Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Comparative Study Observational Study
Comparison of train-of-four count by anesthesia providers versus TOF-Watch(®) SX: a prospective cohort study.
Qualitative monitoring of neuromuscular blockade using the train-of-four (TOF) count is widely used to determine the timing and dose of reversal agents for neuromuscular blockade. We compared TOF count measured manually by anesthesia providers with that determined by TOF-Watch® SX. ⋯ Anesthesia providers report higher values of TOF count compared with the TOF-Watch SX, especially at intermediate levels of neuromuscular blockade. Since the dosing guidelines for the timing and dose of reversal agents are based on the TOF count derived from the TOF-Watch SX, a manually assessed TOF count may lead to inadequate dosing and/or premature administration of reversal agents.
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Randomized Controlled Trial
Effect of prophylactic benzydamine hydrochloride on postoperative sore throat and hoarseness after tracheal intubation using a double-lumen endobronchial tube: a randomized controlled trial.
We evaluated the prophylactic effect of benzydamine hydrochloride (BH) spray on postoperative sore throat and hoarseness secondary to intubation with a double-lumen endobronchial tube (DLT). ⋯ Prophylactic application of BH to the DLT cuff and oropharyngeal cavity reduces the incidence and severity of postoperative sore throat and the incidence of hoarseness associated with DLT intubation. The trial was registered at the Clinical Research Information Service (KCT0001068).
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Cost effectiveness is becoming increasingly important in today's healthcare environment. Remifentanil, dexmedetomidine, and desflurane are costly agents that often have suitable alternatives to their use. We sought to identify changes in cost and outcomes following interventions that limited the availability of these drugs. ⋯ Reducing the accessibility of these cost-prohibitive agents resulted in significant anesthetic drug cost savings and decreased utilization of remifentanil and desflurane. The interventions had no significant effect on patient recovery time, incidence of unplanned intubations, or incidence of reintubation, but they were associated with a decrease in PONV and an increase in naloxone use.
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Case Reports
Inferior vena cava filter migration during the prone position for spinal surgery: a case report.
Inferior vena cava (IVC) filters have been used as an alternative therapy for patients with a contraindication to anticoagulation. We present a case of an IVC filter migration to the right ventricle occurring while a trauma patient was undergoing spinal surgery in the prone position. The patient provided written consent to describe this case. ⋯ The prone position during surgery can induce anatomic and hemodynamic changes in the IVC. This may contribute to the migration of IVC filters--especially flexible retrievable filters. Careful handling and positioning of patients with IVC filters is recommended to avoid a sudden increase in IVC pressure that may predispose to IVC filter migration.