Journal of anesthesia
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Journal of anesthesia · Aug 2011
Case ReportsAdministration of dexmedetomidine alone during diagnostic cardiac catheterization in adults with congenital heart disease: two case reports.
We report the clinical management of 2 adults with mental retardation because of trisomy 21 who were sedated with high-dose dexmedetomidine (DEX) alone during diagnostic cardiac catheterization (DCC). The first patient was a 25-year-old man with aortic regurgitation and ventricular septal defect. DEX increased his Ramsay sedation score; however, a high dose and bolus injection of DEX were required to perform an invasive procedure. ⋯ Percutaneous oxygen saturation was kept above 83%, because of the suspicion that DEX may increase the ratio of pulmonary artery flow to systemic artery flow. In both cases, no respiratory system complications occurred despite inspiration of room air, indicating the usefulness of DEX for DCC. However, because of DEX may affect DCC data, it is necessary to pay careful attention to the use of DEX during DCC.
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Journal of anesthesia · Aug 2011
Case ReportsDexmedetomidine as sole agent for awake fiberoptic intubation in a patient with local anesthetic allergy.
A series of case reports acknowledges the efficacy of dexmedetomidine as a sole sedative for awake intubations in managing a critical airway. However, most case reports documented in the literature used topicalization of the oropharynx either via nebulized lidocaine or the spray-as-you-go technique with either 2% or 4% lidocaine spray to achieve successful intubation. ⋯ The ability of dexmedetomidine to act as a sedative, anxiolytic, analgesic, and antisialagogue without causing respiratory depression is promising to the field of anesthesiology. Additional studies are needed to elucidate its potential role as the sole agent for awake fiberoptic intubation.
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Journal of anesthesia · Aug 2011
Comparison of Laryngeal Mask Supreme® and Soft Seal® for airway management in several positions.
In emergency situations, rescuers occasionally must secure the airway while the patient is in a position other than the ideal supine position. We hypothesized that the laryngeal mask airway Supreme(®) (Supreme) may be useful for emergent airway management in several positions and compared the utility of the Supreme with that of the conventional Soft Seal(®) (Soft Seal) device. ⋯ Airway management attempts by novice doctors were more successful with the Supreme than the Soft Seal in the right-LT, prone, and sitting positions in the manikin. The Supreme may therefore be useful for emergent airway management.
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Journal of anesthesia · Aug 2011
Impact of intraoperative hypotension on hospital stay in major abdominal surgery.
Although the relationship between preoperative risk factors and outcomes has been extensively studied, the effect of intraoperative hemodynamic changes in a patient's postoperative course has been less well defined. ⋯ Persistent hypotension during elective major abdominal surgery is a significant risk factor for postoperative complications and may prolong hospitalization and affect patient outcomes. Anesthetic management for the avoidance of hypotension, as much as possible, during major abdominal surgery may positively affect outcomes.