Journal of clinical anesthesia
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Randomized Controlled Trial Clinical Trial
Active warming, not passive heat retention, maintains normothermia during combined epidural-general anesthesia for hip and knee arthroplasty.
to compare passive heat retention by low-flow anesthesia, alone and with additional thermal insulation by reflective blankets, with forced-air warming preventing intraoperative hypothermia during combined epidural-general anesthesia. ⋯ During combined epidural-general anesthesia for elective hip and knee arthroplasty, passive heat retention by means of low-flow anesthesia alone and in combination with reflective blankets is ineffective in maintaining intraoperative normothermia and definitely inferior to active forced-air warning.
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To determine if the ordering of unindicated preoperative laboratory tests is different for healthy (ASA physical status I and II) versus sicker (ASA physical status III) patients, and to examine the financial implications at our institution of unindicated preoperative testing. ⋯ A large percentage of preoperative tests ordered by surgeons at our institution are not indicated. Eliminating unindicated tests would cut hospital revenues in a climate where testing is fee-for-service and would save the hospital money in a managed-care or capitated system.
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To identify variables influencing the likelihood of unanticipated admission following scheduled ambulatory surgery. ⋯ Surgery duration of 60 minutes or longer was the most important predictor of unanticipated admission following scheduled ambulatory surgery.
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Case Reports
Management of Jehovah's Witness patients for scoliosis surgery: the use of platelet and plasmapheresis.
Four patients whose religious beliefs prohibited accepting blood during surgery for scoliosis were anesthetized and managed successfully using plateletpheresis and plasmapheresis. Blood losses were replaced with crystalloid and hetastarch solutions. In addition, a moderate hypotensive technique was used to minimize surgical blood loss. ⋯ Three of these patients had an uncomplicated postoperative course, however, the fourth patient had some postoperative bleeding with initial hemodynamic instability. We believe that patients who refuse to receive blood transfusion during surgery because of religious beliefs or health issues can be managed safely using other alternatives and techniques such as plateletpheresis and plasmapheresis, which conserve and minimize blood loss. Each case should be assessed on an individual basis.
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The intraoperative monitoring of neuromuscular blockade usually involves measurement of the muscular responses to motor nerve stimulation. Although researchers have the time and technology to obtain predrug control measurements of the twitch responses, these are seldom available to the clinician. ⋯ Concentrations in the effect compartment associated with these two extremes of the TOF count are combined with concentration-time profiles of vecuronium with various dose regimens. This study models the effect compartment concentrations associated with vecuronium-induced paralysis, combining them explicitly with the range of concentrations associated with the TOF count to demonstrate the kinetic mechanisms underlying the time-course of paralysis.