Journal of clinical anesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Nicardipine versus nitroprusside for breakthrough hypertension following carotid endarterectomy.
To evaluate the effectiveness of nicardipine and nitroprusside for breakthrough hypertension following carotid endarterectomy. ⋯ Nicardipine administration produced more rapid BP control, most likely related to the administration of a loading dose. In addition to more rapid control, nicardipine-treated patients had less variability in BP and required significantly fewer additional interventions. Although no patient suffered a major event during this study, this study was not powered sufficiently to assess safety.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of wire reinforced tubes with warmed standard tubes to facilitate fiberoptic intubation.
To compare the ease of insertion of a warmed standard tracheal tube to that of a wire reinforced tracheal tube when placed over a flexible fiberoptic bronchoscope. ⋯ When performing elective flexible fiberoptic bronchoscopy for intubation, we recommend using the less expensive warmed standard tracheal tube.
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The perioperative use of neuraxial techniques in the presence of anticoagulation is a controversial issue. There are significant pharmacokinetic differences between anticoagulants that will affect the timing of neuraxial needle insertion or catheter removal. The pharmacologic profiles of commonly used anticoagulants in the perioperative period are reviewed. Studies examining the use of neuraxial techniques in the presence of various anticoagulants are reviewed and evaluated in the context of the American Society of Regional Anesthesia consensus statements.
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To quantify global coagulation and establish normal ranges for the celite-activated thrombelastograph (TEG) in healthy pediatric patients. ⋯ These data identify changes of small magnitude in three celite-TEG parameters in healthy children compared to adults, without implication of abnormal coagulation between groups. Changes do not seem to be consistently related to age and will be useful for clinicians using the TEG to monitor (ab) normal coagulation in pediatric patients.
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One-lung ventilation is a commonly used technique to facilitate surgical visualization during thoracic surgical procedures. New devices for one-lung ventilation have been introduced into clinical practice over the recent years. One such device is the Arndt Endobronchial Blocker which is a bronchial blocker with a central lumen through which a wire with a looped end has been passed. ⋯ The port for the bronchial blocker can be tightened down so as to hold the blocker in place during the procedure. However, patient issues such as size or airway alterations such as the presence of a tracheostomy may make necessary certain alterations in airway management. I describe four cases and provide suggestions for minor alterations in airway management that may be used to provide successful options for one-lung anesthesia.