AANA journal
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Local anesthetic toxicity can have catastrophic outcome in an otherwise benign procedure. Introduction of even a small amount of local anesthetic into the bloodstream can cause cardiac arrest in a healthy patient. Most healthcare facilities rely on standard resuscitative techniques to treat such events; however, treatment via infusion of lipid emulsion has been used successfully to stabilize the condition of some patients in a safe, effective, and rapid manner. ⋯ The key words included in the search were "Intralipid," "local anesthetic toxicity," "lipid infusion," and "lipid sink." Lipid therapy has shown great promise for the treatment of patients facing cardiovascular collapse due to local anesthetic toxicity. However, the slow adoption of this novel evidence-based practice by healthcare facilities endangers patients who may not receive the best available care when the need is most dire. Current evidence suggests that infusion of lipid emulsion should be considered among the primary treatments for local anesthetic toxicity and be made readily available in every facility's operating or procedure room, and hospital staff should be trained in its use when local anesthetic toxicity is suspected.
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Nearly one-fourth of all trauma admissions present in varying degrees of coagulopathy. According to a US study, 40% of trauma fatalities are due to hemorrhage and hemorrhagic shock, and nearly all patients who are alive when they reach the hospital are coagulopathic when they die. ⋯ Because of the clinical significance of trauma-induced coagulopathy, management strategies to reduce the morbidity and mortality have recently become of interest. This article will review the pathology of trauma-induced coagulopathy and current trends in management, as well as closely examine the data surrounding the use of recombinant factor VII for the treatment of trauma-induced coagulopathy.
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Randomized Controlled Trial
Biphasic dosing regimen of meclizine for prevention of postoperative nausea and vomiting in a high-risk population.
The purpose of this study was to determine if giving 50 mg of meclizine the night before and on the day of surgery would effectively reduce postoperative nausea and vomiting (PONV) for the entire 24 hours after surgery in patients identified as being at high risk for PONV Subjects were randomly assigned to receive either 50 mg of oral meclizine (experimental group) or a placebo (control group) the night before and the day of surgery. All subjects were intravenously administered 4 mg of ondansetron before the conclusion of surgery. ⋯ No difference in sedation or side effects was noted between groups. Based on these results, we recommend that the administration of 50 mg of oral meclizine the night before and on the day of surgery be considered effective antiemetic prophylaxis in patients identified as having a high risk for PONV.
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Awake craniotomy is becoming more popular as a neurosurgical technique that allows for increased tumor resection and decreased postoperative neurologic morbidity. This technique, however, presents many challenges to both the neurosurgeon and anesthetist. An ASA class II, 37-year-old man with recurrent oligodendroglioma presented for repeated craniotomy. ⋯ The patient was awake, alert, oriented, and able to move all extremities but had residual weakness in the right forearm. Awake craniotomy requires appropriate patient selection, knowledge of the surgeon's skill, and a thorough anesthesia plan. This case report discusses the clinical and anesthetic management for awake craniotomy and reviews the literature.
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Aortic dissection is a life-threatening condition with a 50% mortality rate in the first 48 hours and a 3-month mortality rate of 90% in untreated patients. Aortic dissection is a rare complication of pregnancy, but there is significant morbidity and mortality for the mother and infant. A 43-year-old woman with a 37-week intrauterine pregnancy was admitted to the emergency department 6 hours after the onset of tightness in her throat and neck pain. ⋯ An emergency aortic repair and cesarean section were successfully performed. Recognition of aortic dissection and an evidence-based, collaborative approach to optimize treatment and recovery are vital to the patient's survival. The purpose of this article is to highlight successful management of aortic dissection in a parturient and to broaden the body of literature on the topic.