Journal of clinical anesthesia
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Case Reports
Undiagnosed pulmonary sequestration results in an unexplained hemorrhagic shock in thoracoscopic pulmonary lobectomy.
We report the first case of pulmonary sequestration which was not detected in the preoperative evaluation, resulting in a life-threatening hemorrhagic shock rapidly during the procedure of thoracoscopic pulmonary lobectomy. The anesthesiologists could not figure out the reason for the hemorrhagic shock in the surgery until an emergent laparotomy was performed. The aim of presenting this clinical case is to highlight the vigilance for undiagnosed pulmonary sequestration which lacks any specific clinical feature but has the potential to become an anesthetic disaster.
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Observational Study
Anesthetic implications for patients with Segawa syndrome.
To characterize the perioperative course of patients with Segawa syndrome undergoing anesthetic management. ⋯ In this cohort, patients with Segawa syndrome tolerated the anesthetic management, including neuromuscular blocker administration. Although these patients are frequently receiving levodopa therapy, no associated complications were noted.
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Comparative Study Observational Study
Disagreement between fourth generation FloTrac and LiDCOrapid measurements of cardiac output and stroke volume variation during laparoscopic colectomy.
To determine the agreement between cardiac output (CO) and stroke volume variation (SVV) measured simultaneously by the fourth generation FloTrac/Vigileo system and LiDCOrapid system during pneumoperitoneum in patients undergoing laparoscopic colectomy. ⋯ Our study showed disagreement between the 2 methods and the hemodynamic parameters measured by one of the two devices should be interpreted with caution before therapeutic interventions.
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We present a series of 3 cases in which the impact in outcome was, first of all, related to the capacity to offer early and safer treatment to some hip fracture high-risk patients using a fascia iliaca block (FIB; ropivacaine 0,5% 20 cc and mepivacaine 1,3% 15 cc, given 30 minutes before incision) associated only with deep sedation, contributing to better practice and outcome. ⋯ In these cases, surgery would be postponed if the choice was neuroaxial anesthesia, particularly because of P2Y12 receptor inhibitors' effect. FIB puncture site is distal to the fracture and incision site, but proximal local anesthetic migration through the interfascial planes allows for constant block of femoral nerve and lateral cutaneous of femur nerve and, less constantly, block of obturator. FIB may reduce the risk of perineural hematoma associated with several injections in nerve vicinity of different lumbar plexus branches. Frequently, indications for extramedullary or IMF are overlapping, but IMF is associated with less blood loss and may be managed using a low anesthetic depth if an FIB is done, increasing safety. This way, these less invasive surgical techniques combined with an adjusted anesthetic technique may have a crucial role in high-risk patients, particularly if taking P2Y12 receptor inhibitors. In these cases of IMF, surgical manipulation of sciatic and/or inferior subcostal nerves territories was managed with systemic analgesia and deep sedation.
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Comparative Study
Carbetocin for prevention of postcesarean hemorrhage in women with severe preeclampsia: a before-after cohort comparison with oxytocin.
The aim of the study was to compare the incidence of the use of additional uterotonics before and after the change of carbetocin to oxytocin for the prevention of postpartum hemorrhage after cesarean delivery in women with severe preeclampsia. ⋯ As carbetocin appears to be as effective and safe as oxytocin in preeclamptic women, its advantages make it a good uterotonic option in this particular setting.