Journal of clinical anesthesia
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To assess the impact of intraoperative hemodynamics in the development of perioperative myocardial infarction (MI) and myocardial ischemia after noncardiac surgery. ⋯ Low SAS scores (0-4) may be associated with cTn elevation after noncardiac surgery. SAS-based risk stratification may guide perioperative cTn surveillance in lieu of routine postoperative screening.
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The benefits of cardiopulmonary exercise testing have been well established. Certain patient groups present challenges for conducting such a test. We were presented with a patient with a permanent tracheostomy at the preoperative assessment clinic. ⋯ We used a cuffed tracheostomy tube together with some widely available tubing from theaters to connect the patient to the gas analyzer. The test was only stopped because of excessive secretions from the patient, and we had already established enough data to tell us that the patient was fit enough to proceed to surgery. As more patients present with tracheostomies, we feel that this case would be a useful reference in managing and assessing such patients.
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Colonoscopy is widely performed for the diagnosis and treatment of various colonic disorders and the screening and surveillance of colorectal neoplasia. According to research evidence, up to one-third of patients had at least 1 minor and transient gastrointestinal symptom after colonoscopy. ⋯ Here, we present the case of a 95-year-old man with chronic obstructive pulmonary disease who developed bilateral tension pneumothorax during therapeutic colonoscopy for sigmoid volvulus. In this case, air trapping resulting from the Valsalva maneuver under inadequate pain control may be the mechanism for fatal tension pneumothorax during colonoscopy.
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To determine the effect of body mass index (BMI) on the relationship of the popliteal artery to the sciatic and tibial nerves in the popliteal fossa. ⋯ At 5 cm proximal to the distal femoral condyles, the popliteal artery is a reliable sonographic landmark to locate the tibial nerve due to the close proximity and consistent location of the nerve 1 cm posterolateral to the artery, with only a moderate effect of BMI.