Journal of clinical anesthesia
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Randomized Controlled Trial
Prevention of withdrawal associated with the injection of rocuronium in adults and children.
To determine which technique prevents the withdrawal associated with rocuronium administration in adults and children. ⋯ Withdrawal after rocuronium can be eliminated by the pretreatment of lidocaine during the occlusion of the IV flow in adults and addition of sodium bicarbonate in children.
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To evaluate the incidence and impact on clinical outcome of complications observed during high-frequency jet ventilation (HFJV) at interventional bronchoscopy and to identify the perioperative factors that may be associated to an increased incidence of such complications. ⋯ Classification in ASA physical status IV group and a baseline oxygen saturation of 95% or less independently predicted the development of complications during interventional rigid bronchoscopy with HFJV.
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Case Reports
Cardiovascular collapse due to massive pulmonary thromboembolism during orthotopic liver transplantation.
Severe pulmonary thromboembolism has been occasionally reported during orthotopic liver transplantation, with fatal outcomes occurring in about 50% of cases because of low cardiac output and multiple organ failure. Perioperative alterations in coagulation, insertion of pulmonary artery and other invasive catheters, administration of antifibrinolytic agents, and repeated ischemic insults may all promote the formation of intravascular/cardiac blood clots. We present a case of intraoperative right ventricular failure associated with the presence of a large thrombus wrapped around the pulmonary artery catheter. Identification of risk factors for intraoperative pulmonary thromboembolism warrants a prophylactic medical approach including selective blood component therapy and administration of antifibrinolytics guided by bedside coagulation tests as well as noninvasive hemodynamic monitoring.
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To evaluate the drug constitution of dantrolene by comparing reconstitution with diluent at ambient and warmed temperatures, so as to determine whether differences in reconstitution time might provide clinical or therapeutic advantages. ⋯ The use of prewarmed diluent to 41 degrees C significantly reduces dantrolene reconstitution time. Further studies should evaluate the efficacy of dantrolene reconstituted with warmed diluent.