Journal of clinical anesthesia
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We describe a very rare case of an indwelling central venous catheter (CVC) through the left internal jugular vein that perforated the superior vena cava (SVC) wall postoperatively, although the CVC was placed in the appropriate position preoperatively. Three days after CVC insertion, a chest radiograph showed that the CVC tip had moved from the lower SVC to the upper SVC. ⋯ In cases of CVC insertion through the left side, the CVC tip should not be placed in the upper SVC (zone B). Considering individual clinical factors and the indwelling period for the CVC, the left innominate vein (zone C) may be a suitable site for the left-sided CVC tip to reduce the risk of SVC perforation.
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Reintubations are associated with significantly increased morbidity and mortality, increased hospital length of stay, and increased cost. Our aim was to assess the national incidence and associated risk factors for unanticipated early postoperative reintubations. ⋯ A number of risk factors correlate with an increased risk of unanticipated early postoperative reintubations, including extremes of age, patients with greater medical comorbidities, longer operations, and patients undergoing thoracic procedures.
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Case Reports
Hemiparesis after general anesthesia in a patient with migraine with unilateral motor symptoms.
This is a case report. ⋯ General anesthesia may be a trigger for hemiplegic migraine syndromes; however, it behooves the practitioner to rule out acute neurologic and metabolic events before making this diagnosis.
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To assess reliability and reproducibility of a recently instituted anesthesiology resident applicant interview scoring system at our own institution. ⋯ Development of a department-specific interview scoring system including many elements beyond traditional standardized tests shows good-excellent reliability of faculty scoring of both the interview itself (including non-technical skills) and the application resume.
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Clinical Trial
Anesthesia care for subcutaneous implantable cardioverter/defibrillator placement: a single-center experience.
The recently approved subcutaneous implantable cardioverter/defibrillator (S-ICD) uses a single extrathoracic subcutaneous lead to treat life-threatening ventricular arrhythmias, such as ventricular tachycardia and ventricular fibrillation. This is different from conventional transvenous ICDs, which are typically implanted under sedation. Currently, there are no reports regarding the anesthetic management of patients undergoing S-ICD implantation. ⋯ Among a heterogeneous population, anesthesiologists can safely manage patients undergoing S-ICD implantation and repeated DFTs without wide swings in SBP and with minimal intermittent pharmacologic support.