Journal of clinical anesthesia
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A 77-year-old man was scheduled to undergo a cervical lymph node biopsy under general anesthesia. Although awake, nasotracheal fiberoptic intubation was initially planned because of an anticipated difficult airway, the attempt was unsuccessful. ⋯ After initiating positive pressure mechanical ventilation, subcutaneous and mediastinal emphysema developed. The cause of this emphysema was considered to be tracheal perforation after an unsuccessful attempt at fiberoptic tracheal intubation.
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Randomized Controlled Trial Comparative Study
Remifentanil pretreatment reduces myoclonus after etomidate.
The aim of the study was to compare the effect of pretreatment with remifentanil 1 microg/kg and the effect of gender on the incidence of myoclonus after anesthesia induction with etomidate. ⋯ Pretreatment with remifentanil 1 microg/kg reduced myoclonus after etomidate induction without side effects such as sedation, apnea, nausea, or pruritus. Men experience increased incidence of myoclonus than women after etomidate administration.
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Meta Analysis
The effect of neuraxial blocks on surgical blood loss and blood transfusion requirements: a meta-analysis.
The aim of this study was to evaluate the effect of neuraxial blocks on surgical blood losses and on the number of patients requiring blood transfusion. ⋯ Regional anesthesia reduced the number of transfused patients for total hip replacement (P = 0.0009) and spinal fusion (P = 0.04). A reduction of measured blood loss that did not lead to a reduction in the number of transfused patients was also found for fractured hip surgery (P < 0.0001), lumbar disk surgery (P = 0.01), peripheral vascular surgery (P = 0.03), retropubic prostatectomy (P = 0.02), cesarean section (P < 0.0001), and bowel surgery (P = 0.0008). In summary neuraxial blocks have a clear and definite effect on surgical blood loss, but this effect do not usually lead to a reduction in the number of transfused patients except for patients undergoing total hip replacement and spinal fusion.
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To evaluate the different effects on autonomic circulatory control during volatile induction/maintenance of anesthesia (VIMA) vs total intravenous anesthesia (TIVA). ⋯ Our results demonstrated that although reductions in autonomic nervous modulation to the heart might not be so different between the 2 groups, reduction in sympathetic nervous modulation to peripheral vasculature is greater in the VIMA group than in the TIVA group.