Journal of clinical anesthesia
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A 23-year-old female was referred to the University of Arkansas for Medical Sciences at 32 weeks' gestation with a history of aortic stenosis following aortic valve replacement. Evaluation by echocardiography showed an approximately 90 mmHg transvalvular pressure gradient. ⋯ Invasive hemodynamic monitors were used to assess cardiac performance and as a guide for anesthetic management. The impact of aortic stenosis on pregnancy is discussed, as are management aspects of lumbar epidural anesthesia in such patients.
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Review Case Reports
Adult epiglottitis and postobstructive pulmonary edema in a patient with severe coronary artery disease.
Epiglottitis is a rare cause of upper airway obstruction that may lead to death in the adult. We report the case of a patient with severe coronary artery disease with adult epiglottitis who required emergency endotracheal intubation. Relief of the airway obstruction was followed by the development of postobstructive pulmonary edema. ⋯ All others should be observed in an intensive care unit with a skilled anesthesiologist available to carry out emergency endotracheal intubation. Inhalation induction with halothane in oxygen should be considered initially; failing that, rigid bronchoscopy, tracheostomy, or transtracheal ventilation should be available. Postobstructive pulmonary edema should be anticipated after relief of airway obstruction has occurred; it can be treated with fluid restriction, diuretics, and continuous positive airway pressure.
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To determine the feasibility of continuous caudal anesthesia with 2-chloroprocaine in conscious former preterm infants undergoing inguinal hernia repair. ⋯ Three percent 2-chloroprocaine can be used effectively for continuous caudal anesthesia in conscious, former preterm infants for inguinal hernia and penoscrotal surgical procedures lasting 85 to 170 minutes.
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Biography Historical Article
Crawford W. Long: pioneer physician in anesthesia.
Crawford W. Long first used ether as an anesthetic on March 30, 1842. This article examines factors in his education and practice that prompted his discovery. Included in the discussion are some of the circumstances that caused Long to delay publication of his experience with ether, as well as the impact of the "ether controversy" on his life.
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To delineate current practice with regard to how coagulation status is evaluated before induction of regional anesthesia in the preeclamptic parturient, with the goal of defining appropriate testing. ⋯ In the majority of academic programs in the United States, we found that the evaluation of coagulation status in the preeclamptic parturient was based primarily on a platelet count. A review of the literature supports this pattern of testing.