Journal of clinical anesthesia
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Randomized Controlled Trial
Clinical application of a novel developed pressure bladder indicator in lumbar epidural puncture.
A novel pressure bladder indicator was developed, and this study aimed to evaluate the clinical application of the pressure bladder indicator by measuring the epidural space pressure and bladder working pressure on patients undergoing lumbar epidural puncture. ⋯ The novel developed pressure bladder indicator was a reliable and useful technique to conduct successful lumbar epidural puncture.
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Transversus abdominis plane (TAP) blocks have been reported to be an effective method of providing analgesia after abdominal surgery. To perform a prospective audit on the effectiveness of a novel technique of providing continuous transversus abdominis plane (TAP) analgesia in patients undergoing emergency and elective abdominal surgery. ⋯ Four quadrant transversus abdominis plane blocks and continuous TAP analgesia is an effective technique for providing postoperative analgesia after abdominal surgery. It has the potential to be used as a sole analgesic technique when the surgical incision is within its dermatomal limit.
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A 62-year-old woman with prosthetic mitral valve was admitted for explant of an infected prosthetic knee. Perioperatively, she was bridged with heparin and started on empiric vancomycin and piperacillin-tazobactam. Platelet counts dropped precipitously within 2 days reaching a nadir of 6000/μL, without any bleeding. ⋯ She tested positive for IgG antiplatelet antibodies to vancomycin and piperacillin-tazobactam thereby confirming the diagnosis. Drug-induced immune-mediated thrombocytopenia is an underrecognized cause of thrombocytopenia in the intensive care units. Clinicians should be cognizant of this entity, and a definitive diagnosis should be sought if feasible.
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The objective was to present a proof of concept for a simple and consistently successful ultrasonograpy (US)-guided technique to block the internal branch of the superior laryngeal nerve (iSLN). ⋯ A simpler and consistently reproducible US-guided iSLN block is feasible using the thyrohyoid membrane as target plane for local anesthetic injection. Clinical trials are needed to determine its effectiveness and safety, needle entry point, trajectory, and local anesthetic volume.
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While previous studies have shown that elderly patients require lower dosages of opioids, the literature suggests that pain is undertreated in the geriatric population, which may lead to postoperative pain and high rescue analgesia requirements. The purpose of this study is to determine whether elderly patients undergoing hip and knee arthroplasty require higher levels of postoperative rescue opioids than their younger counterparts early after emergence from anesthesia. ⋯ While elderly patients received lower doses of opioids intraoperatively, they were less likely to require rescue analgesia. The variability among providers in rescue opioid administration after emergence presents an opportunity for further research.