JAMA : the journal of the American Medical Association
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Cardiac arrests due solely to anesthesia were studied in a large university hospital over a 15-year period. There were 27 cardiac arrests among 163,240 anesthetics given, for a 15-year incidence of 1.7 per 10,000 anesthetics. Fourteen of these patients (0.9 per 10,000) subsequently died. ⋯ Hemodynamic instability in very ill patients was an association in 22%. Specific errors in anesthetic management could be identified in 75%. Progressive bradycardia preceding the arrest was observed in all but one case.
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Case Reports
Splenic syndrome at mountain altitudes in sickle cell trait. Its occurrence in nonblack persons.
Six consecutive cases of splenic syndrome at mountain altitudes in persons with sickle cell trait are reported and the literature is reviewed. All six cases occurred in men who experienced the acute onset of severe left-upper-quadrant abdominal pain within 48 hours of arrival in Colorado from lower altitudes. ⋯ All recovered with medical management and none required splenectomy, although functional hyposplenia was a sequela in at least one patient. The possibility that nonblack persons with sickle cell trait may be at greater risk than black persons with sickle cell trait for the development of splenic syndrome at moderate altitude is discussed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Thermodilution cardiac output measurement. Effects of the respiratory cycle on its reproducibility.
Thermodilution cardiac output measurements are commonly employed in the management of critically ill patients. Serial measurements often show significant variation, and poor reproducibility limits their clinical utility. ⋯ Saline injections initiated at peak-inspiration or end-exhalation resulted in cardiac output measurements with much smaller standard deviations than those seen with random injections. Thermodilution cardiac output measurements performed at random times in the respiratory cycle should be avoided, and we recommend initiating these measurements at end-exhalation.