Journal of clinical anesthesia
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Case Reports
Real-time measurement of blood pressure with Nexfin in a patient with thalidomide-related phocomelia.
We report the novel application of photoplethysmographic technology with the Nexfin HD monitor for real-time measurement of blood pressure (BP) in a patient with tetraamelia. The patient was a 58-year-old man with tetraamelia secondary to thalidomide exposure in utero, who presented for surgical excision of a maxillary schwannoma. Because difficulty of cuff use on rudimentary limbs and failure to gain invasive arterial access due to abnormalities of limb vasculature, this population is known to pose some unique challenges for BP measurement. Nexfin may offer an alternative noninvasive method to detect BP in patients with phocomelia during the perioperative period.
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Comparative Study
King Vision video laryngoscope versus Lightwand as an intubating device in adult patients with Mallampatti grade III and IV patients.
Anticipated and unanticipated difficult airways are often encountered by anesthesiologists in their clinical practice. There are various devices available in such situations. We aim to compare King Vision video laryngoscope and Lightwand for their performance as an intubating device in predicted difficult intubation. ⋯ Mean intubation time using King Vision video laryngoscope (19.50±6.73 seconds was lower than the intubation time using Lightwand 25.40±7.42 s, P=.00). The difference between number of attempts, success of intubation, numbers of adjustment maneuvers were comparable. There was a significant rise in heart rate within the groups from the pre-induction values. However inter group variations were similar. In addition, there was a significant rise in mean arterial pressure within the groups from the pre-induction values. Inter group variations show less increase in mean arterial pressure with Lightwand at immediate post intubation (P=.0234) and at 3 min and 5 min post intubation anesthesia.
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Randomized Controlled Trial Comparative Study
Randomized comparison of the feasibility of three anesthetic techniques for day-case open inguinal hernia repair.
Comparison of local anesthetic infiltration (LAI), spinal anesthesia (SPIN) and total intravenous anesthesia (TIVA) for open inguinal herniorrhaphy. We hypothesized that patients receiving LAI could be discharged faster than SPIN and TIVA patients. ⋯ Logistically, LAI was superior because of the fastest recovery postoperatively. The anesthetic techniques were adequate for surgery in all but a few LAI and SPIN patients. Lack of urinary retention was probably related to the small IV infusion volumes.
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Clinical Trial Observational Study
Outpatient laparoscopic sleeve gastrectomy: first 100 cases.
The development of outpatient surgery was one of the major goals of public health policy in 2010. The purpose of this observational prospective study was to evaluate the feasibility of laparoscopic sleeve gastrectomy (SG) in an ambulatory setting. ⋯ Laparoscopic SG in an ambulatory setting is feasible with a dedicated anesthesiological approach and an expert surgical team. Appropriate patient selection is important for ensuring safety and quality of care within the outpatient program.
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The aim of this study was to establish the incidence of acute kidney injury (AKI) in patients undergoing elective hip and knee arthroplasty. ⋯ We identified stage 3 or higher CKD as a major risk factor for developing postoperative AKI. Preexisting CKD raised the risk of developing AKI 4-fold. We recommend that all patients undergoing lower limb arthroplasty should have renal function assessed preoperatively. In the perioperative period, renal function should be monitored in all patients. This is of particular importance in patients with estimated glomerular filtration rate <60.