Journal of clinical anesthesia
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Randomized Controlled Trial Comparative Study
Comparison of the cardiovascular effects of isoflurane and sevoflurane as measured by magnetic resonance imaging in children with congenital heart disease.
To compare the cardiovascular effects of isoflurane and sevoflurane at minimum alveolar concentration (MAC) = 1 in children with congenital heart disease using cardiac magnetic resonance imaging. ⋯ Both isoflurane and sevoflurane were found to be comparable in terms of cardiovascular effects.
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A patient undergoing total knee replacement was fitted with a stimulating femoral catheter for postoperative analgesia. After the catheter was secured to the skin, the minimal stimulatory threshold was verified again and found to be extremely low (0.00-0.01 mA; pulse width, 0.1 ms). However, in spite of this situation, no paresthesia or pain was experienced by the patient. ⋯ On the basis of this single report, we cannot recommend the routine use of a threshold inferior to 0.2 mA for neural electrolocation. However, we do not advocate the requirement of strict numerical thresholds either. Further research is needed to understand the relationship linking stimulatory threshold and distance between needle (or catheter) tip and nerve.
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To determine the practice of members of the Society of Ambulatory Anesthesia (SAMBA) in the management of postoperative nausea and vomiting (PONV) before and after the Food and Drug Administration (FDA) black box warning on droperidol. ⋯ Although most surveyed practitioners believed that the FDA black box warning on droperidol is not justified, the use of this cost-effective agent has significantly declined.
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Thoracic bilateral paravertebral block is a technique commonly used in the ambulatory setting for numerous plastic surgery procedures. Paravertebral block has not been reported with abdominoplasty surgery. This case series explores this anesthetic technique in the inpatient and day patient setting.
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Case Reports
Massive retrograde acute type B aortic dissection in a postpartum woman with a family history of Marfan syndrome.
Acute aortic dissection is rare but potentially catastrophic complication of pregnancy. Aortic root enlargement, congenital bicuspid aortic valve disease, and Marfan syndrome have been identified as critical risk factors for peripartum aortic dissection. Most of the aortic dissections reported to date involve the ascending aorta and occur before delivery, but only a few cases of postpartum aortic dissection have been described. In this report, we discuss the management of a multigravid parturient with an extensive family history of Marfan syndrome who developed a massive retrograde type B aortic dissection 7 days after a normal spontaneous vaginal delivery.