Journal of clinical anesthesia
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Meta Analysis Comparative Study
The ProSeal Laryngeal Mask Airway is more effective than the LMA-Classic in pediatric anesthesia: a meta-analysis.
To determine, in pediatric patients, whether the ProSeal Laryngeal Mask Airway (PLMA) has advantages over the LMA-Classic (cLMA) in leak pressure, placement difficulty, incidence of adverse events, postoperative blood staining, laryngospasm, bronchospasm, and hoarseness. ⋯ The PLMA (in sizes 1,1.5, 2, and 2.5) offers some advantages over the cLMA in pediatric anesthesia.
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Review Comparative Study
Comprehensive review: is it better to use the Trendelenburg position or passive leg raising for the initial treatment of hypovolemia?
Hypovolemia is a common clinical problem. The Trendelenburg position and passive leg raising (PLR) are routinely used in the initial treatment while awaiting fluid resuscitation. In this meta-analysis, we evaluated the hemodynamic effects of PLR and Trendelenburg positioning to determine which position had the most optimal effect on cardiac output (CO). ⋯ The effect persisted after this period by 6%, or 0.17 L/min. Both Trendelenburg and PLR significantly increased CO, but only PLR seemed to sustain this effect after one minute. Although the Trendelenberg position is a common maneuver for nurses and doctors, PLR may be the better intervention in the initial treatment of hypovolemia.
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Review Case Reports
Intraoperative hypercyanosis in a patient with pulmonary artery band: case report and review of the literature.
A case of intraoperative cyanosis in a patient with a common atrioventricular canal palliated with a pulmonary artery (PA) band is presented. The patient's physiology was consistent with cyanosis due to inadequate pulmonary blood flow, and responded quickly to typical interventions used for a hypercyanotic episode in a patient with unrepaired Tetralogy of Fallot. Differences and similarities in the physiology of PA banding compared with Tetralogy of Fallot are presented, including a rationale for treatment options for hemodynamic decompensation occurring in the setting of anesthesia and surgery.
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Five patients who underwent surgery for breast cancer were followed for 6 days after placement of a multiple-injection, one-time paravertebral block. Data were collected on patient satisfaction, analgesic consumption, side effects, and complications. Ropivacaine as a sole agent in paravertebral blocks has a clinical duration of up to 6 hours. The addition of epinephrine, clonidine, and dexamethasone prolonged the clinical duration considerably.
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To evaluate the influence of insertion/deletion (ID) polymorphism of the angiotensin-converting enzyme (ACE) gene on clinical outcome of cardiac valve surgery. ⋯ ACE ID polymorphism is associated with a higher incidence of postoperative complications, including postoperative infections, in patients undergoing cardiac valve surgery.