Journal of clinical anesthesia
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Randomized Controlled Trial Clinical Trial
Early anesthesia evaluation of the ambulatory surgical patient: does it really help?
To evaluate whether early evaluation by the anesthesiologist is more beneficial for the ambulatory surgical patient than a day-of-surgery visit. ⋯ Healthy ASA physical status I and II ambulatory surgical patients do not benefit from reducing preoperative anxiety by visiting the anesthesiologist prior to the day of surgery.
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Amniotic fluid embolism (AFE) is a rare obstetric problem characterized by sudden onset of hypotension, hypoxemia, and coagulopathy. This case represents the difficulty in differentiating AFE from other etiologies of cardiopulmonary compromise. The definitive diagnosis of AFE is made at autopsy with the demonstration of fetal cell elements in the pulmonary vasculature. ⋯ Predisposing factors for AFE include advanced maternal age, multiparity, large fetal size, and short tumultuous labor, especially if uterine stimulants are used. Cardiopulmonary resuscitation is the key to the treatment of parturients with AFE. A pulmonary artery catheter can be helpful in diagnosis and hemodynamic management of parturients with AFE.
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Randomized Controlled Trial Clinical Trial
Electroconvulsive therapy-induced cardiac arrhythmias during anesthesia with methohexital, thiamylal, or thiopental sodium.
To determine the frequency of electroconvulsive therapy (ECT)-induced arrhythmias under methohexital, thiamylal, or thiopental sodium anesthesia with and without atropine premedication. ⋯ These data suggest that anesthesia for ECT therapy should be induced with methohexital to minimize the possibility of potentially life-threatening cardiac arrhythmias. Atropine premedication may further decrease the frequency of premature atrial contractions and bradycardia, while increasing the frequency of tachycardia.
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Case Reports
Total intravenous anesthesia with propofol for transsternal thymectomy in myasthenia gravis.
Patients with myasthenia gravis (MG) represent a significant management problem for the anesthesiologist. Anesthetic concerns center on the MG patient's unpredictable response to muscle relaxants and increased susceptibility to postoperative respiratory failure, resulting in prolonged dependence on mechanical ventilation. We describe the first reported use of total intravenous anesthesia with propofol to provide satisfactory surgical conditions in two patients with MG undergoing trans-sternal thymectomy. Propofol is a suitable drug for intubation and continuous infusion anesthesia, allowing fine control of anesthetic depth, good operating conditions, and a recovery profile suitable for MG patients undergoing surgery.
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Case Reports
Rapid orotracheal intubation in the clenched-jaw patient: a modification of the lightwand technique.
Emergency airway management of the patient with a clenched jaw can present a special challenge to the anesthesiologist. We describe four cases in which the patients had a clenched jaw and nasotracheal intubation was either contraindicated or several attempts had failed. All patients were successfully orotracheally intubated by a modification of the lightwand technique.