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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Recommendations for routine screening for colorectal cancer with colonoscopy are likely to substantially increase the demand for provision of sedation for these procedures. Because of this burgeoning caseload and associated economic constraints, it is unlikely that anesthesiologists will be available for all such procedures, particularly those involving average-risk patients. Thus, sedative agents that can be safely administered by nonanesthesiologists, appropriately trained in monitoring and managing the patient's airway, are desperately needed. New concepts in sedation for colonoscopy include enhanced mechanisms for drug delivery such as patient-controlled sedation/analgesia and target-controlled infusion, along with the development of new drugs such as a modified cyclodextrin-based formulation of propofol and fospropofol disodium (Aquavan Injection), a water-soluble prodrug of propofol.
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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.