Journal of clinical anesthesia
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To determine the consequences of esophageal intubation (EI) when using standard indirect clinical tests to detect endotracheal tube (ETT) placement in the emergency setting outside the operating room (OR). ⋯ These data suggest that EI during emergency intubation, when detected by standard indirect clinical tests based on physical examination, contributes significantly to mild and severe hypoxemia, regurgitation, aspiration, bradycardia, cardiac dysrhythmias, and cardiac arrest. Pursuing methods to hasten the detection of EI in the emergency setting appear warranted.
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Randomized Controlled Trial Clinical Trial
The number of injections does not influence absorption of bupivacaine after cervical plexus block for carotid endarterectomy.
To investigate the efficacy and kinetics of bupivacaine when used for deep cervical plexus block (CPB), using either a single-injection or multiple-injections technique. ⋯ The results of this study showed that the absorption of bupivacaine is independent of the number of injections after CPB, and that anesthesia for carotid endarterectomy may be accomplished successfully using either technique.
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Randomized Controlled Trial Clinical Trial
Visual evaluation of fade in response to facial nerve stimulation at the eyelid.
The aim of this study is to investigate the probability of visual detection of fade in response to train-of-four (TOF) stimulation, double-burst stimulation3,3 (DBS(3,3)), or DBS(3,2) at the eyelid in comparison to that at the thumb. ⋯ The probability of visual detection of fade in response to TOF or DBS(3,3) is lower at the eyelid than the thumb. In contrast, DBS(3,2) fade tends to be seen more frequently at the eyelid than at the thumb.
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Comparative Study
Cardiac index measurements during rapid preload changes: a comparison of pulmonary artery thermodilution with arterial pulse contour analysis.
To compare cardiac index (CI) values obtained by pulmonary artery thermodilution (CIPA), arterial thermodilution (CITD), and arterial pulse contour analysis (CIPC) during rapid fluid administration, as accurate and rapid detection of CI changes is critical during acute preload changes for guiding volume and vasopressor therapy in critically ill patients, and the accuracy of CIPC during acute changes in loading condition is currently unknown. ⋯ Compared with pulmonary artery thermodilution, arterial pulse contour analysis reflects relative changes in CI during rapid changes of preload with clinically acceptable accuracy.
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Central venous cannulation, with or without a flow-directed pulmonary artery catheter, is commonly performed in patients undergoing cardiac surgery to measure central filling pressure and cardiac output, and to administer medications and fluids. The complications of central venous cannulation are numerous and include malposition, arterial puncture, pneumothorax, hemothorax, chylothorax, extravasation of infusate, thrombophlebitis, and infection. We describe a single-lumen catheter that was placed through the hemostatic valve of a 9F percutaneous introducer, which inadvertently entered the left internal mammary (internal thoracic) vein. The current case is unique in that it was diagnosed by visualization of the catheter during surgical dissection.