Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2010
Case ReportsCase report: intraoperative management of extreme hemodilution in a patient with a severed axillary artery.
We present a case of extreme hemodilution in which appropriately crossmatched blood was not available. A 53-year-old man was admitted to our hospital because of hemorrhagic shock due to multiple stab wounds. ⋯ No evidence of cardiac ischemia was noted and he was discharged in good condition. Extreme hemodilution can be successfully managed by maintaining a normal blood volume, 100% oxygen, and the use of plasma substitutes.
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Anesthesia and analgesia · Nov 2010
Case ReportsAutonomic dysreflexia-like syndrome in a T12 paraplegic during thoracic spine surgery.
A 19-year-old African American man with a T12 spinal cord lesion underwent a T4-L5 thoracolumbar spinal fusion. Intraoperatively, his arterial blood pressure acutely increased from 110/60 to 260/130 mm Hg without a change in heart rate. ⋯ This presentation differs from autonomic dysreflexia because the spinal cord lesion was well below T6, hypertension was elicited with somatic stimulation above the lesion, and the response required aggressive pharmacologic management. This presentation is consistent with similar cases that support a central autonomic process.
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Anesthesia and analgesia · Nov 2010
Comparative StudyThe pharmacokinetics of ropivacaine after intraperitoneal administration: instillation versus nebulization.
Intraperitoneal local anesthetic administration provides perioperative analgesia during laparoscopic procedures. We compared the pharmacokinetics of intraperitoneal ropivacaine administered by instillation or nebulization. ⋯ The pharmacokinetic profile of ropivacaine nebulization is similar to direct intraperitoneal instillation, but with a lower absorption rate.
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Anesthesia and analgesia · Nov 2010
Implantation of 3951 long-term central venous catheters: performances, risk analysis, and patient comfort after ultrasound-guidance introduction.
Despite evidence demonstrating improved safety with ultrasound-guided placement of central venous catheters (CVC) in comparison with the use of anatomical landmarks, ultrasound guidance is still not routinely used by all physicians when obtaining central venous access. ⋯ Ultrasound guidance reduces complications and improves patient comfort. Further studies are needed to define whether acute leukemia patients should be considered a separate category with regard to the higher incidence of infections.
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Anesthesia and analgesia · Nov 2010
Case ReportsCase report: pediatric liver retransplantation on an extracorporeal membrane oxygenation-dependent child.
We describe the perioperative management of a venovenous extracorporeal membrane oxygenator-dependent child requiring liver retransplantation after emergent hepatectomy because of an ischemic liver graft. This child required renal replacement and inotropic support as well as treatment for heparin-induced thrombocytopenia (HIT). We describe each step in this child's perioperative management leading to the successful liver retransplantation. This is the first description, to our knowledge, of a pediatric patient undergoing liver transplantation while supported by extracorporeal membrane oxygenation (ECMO).