Journal of clinical anesthesia
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Case Reports
Dexmedetomidine as sole sedative for awake intubation in management of the critical airway.
We report a series of successful awake fiberoptic intubations in patients with critical (unstable, difficult) airways using the alpha(2)-agonist, dexmedetomidine. Dexmedetomidine has several desirable pharmacologic properties, including sedation, anxiolysis, hypnosis, analgesia, amnesia, antisialagogue effects, and a unique respiratory-sparing effect. Dexmedetomidine appears to be a useful agent for sedation during awake fiberoptic intubation in difficult airway patients.
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Review Case Reports
A tale of two stents: perioperative management of patients with drug-eluting coronary stents.
Drug-eluting stents were introduced into clinical practice to decrease coronary stent restenosis rates. Though remarkably effective in reducing this complication, recent data reveal that drug-eluting stents pose a significant risk for late stent thrombosis, an event strongly correlated with discontinuation of anti-platelet therapy. ⋯ Along with a review of the recent literature, we present two cases of patients with drug-eluting stents scheduled for renal transplantation. Two distinct antithrombotic management strategies illustrate the risk of either approach-bleeding and transfusion versus stent thrombosis and myocardial infarction.
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To characterize the evolution of postoperative nausea and vomiting (PONV) prophylactic drug use. ⋯ We found a significant and sustained decrease in droperidol use after the FDA-mandated labeling revision. We also found a significant increase in ondansetron use--an increase that exceeded the amount needed to substitute for the decreased droperidol use. The changes may be related to multiple factors, including the FDA warning, a trend toward more PONV prophylaxis, and the increasing predominance of serotonin antagonists for this indication.
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Randomized Controlled Trial
The safety of reused endotracheal tubes sterilized according to Centers for Disease Control and Prevention guidelines.
To investigate safety issues associated with the reuse of sterilized endotracheal tubes (ETTs). ⋯ Endotracheal tubes can be reused sterilized safely. The physical integrity of ETT cuffs may be compromised by glutaraldehyde or ethylene oxide sterilization treatments.
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We report a 22-year-old, 980-lb (445 kg) man with a body mass index of 163 kg/m(2), who needed intubation for tracheotomy surgery, as he was profoundly hypercarbic and reliant on a tight-fitting continuous positive airway pressure mask. Attempts at oral and nasal fiberoptic intubation during topical anesthesia were unsuccessful because of poor patient cooperation and epistaxis. ⋯ We then removed the fiberoptic bronchoscope followed by the LMA. A Parker size 7.5 endotracheal tube was then "railroaded" over the Aintree catheter into the trachea.