Journal of clinical anesthesia
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To evaluate the effectiveness of the CTrach Laryngeal Mask Airway (LMA) when used electively. ⋯ The major advantage of the CTrach LMA is that it is the only device that allows airway visualization during patient ventilation; however, it does not have 100% success with intubation.
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Transesophageal echocardiography (TEE) in cases of orthotopic liver transplantation is gaining acceptance for intraoperative hemodynamic monitoring. The timepoint of TEE probe insertion varies and is based on the fear of bleeding complications in the setting of portal hypertension with esophageal varices. In this case, early insertion of the TEE probe and examination resulted in the early detection of a large intracardiac thrombus, and thus the cancellation of the planned procedure. This case highlights the potential value of early TEE examination in orthotopic liver transplantation.
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While the benefits of continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) for patients with obstructive sleep apnea are well described, reports in the literature of complications from its use are rare. A patient who received postoperative BiPAP after undergoing transsphenoidal craniopharyngioma resection developed severe pneumocephalus and unplanned intensive care unit admission. Although the pneumocephalus resolved with conservative management over two weeks, we propose caution in the use of CPAP postoperatively in patients undergoing procedures of the head and neck.
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Clinical Trial
The optimal dose of remifentanil for acceptable intubating conditions during propofol induction without neuromuscular blockade.
To determine the optimal remifentanil dose required to provide acceptable intubating conditions following induction of anesthesia with propofol without using neuromuscular blockade. ⋯ The optimal bolus dose of remifentanil for acceptable intubating conditions was 2.40 μg/kg (95% confidence interval, 1.90-9.0 μg/kg) in 95% of patients during induction of anesthesia with propofol 2.0 mg/kg without neuromuscular blocking agents.
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1) To develop an in vitro system to simulate the kinetics of ionized calcium in mixed venous blood during rapid transfusion of fresh frozen plasma (FFP) and 2) to use the in vitro data to estimate the effect of the transfusion rate relative to cardiac output (CO) on ionized calcium. ⋯ An instantaneous 50% reduction in ionized calcium occurs in vitro at a proportion equivalent to a transfusion rate of FFP representing 7% of CO.