Journal of clinical anesthesia
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A 69-year-old white female presented for corneal transplant, but her numerous medical problems placed her at unacceptably high risk for prolonged general anesthesia. Routine monitored anesthesia care measures would not have provided her or the surgeon the comfort and repose necessary for a successful outcome. We describe anesthetic management for ophthalmic surgery, using epidural anesthesia in conjunction with retrobulbar block, in an elderly patient at high risk for general anesthesia whose intractable back and leg pain would have otherwise precluded her cooperation in maintaining a motionless operative field.
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Perioperative smoking causes acute changes in cardiopulmonary function that can have unfavorable implications for patients undergoing anesthesia. These cardiopulmonary effects are carbon monoxide and nicotine mediated changes in oxygen (O2) delivery and myocardial O2 balance. ⋯ Bringing about a decrease in postoperative pulmonary complications requires a much longer period of preoperative abstinence. Because the perioperative period is in many ways an ideal time to abandon the smoking habit permanently, anesthesiologists, in cooperation with other health professionals, can perhaps play a more active role in facilitating this process.
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To establish the frequency of large visible bubbles or collections of bubbles in the jugular vein during radical neck dissection in the supine position. ⋯ We theorize that some unexplained, undesirable intraoperative events (hypotension, arrhythmia, and hypoxemia) during radical neck dissection could be a result of venous air embolus or paradoxical air embolus. The anesthesia community should be aware of the high frequency of these visible bubbles in the jugular veins during radical neck surgery, even in the supine position. At minimum, this phenomenon is a frequent event of intellectual interest. At worst, these bubbles may be harbingers of significant central air embolism.
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Editorial Historical Article
A historic occasion: an anesthesia journal turns 70.
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Randomized Controlled Trial Clinical Trial
Effect of preanesthetic intramuscular ranitidine on gastric acidity and volume in children.
To evaluate the effects of preanesthetic administration of intramuscular (IM) ranitidine on pH and volume of gastric contents in children. ⋯ Preanesthetic IM ranitidine 1 to 2 mg/kg resulted in a higher pH and lower volume of gastric fluid at the time of induction and in a higher pH during 3 hours of anesthesia. This therapy may be a useful adjunct to premedication for children who have a greater than normal risk of pulmonary aspiration during anesthesia.