Journal of clinical anesthesia
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To determine the level of care available to obstetric patients during the immediate postanesthesia period. ⋯ In many obstetric PACUs, the level of expertise of personnel needs to be upgraded to ensure the safety of patients recovering from general or major regional anesthesia and to comply with existing care standards.
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Propofol was used for the induction and maintenance of anesthesia in a patient undergoing a laparoscopic tubal ligation. This new anesthetic has not been associated with postoperative ventricular arrhythmias. This report demonstrates the occurrence of supraventricular tachycardia deteriorating to ventricular tachycardia in a patient who received propofol. Included is a discussion of the possible causes of this event.
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This report describes the case of an 80-year-old woman with a long history of chronic, stable angina pectoris who underwent resection of an abdominal aortic aneurysm and placement of an aortobifemoral bypass graft under a combination of epidural and general anesthesia. Epidural morphine was administered postoperatively for pain management. The patient suffered a massive myocardial infarction (MI) in the immediate postoperative period but experienced no chest pain or discomfort similar to her usual anginal symptoms. The use of epidural and spinal opioids in the treatment of anginal pain is reviewed and discussed in terms of the possibility that such epidural opioid therapy may have masked this patient's anginal symptoms.
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A case is presented of a 34-month-old child who developed hyperthermia with a temperature of 40 degrees C while undergoing a suboccipital craniotomy for resection of a medulloblastoma. The presentation is followed by a discussion of the differential diagnosis of hyperthermia during anesthesia. Malignant hyperthermia, septicemia, thyroid storm, neuroleptic malignant syndrome, transfusion reaction, and exogenous causes of fever are discussed. The case serves as an illustration of the association between neurosurgical manipulation, intraventricular hemorrhage, and fever that may result from hypothalamic irritation.