Journal of clinical anesthesia
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Comparative Study
Comparison of patient-controlled analgesia with and without dexmedetomidine following spine surgery in children.
To evaluate the effect of dexmedetomidine as an adjunct to patient-controlled analgesia (PCA) with morphine. ⋯ Postoperative 24-hour dexmedetomidine infusion as an adjunct to PCA with opioids might have a morphine-sparing effect as evidenced by the increase in morphine use on postoperative day 2 after the dexmedetomidine infusion was stopped.
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Spinal epidural hematoma is a rare and devastating complication of epidural catheter removal in an anticoagulated patient. The diagnosis could be quite challenging, especially in patients with preexisting neurological deficits. A 35-year-old patient with remote spinal cord injury and T4 level paraplegia developed a spinal epidural hematoma on the 7th postoperative day. The hematoma developed after epidural catheter removal with concurrent administration of unfractionated heparin.
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To determine the experience, attitudes, and opinions of program directors regarding the reintroduction of residents in recovery from substance abuse into the clinical practice of anesthesiology. ⋯ The practice of allowing residents who have undergone treatment for substance abuse to return to their training program in clinical anesthesia remains highly controversial. They are often lost to follow-up, making it difficult, if not impossible to determine if re-training in a different medical specialty decreases their risk for relapse. A comprehensive assessment of the outcomes associated with alternatives to re-entry into clinical anesthesia training programs is needed.
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Mirror syndrome is a condition in which the mother "mirrors" her hydropic fetus and/or hydropic placenta. Physical and laboratory findings of mirror syndrome include generalized edema, hypertension, and proteinuria similar to preeclampsia. However, unlike preeclampsia, mirror syndrome is associated with hemodilutional anemia and fluid overload, which may progress to pulmonary edema. The anesthetic management of a parturient with fetal sacrococcygeal teratoma, hydrops fetalis, and mirror syndrome complicated by markedly elevated maternal serum human chorionic gonadotropin and subsequent clinical hyperthyroidism, is presented.
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To compare the spread of subarachnoid sensory block with hyperbaric bupivacaine in second trimester pregnant and non-pregnant women. ⋯ Pregnant women in the second trimester exhibit enhanced spread of spinal analgesia with hyperbaric bupivacaine more so than non-pregnant women.