening turnover times would increase the amount of elective OR time available, but the impact would not be significant because the number of procedures done per OR each day is low.