Journal of clinical anesthesia
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Comparative Study Observational Study
Sedation or general anesthesia for patients undergoing transcatheter aortic valve implantation-does it affect outcome? An observational single-center study.
Aortic stenosis is one of the most common valvular lesions. Nowadays, a new treatment is emerging: the transcatheter aortic valve implantation (TAVI). It is considered a suitable alternative for the surgical approach in selected high-risk patients. This procedure may be performed under sedation (SED) or under general anesthesia (GEA). ⋯ The results of the current study, which included a relatively large number of patients, suggest that both anesthetic modalities are safe for patients undergoing TAVI. The anesthesiologist should thus tailor the anesthetic approach to the patient, taking into account the team's experience as well as the hemodynamic status of the patient. With growing experience, our team recommends performing TAVI under SED and in selected cases under GEA.
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The anesthetic management of patients with morbid obesity is challenging. There is no consensus on the routine use of aspiration prophylaxis in morbidly obese patients undergoing elective surgery. ⋯ Morbidly obese patients undergoing elective surgery are at a higher risk for regurgitation and pulmonary aspiration when compared with lean patients. Preoperative aspiration prophylaxis decreases gastric volume and increases gastric pH and thus should be routinely prescribed.
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Case Reports
Reprogramming of in situ spinal cord stimulator for covering newly developed postthoracotomy pain.
The objective of this case report is to describe the use of in situ spinal cord stimulator (SCS) for postthoracotomy pain syndrome (PTPS). We report a 39-year-old woman with complex regional pain syndrome type I of the left lower extremity. The patient's pain was relieved by a SCS for 1 month before the patient developed slipping rib syndrome at her T12 rib from an unrelated trauma. ⋯ The patient was followed for 1 year, and her quality of life improved since her initial presenting symptoms. The use of the SCS in this patient provided significant lasting pain relief for both complex regional pain syndrome and PTPS. We believe that the use of SCS should be considered as a treatment option for patients with PTPS to avoid side effects associated with medications and to provide long-term pain relief.
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Case Reports
Dystonic reaction associated with ondansetron administration in a patient with normal pressure hydrocephalus.
A 77-year-old female with normal pressure hydrocephalus underwent urgent revision of the abdominal component of a ventriculoperitoneal shunt. Upon emergence from an uneventful general anesthetic, the patient exhibited cogwheel rigidity with decerebrate posturing and a markedly irregular respiratory rate. ⋯ In a previous procedure, the patient had been given ondansetron without a similar reaction. This presentation may have been provoked by existing pathology such as her underlying normal pressure hydrocephalus and small increases in intracranial pressure.