Journal of clinical anesthesia
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Randomized Controlled Trial
Similar recovery from bispectral index-titrated isoflurane and sevoflurane anesthesia after outpatient gynecological surgery.
To test the hypothesis that the recovery of gynecological day-case patients is equally fast after isoflurane and sevoflurane anesthesia, when administration of the inhaled agent is adjusted by monitoring the bispectral index (BIS). ⋯ Isoflurane and sevoflurane are equally acceptable maintenance anesthetics in terms of the speed and quality of recovery in gynecological ambulatory surgery patients when the dose of the inhaled agent is adjusted to achieve a BIS between 50 and 60.
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Clinical Trial
Peripheral venous pressure as a predictor of central venous pressure during orthotopic liver transplantation.
To assess the reliability of peripheral venous pressure (PVP) as a predictor of central venous pressure (CVP) in the setting of rapidly fluctuating hemodynamics during orthotopic liver transplant surgery. ⋯ Our study confirms that PVP correlates with CVP even under adverse hemodynamic conditions in patients undergoing liver transplantation.
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We report the case of a 19-year-old man with a drug abuse history, admitted to the intensive care unit for head and chest trauma, who experienced an acute tolerance to sedative and respiratory depression effects of remifentanil, which was given as the sole agent for sedation. He did not exhibit any signs of drug tolerance or intraoperative awareness during prolonged remifentanil-based anesthesia using propofol or sevoflurane as adjuvants. ⋯ The clinical relevance of this report is that if a patient with a previously acute tolerance to remifentanil during sedation undergoes long-term surgery, and propofol or sevoflurane is coadministered in a remifentanil-based anesthesia, the patient will not necessarily develop opioid tolerance. It is of interest for anesthesiologists, given the high frequency of patients with drug abuse history who are admitted to intensive care units, often sedated with remifentanil, who undergo anesthesia for emergency surgery.
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To review anesthesia and pain management in pediatric patients with recessive dystrophic epidermolysis bullosa (RDEB). ⋯ Patients with RDEB can present considerable management issues for the anesthesiologists. Anesthesia and pain management can be carefully delivered with proper preoperative evaluation and preparation for pediatric patients with RDEB.