Journal of clinical anesthesia
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A patient who manifested signs of serotonin syndrome during an intravenous anesthetic with remifentanil and propofol is presented. The patient displayed lower extremity clonus, nystagmus, and diaphoresis. ⋯ A presumptive diagnosis of serotonin syndrome was made intraoperatively and all opioids were discontinued. His symptoms resolved in the Postanesthesia Care Unit without incident.
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Postoperative airway compromise due to laryngopharyngeal edema is a potentially serious adverse event associated with anterior cervical spine surgery. The reported incidence of this complication has varied from 1.2% to 6.1%, with a higher incidence following multi-level surgery. The relevant literature on airway compromise following anterior cervical spine surgery is reviewed.
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Postanesthetic involuntary movements are triggered by a variety of drugs, including propofol, sevoflurane, anti-emetics, and anti-psychotics. A case of acute involuntary movements in a healthy man after fentanyl exposure is presented. The movements consisted of large-amplitude motions of the upper limbs of the elbow joint for flexion and extension, and shaking of the head from side to side.
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Randomized Controlled Trial
The effect of a continuous infusion of low-dose esmolol on the requirement for remifentanil during laparoscopic gynecologic surgery.
To investigate whether a continuous infusion of low-dose esmolol results in an opioid-sparing effect during surgery. ⋯ Intraoperative esmolol infusion decreases both the requirement for remifentanil and postoperative administration of rescue analgesics.
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To monitor the pulmonary hemodynamics of patients undergoing bilateral total knee arthroplasty (BTKA) intraoperatively and up to 24 hours following surgery. ⋯ The PVR/SVR ratio on the day following BTKA was increased. This change may represent the different effects of inflammatory perioperative stresses on the pulmonary and systemic vasculature.