Journal of clinical anesthesia
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The justification, implementation, and services of a comprehensive on-site operating room (OR) pharmacy are reviewed. Justification was accomplished through audits of controlled substance accountability, drug preparation, labeling and storage, and cost analyses of drug waste and potential savings. ⋯ Services of the OR pharmacy are dynamic and include standardized drug preparation, case-by-case drug distribution and patient billing, controlled substance accountability, provision of drug information, and clinical research support. This pharmacy has proven cost effective and has become integral to the daily function of the OR.
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A case is presented of a 34-month-old child who developed hyperthermia with a temperature of 40 degrees C while undergoing a suboccipital craniotomy for resection of a medulloblastoma. The presentation is followed by a discussion of the differential diagnosis of hyperthermia during anesthesia. Malignant hyperthermia, septicemia, thyroid storm, neuroleptic malignant syndrome, transfusion reaction, and exogenous causes of fever are discussed. The case serves as an illustration of the association between neurosurgical manipulation, intraventricular hemorrhage, and fever that may result from hypothalamic irritation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Anesthesia for craniotomy: total intravenous anesthesia with propofol and alfentanil compared to anesthesia with thiopental sodium, isoflurane, fentanyl, and nitrous oxide.
To compare a total intravenous (IV) anesthetic technique based on propofol and alfentanil with a commonly used anesthetic technique for craniotomy. ⋯ A total IV anesthetic technique with propofol and alfentanil is a valuable alternative to a more commonly used technique based on thiopental sodium, N2O, fentanyl, and isoflurane.
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Randomized Controlled Trial Clinical Trial
Continuous alfentanil infusion in pediatric patients undergoing general anesthesia for complete oral restoration.
To study the safety and efficacy of continuous alfentanil infusions in children. ⋯ Alfentanil appears to be a safe anesthetic. The reason for prolonged discharge time in the alfentanil-anesthetized patient is unclear, but it may be related to postoperative vomiting.
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To determine the level of care available to obstetric patients during the immediate postanesthesia period. ⋯ In many obstetric PACUs, the level of expertise of personnel needs to be upgraded to ensure the safety of patients recovering from general or major regional anesthesia and to comply with existing care standards.