Journal of clinical anesthesia
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To determine the influence of profiling and incentives on anesthesiologist behavior in relation to several key indicators of performance. ⋯ Tracking and rewarding physician performance with monthly profiling and a financial incentive given to the best in a peer group improves anesthesiologist performance in several key areas.
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Case Reports
Emergency airway management with a laryngeal mask airway in a patient placed in the prone position.
Accidental extubation of a patient while placed in the prone position is a life-threatening, anesthesia-related complication. We describe a case of accidental extubation of the trachea during spine surgery in a patient placed in the prone position. We successfully managed this emergent problem by inserting a Laryngeal Mask Airway while maintaining the patient in the same position.
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative analgesic effect of epidural neostigmine and plasma cortisol and IL-6 responses.
To examine whether epidural administration of neostigmine reduces the stress and inflammatory responses thereby improving postoperative pain status. ⋯ The preincisional epidural neostigmine transiently suppresses the stress responses during surgery and improves postoperative analgesia in patients undergoing lower open abdominal surgery.
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Randomized Controlled Trial Clinical Trial
Prophylactic nebulized lidocaine attenuates hyperdynamic response to abrupt mask inhalation of isoflurane in adults.
To examine whether prophylactic, atomized lidocaine blunts hyperdynamic responses and catecholamine release after an abrupt increase in volatile anesthetic administration. ⋯ Prophylactic ultrasonically nebulized lidocaine (2 mg/kg) obtunds the hyperdynamic responses to abrupt inhalation of 5% isoflurane but does not completely block catecholamine release.
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Case Reports
Variable systolic pressure variation and dynamic hyperinflation due to an intrabronchial tumor.
Systolic pressure variation (SPV) is the cyclic change in systolic blood pressure secondary to positive-pressure ventilation. It is normally a good indicator of intravascular volume and often can be substituted for central venous pressure monitoring, but the reliability of SPV for this use depends on the multiple determinants of intrathoracic pressure remaining constant. ⋯ This situation, in turn, caused a marked increase in SPV but, more importantly, it increased variability of the SPV despite normal intravascular volume. We discuss the physiology of SPV and the implications of this case for the use of SPV as a monitor of intravascular volume.