Journal of clinical anesthesia
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Review Case Reports
Perioperative atrial fibrillation and epidural anesthesia: case report and review of the literature.
A case of new-onset atrial fibrillation subsequent to activation of neuraxial anesthesia is presented. The development of atrial fibrillation was temporally related to placement and dosing of an epidural catheter, and may have been triggered by a vagal response to dosing of the anesthetic or the resulting treatment with fluid and an adrenergic agent. The literature on the acute preoperative management of atrial fibrillation and the implications of atrial fibrillation for the patient undergoing regional anesthesia are reviewed.
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Comparative Study
Comparison of noninvasive continuous arterial waveform analysis (Nexfin) with transthoracic Doppler echocardiography for monitoring of cardiac output.
To compare the Nexfin cardiac output (CO) with the CO obtained from transthoracic Doppler echocardiography (TTE) during routine cardiac function screening. ⋯ Considering limits of precision of CO measurements with Doppler echocardiography (± 30%), the agreement between noninvasive CO measurement with the Nexfin and TTE is reasonable.
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Randomized Controlled Trial
The effect of low versus high tidal volume ventilation on inflammatory markers in healthy individuals undergoing posterior spine fusion in the prone position: a randomized controlled trial.
To evaluate the effect of ventilation strategy on markers of inflammation in patients undergoing spine surgery in the prone position. ⋯ Although markers of inflammation are increased after posterior spine fusion surgery, ventilation strategy has minimal impact on markers of systemic inflammation.
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Review
Perspectives on transdermal scopolamine for the treatment of postoperative nausea and vomiting.
Transdermal scopolamine, a patch system that delivers 1.5 mg of scopolamine gradually over 72 hours following an initial bolus, was approved in the United States in 2001 for the prevention of postoperative nausea and vomiting (PONV) in adults. Scopolamine (hyoscine) is a selective competitive anatagonist of muscarinic cholinergic receptors. Low serum concentrations of scopolamine produce an antiemetic effect. Transdermal scopolamine is effective in preventing PONV versus placebo [relative risk (RR)=0.77, 95% confidence interval (CI), 0.61-0.98, P = 0.03] and a significantly reduced risk for postoperative nausea (RR=0.59, 95% CI, 0.48-0.73, P < 0.001), postoperative vomiting (RR=0.68, 95% CI, 0.61-0.76, P < 0.001), and PONV (RR 0.73, 95% CI, 0.60-0.88, P = 001) in the first 24 hours after the start of anesthesia.
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All-trans retinoic acid (ATRA), a vitamin A derivative, is prescribed for induction of chemotherapy in patients with acute promyelocytic leukemia. Like other chemotherapy agents, ATRA has an adverse effect known as retinoic acid syndrome. The case of a 22 year old woman with acute promyelocytic leukemia, who received ATRA and subsequently developed retinoic acid syndrome, is presented. The patient's symptoms resolved after administration of dexamethasone, allowing the completion of chemotherapy without further complications.