AANA journal
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Although uncommon and rarely reported, pharyngoesophageal perforation has medical and legal consequences of substantial proportion. Perforation of the upper aerodigestive system may result in severe airway complications that include pneumothorax, pneumonia, mediastinitis, and retropharyngeal abscess. ⋯ Postoperatively she developed what appeared to be symptoms of pharyngoesophageal injury, suspected to be related to blunt trauma from laryngoscopy. Knowledge of and prompt attention to the cardinal signs of pharyngoesophageal injury in partnership between the anesthetist and the surgical team were the key instruments in ruling out this potentially devastating diagnosis.
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The goal of our study was to evaluate whether the combination of remifentanil and propofol facilitated shorter recovery time and decreased charges compared with conventional balanced anesthesia. We studied 49 patients, aged 13 to 75 years, who underwent elective outpatient surgery. All data were analyzed using the Pearson chi2 and the Student t test; results were considered statistically significant at a P value of.05 or less. ⋯ Group 1 had less PACU time (48.26 vs 59.62 minutes) and 2 group 1 patients bypassed the PACU. We conclude that a remifentanil-propofol combination is more cost effective than conventional balanced anesthetics and enables some patients to bypass the PACU, resulting in quicker discharge. Our findings have important implications for ambulatory surgery centers and office-based practices.
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Randomized Controlled Trial Comparative Study Clinical Trial
The effect of Pencan needle orientation on spinal anesthesia outcomes.
Slow resolution of block and incidence of side effects deter many practitioners from choosing spinal anesthesia for out-patient surgical procedures. Some studies suggest that controlling bevel or side port orientation of a spinal needle during anesthetic injection can affect occurrence of side effects and time to block resolution. The objective of this study was to determine the effects of varying Pencan spinal needle (B-Braun, Bethlehem, Pa) side port orientations on duration of block and incidence of side effects in groups of patients receiving spinal anesthesia. ⋯ Differences were noted in time to discharge from the hospital (P = .027) and time to first voiding (P = .023) in the lateral compared with the cephalad and caudad orientation groups. Patients in whom the lateral needle side port orientation was used for injection were discharged earlier and had fewer side effects. This could translate into significant savings, financially and in terms of staff requirements.
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Patients with Down syndrome, or trisomy 21, present a unique set of anesthetic considerations to anesthesia providers. Down syndrome is the most prevalent genetic disorder worldwide and affects more than 1 in 800 live births. ⋯ The purpose of this review is to describe clinically significant findings that are common to patients with Down syndrome. In addition to the presentation of clinical anomalies associated with trisomy 21, specific anesthetic considerations and interventions are reviewed.
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We describe a patient who sustained facial burns during a tracheotomy. The electrosurgical unit indirectly started the fire during monitored anesthesia care when a high inspired oxygen concentration was being delivered to the patient by simple face mask. This case points out the need for prevention strategies, intraoperative vigilance, and quick intervention to prevent further patient injury any time the electrosurgical unit is used in an oxygen-enriched atmosphere.