Journal of clinical anesthesia
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Randomized Controlled Trial Comparative Study
Influence of aging on lidocaine requirements for pain on injection of propofol.
To evaluate the influence of aging on lidocaine requirements for propofol-induced pain on injection. ⋯ A lidocaine dose of 40 mg for young patients and 20 mg for old patients, with venous occlusion for two minutes, is sufficient to reduce pain on injection of propofol.
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Randomized Controlled Trial
Concurrent expansion of plasma volume and left ventricular end-diastolic volume in patients after rapid infusion of 5% albumin and lactated Ringer's solution.
To examine the effects of plasma volume expansion on plasma volume, left ventricular end-diastolic volume (LVEDV), and cardiac index (CI) after rapid fluid infusion, as knowledge of the degree of concordance between plasma and cardiac preload expansion could optimize LVEDV expansion without administering excessive fluid. ⋯ Intravenous fluids increased LVEDV to a lesser extent and duration than did plasma volume expansion. Monitoring of LVEDV was a poor guide for fluid administration to maximize CI.
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Randomized Controlled Trial
Effect of postoperative epidural analgesia on morbidity and mortality after lung resection in Medicare patients.
To perform an analysis of the Medicare claims database in patients undergoing lung resection to determine whether there is an association between postoperative epidural analgesia and mortality. ⋯ Postoperative epidural analgesia may contribute to lower odds of death after segmental excision of the lung, although the mechanism of such a benefit is not clear from our analysis.
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Case Reports
Bedside ultrasonography in the differential diagnosis of pulmonary pathologies in the intensive care unit.
Among critically ill patients, opacification of a part or whole lung field on chest radiography may pose a challenge in the differential diagnosis of acute pulmonary pathologies (eg, pneumothorax, hemothorax, pleural effusion, atelectasis, and solid organ in thoracic cavity) and selection of treatment modalities. In cases in which clinical findings, history, and imaging studies are not conclusive, bedside ultrasonography may be invaluable in achieving a diagnosis. We present two cases in which portable ultrasonography at the bedside was critical to the diagnosis and subsequent management of the patient.
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We present the case of a 56-year-old man who underwent axillary nerve block for a wrist arthroscopy procedure, with real-time ultrasound and peripheral nerve stimulator guidance. The ulnar nerve and radial nerve were located medial and posterior to the brachial artery, respectively. A large complex structure was noted in the position typically occupied by the median nerve. ⋯ We believe that these components represented the median and musculocutaneous nerves lying together, lateral to the artery. Radial, median, ulnar, and musculocutaneous nerve block ensued, and wrist arthroscopy was carried out uneventfully. Knowledge of this anatomical variation may improve anesthesiologists' ability to provide effective axillary block.