Journal of clinical anesthesia
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To evaluate a new 20-gauge (G) fenestrated needle designed to be used with ultrasound guidance to deliver local anesthetic into the tissue plane of the fascia iliaca without immediate proximity to the femoral nerve. ⋯ The needle is novel in that it does not require immediate proximity to the femoral nerve or precise placement of the needle tip in the plane of the fascia iliaca. The 20-G fenestrated needle is stronger under compressive force than existing 22-G needles.
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We report the efficacy of perioperative infusion of clonidine and bupivacaine for above-knee amputation in a patient with a history of phantom limb pain in the same extremity after a previous below-knee amputation. The patient underwent general anesthesia. Before transection, the sciatic nerve was infiltrated with 0.25% bupivacaine 5 mL and clonidine 50 microg. ⋯ The mean postoperative pain score (from 0 to 10) for 96 hours was 1.2 +/- 0.7. The patient required a total of 10 mg of oxycodone postoperatively. The patient did not report either stump or phantom pain for 12 months after surgery.
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Case Reports
Difficult airway management after carotid endarterectomy: utility and limitations of the Laryngeal Mask Airway.
This case series details successful management of life-threatening airway obstruction after carotid endarterectomy. In the first case, ventilation was restored with a Laryngeal Mask Airway. In the second case, laryngeal mask airway rescue was unsuccessful, necessitating percutaneous transtracheal jet ventilation and subsequent endotracheal intubation with direct laryngoscopy.
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To evaluate serum C-reactive protein and cholesterol as a prognostic factor for survival in patients with severe sepsis. ⋯ Serum C-reactive protein and cholesterol are a predictor of survival in patients with severe sepsis. Low cholesterol and high C-reactive protein levels appear as a valuable tool for individual risk assessment in severe sepsis patients and for stratification of high-risk patients in future intervention trials.