Journal of clinical anesthesia
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Randomized Controlled Trial Comparative Study
Preincisional local infiltration of tramadol at the trocar site versus intravenous tramadol for pain control after laparoscopic cholecystectomy.
To compare the effects of preoperative intravenous (IV) tramadol and preoperative tramadol infiltration of trocar sites on postoperative pain and postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy. ⋯ Trocar site infiltration of tramadol improves early postoperative pain and decreases PONV.
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Case Reports
Accidental pulmonary emboli noted by TEE during aortic valve replacement: a case report.
Pulmonary embolism (PE) is difficult to diagnose clinically. In a patient who was scheduled for elective aortic valve replacement, several fresh emboli were recognized in the right atrium on transesophageal echocardiography (TEE). ⋯ After cardiopulmonary bypass and aortic valve replacement, PA thromboembolectomy was performed successfully. The patient survived and was discharged from the hospital 17 days later without sequelae.
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To identify risk factors for life-threatening critical respiratory events occurring during parenteral analgesic therapy for acute postoperative pain. ⋯ The first 24 hours after commencing opioid-based analgesic therapy represents a high risk period. Obstructive sleep apnea, deep levels of sedation, nocturnal presentation, and postoperative acute renal failure were seen in patients who died as a result of these critical respiratory events.
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Intraneural hematoma after a peripheral nerve block is a theoretical cause of postoperative nerve injury that has not been previously documented in humans. We report an intraneural hematoma after nerve stimulation-guided femoral block, which occurred in a patient with undiagnosed factor XI deficiency and a slightly prolonged activated partial thromboplastin time. ⋯ Improvement in motor function was noted after epineurolysis of the femoral nerve. Early nerve decompression contributed to a satisfactory outcome.
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Placement of a central venous catheter into an internal thoracic vein occurs in approximately 2% of all catheterizations. A case in which a pulmonary artery catheter was trapped within the internal thoracic vein during orthotopic heart transplantation is presented.