Journal of clinical anesthesia
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To describe the challenges associated with the development and assessment of an obstetric emergency team simulation program. ⋯ Program feedback indicates a high level of participant satisfaction and improved confidence yet further program refinement is required.
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Comparative Study
Guidelines for preoperative investigations for elective surgery at Queen Elizabeth Hospital: effects on practices, outcomes, and costs.
We endeavor to assess the impact of introduction of guidelines for preoperative investigations (PIs) on anesthetic practices and costs and compare their efficacy to current practices. ⋯ Our findings indicate that introduction of guidelines has reduced the level of preanesthetic investigations to some extent; nevertheless, further change is desirable. In addition, costs to the institution were decreased with no compromise to patient safety.
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Observational Study
Risk factors for failed reactivation of a labor epidural for postpartum tubal ligation: a prospective, observational study.
To determine specific risk factors that increase the failure rate of labor epidurals reactivated for use as a surgical block for postpartum tubal ligation. ⋯ Poor satisfaction score of the epidural during labor and delivery, increasing time from delivery to epidural reactivation for tubal ligation, and the need for top-ups during labor and delivery increase the incidence of reactivation failure. No correlation was found with body mass index or loss of resistance and failure to reactivate.
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To determine the optimal epidural analgesia for patients receiving interstitial brachytherapy (ISBT) for gynecologic cancers. ⋯ For patients receiving ISBT for gynecologic cancer, epidural analgesia provides safe and effective pain control. Combined modality epidural analgesia improves pain control and lessens oral and intravenous opioid requirements without increased risk of adverse effects compared with epidural analgesia with local anesthetic alone.
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Porphyria is caused by disorders of enzymes that synthetize porphyrins. Both elective and emergency surgical procedures on patient suffering from porphyria may provoke acute symptoms. These patients require special anesthetic management since some of commonly used anesthetic agents may also induce acute manifestation of porphyria. ⋯ Propofol-based total intravenous anesthesia with target-controlled infusion was used. Such conduct proved to be safe regarding clinical symptoms, although biochemical markers were slightly elevated after procedure. Propofol seems to be the safest hypnotic drug to use in porphyria; however, special care should be taken is such cases.