Journal of clinical anesthesia
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Case Reports
A case of central diabetes insipidus after ketamine infusion during an external to internal carotid artery bypass.
We report the first teenage case of ketamine-induced transient central diabetes insipidus. ⋯ Urine output, urine osmolarity, and serum osmolarity should be monitored in patients given ketamine anesthetic; desmopressin should be present to prevent dangerous long-term sequela.
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Obese parturients both greatly benefit from neuraxial techniques, and may represent a technical challenge to obstetric anesthesiologists. Several studies address the topic of obesity and neuraxial analgesia in general, but few offer well described definitions or rates of "difficulty" and "failure" of labor epidural analgesia. Providing those definitions, we hypothesized that increasing body mass index (BMI) is associated with negative outcomes in both categories and increased time needed for epidural placement. ⋯ Obesity is associated with increasing technical difficulty and failure of neuraxial analgesia for labor. Practitioners should consider allotting extra time for obese parturients in order to manage potential problems.
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Comparative Study
Perioperative opioid administration in children with and without developmental delay undergoing outpatient dental surgery.
Prior research has indicated that children with developmental delay (DD) experience qualitative and quantitative differences in health care (Boulet et al., 2009). In the perioperative setting, there is concern that children with DD may be more likely to experience postoperative complications including agitation and nausea/vomiting than typically developing patients (TDP). Differences in the administration and dosage of perioperative opioids may contribute to this, however, empirical investigations are lacking. The purpose of this research was to compare the experience of postoperative nausea/vomiting and agitation, as well as to examine perioperative opioid administration, among children with DD as compared to TDP. ⋯ Children with DD experience similar rates of postoperative complications including nausea/vomiting and agitation as TDP. DD children were less likely to receive both intra and postoperative opioids than TDP. Importantly, while the dosage of intraoperative opioids was predictive of administration of postoperative opioids in the TDP group, this was not the case for the DD group. Clinical implications are discussed.
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Observational Study
Frequency of inadequate neuromuscular blockade during general anesthesia.
We used electronic health record data to define frequency of inadequate intraoperative neuromuscular blockade (NMB). ⋯ Nearly 1% of all general anesthetic procedures involving NMB exhibit inadequate relaxation resulting in procedural interruption. These data suggest that current use of neuromuscular blocking drugs and NMB monitoring expose patients to inadequate blockade. The risk of this phenomenon warrants further study.
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Case Reports
Monitoring of the intraoperative analgesia by pupillometry during laparoscopic splenectomy for splenic hydatid cyst.
Echinococcosis causes a hydatid cyst, a worldwide disease. Human beings are intermediate hosts, but dogs complete the life cycle of the cestode. The most common presentation sites are the liver and lungs. ⋯ This is regulated by the autonomous sympathetic system. It appears to be more sensitive and reliable than using simple variations in heart rate and blood pressure. It is an easy and safe to use method that might allow a reduction in postoperative analgesic requirements.