Journal of clinical anesthesia
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Randomized Controlled Trial
Preliminary evaluation of a virtual reality-based simulator for learning spinal anesthesia.
To evaluate the influence of a simulation-based program on the initial performance of dural puncture by medical interns, and to refine the design of simulator-based teaching and competence assessment. ⋯ Overall, no difference was measured between those taught with traditional methods and those, by a simulator based program in regard to the performance of spinal anesthesia.
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Case Reports
Anesthesia in a 12 year old boy with somatic overgrowth secondary to pericentric inversion of chromosome 12.
The management of a splenectomy in a boy with an unusual form of somatic overgrowth is presented. Except for a moderately difficult airway, no unusual reactions to anesthesia and surgery were encountered. Possible anesthetic implications of different somatic overgrowth syndromes in children are presented.
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A 35 year old woman, 6 days after ileal neobladder construction, reported uncontrolled pain despite 33 mg hydromorphone via patient-controlled analgesia (PCA). Abdominal compartment syndrome was suspected based on worsening tachypnea, oxygen desaturation, and severe, prolonged ileus. Following emergent intubation, peak airway and bladder pressures were elevated. ⋯ Continuous ketamine infusion was used for opioid resensitization and the patient was extubated following return of bowel function. Opioid use contributed to the ileus, caused gastric distension, and displaced the diaphragm cephalad. The patient interpreted the subsequent dyspnea as pain and increased PCA opioid use, thereby worsening the ileus.
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To survey anesthesia providers for their opinion on "best practice" in perioperative peripheral intravenous catheter (PIV) management, and to determine if they follow those opinions. ⋯ There is no commonly accepted standard for management and documentation of PIVs in the operating room. From our survey, what providers think is "best practice" in the management and documentation of PIVs is not what is being done.
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The management of cesarean delivery for a parturient with placenta previa at 36 weeks' gestation and glutaric aciduria type 1 is presented. The management goal was to prevent encephalopathic crisis by ensuring adequate caloric intake with dextrose infusion and to provide carnitine supplementation and adequate anesthesia.