International anesthesiology clinics
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Facility in the use of head and neck regional blocks will provide excellent perioperative analgesia and patient satisfaction. The scope of ambulatory surgical care for head and neck surgery will undoubtedly increase as expertize in these blocks expand in the face of strict criteria for patient selection. Supplemental sedation will be more precise with the intended result of less hangover and nausea and vomiting.
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Int Anesthesiol Clin · Jan 2012
ReviewOutpatient regional anesthesia for upper extremity surgery update (2005 to present) distal to shoulder.
Multiple different approaches to the brachial plexus are available for the regional anesthesiologist to provide successful anesthesia and analgesia for ambulatory surgery of the upper extremity. Although supraclavicular and infraclavicular blocks are faster to perform than axillary blocks, the operator needs to keep in mind that blocks performed around the clavicle carry the risk for specific side effects and complications, no matter whether ultrasound or nerve stimulation is the chosen modality for neurolocation. ⋯ Smaller interventions such as carpal tunnel release or trigger finger release can be performed under elbow, wrist, or digital blocks. The regional anesthesiologist should strive to develop a tailored plan for each individual case to provide the most effective and safest nerve block technique for their patients.
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Int Anesthesiol Clin · Jan 2012
ReviewThe role of extracorporeal membrane oxygenation (ECMO) therapy in acute heart failure.
ECMO is a reliable and useful treatment for patient with acute cardiac failure. However, outcomes of cardiac ECMO are not yet as successful as case of ECMO support for respiratory failure. ⋯ Other options, including LVADs and heart transplant, should be considered when patients do not show any improvements under ECMO therapy. A multidisciplinary approach is required to provide the maximum chance of survival after ECMO treatment.
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Int Anesthesiol Clin · Jan 2012
ReviewManagement of bladder volumes when using neuraxial anesthesia.
The major principles of management of bladder function during outpatient neuraxial blockade include choice of short-acting local anesthetics, avoidance of adding epinephrine, and reasonable fluid administration (750 to 1000 mL) to avoid overdistention of the bladder. Data suggest that low-risk patients are at no greater risk of retention than after general anesthesia, and may be discharged home with similar instructions regarding return if unable to void. High-risk patients may require closer monitoring with a BUS, and catheter drainage if volumes exceed 600 mL.