Journal of clinical anesthesia
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Observational Study
Pupil diameter during postanesthetic recovery is not influenced by postoperative pain, but by the intraoperative opioid treatment.
To investigate whether pupil diameter (PD) measured during scotopic conditions is influenced by pain in conscious patients in the early postoperative period. ⋯ Because of a residual effect of intraoperative opioids and a level of nociceptive stimulation lower than in surgical conditions, PD is not significantly influenced by early postoperative pain or pain relief.
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The aim of this study was to determine the independent factors associated with performance on the Maintenance of Certification in Anesthesiology Program (MOCA) examination. ⋯ Several factors in addition to performance on the written examination for primary certification (Part 1 Examination) are independently associated with performance on the MOCA examination. Because many of these factors are not modifiable, those diplomates who possess unfavorable risk factors should pay special attention to engaging in continuing learning to prepare for the MOCA examination.
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Anterior spinal artery syndrome has rarely been reported as a cause of permanent neurologic complications after neuraxial anesthesia in obstetric patients. A parturient developed anterior spinal artery syndrome after spinal anesthesia for cesarean delivery. A healthy 32-year-old parturient presented at 41(2/7) weeks for primary elective caesarean delivery for breech presentation. ⋯ Intraoperative course was uneventful except for symptomatic bradycardia (37-40 beats per minute) and hypotension (88/44 mm Hg) 4 minutes postspinal anesthesia, treated with ephedrine and atropine. Dense motor block persisted 9 hours after spinal anesthesia, and magnetic resonance imaging of the lumbosacral region was normal, finding no spinal cord compression or lesion. Physical examination revealed deficits consistent with a spinal cord lesion at T6, impacting the anterior spinal cord while sparing the posterior tracts.
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The cohort of the adult population with congenital heart disease is steadily growing, as surgical and medical management advances; and many women with congenital heart disease are becoming pregnant and presenting to the labor and delivery suite [1]. The anesthesiologist must therefore have an understanding of the physiology of the corrected heart lesion and the impact of the physiologic changes of pregnancy [2]. A woman status post-Fontan procedure requiring cesarean delivery is presented.
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Case Reports
The versatility of intraosseous vascular access in perioperative medicine: a case series.
Intraosseous vascular access is a time-tested procedure that is reemerging in popularity. This is primarily a result of the emphasis on intraosseous access in the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Advanced Cardiac Life Support. Modern intraosseous insertion devices are easy to learn and use, suggesting the possibility of use beyond the resuscitation setting. We present a case series of recent intraosseous insertions for a variety of indications by anesthesiologists at our institution to demonstrate the potential utility of this alternative access technique.