Journal of clinical anesthesia
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Case Reports
Complete heart block in pregnancy: case report, analysis, and review of anesthetic management.
Maternal complete heart block can pose significant challenges for the anesthesiologist in the antepartum, peripartum, and postpartum periods. Some patients may present for the first time in the puerperium with dizziness, weakness, syncope, or congestive heart failure as a result of the additional hemodynamic burden that accompanies pregnancy. ⋯ The parturient with complete heart block must be followed vigilantly during pregnancy and post delivery, as the need for pacemaker insertion can also arise in the postpartum period. We present a case of third-degree heart block in a 26-year-old parturient.
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Hemispherectomy is an established surgical procedure to treat medically refractory epilepsy caused by diffuse hemispheric diseases. The most common complication of hemispherectomy is intraoperative bleeding. Perioperative allogeneic blood transfusion increases mortality and morbidity in pediatric patients. ⋯ We present a series of three cases undergoing pediatric hemispherectomy, where a new algorithm was employed to manage coagulation. This new algorithm was mainly based on timely thrombelastogram analyses guided clotting factors supplement and continuous administration of tranexamic acid. In our cases, the amount of blood loss and subsequent allogeneic blood transfusion seemed to be less than literature reported.
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Randomized Controlled Trial
Preoperative paracetamol improves post-cesarean delivery pain management: a prospective, randomized, double-blind, placebo-controlled trial.
To evaluate the analgesic effect of preoperative single dose intravenous paracetamol on postoperative pain and analgesic consumption within 24hours after elective cesarean surgery. ⋯ Preoperative use of single-dose intravenous 1g paracetamol was found to be effective in reducing the severity of pain and opioid requirements within 24hours after cesarean section.
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Randomized Controlled Trial
Remifentanil infusion during emergence moderates hemodynamic and cough responses to the tracheal tube: A randomized controlled trial.
To examine the severity of cough and straining at the time of emergence from anesthesia. ⋯ Infusion of REM at the end of craniotomy procedures results in significant reduction of the frequency and severity of coughing and straining. Compared to placebo, REM moderates increases in MAP upon emergence from general anesthesia until the time of extubation.
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We describe a novel technique of real-time ultrasound-guided superior laryngeal nerve and translaryngeal blocks in 4 patients with anticipated difficult airways. All patients had altered neck anatomy, and 1 had a prior unsuccessful awake fiberoptic bronchoscopic intubation. For block performance, an 11-mm broadband curved array transducer with a scanning frequency between 8 and 5 MHz (Sonosite, Bothell, WA) was used for anatomical structure identification, needle guidance toward each superior laryngeal nerve and through the cricothyroid membrane, and deposition of local anesthetic in the appropriate location. This was followed by successful awake fiberoptic bronchoscopic endotracheal intubation in all cases.