Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2010
Perioperative seizures in patients with a history of a seizure disorder.
The occurrence of perioperative seizures in patients with a preexisting seizure disorder is unclear. There are several factors unique to the perioperative period that may increase a patient's risk of perioperative seizures, including medications administered, timing of medication administration, missed doses of antiepileptic medications, and sleep deprivation. We designed this retrospective chart review to evaluate the frequency of perioperative seizures in patients with a preexisting seizure disorder. ⋯ We conclude that the majority of perioperative seizures in patients with a preexisting seizure disorder are likely related to the patient's underlying condition. The frequency of seizures is not influenced by the type of anesthesia or procedure. Because patients with frequent seizures at baseline are likely to experience a seizure in the perioperative period, it is essential to be prepared to treat seizure activity regardless of the surgical procedure or anesthetic technique.
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Anesthesia and analgesia · Sep 2010
Computational modeling and prototyping of a pediatric airway management instrument.
Anterior retraction of the tongue is used to enhance upper airway patency during pediatric fiberoptic intubation. This can be achieved by the use of Magill forceps as a tongue retractor, but lingual grip can become unsteady and traumatic. Our objective was to modify this instrument using computer-aided engineering for the purpose of stable tongue retraction. ⋯ Computer-aided engineering can be used to redesign and prototype a popular instrument used in airway management. On a computational model, our modified Magill forceps demonstrated stable retraction forces, while maintaining the original geometry and versatility. Its application in humans and utility during pediatric fiberoptic intubation are yet to be studied.
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Anesthesia and analgesia · Sep 2010
Introduction of a rapid response system at a United States veterans affairs hospital reduced cardiac arrests.
We sought to determine the impact of a rapid response system on cardiac arrest rates and mortality in a United States veteran population. ⋯ A significant reduction in the rate of cardiac arrests was realized with this intervention, as well as a trend toward lower mortality. We estimate that 51 arrests were prevented in the timeframe studied. Our results suggest that further reductions in morbidity can be realized by expansion of rapid response systems throughout the Veterans Affairs network.
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Anesthesia and analgesia · Sep 2010
Case ReportsCase report: pneumothorax as a complication of the ultrasound-guided supraclavicular approach for brachial plexus block.
In this case report, we are the first to describe the occurrence of a pneumothorax after ultrasound-guided supraclavicular block. The block was performed using a medial-to-lateral in-plane needle insertion technique. The predisposing operator, technical, and patient factors as well as strategies for preventing this uncommon yet potentially severe complication are discussed.
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Anesthesia and analgesia · Sep 2010
Brief reports: a clinical evaluation of block characteristics using one milliliter 2% lidocaine in ultrasound-guided axillary brachial plexus block.
We report onset and duration of ultrasound-guided axillary brachial plexus block using 1 mL of 2% lidocaine with 1:200,000 epinephrine per nerve (total local anesthetic volume 4 mL). Block performance time, block onset time, duration of surgery, and block duration were measured. Seventeen consecutive patients were recruited. ⋯ Block duration was 160.8 (30.7) minutes. All operations were performed using regional anesthesia alone. The duration of anesthesia obtained is sufficient for most ambulatory hand surgery.