Journal of clinical anesthesia
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Spinal cord injuries continue to be a devastating medical problem. By impairing voluntary and involuntary nervous system function, virtually every body system function is affected. However, pulmonary function alteration and respiratory complications continue to be the major causes of morbidity and mortality in patients with spinal cord injuries. The current understanding of respiratory problems faced by patients with loss of innervation from cervical spinal cord injuries are reviewed.
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Clinical Trial
Perioperative use of the Thrombelastograph in patients with inherited bleeding disorders.
There are few reports of the use of Thrombelastgraph (TEG) in patients with isolated or inherited bleeding disorders. Three surgical patients are presented with von Willebrand's disease, factor XII deficiency, and hemophilia A with dysfibrinogenemia in which the abnormalities detected by the TEG were similar to the expected coagulation abnormalities based on preoperative laboratory studies. This initial report suggests that this potential application of the TEG be further investigated.
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Beta-adrenergic agents have been widely used in obstetrics to attenuate premature labor (termed tocolytic therapy), delay delivery, allow fetal maturation, and thereby reduce neonatal morbidity and mortality. Hypokalemia is a common side effect during beta-adrenergic tocolytic therapy for the treatment of preterm labor. Although rebound hyperkalemia after cessation of tocolytic therapy with ritodrine has been reported, there have been no reports of hyperkalemia occurring after the cessation of beta-adrenergic tocolytic therapy with terbutaline for preterm labor; we report such a case.
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Cervicofacial necrotizing fasciitis is a necrotizing soft tissue infection of face and neck spreading at the level of fascia. It has been described as a putrid ulcer, phagedaena, and hospital gangrene. It has a high mortality rate, and presents a challenge to anesthesiologists who must secure an airway to deliver anesthesia safely. ⋯ The tracheas of these patients should remain intubated after initial debridement. Tracheostomy should be performed early. Antibiotic therapy, nutritional support, early debridement, and hyperbaric oxygen therapy all help to decrease mortality in these patients.