Journal of clinical anesthesia
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Randomized Controlled Trial Clinical Trial
Unilateral spinal block for outpatient knee arthroscopy: a dose-finding study.
To evaluate the onset time, success rate, and recovery profile of unilateral spinal anesthesia produced with 4 mg, 6 mg, and 8 mg of 0.5% hyperbaric bupivacaine. ⋯ Hyperbaric bupivacaine 4 mg injected slowly through pencil-point directional needles in patients who are maintained in the lateral decubitus position for 15 minutes provided a surgical block that was mostly restricted to the operative side and adequate to perform knee arthroscopy, with a faster recovery profile than when a 6 mg or 8 mg dose was used.
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Substance abuse has crossed social, economic, and geographic borders and--throughout the world--remains one of the major problems facing society today. The prevalence of substance abuse in young adults (including women) has increased markedly over the past 20 years. ⋯ The diverse clinical manifestations of drug abuse combined with physiologic changes of pregnancy, and pathophysiology of coexisting pregnancy-related disease may lead to life-threatening complications and significantly impact the practice of obstetrical anesthesia. Regardless of the drug(s) ingested and clinical manifestations, it is always difficult to predict the exact anesthetic implications in chemically dependent patients.
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Comparative Study Clinical Trial
Predicting recovery from deep neuromuscular block by rocuronium in the elderly.
To determine the influence of aging on the relationship between posttetanic count (PTC) and train-of-four (TOF) response during intense neuromuscular blockade caused by rocuronium. ⋯ Posttetanic twitch stimulation is a useful method of monitoring intense neuromuscular blockade caused by rocuronium in both age groups. The interval between the earliest appearance of a posttetanic response and the first response to TOF stimulation (T1) is greater in the elderly than in the young.
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Case Reports
An initially unnoticed piece of nasal jewelry in a parturient: implications for intraoperative airway management.
The literature documenting the anesthetic implications of body piercing consists only of a few case reports that focus exclusively on interference with airway management by oral jewelry. To date, no case reports documenting anesthetic problems resulting from the presence of nasal jewelry have been reported. ⋯ This situation necessitated fiberoptic examination of the nasopharyngeal and oropharyngeal cavities and radiologic imaging studies to rule out aerodigestive tract aspiration of retained and missing piece(s) of the jewelry. Based on this experience, we now advise all laboring parturients with nasal or oral jewelry in situ to remove the hardware on admission to Labor and Delivery for safety precautions.
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Beta-adrenergic agents have been widely used in obstetrics to attenuate premature labor (termed tocolytic therapy), delay delivery, allow fetal maturation, and thereby reduce neonatal morbidity and mortality. Hypokalemia is a common side effect during beta-adrenergic tocolytic therapy for the treatment of preterm labor. Although rebound hyperkalemia after cessation of tocolytic therapy with ritodrine has been reported, there have been no reports of hyperkalemia occurring after the cessation of beta-adrenergic tocolytic therapy with terbutaline for preterm labor; we report such a case.