Journal of clinical anesthesia
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Sugammadex is a novel cyclodextrin, the first in a new class of selective binding reversal agents that terminates neuromuscular block (NMB) with the steroidal nondepolarizing agents, rocuronium and vecuronium. Sugammadex can reverse a moderate or deep NMB. The dose required depends on the level of NMB that needs to be reversed. ⋯ Food and Drug Administration (FDA). The FDA issued a not-approvable letter in July 2008. The manufacturer continues clinical trials.
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Randomized Controlled Trial
Spread of spinal anesthesia in patients having perianal surgery in the jackknife position: effects of baricity of 0.5% bupivacaine and positioning during and after induction of spinal anesthesia.
To compare the influence of baricity and patient positioning during onset of subarachnoid block in patients placed in the prone, jackknife position with head-down tilt of 15 degrees . ⋯ Patient positioning, not baricity of bupivacaine, significantly affected the cephalad spread of spinal anesthesia, and a 10-minute period in the sitting position limits the maximum cephalad spread to T11.
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Lingual tonsillar hyperplasia is rare, and it may cause difficulty with tracheal intubation during induction of general anesthesia. A different orotracheal intubation technique was performed using a double-lumen endotracheal tube, flexible fiberoptic bronchoscope, and a stylet, in an unexpected difficult endobronchial intubation case due to massive lingual tonsillar hyperplasia.
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The case of a 70 year-old man undergoing bilateral carotid endarterectomy (CEA), for whom alterations in his bispectral index (BIS) values were noted during general anesthesia, is presented. Prior to bypass of the internal carotid artery (ICA), there were no significant differences in bilateral BIS values. ⋯ BIS is useful in detecting cerebral hypoperfusion during a lower limit of autoregulation. Attaching bilateral BIS monitors may indicate successful reperfusion of cerebral blood flow in CEA.