Anesthesia, essays and researches
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Monitored anesthesia care (MAC) combines intravenous sedation along with local anesthetic infiltration or nerve block. Several drugs have been used for MAC, but all are associated with complications. Dexmedetomidine is a selective α2-adrenoceptor agonist with both sedative and analgesic properties and is devoid of respiratory depressant effects. Its short elimination half-life makes it an attractive agent for sedation during MAC. ⋯ During MAC dexmedetomidine provides better sedation and analgesia than midazolam.
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Anesthetic agents should be chosen not only on the basis of safety-efficacy profile, but also on the economic aspect. Propofol and sevoflurane are commonly utilized anesthetic agent for general anesthesia. ⋯ We conclude that sevoflurane appears to be better anesthetic agents in terms of cost-effectiveness and recovery profile.
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Regional anesthesia is favored in patients who undergo emergency extremity (limb) surgery, and specifically so in the absence of fasting status. In the absence of ultrasonic guidance, the nerve stimulator still remains a valuable tool in performing a brachial block, but its use is difficult in an emergency surgical patient and greater cautious approach is essential. We identified the supraclavicular plexus by the nerve stimulation-motor response technique as follows. ⋯ The series of patients had difficulty for administering both general and regional anesthesia and we considered them as complex scenarios. The risk of the block failure was weighed heavily against the benefits of its success. The described series includes patients who had successful outcomes in the end and the techniques, merits, and risks are highlighted.
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The sparing of ulnar nerve often leads to the failure of the upper limb blockade. It has been claimed that local anesthetic injection at the site of stimulator evoked finger flexion response is associated with highest success rate of a successful block. The lower trunk stimulation of plexus should yield similar results as this trunk contributes significantly for median and ulnar nerves of hand and forearm. ⋯ We conclude other than finger flexion, the wrist flexion the forearm twitches, pronation and wrist adduction may be used for lower trunk blockade and thus for higher accuracy.
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Thyroid diseases have an anesthetic implication that includes difficult airway management, uncontrolled hyperthyroidism, hypothyroidism and postthyroidectomy complications. Securing airway: Intubation and extubation both require skillful management and timely decision to reduce morbidity and mortality in the case of large goiter with retrosternal extension that leads to tracheal compression and deviation. We present the anesthetic management in a patient with a large goiter with retrosternal extension leading to tracheal compression and deviation. We managed the case with an awake fiberoptic intubation and guided extubation.