Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Poor outcome in patients with cerebral vasospasm following subarachnoid hemorrhage remains a serious clinical problem. The current management with focus on the cerebrovascular constriction accounts for the use of "triple-H" therapy (hypertension, hypervolemia, and hemodilution) to enhance cerebral blood flow through constricted vessels. Recent work suggests that spreading depression (a stereotypical response of cerebral cortical tissue to noxious stimuli with subsequent oligemic blood flow) occurs in patients with cerebral vasospasm. A narrative review was conducted to examine the relationship between spreading depression and subarachnoid hemorrhage and to identify the anesthetic effects on the propagation of spreading depression. ⋯ The implication for clinical management is discussed supposing glial cell dysfunction is an underlying mechanism responsible for the vascular spasm.
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The objective of this continuing professional development module is to describe the role of ultrasound for central venous catheterization and to specify its benefits and limitations. Although ultrasound techniques are useful for all central venous access sites, the focus of this module is on the internal jugular vein approach. ⋯ To improve patient safety, we recommend the use of ultrasound for central venous catheterization using the internal jugular approach.
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Letter Clinical Trial
Cuff inflation as an aid to nasotracheal intubation using the Airtraq laryngoscope.