Journal of clinical anesthesia
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Review Case Reports
Anesthetic management of obstructive sleep apnea patients.
Presented in an illustrative case report and a review of the anesthetic management of obstructive sleep apnea patients. Preoperative evaluation should include a thorough airway evaluation and a comprehensive cardiovascular and pulmonary evaluation. With polysomnography, identification of the severity of sleep apnea can be idenified. ⋯ Opioids and sedatives should be avoided, as should other drugs that have central and sedating effects. Postoperative pain is effectively controlled with acetaminophen and topical anesthetic sprays. Postoperative monitoring for apnea, desaturation, and dysrhythmias is a necessity in sleep apnea patients.
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Comparative Study
Frequency of anesthetic cardiac arrests in infants: effect of pediatric anesthesiologists.
To determine whether the presence of pediatric anesthesiologists decreases the frequency of anesthetic-related cardiac arrests in infants (children who are 1 year of age or younger). ⋯ The results suggest that the use of pediatric anesthesiologists for all infants 1 year of age or younger might decrease anesthetic morbidity in this age-group.
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Comparative Study
Comparison of train-of-four and posttetanic response as guides for endotracheal intubation in children.
To evaluate and compare the predictive values of the absence of train-of-four (TOF) or posttetanic response as guides for endotracheal intubation in children. ⋯ Good intubating conditions can generally be counted on when the TOF has disappeared; additional waiting for the disappearance of posttetanic response is unnecessary. The observation that the disappearance of the tetanus-twitch sequence is a good indicator of deep neuromuscular blockade during recovery from atracurium in children cannot be extrapolated to the induction period.
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To examine the efficacy of a nasal continuous positive airway pressure (CPAP) system for respiratory support in patients who have respiratory insufficiency but are able to maintain spontaneous breathing without hypercapnia, respiratory acidosis, or deteriorated mental status. ⋯ Nasal CPAP (10 cmH2O) is a reliable alternative to support arterial oxygenation in patients with respiratory failure who are alert and vigorous enough to avoid hypercapnia and respiratory acidosis while breathing spontaneously. In addition, since the patients are able to speak and thus are capable of expressing their feelings, the anxiety observed during respiratory support can be reduced.
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To evaluate the accuracy of the nasal septum site for pulse oximetry measurement of arterial oxyhemoglobin saturation (SpO2) in hypothermic patients. ⋯ Monitoring SpO2 at the nasal septum site is more reliable than monitoring it at the finger site in hypothermic patients.