Journal of clinical anesthesia
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Inhaled nitric oxide is a selective pulmonary vasodilator that has been used successfully to treat hemodynamic embarrassment and right-to-left interatrial shunting in acute right heart failure. Previous reports have been in the setting of disorders causing elevated right heart afterload, such as pulmonary embolism, acute respiratory distress syndrome, and chronic obstructive pulmonary disease. ⋯ We report a patient with right ventricular infarction for whom cardiogenic shock and refractory hypoxemia due to right-to-left interatrial shunting were effectively treated with inhaled nitric oxide. The potential for broader application of inhaled nitric oxide as a therapy for right ventricular infarction is discussed.
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To examine whether increasing mean arterial pressure (MAP) with the administration of phenylephrine would improve internal jugular venous oxygen saturation (SjvO2) during normothermic cardiopulmonary bypass (CPB) in patients with preexisting stroke. ⋯ Increasing MAP improves SjvO2 in patients with or without preexisting stroke during normothermic CPB.
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A 6-year-old girl with laryngeal papillomatosis underwent ablation of the tumors with Nd-YAG laser under microlaryngosurgery. During the surgery, she was managed with subglottic high-frequency jet ventilation using a stainless steel cannula made from a nerve block needle. ⋯ There was no hypoxia or barotrauma to the lungs during the surgery. The postoperative course was uneventful.
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Case Reports
An initially unnoticed piece of nasal jewelry in a parturient: implications for intraoperative airway management.
The literature documenting the anesthetic implications of body piercing consists only of a few case reports that focus exclusively on interference with airway management by oral jewelry. To date, no case reports documenting anesthetic problems resulting from the presence of nasal jewelry have been reported. ⋯ This situation necessitated fiberoptic examination of the nasopharyngeal and oropharyngeal cavities and radiologic imaging studies to rule out aerodigestive tract aspiration of retained and missing piece(s) of the jewelry. Based on this experience, we now advise all laboring parturients with nasal or oral jewelry in situ to remove the hardware on admission to Labor and Delivery for safety precautions.
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Clinical Trial
Combined local-propofol anesthesia with noninvasive positive pressure ventilation in a vasectomy patient with sleep apnea syndrome.
A vasectomy patient with sleep apnea syndrome, who requested general anesthesia and day surgery, was given sole propofol infusion with airway maintenance by noninvasive positive-pressure ventilation. Surgery was performed with additional local anesthesia. Because this patient was treated successfully, this anesthetic technique may also be applicable to other normal patients.