Journal of clinical anesthesia
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Randomized Controlled Trial
Effects of a 1:1 inspiratory to expiratory ratio on respiratory mechanics and oxygenation during one-lung ventilation in patients with low diffusion capacity of lung for carbon monoxide: a crossover study.
To investigate the effects of a 1:1 inspiratory-to-expiratory (I:E) ventilation ratio on oxygenation and respiratory mechanics during one-lung ventilation (OLV) in patients with low diffusion capacity of lung for carbon monoxide (DLCO). ⋯ Pressure-controlled ventilation with a 1:1 I:E ventilation ratio did not improve oxygenation in patients with low DLCO during OLV compared with a 1:2 I:E ventilation ratio. However, it did provide benefits in terms of respiratory mechanics and increased the efficiency of alveolar ventilation during OLV.
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The mechanism of action of commonly used general anesthetics is largely unknown. One hypothesized mechanism is through modulation of microtubule stability. Taxanes, a subset of chemotherapeutic drugs known to alter microtubule stability and commonly used to treat breast cancer, offer a natural experiment to test our hypothesis that patients exposed to taxanes prior to surgery, as compared to after surgery, would have a partial resistance to general anesthetics. ⋯ These results suggest that the alteration of microtubule stability is one of a number of mechanisms of inhaled anesthetics.
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The study objectives are to (1) assess prevalence of congenital heart disease (CHD), (2) describe outcomes of pregnancies in women with CHD, (3) compare outcomes in women with and without CHD, and (4) characterize neonatal outcomes in pregnancies complicated by CHD. ⋯ Operative abdominal deliveries and neonatal ICU admissions are more common in women with CHD, but these pregnancies are generally well tolerated with low mortality rates.
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Catastrophic complications have been reported for selective cervical nerve root block (SCNRB) or pulsed radiofrequency (PRF) via an anterolateral transforaminal approach. A posterior approach to these procedures under computed tomography guidance has been reported. Here, we report the clinical outcomes of 42 patients with chronic cervical radicular pain (CCRP) treated with a combination of SCNRB and PRF through a posterior approach under fluoroscopy guidance. ⋯ The posterior approach to combined SCNRB and PRF under fluoroscopy guidance appears to be safe and efficacious in the management of CCRP.
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To evaluate changes in cerebral tissue oxygen index (TOI) values under the beach chair position before and during general anesthesia in surgical patients with or without cardiovascular risk factors. ⋯ The beach chair position under general anesthesia did not alter cerebral oxygenation in patients with or without cardiovascular risk factors showing normal preoperative cerebral TOI values when the mean blood pressure was maintained above 60 mm Hg. The careful management using the cerebral oxygenation monitoring appears to maintain cerebral perfusion in the beach chair position during general anesthesia.