Journal of clinical anesthesia
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Trauma to epidural catheters on insertion or removal may result in shearing or breakage. Although there is no evidence of neurologic sequelae from a sheared catheter, many reports still advocate eventual surgical removal. The literature suggests the following options: (1) using slow continuous force at all times; (2) discontinuing application of force if the catheter begins to stretch and reapplying traction several hours later; (3) placing of the patient in the same position as insertion; (4) placing the patient in the lateral decubitus position if possible; (5) attempting to remove in extreme flexion if the previous interventions are not efficacious; (6) attempting extension if flexion fails; (7) attempting removal after injection of preservative-free normal saline through the catheter; (8) considering use of a convex surgical frame; (9) considering computed tomographic scan to identify the etiology of entrapment; (10) considering leaving a retained epidural catheter in place in adult patients; (11) providing patient education regarding "red flags" to watch out for; and (12) neurosurgical consultation for all cases in which the catheter fragment is in the spinal canal.
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Randomized Controlled Trial
The analgesic efficacy of continuous elastomeric pump ropivacaine wound instillation after appendectomy.
To evaluate the analgesic efficacy and safety of ropivacaine 0.2% when administered continuously via elastomeric pump after appendectomy. ⋯ Wound instillation with ropivacaine 0.2% is a useful, practical, and safe method for management of postoperative pain after appendectomy.
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Randomized Controlled Trial
The ideal oxygen/nitrous oxide fresh gas flow sequence with the Anesthesia Delivery Unit machine.
To determine whether early reduction of oxygen and nitrous oxide fresh gas flow from 6 L/min to 0.7 L/min could be accomplished while maintaining end-expired nitrous oxide concentration > or =50% with an Anesthesia Delivery Unit anesthesia machine. ⋯ A 3-minute high-flow period (oxygen and nitrous oxide fresh gas flow of 2 and 4 L/min, respectively) suffices to attain and maintain end-expired nitrous oxide concentration > or =50% and ensures an adequate bellows volume during the ensuing low-flow period.
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Randomized Controlled Trial Comparative Study
Opioid consumption in total intravenous anesthesia is reduced with dexmedetomidine: a comparative study with remifentanil in gynecologic videolaparoscopic surgery.
To evaluate the capacity of dexmedetomidine (DEX), an alpha(2) adrenergic agonist drug, as a substitute for remifentanil (REM), a potent opioid, in total intravenous anesthesia (TIVA), in patient undergoing gynecologic videolaparoscopy. ⋯ Dexmedetomidine was a clinically effective drug as a REM substitute in TIVA, during minimally invasive video gynecologic surgical procedures; however, patients anesthetized with DEX showed a more prolonged recovery time for some parameters such as orientation and extubation times.
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We report the case of a 23-year-old woman who was diagnosed with an axonal type of Guillain-Barré syndrome at 16 weeks' gestation. The patient had severe motor loss but she was treated effectively with intravenous immunoglobulin, and she underwent cesarean delivery with epidural anesthesia at full term.