Journal of clinical anesthesia
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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
Determination of insertion depth of flexible laryngeal mask airway in pediatric population-A prospective observational study.
The purpose of this study was to determine the ideal insertion depth of the flexible laryngeal mask airway (FLMA) by elucidating the relationships between insertion depth and patient's age, body weight, height, and other parameters. We also evaluated an insertion technique that uses the change in intracuff pressure for proper positioning of the FLMA in cases where it is difficult to sense resistance during FLMA insertion. ⋯ The FLMA insertion depth can be calculated using height and weight. Continuous monitoring of intracuff pressure during FLMA insertion is a useful alternative insertion method in cases where resistance is difficult to sense.
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Digestive endoscopic procedures have become increasingly common diagnostic and therapeutic procedures in hospitals. Generally they are safe procedures and complications, though infrequent, can occur and are potentially lethal. ⋯ In such cases there are usually local circumstances exist favoring the entry of air into the bloodstream, and in some cases it is the presence of a patent foramen ovale that favors the passage of air into the arterial system. The clinical signs and symptoms will depend on the speed and volume of the air infused and on the territory affected, and in some cases the consequences may be fatal.
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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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Transient Global Amnesia (TGA) is short-term inability to form new memories despite otherwise normal neurological function. There is associated anterograde and retrograde amnesia. The memory loss is often accompanied by repetitive questioning and temporal disorientation while higher cognitive functions are preserved. The symptoms usually resolve by 24h. ⋯ TGA presents dramatically, it needs to be differentiated from cerebral event. It resolves on its own. But one needs to be aware of existence of such an entity.