Journal of clinical anesthesia
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Randomized Controlled Trial Clinical Trial
Effects of alkalinization of lidocaine on the pain of skin infiltration and intravenous catheterization.
To test the hypothesis that alkalinization of lidocaine decreases the pain of skin infiltration in surgical patients. ⋯ Pain resulting from skin infiltration of lidocaine solutions can be diminished by adding NaHCO3. However, catheter size is more important than the presence or absence of NaHCO3 in determining the pain of i.v. catheterization.
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Case Reports
Nasotracheal intubation in a child with Treacher Collins syndrome using the Bullard intubating laryngoscope.
Tracheal intubation may be difficult or impossible in children with Treacher Collins syndrome. Nasotracheal intubation may be required for appropriate repair of cleft palate in these patients. This report describes the use of the Bullard intubating laryngoscope to facilitate nasotracheal intubation in a child with severe mandibulofacial dysplasia.
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Recent pharmacologic and technologic advances in anesthesia and surgery allow outpatients with complex medical problems to undergo a wide variety of diagnostic and surgical procedures on an ambulatory basis. Increasingly, however, anesthesia practitioners, as well as pharmacy and therapeutic committees, are demanding proof that a new, more costly drug or medical device is superior to existing products in achieving its desired effect, is associated with fewer adverse effects, enhances efficiency, and reduces health care costs. The new field of pharmacoeconomics has emphasized the importance of cost-effectiveness analyses that consider both direct and indirect costs of newer drugs and therapeutic modalities. ⋯ Ambulatory anesthesia and surgery will continue to increase because of the potential cost savings for patients undergoing elective operations on an outpatient basis. However, the challenge we face will be to continue to provide high-quality anesthesia care at a reduced cost. A careful examination of commonly accepted (but unproven) clinical practice patterns will be necessary to meet this challenge.
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The LMA has been commercially available since 1988, and in the United States since 1992. The device combines several advantages of endotracheal tubes and face masks and may be used in many situations where either device was previously used routinely. ⋯ Although not suitable for all patients and procedures, the LMA has become widely used in all other countries where it is available. Many of the surgical procedures for which the LMA is most suited are performed in outpatients, and we expect this device will soon become popular in carefully selected cases in this country.
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Randomized Controlled Trial Clinical Trial
Heated breathing tubes affect humidity output of circle absorber systems.
To verify whether the airway climate in circle systems can be improved with heated breathing tubes. ⋯ Low-flow systems need at least 120 minutes to achieve a satisfactory airway climate. Heated breathing tubes effectively reduce this delay.