Journal of clinical anesthesia
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Clinical Trial
Total intravenous anesthesia for children undergoing brief diagnostic or therapeutic procedures.
To compare the quality of anesthesia with propofol, ketamine, or etomidate in children undergoing brief diagnostic or therapeutic procedures. ⋯ Anesthesia with propofol, ketamine, or etomidate is safe and efficacious for children undergoing brief procedures. Propofol is associated with a decreased incidence of postanesthetic agitation and vomiting. Its association with respiratory depression is confirmed.
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Due to the risks of transfusion reactions and the transmission of infectious diseases, there has been increased interest in measures to limit intraoperative blood loss and avoid the need for homologous transfusion. Controlled hypotension is one technique that has been used to limit intraoperative blood loss. Several drugs have been used alone or in combination for controlled hypotension, including the inhalational anesthetics, direct acting vasodilators such as nitroglycerin and nitroprusside, beta adrenergic antagonists, and calcium channel blockers. Various drugs available to the clinician for controlled hypotension are reviewed.
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Cardiopulmonary bypass (CPB) does not appear to cause excessive maternal risk, but the potential for fetal complications is of great concern. In general, operative intervention should be delayed until at least the second trimester. ⋯ This conflict is further complicated by maternal status changes that may accompany valvular disease or develop after CPB. The case described herein summarizes and discusses these conflicts.
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The successful management of major conduction anesthesia in a patient with Klippel-Trenaunay syndrome is discussed. This case illustrates that major conduction anesthesia can be safely used if proper imaging studies are obtained, if one is aware of the underlying disease process, and if there is no port wine lesion in the dermatomal area corresponding to the spinal segment where the needle is to be inserted.
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Arterial misplacement of the Swan-Ganz catheter occurs occasionally and usually can be easily detected. However, in some special clinical settings, the problem may become more complicated. We report a case of chronic obstructive pulmonary disease in which, because of severe hypoxemia, systemic hypotension, and pulmonary hypertension, conventional methods failed to recognize the misplacement, until confirmed with blood gas analysis.