Journal of clinical anesthesia
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To define the depth of the thoracic epidural space in the paramedian axis. ⋯ Body weight, body mass index, and anatomical levels determine the paramedian thoracic epidural depth. The greater the patient's weight and the higher the puncture level, the deeper the thoracic epidural space from the body surface.
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Recently, there has been a focus on the teaching of professionalism in postgraduate medical education. Many discussions and studies have been performed to help in teaching professionalism and in the evaluation of the effectiveness of this teaching process. Unfortunately, many anesthesiologists are unaware of the literature and the discussions that have taken place. This review article serves as a primer for those individuals faced with the task of instilling the concepts of professionalism, not only in trainees but also in anesthesiologists practicing today.
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Randomized Controlled Trial
Effect of catheter site on the agreement of peripheral and central venous pressure measurements in neurosurgical patients.
Previous studies suggest a correlation of central venous pressure (CVP) with peripheral venous pressure (PVP) in different clinical setups. The aim of this study was to investigate the effect of measurement site on PVP and its agreement with CVP in patients undergoing general anesthesia. ⋯ Peripheral venous pressure measurement may be a noninvasive alternative for estimating CVP in patients undergoing elective neurosurgical operations. Measuring PVP from hand dorsum does not interfere with the agreement of CVP and PVP.
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To investigate the difference of regional cerebral oxygen saturation (rSo2) decrease in response to the decrease in mean arterial blood pressure (MAP) in young and elderly patients. ⋯ After propofol induction, there was no difference between young and elderly patients in rSo2 decrease in response to the decrease in MAP.
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We report a case of subdural hematoma in a 68-year-old white man who underwent left inguinal hernia repair with spinal anesthesia. The patient had a postdural puncture headache (PDPH) on postoperative day 4, but he refused invasive treatment. Instead, he self-administered acetaminophen, aspirin, and caffeine. ⋯ Immediate treatment of the PDPH with an epidural blood patch should be considered. If a patient refuses invasive treatment, he should be counseled for the possibility of subdural hematoma. The patient also should be advised to avoid medications with anticoagulant properties.